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WISAN JOAQUIN COUNTY <br />RONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigov.org/eh <br />UNDERGROUND STORAGE TANK UST) PROGRAM SERVICE R QUEST INSPECTION REPORT <br />Facility Name: Inspection Date: <br />.4 <br />F4 EON S 12310 <br />Facility Address: Service Request #: <br />.�44 e1JI& S -T 00 <br />It <br />Onsite Service Technician's Name: [CC Service Technician/Installer Certification #: Manufacturer Training: <br />/0 1 1;22,36756 -UT q16110 A27 2- 112-9t" <br />EHD 23-04 <br />Rpv nR/22/n7 <br />5A <br />Leak detector <br />El <br />El mechanical Model: <br />El electronic Serial #: <br />0 line test programmed <br />0 <br />Leak detector <br />0 <br />El mechanical Model: <br />0 electronic Serial #: <br />0 <br />0 line test proEammed <br />Leak detector <br />0 <br />0 mechanical Model: <br />0 <br />0 electronic Serial #: <br />0 line test proEarnmed <br />sensor <br />0 <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />0 NA <br />0 <br />sensor <br />0 <br />0 positive shutdown Model: <br />El fail safe Serial #: <br />0 <br />El NA <br />11 <br />sensor <br />El <br />El positive shutdown Model: <br />El fail safe Serial #: <br />El NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />D <br />Drop tube with mechanical overfill at 95% <br />FE] <br />Overfill prevention (see LG letter 150-1) <br />EHD 23-04 <br />Rpv nR/22/n7 <br />5A <br />- Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic El Incon TS -STS <br />El Caldwell System 1:1 Other <br />Spill bucket El minimum 5 gallon <br />0 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 1:1 Other <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />El Caldwell System 0 Other <br />Primary piping testing at: <br />0 <br />psi <br />minutes <br />Secondary piping testing at: <br />0 <br />psi <br />minutes <br />Secondary containment repairs for: <br />0 <br />UDC(s) Piping <br />Sump(s) UST(s) <br />Cold start of monitoring panel tie <br />0 <br />Corrosion protection <br />11 <br />Other: see below <br />EHD 23-04 <br />Rpv nR/22/n7 <br />5A <br />