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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: ov.orelehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE QUEST INSPECTION REPORT Fa lity Name: Inspection Date: �Aq W b - * 11110161 Facility Addrels: I Servic6 Regnest #- / �jo 0 .6410 " Onsite Service Technician's Name: J�qq :,7 _�qt/JOL V� Technician/Installer Certification #: SERVICE Leak detector ❑ El mechanical Model: 0 electronic Serial 11 line testpro grammed Spill bucket El minimum 5 gallon Leak detector El I hour hydrostatic F-1 Incon TS -STS 0 mechanical Model: El Caldwell System 0 Other 0 electronic Serial #: Spill bucket El minimum 5 gallon 0 line test programmed F-1 I hour hydrostatic 0 Incon TS -STS . Leak detector F-1 0 mechanical Model: Primary piping testing at: F-1 electronic Serial #: psi 11 line test programmed minutes sensor ❑ F1 positive shutdown Model: psi 0 fail safe Serial 9: minutes 0 NA Secondary containment repairs for: sensor ❑ 0 positive shutdown Model: Sump(s) UST(s) 0 fail safe Serial #: Cold start of monitoring panel., El NA Corrosion protection sensor F] 0 positive shutdown Model: El fail safe Serial #: El NA F-1 Drop tube with mechanical overfill at 95% El Drop tube with mechanical overfill at 95% Overfill❑ prevention (see LG letter 150-1) nufVurer 640 4 SERVICE Spill bucket El minimum 5 gallon ❑ El I hour hydrostatic 0 Incon TS -STS F-1 Caldwell System 0 Other Spill bucket El minimum 5 gallon El El I hour hydrostatic F-1 Incon TS -STS W El Caldwell System 0 Other Spill bucket El minimum 5 gallon n F-1 I hour hydrostatic 0 Incon TS -STS El Caldwell System 0 Other Primary piping testing at: ❑ psi minutes Secondary piping testing at: ❑ psi minutes Secondary containment repairs for: ❑ UDC(s) Piping Sump(s) UST(s) Cold start of monitoring panel., ❑ Corrosion protection 19- Other: see below An W 191 Iva.