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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigov.org/ehd <br />UNDERGROUND STORAGE TANK (US 22 PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Fa;i-�H�tyme: <br />N Inspection Date: <br />J� a <br />Facility Addy s: Servi& Riquest <br />Onsite Service Technician's Name: ICC Service Techniciantinstaller Certification #: Mianufac rerTraT <br />Ot VK Its el <br />2�ky t f <br />SERVICE SERVICE <br />Leak detector <br />0 <br />1-1 mechanical Model: <br />MA <br />0 electronic Serial <br />0 line test programmed <br />0 <br />Leak detector <br />El <br />0 mechanical Model: <br />0 electronic Serial #: <br />El <br />0 line test programmed <br />Leak detector <br />❑ <br />0 mechanical Model: <br />❑ <br />0 electronic Serial #: <br />0 line test programmed <br />sensor <br />E3 <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />0 NA <br />❑ <br />sensor <br />ri <br />0 positive shutdown Model: <br />__ <br />0 fail safe Serial #: <br />13, <br />0 NA <br />Ef <br />sensor <br />❑ <br />0 positive shutdown Model: <br />n fail safe Serial #: <br />El NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />LO <br />Drop tube with mechanical overfill at 95% <br />Overfill prevention (see LG letter 150-1) <br />Spill bucket El minimum 5 gallon <br />❑ <br />0 1 hour hydrostatic 0 Incon TS -STS <br />MA <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />MUM <br />0 Caldwell System 0 Other <br />- Spill bucket 0 minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />El Caldwell System 0 Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary piping testing at: <br />E3 <br />psi <br />minutes <br />Secondary containment repairs for: <br />❑ <br />UDC(s) Piping <br />Sump(s) UST(s) <br />__ <br />cold start of monitoring panel <br />13, <br />Corrosion protection <br />Ef <br />Other: see below <br />MA <br />WrAW <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />MUM <br />i le. <br />