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SAN JOAQUIN COUNTY AM, <br /> 0 ENVIRONMENTAL HEALTH DEPARTMEW <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigoy.orgLehd <br /> — <br /> UNDERGROUND STORAGE TAN UST PROGRAM SERVICE QUEST INSPECTION REPORT <br /> Faciti me: Inspection ate: <br /> Facili S Svice Rectues,#: <br /> Onsite rvice Technician's Name: fCC Service Technician/Installer Certification#: Manufacturer Training: <br /> --T <br /> SERVICE SERVICE <br /> Leak detector Spill bucket F-1 minimum 5 gallon <br /> ❑ 0 mechanical Model: <br /> D electronic Serial#: I hour hydrostatic 0 Incon TS-STS <br /> El line test proffarnmed El Caldwell System 0 Other <br /> Leak detector —Spill bucket El minimum 5 gallon <br /> F1 D mechanical Model: 0 El I hour hydrostatic 0 Incon TS-STS <br /> El electronic Serial#: F1 Caldwell System 0 Other <br /> 0 line test programmed <br /> . Leak detector Model: Spill bucket 0 minimum 5 gallon <br /> 11 mechanical <br /> 0 electronic Serial#: 0 D I hour hydrostatic 0 Incon TS-STS <br /> 0 line test proEammed El Caldwell System 0 Other <br /> sensor Primary piping testing at: <br /> ❑ 0 positive shutdown Model: Elnsi <br /> 0 fail safe Serial#: <br /> DNA minutes <br /> sensor Secondary piping testing at: <br /> 0 positive shutdown Model: ❑ psi <br /> 0 fail safe Serial#: <br /> 0 NA minutes <br /> sensor Secondary containment repairs for: <br /> El 0 positive shutdown Model: ❑ UDC(s) Piping <br /> 0 fail safe Serial#: Sump(s) UST(s) <br /> El NA <br /> Drop tube with mechanical overfill at 95% 11 Cold start of monitoring panel <br /> F-1 _Drop tube with mechanical overfill at 95% 0 Corrosion protection <br /> L El-L Overfill prevention(see LG letter 150-1) EJ- Other: see below <br /> A <br /> TIJISClIS SUBJECT TO REINSPECT ON AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> 14D : Recei Title: <br /> I,101L <br /> EHD 23-04 <br /> Rev 06/22/07 <br />