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0 SAN JOAQUIN COUNTY 40 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fav(209)468-3433 Web:www.sjgov.orgZeh <br /> UNDERGROUND STORAGE TANK(UST I PROGRAM SERVICE R QUEST INSPECTION REPORT <br /> Facit!y N e: Inspection Date- <br /> Facility Address: ServicetRequest#: <br /> 00!5 (7 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Certification#: Manufacturer Training: <br /> —up <br /> f SERVICE SERVICE K— f-x-/3 <br /> Leak detector —Spill bucket El minimum 5 gallon <br /> El El mechanical Model: El 0 1 hour hydrostatic El Incon TS-STS <br /> 0 electronic Serial#: 0 Caldwell System ❑0 Other <br /> 0 line test 2rogEarnmed <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> ❑ 0 mechanical Model: 0 F-1 I hour hydrostatic 0 Incon TS-STS <br /> El electronic Serial#: 0 Caldwell System 0 Other <br /> 0 line test prolEammed <br /> . Leak detector <br /> 0 mechanical Model: Spill bucket Nkminimum 5 gallon <br /> I hour hydrostatic 'El Incon TS-STS <br /> 0 electronic Serial #: <br /> El Caldwell System 0 Other <br /> 0 line test prog!ammed <br /> sensor <br /> 0 positive shutdown Model: Primary piping testing at: <br /> ❑ nsi <br /> F-1 fail safe Serial #: <br /> El NA minutes <br /> sensor Secondary piping testing at: <br /> El 0 positive shutdown Model: ❑ psi <br /> El fail safe Serial#: minutes <br /> 11 NA <br /> sensor Secondary containment repairs for: <br /> ❑ 0 positive shutdown Model: El UDC(s) Piping <br /> D fail safe Serial #: Sump(s) UST(s) <br /> El NA I <br /> C1 r,.-a Drop tube with mechanical overfill at 95% 0 Cold start of monitoring panel <br /> El Drop tube with mechanical overfill at 95% El Corrosion protection <br /> 0 Overfill prevention(see LG letter 150-1) 0 Other: see below <br /> 447 4�n -715 "" <br /> I <br /> el, W,4 <br /> G_ <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHDIS CURRENT HOURLY RATE. <br /> EHD Ins - Received B,�: Title: <br /> EHD 23-04 <br /> Pa,,nA/99/07 <br />