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SAN JOAQUIN COUNTY <br />x ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />(209) 468-3433 Web: www.sigov.org/ehd <br />Telephone: (209) 468-3420 Fax. <br />I— —, SERVICE I I SERVICE <br />I W"I 6-11-414111111 CA T=IUI= AT 1=14 'S CURRENT HOURLY RATE. <br />EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 11/17//08 <br />Lea-k-de11 <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />mechanical <br />Model: Adeq LZ <br />■tector <br />electronic <br />Serial #: Dqb <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 line test programmed <br />0 Caldwell System El Other <br />Leak detector <br />Spill bucket 0 minimum 5 gallon <br />11 <br />0 mechanical <br />Model: <br />0 Caldwell System 0 Other <br />0 electronic <br />Serial #: <br />El <br />0 line test programmed <br />Leak detecto■ r <br />Secondary containment testing for: <br />0 mechanical <br />Model: <br />0 electronic <br />Serial #: <br />Testing for the above components are next due by: <br />0 line test programmed <br />Note: Please be aware that 21 containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />sensor <br />Cold start of monitoring panel <br />El <br />0 positive shutdown <br />Model: <br />Other: see below <br />El fail safe <br />Serial #: <br />DNA <br />sensor <br />0 positive shutdown <br />Model: <br />0 fail safe <br />Serial #: <br />El NA <br />sensor <br />0 positive shutdown <br />Model: <br />0 fail safe <br />Serial #: <br />0 NA <br />Drop tube with mechanical overfill at 95% <br />Overfill prevention (see LIS letter 150-1 <br />I W"I 6-11-414111111 CA T=IUI= AT 1=14 'S CURRENT HOURLY RATE. <br />EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 11/17//08 <br />Spill bucket El minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System El Other <br />Spill bucket 0 minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System El Other <br />Spill bucket 0 minimum 5 gallon <br />0 El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at: <br />El <br />psi <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) UST(s) <br />Testing for the above components are next due by: <br />Note: Please be aware that 21 containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />El <br />Cold start of monitoring panel <br />El <br />Corrosion protection <br />El <br />Other: see below <br />I W"I 6-11-414111111 CA T=IUI= AT 1=14 'S CURRENT HOURLY RATE. <br />EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 11/17//08 <br />