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SAN JOAQUIN COUNTY 0-1 <br />9 IMF <br />ENVIRONMENTAL HEALTH DEPAV.TIIE',WT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST <br />INSPECTION REPORT <br />Fac' N <br />7> <br />6� <br />Inspection Date: <br />'09 <br />Facility Address: <br />��� <br />Service Request #: <br />Onsite Service e: <br />ICC Service Technician/installer Certification #: <br />M ufacturer T aining: <br />SERVICE <br />Leak detector <br />El <br />0 mechanical Model: <br />F1 electronic Serial #: <br />El line test programmed <br />0 <br />Leak detector <br />0 mechanical Model: <br />R electronic Serial #: <br />F-1 <br />0 line test programmed <br />. Leak detector <br />0 <br />El mechanical Model: <br />El <br />0 electronic Serial <br />0 line test programmed <br />sensor <br />0 <br />R positive shutdown Model: <br />0 fail safe Serial #: <br />DNA <br />El <br />sensor <br />❑ <br />0 positive shutdown Model: <br />0 <br />F1 fail safe Serial #: <br />ECorrosion <br />0 NA <br />ED <br />sensor <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />DNA <br />El <br />Drop tube with mechanical overfill at 95% <br />El <br />Drop tube with mechanical overfill at 95% <br />El <br />Overfill prevention (see LG letter 150-1) -j <br />SERVICE <br />Spill bucket 0 minimum 5 gallon <br />El <br />0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System El Other <br />- Spill bucket El minimum 5 gallon <br />F-1 <br />El I hour hydrostatic E-1 Incon TS -STS <br />El Caldwell System [I Other <br />Primary piping testing at: <br />El <br />psi <br />minutes <br />Secondary piping testing at: <br />F-1 <br />psi <br />minutes <br />Secondary containment repairs for: <br />El <br />UDC(s) Piping <br />Sump(s) UST(s) <br />0 <br />Cold start of monitoring panel <br />ECorrosion <br />protection <br />'Other: <br />ED <br />see below <br />W <br />E121", M <br />THIS.FfCI49rY IS SUBJECT T N AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD 23-04 <br />Rev 06/22/07 <br />