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oR4utN ° SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> w: <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sogov.org/ehd <br /> cgciFij¢��� <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> SJC Sheriffs Operations Center#2 Thursday, December 2, 2010 <br /> Facility Address: Service Request tk: <br /> 7000 N. Michael Canlis Blvd., French Camp SR0061417 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Data: Manufacturer Training: <br /> James C. Payton 19/22/12 LA x. 11/29/12 <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑electronic Serial#: ❑ Caldwell System ❑Other <br /> ❑ line test programmed <br /> DSL PIPING sensor <br /> ❑ ❑positive shutdown Model: LALS-1 Primary piping testing at: <br /> X ❑fail safe Serial#: 09080 ❑ psi <br /> ❑ NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model: UDC(s) Piping <br /> ❑fail safe Serial#: Sump(s) UST(s) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑fail safe Serial#: Note: Please be aware that 2°containment components are required to be tested upon <br /> ❑ NA installation,6 months after,and every 36 months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> 171Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention(see LG letter 150-1) ❑ Other: see below <br /> ❑x This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Verified sump sensor functionality in north diesel sump. Passed. No positive shutdown, sensor out, <br /> or fail,safe tested. <br /> THIS FACILITY I BJECT TO REINSPECTION Y TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspect eceiv y: Title: <br /> .© <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />