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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> Telephoner(209)468-3420 Fax.(209)468.=3433 Web:www.sjgov.orgZed <br /> UNDERGROUND STORAGE TUST) PR06RAM SERVICE QUEST INSPECTION REPORT <br /> Facility Ne. Inspection Date: <br /> km 16 -Q1' G I <br /> Facility Address: Service Request#: <br /> 'i <br /> Onsite Service Technician's ame: ICC Service Technician/Installer Certification#: Manufacturer Training: <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ® ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test progammed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ® ❑ mechanical Model: ❑ ❑ 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: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor Primary piping testing at: <br /> ❑ positive shutdown Model: ❑ psi <br /> fail safe Serial#: minutes <br /> ❑ NA <br /> sensor Secondary piping testing at: <br /> ® ❑ positive shutdown Model: ❑ psi <br /> El fail safe Serial#: <br /> minutes <br /> ❑ NA <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: ❑ UDC(s) Piping j <br /> ❑ fail safe Serial #: Sump(s) UST(s) <br /> ❑ NA <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> EOverfill <br /> Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> prevention(see LG letter 150-1) ❑ Other: see below <br /> THS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received B Title: <br /> EHD 23-04 <br />