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0 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.-(209)468-3433 Web:www.sjgov.orjz/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE QUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Fa tl rity Address: Service Request#: <br /> Ons'eSprvice Technician's Name: ICC Service Technician/Installer Certification#: T-Manufacturer Training: <br /> SERVICE SERVICE <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> ❑ 11 mechanical Model: <br /> 0 electronic Serial #: 0 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 line test progEammed 0 Caldwell System 0 Other <br /> Leak detector Spill bucket D minimum 5 gallon <br /> 0 mechanical Model: - <br /> 0 electronic Serial #: 0 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 line test 2roEammed 0 Caldwell System 0 Other <br /> I Leak detector Spill bucket 0 minimum 5 gallon <br /> 0 mechanical Model: - <br /> 0 electronic Serial #: 0 El 1 hour hydrostatic El Incon TS-STS <br /> .0 line test programmed El Caldwell System 0 Other <br /> 2� sensor Primary piping testing at: <br /> 0 positive shutdown Model: 0 psi <br /> ;Rail safe Serial#:77-573 j!:j-7 <br /> NA minutes <br /> E1- <br /> sensor Secondary piping testing at: <br /> ❑ 11 positive shutdown Model: 0 psi <br /> 0 fail safe Serial #: <br /> E] NA minutes <br /> sensor Secondary containment repairs for: <br /> ❑ 0 positive shutdown Model: UDC(s) Piping <br /> ❑ fail safe Serial#: ❑ <br /> 0 NA Sump(s) UST(s) <br /> ❑ Drop tube with mechanical overfill at 95% 0 Cold start of monitoring panel <br /> F-1 Drop tube with mechanical overfill at 95% 0 Corrosion protection <br /> 0 Overfill prevention(see LG letter 150-1) 0 Other: see below <br /> 77— <br /> a z-6i,/A-// <br /> TH!4X,ACILITY IS SUBJECT TO RtINSPECTION AT ANY TIMAT EHDIS CURRENT HOURLY RATE. <br /> EHD Ins -FR <br /> EHD 23-04 <br /> Rev 06/22JQ7 <br />