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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN00 <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> -7 <br /> Facility Address: Service Request#: <br /> TE * A1U' "Ai <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Certification Manufacturer Training: <br /> � <br /> • 4-Vc <br /> 1�z ox� 7 <br /> SERVICE SERVICE <br /> Leak detectorSpill bucket El minimum 5 gallon <br /> EVmechanical Model: I/I El F-11 hour hydrostatic El Incon TS-STS <br /> 0 electronic Serial 71 t,�7 0 Caldwell System El Other <br /> El line test programmed <br /> Leak detector Spill bucket El minimum 5 gallon <br /> F-1 F-1 mechanical Model: 0 0 1 hour hydrostatic El Incon TS-STS <br /> 0 electronic Serial El Caldwell System 0 Other <br /> 1 0 line test programmed <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> 0 0 mechanical Model: 0 El 1 hour hydrostatic El Incon TS-STS <br /> 0 electronic Serial#: F1 Caldwell System El Other <br /> 0 line test programmed <br /> sensor Primary piping testing at: <br /> 0 0 positive shutdown Model: 1:1 psi <br /> El fail safe Serial minutes <br /> 0 NA <br /> sensor Secondary piping testing at: <br /> F1 0 positive shutdown Model: 0 psi <br /> 0 fail safe Serial minutes <br /> El NA <br /> sensor Secondary containment repairs for: <br /> F-1 0 positive shutdown Model: El UDC(s) Piping <br /> El fail safe Serial Sump(s) UST(s) <br /> El NA <br /> R Drop tube with mechanical overfill at 95% El Cold start of monitoring panel <br /> F-1 Drop tube with mechanical overfill at 95% 0 Corrosion protection <br /> El I Overfill prevention (see LG letter 150-1) El Other: see below <br /> -7 tD 7 hIr �-61S 4 <br /> t <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE.] <br /> EHD Inspector: Aj ] Received 13yeTitle: <br /> EHD 23-04 <br /> 1/3/07 <br />