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THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspect Received By: JZ <br />Title: <br />IV( <br />EHD 23-04 <br />Rev 06/22/07 <br />Leak detector <br />0 SAN JOAQUIN COUNTY <br />0 mechanical Model: <br />El electronic Serial #: <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />0 line test pro immed <br />0 <br />Leak detector <br />600 East Main Street, Stockton, CA 95202-3029 <br />El mechanical Model: <br />Telephone: <br />(209) 468-3420 Fax. (209) 468-3433 Web: www.sigov.org/chd <br />UNDERGROUND STORAGE TANK UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />. Leak detector <br />F-1 <br />Inspection Dt: <br />E <br />T <br />❑ <br />El electronic Serial #: <br />-f d <br />Facility Address: <br />— <br />VD6 3/14 sensor <br />&Zpositive shutdown Model: <br />❑ <br />Service Req est #: <br />EINA <br />sensor <br />Onsite Service Technician's Name: <br />D positive shutdown Model: <br />ICServiceTechnician/installer Certification #: <br />Ma f cturer Training: <br />F-1 <br />0 NA <br />❑ <br />5/1'6/0--7 <br />Lt <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspect Received By: JZ <br />Title: <br />IV( <br />EHD 23-04 <br />Rev 06/22/07 <br />Leak detector <br />El <br />0 mechanical Model: <br />El electronic Serial #: <br />0 line test pro immed <br />0 <br />Leak detector <br />❑ <br />El mechanical Model: <br />0 electronic Serial <br />❑ <br />El line test 2roEammed <br />. Leak detector <br />F-1 <br />El mechanical Model: <br />❑ <br />El electronic Serial #: <br />0 line test proEammed <br />— <br />VD6 3/14 sensor <br />&Zpositive shutdown Model: <br />❑ <br />fail safe Serial #: <br />EINA <br />sensor <br />El <br />D positive shutdown Model: <br />0 fail safe Serial #: <br />F-1 <br />0 NA <br />❑ <br />sensor <br />El <br />F-1 positive shutdown Model: <br />0 fail safe Serial #: <br />DNA <br />❑ <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) <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspect Received By: JZ <br />Title: <br />IV( <br />EHD 23-04 <br />Rev 06/22/07 <br />Spill bucket 0 minimum 5 gallon <br />El <br />❑ I hour hydrostatic El Incon TS -STS <br />0 Caldwell System El Other <br />— Spill bucket El minimum 5 gallon <br />0 <br />El I hour hydrostatic El Incon TS -STS <br />F-1 Caldwell System ❑ Other <br />Spill bucket El minimum 5 gallon <br />❑ <br />0 1 hour hydrostatic F-1 Incon TS -STS <br />El Caldwell System 0 Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary piping testing at: <br />❑ <br />Psi <br />minutes <br />Secondary containment repairs for: <br />0 <br />UDC(s) Piping <br />Sump(s) UST(s) <br />F-1 <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspect Received By: JZ <br />Title: <br />IV( <br />EHD 23-04 <br />Rev 06/22/07 <br />