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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. wwwsjgov.orgiehd <br />UNDERGROUND STORAGE TANK Q2S:Q PROG,RAM SERVICE UEST INSPECTION REPORT <br />Facility Name: Inspection Date: <br />e --o 1- 0 -C)2 <br />FadUVA—ddrem: Service Request 0: <br />�2226 i4-1 <br />Onsite Service Technicians Name: ICC Service71—dantinstafler Certification Manufacturer Training: <br />Sbp <br />SERVICE <br />SERVICE <br />Leak detector <br />0 <br />0 mechanical Model: <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 electronic Serial #: <br />0 Caldwell System 0 Other <br />0 line test proffarnmed <br />Spill bucket 0 minimum 5 gallon <br />Leak detector <br />0 <br />0 mechanical Model: <br />0 Caldwell System 0 Other <br />0 electronic Serial #: <br />Spill bucket 0 minimum 5 gallon <br />0 line test programmed <br />0 1 hour hydrostatic 0 Incon TS -STS <br />I Leak detector <br />0 Caldwell System 0 Other <br />0 mechanical Model: <br />Primary piping testing at: <br />C1 electronic Serial #: <br />psi <br />0 line test j2 ogrammed <br />minutes <br />- sensor <br />� <br />Secondary piping testing at: <br />positive shutdown Model: <br />psi <br />�R fail safe Serial #: <br />minutes <br />0 NA <br />Secondary containment repairs for: <br />sensor <br />UDC(s) Piping <br />0 positive shutdown Model: <br />Sump(s) UST(s) <br />0 fail safe Serial #: <br />Cold start of monitoring panel <br />0 NA <br />Corrosion protection <br />sensor <br />0 <br />C1 positive shutdown Model: <br />0 fail safe Serial #: <br />0 NA <br />C1 <br />Drop tube with mechanical overfill at 95% <br />El <br />Drop tube with mechanical overfill at 95% <br />C1 <br />Overfill prevention (see LG letter 150-1) <br />SERVICE <br />Spill bucket El minimum 5 gallon <br />0 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic 0 Incon. TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at: <br />0 <br />psi <br />minutes <br />Secondary piping testing at: <br />0 <br />psi <br />minutes <br />Secondary containment repairs for: <br />0 <br />UDC(s) Piping <br />Sump(s) UST(s) <br />• <br />Cold start of monitoring panel <br />• <br />Corrosion protection <br />0 <br />Other: see below <br />