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SAN JOAQUIN COUNTY <br />X ENVIRONMENTAL HEALTH DEPARTMENT <br />i <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />SERVICE <br />Leak detector <br />❑ El mechanical Model: <br />El electronic Serial #: <br />0 line test programmed <br />----------- <br />Leak detector <br />❑ <br />0 mechanical Model: <br />El <br />El electronic Serial #: <br />'W"'yvi'miffi/M I KWO, <br />0 line test programmed <br />Leak detector <br />❑ <br />0 mechanical Model: <br />El electronic Serial #: <br />El line test programmed <br />❑ <br />71 :E; /I sensor <br />positive shutdown Model: <br />,KUail safe Serial #: <br />0 NA <br />sensor <br />❑ <br />0 positive shutdown Model: <br />El <br />0 fail safe Serial #: <br />El NA <br />sensor <br />El <br />0 positive shutdown Model: <br />El <br />El fail safe Serial <br />0 NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Drop tube with mechanical overfill at 95% <br />El <br />Overfill prevention (see LG letter 150-1) <br />SERVICE <br />M O',lvwl OEM <br />Spill bucket 0 minimum 5 gallon <br />0 <br />111 hour hydrostatic 0 Incon TS -STS <br />----------- <br />• Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />'W"'yvi'miffi/M I KWO, <br />• Caldwell System 0 Other <br />- Spill bucket 0 minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />El Caldwell System 0 Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment testing for: <br />LIDC(s) Piping <br />Sump(s) III <br />El <br />Testing for the above components are next due by: <br />Note: Please be aware that 20 containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />Cold start of monitoring panel <br />El <br />Corrosion protection <br />El <br />Other: see below <br />ER <br />M O',lvwl OEM <br />----------- <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHII CURRENT HOURLY RATE. <br />'W"'yvi'miffi/M I KWO, <br />110FIR&�M-W) <br />EHD 23-04 <br />Rev 11/17//08 <br />UST SERVICE REQUEST INSPECTION REPORT <br />