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SAN JOAQUIN COUNTY 10 <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.orWehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE R <br />QUEST INSPECTION REPORT <br />Facilit Name- <br />Inspection Date. <br />0 1 hour hydrostatic El Incon TS -STS <br />F-1 electronic Serial <br />Facility Address: <br />Service Request #: <br />Spill bucket 0 minimum 5 gallon <br />-7 <br />O Service Technician's e: <br />ICC S, Technician/Installer Cprtiflcation #: <br />Manufacturer Training: <br />■ electronic Serial #: <br />Spill bucket F-1 minimum 5 gallon <br />El line test programmed <br />SERVICE <br />SERVICE <br />Leak detector <br />Spill bucket 0 minimum 5 gallon <br />0 mechanical Model: <br />0 1 hour hydrostatic El Incon TS -STS <br />F-1 electronic Serial <br />0 Caldwell System 0 Other <br />Oline test pro amme <br />Spill bucket 0 minimum 5 gallon <br />Leak detecto■ r <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 mechanical Model: <br />0 Caldwell System 0 Other <br />■ electronic Serial #: <br />Spill bucket F-1 minimum 5 gallon <br />El line test programmed <br />0 1 hour hydrostatic El Incon TS -STS <br />Leak detector <br />III <br />0 mechanical Model: <br />Primary piping testing at: <br />0 electronic Serial #: <br />psi <br />El line test•rogammed <br />minutes <br />sensor <br />Secondary piping testing at: <br />El positive shutdown Model: <br />psi <br />0 fail safe Serial #: <br />minutes <br />El NA <br />Secondary containment repairs for: <br />senso■ r <br />UDC(s) Piping <br />1:1 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 />Other: see below <br />0 positive shutdown Model: <br />El fail safe Serial #: <br />0 NA <br />1 Drop tube with mechanical overfill at 95% <br />SERVICE <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket F-1 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic El 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 />❑ <br />psi <br />minutes <br />Secondary containment repairs for: <br />❑ <br />UDC(s) Piping <br />Sump(s) UST(s) <br />Cold start of monitoring panel <br />• <br />Corrosion protection <br />• <br />Other: see below <br />Eli <br />EHD 23-04 <br />Rev 06/22/07 <br />lix <br />9: 1 &zl Iffei 1 0 01 N 410 6J:j *41 <br />Eli <br />EHD 23-04 <br />Rev 06/22/07 <br />lix <br />