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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENO <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE QUEST INSPECTION REPORT <br />Facility Name: Inspecta ? n Date: <br />L / (-- !, 16 `5 <br />Facility Address: Servide Reqdest <br />Gni <br />Onsite Service Technician's Name: 4[tC Service Technician/installer CertK—ation #: Manufacturer Training: <br />1 01 <br />SERVICE <br />Leak detecto■ r <br />El 0 1 hour hydrostatic El Incon TS -STS <br />0 mechanical Model: <br />► <br />0 electronic Serial #: <br />El <br />0 line test progamined <br />Leak detector <br />■ <br />0 mechanical Model: <br />El <br />0 electronic Serial #: <br />El line test programmed <br />-- <br />Leak detector <br />■ <br />El mechanical Model: <br />0 electronic Serial #: <br />11 line test programmed <br />❑ <br />senso■r <br />i F-1 positive shutdown Model: <br />0 fail safe Serial #: <br />❑ <br />0 NA <br />• <br />F-1 <br />Cold start of monitoring panel <br />0 <br />■ <br />Other: see below FOZ iz/— <br />sensor <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />DNA <br />Drop tube with mechanical overfill at 95% <br />Drop tube with mechanical overfill at <br />NOR M -Rol <br />SERVICE <br />— Spill bucket El minimum 5 gallon <br />El 0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System R Other <br />► <br />Spill bucket R minimum 5 gallon <br />El <br />El I hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System R Other <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIM <br />Spill bucket R minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />F-1 Caldwell System 0 Other <br />Primary piping testing at: <br />F1 <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 />F-1 <br />Cold start of monitoring panel <br />0 <br />Corrosion protection <br />Other: see below FOZ iz/— <br />EHD 23-04 <br />Rev 06/22/07 <br />► <br />A AM <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIM <br />HD'S CURRENT HOURLY RATE. <br />1 EHD Inspector <br />EHD 23-04 <br />Rev 06/22/07 <br />