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SAN JOAQUIN COUNTY OCT 04 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 SAN <br /> Telephone:(209)468-3420 Pax.(209)468-3433 Web:www.s*qov.or-q/ehd ENViFiONN-10NIAL <br /> FEEAL7 h'D ERA-ITM ENT <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facillame: Inspecdo 0 te <br /> i A 61 /'? o I I <br /> Facility Address: Service Request#: <br /> ii Lou isR Aue <br /> Onsite Service T n1clan'sIame: I ICC Service Tqchnicianfinstallor Exp.Date: Manufacturer Training: <br /> ?1020641Ui P— 6.57-2!5_3 6 It,Al <br /> SERVICE SERVICE <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> ci 0 mechanical Model: 0 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic serial <br /> 0 line test 0 Caldwell System 0 Other <br /> programmed <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> ® 0 mechanical Model: 0 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial#: <br /> 0 line test 0 Caldwell System 0 Other <br /> programmed <br /> —sensor Primary piping testing at: <br /> 0 positive shutdown Model: psi <br /> 0 fail safe Serial minutes <br /> [3 NA <br /> sensor Secondary containment testing for: <br /> 0 positive shutdown Model: UDC(s) Piping <br /> 13 fail safe Serial#: Sump(s) UST(s) <br /> 0 NA sensor C1 Testing for the above components are next due by: <br /> 0 0 positive shutdown Model: <br /> 0 fall safe Serial#: Note:Haase be aware that 2*containment components are required to be tested upon <br /> 0 NA instdation.6 months aW and wmy 36 months thereafter. <br /> 01 Drop tube with mechanical overfill at 95% 0 Cold start of monitoring panel <br /> C3 _Drop tube with mechanical overfill at 95% n Corrosion protection <br /> C3 Overfill prevention(see LG letter 150-1) C1 Other:see below <br /> 0 This UST facility is APPROVED to operate El This UST facility is NOT APPROVED to operate <br /> -rec�n-,c;co) r4ef'10-62d CPU bc5etf-d <br /> P-Z <br /> Co ldr-c- V- JeLk (e))'1dke+ed <br /> f <br /> C)6-s evrvtA Qf)-Sors- stpisor 0,J) okf)j <br /> FOA CoW s (j:r- Ali Rx S-Qj .7 <br /> day 0+ <br /> THIS FAMILITY IS SU ECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD In tor. Received By: Title: <br /> EHO 2IJ& UST SERVICE REQUEST INSPECTION REPORT <br /> Rey 1 611 <br /> T/ <br />