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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEP <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax.- (209) 468-3433 Web: www.sjgov.oree <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE R QUEST INSPECTION REPORT <br />Facility Name: Inspection Date: <br />715— -711-1o5 <br />Facility Address: Se ice Request #: <br />p5q-v �j 3 '5P-005z7�L72Z <br />Onsite Service Technician's Name: ICC Service Technician/Installer Certification #: Manufacturer Training: <br />SERVICE <br />7 <br />Leak detecto■r <br />e4r-1 Spill bucket .:Kminimum 5 gallon <br />li El mechanical Model: <br />0 1 hour hydrostatic 0 Incon TS -STS <br />■ electronic Serial #: <br />rl- <br />�gCaldwell System ther4ml— <br />0 line test programmed <br />Leak dete■ ctor 7 <br />Spill bucket El minimum 5 gallon <br />0 mechanical Model: <br />0 1 hour hydrostatic 0 Incon TS -STS <br />El electronic Serial #: <br />0 Caldwell System 0 Other <br />El line test programmed <br />— Spill bucket 0 minimum 5 gallon <br />Leak dete■ ctor <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 mechanical Model: <br />0 Caldwell System 0 Other <br />1:1 electronic Serial #: <br />Primary piping testing at: <br />0 line test programmed <br />psi <br />sensor <br />minutes <br />El positive shutdown Model: <br />Secondary piping testing at: <br />7 fail safe Serial #: <br />psi <br />El NA <br />minutes <br />sensor <br />1� <br />D positive shutdown Model: <br />UDC(s) Piping <br />El, safe Serial #: <br />Sump(s) UST(s) <br />DNA <br />Cold start of monitoring panel <br />Will <br />Corrosion protection <br />Not <br />Other: see below <br />Drop tube with mechanical overfill at 95% <br />Drop tube with mechanical overfill at 95% <br />SERVICE <br />e4r-1 Spill bucket .:Kminimum 5 gallon <br />'0 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />rl- <br />�gCaldwell System ther4ml— <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 />Primary piping testing at: <br />F-1 <br />psi <br />minutes <br />Secondary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment repairs for: <br />El <br />UDC(s) Piping <br />Sump(s) UST(s) <br />R <br />Cold start of monitoring panel <br />0 <br />Corrosion protection <br />0 <br />Other: see below <br />EHD 23-04 <br />Rev 06/22/07 <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD inspector- <br />EHD 23-04 <br />Rev 06/22/07 <br />