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SAN JOAQUIN COUNTY 0 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, P Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Leak detector <br />0 <br />Inspection Dat . <br />-7/6/a -7 <br />Facility Address: <br />0 electronic Serial <br />Service Request #: <br />M&N 9-7 <br />f�k F0,0 <br />L"K 065111 <br />Onsite Service Technician's Name: <br />I' ICC Service Technician/Installer Certification #: <br />Manufacturer Training: <br />0 line test programmed <br />(5;(AZMPVJ <br />1 — (,A'F <br />❑ <br />`HD 23-04 <br />/3/07 <br />Leak detector <br />0 <br />❑ mechanical Model: <br />0 electronic Serial <br />0 line test proEammed <br />Leak detector <br />E] <br />0 mechanical Model: <br />• electronic Serial <br />0 line test programmed <br />Leak detector <br />❑ <br />F mechanical Model: <br />El <br />• electronic Serial #: <br />El line test programmed <br />sensor <br />❑ <br />El positive shutdown Model: <br />El fail safe Serial #: <br />0 NA <br />❑ <br />sensor <br />❑ <br />El positive shutdown Model: <br />El <br />0 fail safe Serial #: <br />El <br />DNA <br />El <br />sensor <br />❑ <br />El positive shutdown Model: <br />0 fail safe Serial <br />El NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />0 <br />Drop tube with mechanical overfill at 95% <br />0 <br />Overfill prevention (see LG letter 150-1) <br />`HD 23-04 <br />/3/07 <br />0 OpJ Spill bucket eminimum. 5 gallon <br />N( <br />El I hour hydrostatic 0 Incon TS -STS <br />0"Caldwell System El Other <br />00 Spillbucketill ER(minimum. 5 gallon <br />V0 hour hydrostatic F-1 Incon TS -STS <br />Caldwell System 0 Other <br />of 0 Spill bucket 06L 0?'minimurn 5 gallon <br />0 1 hour hydrostatic 0 Incon TS -STS <br />ED-I�aldwell System El Other <br />Primary piping testing at: <br />El <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 />El <br />Cold start of monitoring panel <br />El <br />Corrosion protection <br />El <br />Other: see below <br />`HD 23-04 <br />/3/07 <br />