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JUN 13 2000 1:07PM HP LASERJET 3200 p.2 <br />SAN 10A U1N <br />!. EMrIR Ah' LTH DEPARTMENT <br />° <br />3 r, Stocldon, CA 95202-2708 , <br />Telephone. (209) 468-9420 For. (09) 468-3433 Web: www.sjgov.org/ohd t; <br />yy SERVICE <br />UNDERGROUND STORAGE T S PR SERVICE UE31 INSPE4MON RE1�d►ll2�T a <br />Faastglpamet Inspection Date- <br />Service (a /esstAM <br />Facilit�ypAddrent Cyt p y %i f y // 14 <br />t f <br />.ems <br />^ ff� w <br />Onsite service Technician's Name: ICC Service T niy n/Itrsttaikr <br />Certitfeaden ti: Manufacturer Training: <br />SERVICE <br />SERVICE,;;.. <br />Leak detector*' t ► <br />eo 'cal ,.; Model: <br />Spill bucket 11um 5. an . <br />❑ elecixonic Serial #: <br />® ❑ 1 hour hydrostatic ❑ Incon TS- <br />`Iiue test ed. .. <br />❑Caldwell System 0 Other <br />Leak defector <br />Spill bucket ❑ minimum., 5 gallon <br />C] <br />❑ mechanical Model: <br />❑ <br />❑ Y hour hydrostatic ❑ Incon TS -STS <br />EJ electronic, Serial #: <br />❑ Caldwell System ❑ Other 't <br />1=1 line test Provammed <br />`� dec br <br />❑ mec cal Model: <br />Spill bucket ❑. minimum 5 gallon <br />❑ <br />❑ ;electronic ' Serial #: <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />) <br />®: Title test E2Fammed <br />❑ Caldwell System ❑ Other <br />i 4'.r ' sensor Veal hU! C 4_� <br />®positive shutdown Model: '; <br />❑ <br />Primary piping testing at: <br />11fail safe Serial #•bit jo <br />psi <br />minutes <br />❑ NA <br />sensor <br />❑ positive shutdown Model: <br />Secondary piping testing at, <br />Q fail safe Serial #: <br />❑si <br />minutes <br />i0 <br />NA <br />sensor <br />Secondary containnient repairs for: <br />I ' <br />❑ <br />❑ positive shutdown Model:.❑ <br />UDC{s} iping <br />O fail safe Serial #: <br />sump(s) TBT(s) <br />D A <br />® <br />Drop tube with mechanical overfill at 95%1 <br />❑ <br />Cold start of monitoring panel <br />❑ <br />Drop tube with mechanical overfill at 95%1 <br />❑ <br />Corrosion protection <br />❑ Overfill prevention (see LG letter 150-1) <br />❑ Other: see below <br />A %d1VlU'7� <br />THIS FACILITY IS SUBJECT TO REINSPECTIO AT TIME T EHD'S CURRENT HOURLY Rat, <br />EHD pector y4� Received $ a' Title: <br />Y <br />w <br />� ivm <br />