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SAN JOA C't jtlj Y <br />Q <br />i Or, StOcktOn, CA 95202-2708 <br />telephone: (209) 458-3420 PO (209) 468-3433 Web, <br />wWW.sjgnv,Org/dhd <br />UNDERGROUN0 ST Gig T 10r SI IMCE RE <br />F�tlllty N��nc: <br />UEST INSPECTION p . RT <br />F ® {,i <br />l+itclilty <br />Inspection n)ntc: <br />" <br />t <br />,Address: <br />.w- <br />1 <br />Cen�llp Ser ylu Tfthnimoi <br />S4rVICC Retr(149t <br />s Not",. <br />i�� ICC service 1 j Mclatl/(nataflop Certifics—on #: Mik", 4:ctur et rrnlnlnq: <br />�^ all�`"` f t <br />! <br />SERVICE <br />Lir lit detet~tax . , p . • <br />SERVICE <br />m ltarli al Model: T (� - I" t ►� <br />Cflecttonld <br />Spill bucket Cl miniqal <br />Serial #:i <br />litie test <br />C! 1 hour hydrostatic In, cu <br />ro ed . <br />€ Caldwell System. ❑ Othe <br />Leak detector <br />b mechanical Model: <br />C1 electronic Serial <br />Spill bucket d zxlirli <br />I� Q 1 hour h <br />ydrostatic ❑ TnconQ <br />line t.st ro ed '® <br />Ci Caldwell System ❑ Othe <br />_ Leak deter lir <br />❑ Cl mechanical ,,.Model: <br />electronic Serial # : <br />Spill bucket 0 mi um 5 gallon <br />❑ ® 1 hour hydrostatic C Incon TS-STS <br />6. <br />. d .�nne tett ed-----�-' --- <br />❑ Caldwell System O Other . <br />{, <br />❑ pdSitiVe sirtitdotun Model: ^ <br />.primary piping testing at: <br />1 fail safe Serial:t_ <br />® ---- psi <br />®N� <br />minutes <br />sensor <br />d Ci positive shutdown Model: <br />Secondary piping testing at: <br />C.I fall safe Serial # <br />d ns-1 <br />G7 A <br />minutes <br />--- sensor <br />❑ ❑ P08itive shutdown Model:.:. <br />h . <br />• <br />Secondary containment repairs for: <br />® fail safe Senal : <br />C1 N� <br />® s UDC <br />() Piping _.. <br />El _ Drop tube with mechanical overfill at 95% <br />Sump(s) UST(s) <br />❑ Cold start of monitoring panel <br />❑ Drop tube with mechanical overfill at 95% <br />Cl Corrosion, protection <br />Q Overfill ptevemhtion (ace LG letter 150-1 <br />