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71 <br /> SAN JOAQUIN COUNTY <br /> CRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigoy.org/ehd <br /> UNDERGROUND STORAGE TANK ST PROGRAM SERVICE QUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Facility Address: Service Request#: <br /> 3 oa'� t <br /> Onsite Service Technician's Name: ICC Service Technician/Inssttaller Certification#: Manufacturer Training: 1 L <br /> ', 1'"l 3® V <br /> O <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test ro ammed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ® ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: <br /> line test roammed ❑ Caldwell System ❑ Other <br /> ❑ <br /> sensor Primary piping testing at: <br /> ® ❑ positive shutdown Model: ® psi <br /> ❑ fail safe Serial#: <br /> ❑ NA minutes <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial#: <br /> minutes <br /> ❑ NA <br /> sensor Secondary containment repairs for: <br /> ® ❑ positive shutdown Model: ❑ UDC(s) Piping <br /> ❑ fail safe Serial#: <br /> ❑ NA Sump(s) UST(s) <br /> ❑ Drop tube with mechanical overfill at 95% Cold start of monitoring panel <br /> E <br /> Drop tube with mechanical overfill at 95%0 F-1Corrosion protection <br /> Overfill prevention(see LG letter 150-1) ❑ Other: see below <br /> � G ® <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD inspector: Received DWI, Title: <br /> EHD 23-04 <br /> Rev 06/22./07 <br />