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0 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: lnspe ion D te: <br /> A(L (b4)A PM �� � o tpl. oibe. <br /> . <br /> Facility Address: Service Request#: <br /> I 9 (� W, F re1h(Y", �-- � �-, E46 6 V {0/1 S/ZDvS- Y2,Y6 <br /> Onsite Service Technician's Name: ICC Service Technicianlinstaller Certification#: Manufacturer Training: <br /> V 0(Iu--L- iI& 2b 26 OPIA/ <br /> SERVICE SERVICE <br /> Leak detector <br /> Spill bucket ,'minimum 5 gallon <br /> ❑ ❑ mechanical Model: 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector <br /> F-1 mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> � El El❑ electronic Serial#: 1 hour hydrostatic ❑ Incon TS-STS <br /> El line test programmed <br /> ❑ Caldwell System ❑ Other <br /> Leak detector <br /> 11 mechanical Model: Spill bucket El minimum 5 gallon <br /> El ❑ electronic Serial ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> El line test programmed <br /> ❑ Caldwell System ❑ Other <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial #: <br /> minutes <br /> ❑ NA <br /> sensor Secondary piping testing at: <br /> 0 ❑ positive shutdown Model: ❑ psi <br /> El fail safe Serial#: <br /> minutes <br /> El NA <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: p UDC(s) Piping <br /> ❑ fail safe Serial#: Sump(s) UST(s) <br /> ❑ NA <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention(see LG letter 150-1) ❑ Other: see below <br /> QrI grLQ, 0(>r` =n) <br /> cap <br /> `►Vt `rvs � D S i d 1 kn10.7__ <br /> tip nolr --el <br /> THIS FACILITY IS SUBJECT 1r6 REINSPECT ON#T NY M HD'S CURRENT HOURLY RATE. <br /> AD Inspector: Received7y Title: <br /> s <br /> � Vf1(- I <br /> EHD V <br /> Rev 06122/6/22/07 �i � <br />