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SAN JO IN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone:(209) 468-3420 Fox. (209) 468-3433 Web. WWwXWV-9[o&hd <br />SERVICE SERVICE <br />UST SERVICE REQUEST INSPECTION REPORT <br />Leak detector <br />0 <br />El <br />0 mechanical <br />Model; <br />0 electronic <br />Serial <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 line test pnrammed <br />0 Caldwell System 0 Other <br />Leak detector <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 mechanical <br />Model: <br />0 Caldwell System 0 Other <br />0 electronic <br />Serial <br />0 line test pMrammed <br />Leak detector <br />❑Llnechanical <br />Model: <br />0 electronic <br />Serial it <br />Testing for the above components are next due by, <br />0 line test programmed <br />sensor <br />Wr. PWwbe&wmmat 2'coftnm-n1 camper -rd, -are re**W to be Wed upon <br />knWIftwh 6 nwft WW. wW every 36 mmft ftmiter. <br />El <br />0 positive shutdown <br />Model. <br />Corrosion protection <br />0 fall safe <br />Serial M <br />ONA <br />sensor <br />13 <br />C1 positive shutdown <br />Model: <br />• fail safe <br />Serial #: <br />• NA <br />sensor <br />El <br />0 positive shutdown <br />Model: <br />0 fail safe <br />Serial <br />0 NA <br />❑ <br />Drop tube with <br />mechanical overfill at 95% <br />❑ <br />Drop tube with <br />mechanical overfill at 950 <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />UST SERVICE REQUEST INSPECTION REPORT <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at, <br />psi <br />minutes <br />SeLcpndary containment testing for: <br />UDC(s) P7 - 11 Piping <br />Sump(s) UST(s) <br />Testing for the above components are next due by, <br />Wr. PWwbe&wmmat 2'coftnm-n1 camper -rd, -are re**W to be Wed upon <br />knWIftwh 6 nwft WW. wW every 36 mmft ftmiter. <br />❑ <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other see below <br />UST SERVICE REQUEST INSPECTION REPORT <br />