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SAN JOAQUIN COUNTY kdolk <br />40 ENVIRONMENTAL HEALTH DEPARTMERF <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigov.or ehd <br />UNDERGROUND STORAGE TANK JUST) PROGRAM SERVICE QUEST INSPECTION "PORT <br />Facil* Name: inspection Date: <br />91 <br />d 8Q <br />Facility Address: Ln Service Request #: <br />179,1 ('�heyvkee L�j #t cus-�Zlof <br />Ouw'te Service Technician's Name: ICC Service Technician/Installer Certification Manufacturer Training: <br />-/2 <br />-07 <br />I M T-Iff � <br />SERVICE <br />Leak dete■ ctor <br />F-1 0 1 hour hydrostatic 0 Incon TS -STS <br />r■ -1 mechanical Model: <br />0 electronic Serial #: <br />0 <br />0 line test programmed <br />Leak detecto■ r <br />0 mechanical Model: <br />0 <br />0 electronic Serial #: <br />0 line test programmed <br />Leak detecto■ r <br />0 <br />F-1 mechanical Model: <br />0 electronic Serial #: <br />0 line test programmed <br />K <br />sensor <br />■ <br />El positive shutdown Model: <br />r-1 fail safe Sen*al #: <br />D NA <br />sensor <br />■ <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />El <br />0 NA <br />0 <br />sensor <br />■ <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />El NA <br />Drop tube with mechanical overfill at 95% <br />Overfill prevention (see LG letter 150-1) <br />SERVICE <br />Spill bucket El minimum 5 gallon <br />F-1 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 />El Caldwell System n Other <br />— Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System El Other <br />Primary piping testing at: <br />0 <br />psi <br />minutes <br />Secondary piping testing at: %® %,c), <br />K <br />5 Ps' f 11 AA)AA4,W <br />go minutes 4* <br />Secondary containment repairs for: <br />UDC(s) Piping <br />Sump(s) UST(s) <br />Cold start of monitoring panel <br />El <br />Corrosion protection <br />0 <br />Other: see below <br />"T R P.0,1A 11 <br />--I L <br />EHD 23-014 IA -707-6"-574y <br />Rev 06/22/07 4w UPML,�-- G <br />le I AU <br />TWK!�TW., <br />�,►�---------- NOUN" <br />--I L <br />EHD 23-014 IA -707-6"-574y <br />Rev 06/22/07 4w UPML,�-- G <br />le I AU <br />