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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.sjgov.orgjeh <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE R QUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> 12410-49 <br /> Fu,i w(, 3 ::710 <br /> Facility Address: Service Request#: <br /> I Sze) JRtpor,1 51LO (3 54,94 <br /> Onsite Service Technician's Name: [CC Service Technician/installer Certification#: Manufacturer Training: <br /> fv� LA —) I I <br /> SERVICE SERVICE <br /> Leak detector —Spill bucket 11 minimum 5 gallon <br /> ❑ 0 mechanical Model: 0 0 1 hour hydrostatic 13 Incon TS-STS <br /> 0 electronic Serial #: 0 Caldwell System 11 Other <br /> 0 line test proffammed <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> El 0 mechanical Model: 0 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial#: <br /> F-1 line test programmed 0 Caldwell System 0 Other <br /> . Leak detector Spill bucket 0 minimum 5 gallon <br /> El mechanical Model: 0 0 1 hour hydrostatic El Incon TS-STS <br /> 0 electronic Serial#: <br /> D line test roed <br /> 0 Caldwell System 1:1 Other <br /> 2yamm <br /> sensor Primary piping testing at: <br /> El 0 positive shutdown Model: 0 psi <br /> 0 fail safe Serial minutes <br /> 0 NA <br /> sensor Secondary piping testing at: <br /> 0 0 positive shutdown Model: ❑ psi <br /> 0 fail safe Serial <br /> DNA minutes <br /> sensor Secondary containment repairs for: <br /> 0 El positive shutdown Model: UDC(s) Piping <br /> 11 fail safe Serial#: Sump(s) UST(s) <br /> El NA <br /> 0 —Drop tube with mechanical overfill at 95% El Cold start of monitoring panel <br /> 0 Drop tube with mechanical overfill at 95% El Corrosion protection <br /> ❑ Overfill prevention(see LG letter 150-1) 19 Other: see below <br /> V WLk a—f <br /> k <br /> At <br /> THIS FACILITY ISS LIBJECT TO REMPECTiON AT ANY TIME AT EH 'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received Title: <br /> 'A <br /> A <br /> LP J A <br /> EHD 23-04 <br /> Ppv nA/99/n7 <br />