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UV I <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />-3029 <br />600 East Main Street, Stockton, CA 95202 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.orq/e1 <br />SERVICE <br />Spill bucket 0 minimum 5 gallon <br />Leak detector <br />0 1 hour hydrostatic El Incon TS -STS <br />0 mechanical Model: <br />0 Caldwell System 0 Other <br />—1 <br />1 0 electronic Serial #: <br />Spill bucket 0 minimum 5 gallon <br />0 line test oroarammed <br />0 1 hour hydrostatic 0 Incon TS -STS <br />Leak detector <br />1 0 Caldwell System 0 Other <br />0 mechanical Mode■ l: <br />Spill bucket 0 minimum 5 gallon <br />r-1 electronic Serial #: <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 line test pro,• ramme • <br />0 Caldwell System 0 Other <br />Leak detector <br />ii <br />0 mechanical Model: <br />psi <br />7 <br />0 electronic Serial #: <br />ut <br />minutes <br />0 line testprogrammed <br />Secondary containment testing for: <br />-6 <br />'D posve shutdown M del: <br />Isensor <br />0 fail safe Serial #: 9-6?q9t 3 <br />Sump(s) LIST(s) <br />Testing for the above components are next due by: <br />• <br />i Note: Please be aware that 2* containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />Cold start of monitoring panel <br />■ <br />sensor <br />10 <br />• positive shutdown Model: <br />• fail safe Serial #: <br />NA <br />Drop tube with mechanical overfill at 95% <br />Drop tube with mechanical overfill at 95% <br />UWW-T;:T-41V2 <br />I SERVICE <br />EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 11/17/108 <br />Spill bucket 0 minimum 5 gallon <br />■ <br />0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System 0 Other <br />—1 <br />Spill bucket 0 minimum 5 gallon <br />11 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />1 0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at: <br />psi <br />7 <br />ut <br />minutes <br />Secondary containment testing for: <br />LIDC(s) Piping <br />Sump(s) LIST(s) <br />Testing for the above components are next due by: <br />i Note: Please be aware that 2* containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />Cold start of monitoring panel <br />EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 11/17/108 <br />