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L1/3U/ZU1U TUE 1U:39 VAX Zy" b2534-13 <br />*** FAX TX REPORT *** <br />********************* <br />TRANSMISSION OK <br />JOB NO. <br />DESTINATION ADDRESS <br />PSWD/SUBADDRESS <br />DESTINATION ID <br />ST. TIME <br />USAGE T <br />PGS. <br />RESULT <br />3821 <br />98458953 r4A'►kb1b 44yke ty' <br />11/30 10:38 <br />00' 32 <br />1 <br />OK <br />op4�!lY., o <br />SAN .JOAQUIN COUNTY <br />��''11■■ ,�,�, ENVIRONMENTAL HEALTH DEPARTMENT <br />< 600 East Main Street, Stockton, CA 95202-3029 <br />;P Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sogov.org/ehd <br />4Chi* R* <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />�, <br />s� 15 <br />Inspection Date: <br />.-ZO - 3,iou <br />Facility Address: gyp/ l S <br />] <br />l t l �V �J� �I l � " "� <br />Service Request #: <br />006 4 X Is <br />Onsite Service Technician's Name: <br />LI Int <br />ICC Service Technician/Installer Exp. Date: <br />�� J -U I <br />r `Maanufactur Training: <br />V ►L <br />_ <br />❑ line test programmed <br />1pze <br />SERVICE <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <br />❑ line test programmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ <br />❑ fail safe Serial #: <br />11 <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />SERVICE <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) UST(s) <br />❑ <br />Testing for the above components are next due by: <br />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 />Corrosion protection <br />11 <br />Other: see below <br />19 <br />—U V.L <br />