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i I <br /> M 1 <br /> W <br /> SAN JOAQ COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> :ast Hazelton Avenue, Stockton, CA 95205-6232 <br /> 1) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.orq/ehd <br /> NK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Inspection Date: <br /> Service Request#: <br /> C-A <br /> 1CC Service Technician/installer Exp. Date: Manufacturer Training: <br /> SERVICE <br /> Spill bucket ❑ minimum 5 gallon <br /> ❑ D 1 hour hydrostatic ❑ Incon TS-STS <br /> D Caldwell System ❑ Other <br /> Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STNS <br /> ❑ Caldwell System ❑ Other L�. '1 <br /> Primary piping testing at: SPPr2 2 2017 <br /> psi <br /> h; <br /> minutes ENVIRONMENTAL HI'• <br /> Secondary containment testing for: <br /> UDC(s) Piping <br /> Sump(s) UST(s) <br /> ❑ Testing for the above components are next due by: <br /> Note. Please be aware that 21 containment comVonents are required to be tested upon <br /> installation,5 months after,and every 35 months thereafter, <br /> ,erfill at 95% ❑ Cold start of monitoring panel <br /> ,erfill at 95% ❑ Corrosion protection <br /> -1) ❑ Other: see below °:;r1 f `.. { } s <br /> operate ❑ This UST facility is NOT �WPROVED to operate <br />