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SAN JOAQUIN COUNTY <br /> ,..,,W1RONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:, sigov org�ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUESTinsction DeNSPECTION REPORT <br /> Facility Name: <br /> a7 xs �e NGL(N G <br /> Service Request#: <br /> Facility Address: ^e o ��/,s <br /> -7611 I1Kpg1er W S��� ([ <br /> Onsite Service Technician's Name: ICC Service Techniciadlnstaller Certification#: Manufacturer Training: <br /> C�►2tc Mc <br /> SERVICE SERVICE <br /> Leak detector DI Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: EW P l hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test proyarnmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test pro ammed <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> El fail safe Serial #: minutes <br /> ❑ NA <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial #: minutes <br /> ❑ NA <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: ❑ UDC(s) Piping <br /> ❑ fail safe Serial #: Sump(s) UST(s) <br /> ❑ NA <br /> ❑ Drop tube with mechanical overfill at 95% Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention (seekLG letter 150-1) El Other: see below 1 <br /> l Xfx' 1 S61 1 <br /> aQ k tw7 <br /> o>'AQ e <br /> THIS FACILITY IS SU JECT TO RE PEC ION AIAW TIME AT EHEVS C RRENT HOURLY RATE. <br /> EHD Inspector: Received B Title: <br /> /rl G <br /> EHD 23-04 <br /> Rev 06/22/07 <br />