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Poet-It"brand <br /> I ax Transmittal Memo 76 ( No.ofPages ^ *Tody''sDate� �/ Time <br /> To Bob �Sh"��l`"P� From O� SAN JOAQUIN COUNTY V <br /> Compan .n J L/ Company PUBLIC HEALTH SERVICES <br /> Ct c) z L/U r( HIL <br /> y` /l Location ENVIRONMENTA�e <br /> Location bbb I'TH DIVISION <br /> O �.L- f � CP G�E POST OFFIC�BQ X 2009 <br /> Fax# Telephone# Fax# STOCRTON, IB IX2A95201 <br /> (.61q) n � �� � <br /> Comments Original <br /> Disposition: DestroyReturn Call for pickup <br /> t J UNDERGROUND TANK INSPECTION RECORD ! <br /> NEW TANK INSTALLATION <br /> SITE NAME .tl� G] 1�� qLi I ,.I . - n INSPECTOR'S NAME <br /> ADDRESS 4� 4-D L(JO.S �� CITY 1 TDGK J/I/L� / ry.(�zip (� O <br /> CONTRACTOR: NAME F�H"j/E' rn�. C� PHONE (-�� 6, 6 2$ -"'2 7 7-7 <br /> OWNER: NAME 'Y cV y PHONE �6 _3 — 5_c ! 7 <br /> DIS INSPECTOR'S <br /> DATE IPPROVED uPPROVED INITIALS <br /> ?/( 11 <br /> q( V/ ITEM OR EQUIPMENT INSPECTED <br /> -7R.. <br /> 1. Fees paid <br /> �r�'1�' •/ . Plans Approved <br /> INITIAL INSPECTION2�ctt� <br /> f(�y/�L ✓ 'r�-- 1. UL numbers oa tank size iD <br /> �t, . Tank tested upon delivery <br /> 1K1 (Hol idey (pl as teeyor air at 5 PSI ( RP)l <br /> t ' — . Visual inspection of secondary containment. <br /> ID . . Tank appropriately placed with approved backfil(- <br /> (PING STAGE INSPECTION <br /> �Z� C 1. Pressure test of piping. ((Primary and Secondary (NFPA 30)] <br /> 2. Sall float valves installed. <br /> 3. Overfill protection installed, describe: <br /> „ <br /> AL .!) 4. Unused tank openingeated-nd cathodicatty protected. <br /> S. Visual inspection of secondary containment on piping. <br /> 6. Monitoring 1 in place and brought to gr e. lockable weather proof covers) <br /> to <br /> 7. Fill and vent piping brought tog ace. ' <br /> 8. Product tine leak detector in place. (Hard wired) <br /> 9. Approved tank leak monitoring device installed. <br /> 10. All galvanized piping and fittings properly wrapped. <br /> 11. Pressure decay test on complete tank and product delivery system- <br /> �%n ��! �/ � Uf ruF)n h!S".on � SP�t`.tM o� i 4v#a.vlil 1T�Li-•,A h,4iAt.SCPA'1/�.aifc <br /> INAL INSPECTION �� <br />