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DEC,23-2009 11 :49 AM GETTLER—RYAN INC. 925 551 4770 P. 03 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONME=NTAL HEALTH DEPARTMEN r <br /> A IF W..f 600 East Main Street, Stockton, CA 95202.;9029 <br /> \ •, .',,.',J Telephone: (209)468.3420 Fax:(209)468-3433 Web: tiwwsiaov.o—rgletld <br /> d6jy G�p� <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Faellity Warne: <br /> i ..._ <br /> Inspection ate <br /> Facility Address: <br /> / ; Service Rsqueet#: <br /> Onsite$erviee Technician's Namsa f'-.ICC Servlco Technicianllnstaller Exp. Date'. Manufacturer Training: <br /> I ♦ <br /> __SERVICE -- SERVICE <br /> Leak detector <br /> U mechanical Model: —,Spill bucket ❑ minimum 5 gallon <br /> CI electronic Serial #: J F1 1 hour hydrostatic ❑ Incon TS-STS <br /> �'.-----"--'-- I'. Caldwell System <br /> IiLeak det ctoammed — <br /> " Y <br /> ❑ mechanical Model — -- spill bucket ❑ .minimum 5 gallon <br /> Cl electronic Serial #: I t hour hydrostatic r,. Incon T'S•STS <br /> ❑ line test ro rammed J Caldwoll System ❑ Other <br /> Leak detector '��-- - ----- -- — - -- <br /> 1 1 mechanical Model — - - - _ _Spill bucKet ❑ minimum 5 gallon <br /> 13 electronic Serial #; I 1 1 hour hydrostatic Q Incon TS-STS <br /> 'I line test programmed ! Caldwell System ❑ Other <br /> sensor _ �__..--- ___ ----- -------- <br /> CJ positive shutdown Model: Primary piping testing at: <br /> _1 ❑ fail safe Serial psi <br /> ❑ NA --____,..—_--- y ._......._ minutes <br /> sensor —�� Secocdary containment testing for: <br /> ❑positive shutdown Model: UDC(s) ___,___-___ Piping <br /> C1 fail safe Serial #: --_ - --M NA Sump(s)_ ---_.__ _ UST(s) <br /> __sensor Testing for the above components are next due by: <br /> ❑positive shutdown Model: <br /> ❑fail safe Serial #: <br /> FJ NA -- - ---- N ;,'a,.• ,,:,,.,,r,,,,,,: n;,;:,woi D ,�a.; :r..r.,,,;,r„� ,;o,:r,.,,,�, <br /> ....fi rq.9Pe..•vl•r!i,itod�.w•y:IA m1fil, <br /> ❑ Drop tube with mechanical overfill at 95"ia ❑ Cold start of monitoring panel — <br /> ❑ Drop tube with mechanical overfill at 950 ] Corrosion protection <br /> 7 Overfill prevention (see LG letter 150-1) Other, see belowy <br /> - THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE, <br /> r2tpeeivNd ay: ..._.-.....�--.._-�W�1':5 <br /> -HD 23 04 J^•T GFF\•i��F+i!.fr =.E !"IEurt r�.ry�.�n�,e. <br /> ae„11.171108 <br />