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SAN JOAQUIN COUNTY <br />ENVIRONMENTA4, HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 I/ <br />Telephone: (209) 468-3420 Fax; (209) 468-3433 Web: www.slgov.orq/ehd <br />'�f FORS <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPOR <br />Faci <br />i <br />onsite Service <br />\ t: rQ <br />Name: ICC Service Te <br />J <br />❑ This UST facility is APPROVED to operate <br />IN <br />EHD In <br />EHD 23-04 <br />Hev 4/30/12 <br />Inspection Date: <br />15 <br />4A ,() IIIIII( C <br />Service Request #: <br />III L ooq k4 <br />Manufacturer Training: <br />SERVICE <br />-sa <br />IIIIIIII <br />Spill bucket ❑minimum 5 gallon <br />❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑minimum 5 gallon <br />❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Primary piping testing at: <br />psi <br />InAl minutes <br />S ndary containment <br />�'-lci UDC(s) <br />Sump(s) <br />r: <br />l.i Piping <br />__ UST(s) <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 />F <br />ld start of monitoring panelrrosion protection <br />Other: see below /jA k, JRIC A) <br />❑ This UST facility is NOT APPROVED to operate <br />c_ g <br />ME <br />'I <br />Z - <br />THIS FACILITY IS S BJECT TO EINSPECTIO AT ANY TIME AT HD'S CURRtENT OURLY RATE. <br />Receive <br />a UST SERVICE REQUEST INSPECTION REF <br />