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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: )A w sjgoy_orgLehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />u wssfA <br />— - ---- --- <br />Inspection Date: <br />&f1C1WX4-11-f <br />❑ mechanical Model: <br />� <br />10-11-01 <br />Facility Addr S. <br />�' <br />Si I� <br />Service Request #: <br />052vEs' 1 <br />Onsite Service Technician's Name: <br />V� �� ► �!�,✓ <br />Leak detector <br />ICC Service Technician/Installer Certification #: <br />l l <br />Ma facturer Training: <br />SERVICE <br />u wssfA <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />ect <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />Primary piping <br />❑ line test programmed <br />psi 10/11:,2007 q:1y AM <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />Secondary cont; END LEVEL 6.537-8' TN <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />TEST RESULT LLT PASSED <br />Cold start of monitoring panel <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />SERVICE <br />u wssfA <br />Spill bucket ❑ minimum 5 gallon <br />❑ 1 hour hydrostatic moon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />EHD'S CURRENT HOURLY RATE. <br />❑ Caldwell System ❑ Other <br />ect <br />Spill buc l <br />❑ <br />❑ 1 hour hydro <br />❑ Caldwell Sy, ,rEwr;� 152y?_ <br />TRHCY CA <br />Primary piping <br />❑ <br />psi 10/11:,2007 q:1y AM <br />minutes S!JMP LEAs; TENT REPORT <br />REGFBK:T <br />Secondary pipit <br />❑ <br />TEST STARTED P'::04 AM <br />psi TEST STARTED 1CW11: 2007 <br />minutes SEG I N I-00" 6.5363 IN <br />END TTME 9.1.9 AM <br />END DATE 10/11/2007 <br />Secondary cont; END LEVEL 6.537-8' TN <br />El <br />LEAK; THRESHOLD 0.002 IN <br />TEST RESULT LLT PASSED <br />Cold start of monitoring panel <br />❑ <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />jWMA MI41fRL�W <br />u wssfA <br />T IS AC ITY IS SUBJECT O R PECTION AT ANY TIMP <br />EHD'S CURRENT HOURLY RATE. <br />EH <br />ect <br />Received <br />Title: <br />/1441^ ,� <br />I INV. <br />EHD 23-04 <br />Rev 06/22/07 <br />