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JUL-12-2010 12 :01 PN GETTLER—RYAN INC. 925 551 4770 P. 06 <br /> SAN JOAQUIN COUNTY <br /> I, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202•-3029 <br /> Telephone: (209) 468-3424 Fax: (209)468-3333 Web: www.sjgP Lehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Feclll Nreme: —� "— Inspection Date, <br /> FecllltyAddress: --_.—___...�_. -------- ServicoRequest## <br /> 1 � M <br /> Onsite Service Techniclan's Name: ICC Service Tech nieianllnstaller Exp. Date: Manufacturer Tralning <br /> I <br /> SERVICE SERVICE <br /> Leak detector s __Spill bucket — C'I minlmum 5 gallon <br /> J 0 mechanical Model: _._ r_� � I � hour hydrostatic 0- InconTS-STS <br /> 0 electronic Serial#: � � �; <br /> Caldwell 5ystern IJ Other •° <br /> 11 line test programmed <br /> __Leak detector —Spill bucket C, minimum 5 gallon <br /> a 0 mechanical Model: <br /> 0 electronic Serial C hour hydrostatic F1 Incon T5-STS <br /> #; __- <br /> line test programmed - U Caldwell System [❑ Other <br /> Leak detector <br /> LJ mechanical Model; Spill bucket O minirnum 5 gallon <br /> 0 electronic Serial#: _ i] El 1 hour hydrostatic M Incon TS-STS <br /> -- ----- n Caldwell System ❑ Other <br /> _ _El line_ tes_t_pro�rarnmed <br /> _ -- sensor <br /> ❑ positive shutdown Model: Primary piping testing at <br /> r.� si <br /> 0 fall safe 9erlal#: _^"-----_—�--- L ____,_minutes <br /> 1 C1 NA <br /> sensor Secondary containment testing for, <br /> 171 positive shutdown Model: 'jDC(s) „T Pipinq <br /> ❑ fail:safe Serial#:—.-------.____ —�_� Sump(s) _ ._._UST(s) <br /> O NA — <br /> sensor -resting for the above components are next due by: <br /> ❑ El positive shutdown Model: -�r_ -- - ------'' <br /> r0 fall :safe Serial#: Nuts. f'leaee ae aware tt,at 2^cvytomiem oowv"nt%we�&Wjfeo to ha tauted�Por <br /> NA �— .. �etaaetion,5—*,s after-and awy 35 MaMha I &FOaftiv <br /> Drop tube with mechanical overfill at 95% Cold start of monitoring panel _- <br /> _�Drop tube with mechanical overfill at 95% [ Corrosion-protection --J- �- <br /> Overfill prevention (see LO letter 150-1) CU Other; see below <br /> •^fit 4-- i"\ _..-,✓ ''— --�-- <br /> "CKmFACt1.lTY IS SUBJECT TO REINSPECTIO AT ANY TIME�AT EHD'S CURRENT HOURI..Y RATE.7 y- <br /> t.1,1� .....— <br /> uSTSeKVICErerautti'rws;r c. <br />