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.�. .r..�.. s �. y.. i. -z:-...... „-....._..-... ...-.- .,.... .....,,.., r. ...: -.. . -. ,... r .r. raw• �"••^" A . P4UIM� .1 SAN JOAQUIN COUNTY - ALTH-EPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209 468-3433 Web: UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Inspection Date: TIAO i -C)g -c�OX4 Service Request Y: - fi-F}P/-i'If' •711iCr"; �77�Z�t�TIYZT — —_ _ _ _. _ _— -- _ __.. ___ SERVICE I oii IN a(ar: a rouart' �e I1lCu i �0/. 5NS/eW . C4!P . Aceordr. 40 ie rR Olt $i l� _ Leak detector —�vlodet- 7%ie 46Q"t..,;Oi f.1l lied 4o 6ueAef lb erred v¢rt eCr 5- a&ok- c,a4paei CLc�� aoGrdu�� a -h¢r✓� ��ydrosl �' -94neeharitcat ❑ electronic Serial #: ' ' V ❑ line test programmed EHD Inspe f: Vena— Iia --a a 4 — - V Leak detector ❑ _ mechanical Model: C,❑ ❑ electronic Serial #: ❑ line test pro2rammed ❑ sensor ❑ positive shutdown Model: ❑ ❑ fall safe Serial #: ❑ NA sensor .❑,^- ❑ positive shutdown Model: ❑ ❑ fail safe Serial #: ❑ NA 1 I ❑ sensor ❑ ❑ positive shutdown Model: ❑ ❑ fail safe Serial #: ❑ NA ❑ _ Drop tube with mechanical overfill at 959/6 ❑ _ Drop tube with mechanical overfill at 95% ❑ I Overfill prevention (see LG letter 150-1) ❑ This UST facility is APPROVED to operate SERVICE I oii IN a(ar: a rouart' �e I1lCu i �0/. 5NS/eW . C4!P . Aceordr. 40 ie rR Olt $i l� mum ga on 7%ie 46Q"t..,;Oi f.1l lied 4o 6ueAef lb erred v¢rt eCr 5- a&ok- c,a4paei CLc�� aoGrdu�� a -h¢r✓� ��ydrosl �' 1 hour hydrostatic ❑ Incon TS -STS ' V ❑ Caldwell System ❑ Other EHD Inspe f: Vena— Iia --a a 4 — - V _ Spill bucket ❑ minimum 5 gallon , ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Primary piping testing at: ❑ _ psi minutes Secondary containment testing for: UDC(s) Piping Sump(s) UST(s) .❑,^- 1% , Testing'for'the 66ove components are `ext due by: Nola: PHase W Mclellalian. 8mn1h. eft., aPE C...ery 36e mocon. M..a Xeerre requred to Ee lestetl upon ❑ Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below ❑ This UST facility is NOT APPROVED to operate ousik -ID v8-"vevb5bjt euedl.e.f 0a0.4&0- rWedcd curca Cr— I oii IN a(ar: a rouart' �e I1lCu i �0/. 5NS/eW . C4!P . Aceordr. 40 ie rR Olt $i l� lie clraia at vg. aotxl corp were r laevd vaA4.d Jill a r W0 h-1 n e-d- 7%ie 46Q"t..,;Oi f.1l lied 4o 6ueAef lb erred v¢rt eCr 5- a&ok- c,a4paei CLc�� aoGrdu�� a -h¢r✓� ��ydrosl �' ' V THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. EHD Inspe f: Vena— Iia --a a 4 — - V ReceiveA By: — — --- — -- Title: AA -ID 23-04 R 4130112 UST SERVICE REQUEST INSPECTION REPORT