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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME . <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:mm.sj og v.or <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> F •3;6N <br /> Inspection Date: <br /> s- - -C& " -S-30 - <br /> Facility Address. Service Request#: <br /> 1132 � F 9PI— 0011.1 ' <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Certification#: Manufacturer Training: <br /> SERVICE SERVICE <br /> $ Leak detector <br /> Spill bucket El minimum 5 gallon <br /> Pa mechanical Model: O&P ML Q SU 1— ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector <br /> El mechanical Model: Spill bucket El minimum 5 gallon <br /> ❑ ❑ electronic Serial ❑ El hour hydrostatic El Incon TS-STS <br /> El line test programmed El Caldwell System ❑ Other <br /> Leak detector <br /> El mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ electronic Serial ElEl1 hour hydrostatic El Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> sensor <br /> F-1 El positive shutdown Model: El psi piping testing at: <br /> ❑ fail safe Serial #: p <br /> minutes <br /> El NA <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> El fail safe Serial #: <br /> minutes <br /> ❑ NA <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: ❑ UDC(s) Piping <br /> ❑ fail safe Serial #: Sump(s) UST(s) <br /> ❑ NA <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention (see LG letter 150-1) ❑ Other: see below <br /> OVA11r <br /> ,r ID <br /> psi 4gg- <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: Receiveo,13 Title: <br /> EHD 23-04 <br /> Rev 06/22/07 <br />