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TRANSMISSION VERIFICATION REPORT11' <br /> TIME 09/03/2014 09:04 <br /> NAME SJC EHD UNIT 3 <br /> FAX 2094683433 <br /> SER.# BROM7F534354 <br /> DATEJIME 09/03 09:02 <br /> FAX NO./NAME 919728281125 <br /> DURATION 00:01:05 <br /> PAGE(S) 02 <br /> RESULT OK <br /> MODE STANDARD <br /> ECM <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton,CA 95205-6232 <br /> Telephone.,(209)468-3420 FAX;(209)468-3433 Web:www.sigov.orglehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: inspection Date: <br /> —I cl-� 'C-A019 <br /> Facility Address- Service Request#, <br /> Mxbq vv. +fwrner L".4, 6�W�� S��NQO--tQOtA <br /> Onsite Service Technician's Name: ICC Service Tachniclanlinstallar Exp.Data: Manufacturer Training: <br /> 110 Will <br /> Idou k3 a2cl-I <br /> SERVICE SERVICE <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> El 0 mechanical Model: 1710 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial 0 Caldwell System 0 Other <br /> 0 line test programmed <br /> - Leak detector Spill bucket 0 minimum 5 gallon <br /> El : <br /> mechanical Model: El r-1 1 hour" hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial 0 Caldwell System 0 Other <br /> El line test programmed <br /> sensor 0 positive shutdown Model: Primary piping testing at: <br /> El ❑ <br /> psi <br /> *fall safe Serial <br /> * NA minutes <br /> sensor $econdary containment testing for: <br /> ❑ 0 positive shutdown Model; UDC(s) Piping <br /> 0 fall safe * Serial#: Sump(s) UST(s) <br /> t3 NA ❑ <br /> sensor Testing for the above components are next due by: <br /> 0 positive shutdown Model: <br /> 0 fall safe Serial Note! Pleskse be aware riM 2*corfthmerd omporwft are reqWred to be tesW upon <br /> 11 NA Insdalaflon,a moms after,and amry as months thereaftmr. <br /> Drop tube with mechanical overfill at 06% Cold start of monitoring panel,CtAJ <br /> IL <br /> El Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> El Overfill prevention (see LG letter 150-1) ❑ Other:see below <br />