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TRANSMISSION VERIFICATION REPORT <br /> TIME : 11/03/2014 13:46 <br /> NAME : SJC EHD UNIT 3 <br /> FAX : 2094683433 <br /> SER.* BROM7F534354 <br /> DATE,TIME 11/03 13:46 <br /> FAX N0./NAME 919728281125 <br /> DURATION 00:00:00 <br /> PAGE(S) 00 <br /> RESULT BUSY <br /> MODE STANDARD <br /> BUSY: BUSY/NO RESPONSE <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> +:• . 1868 East Hazelton Avenue, Stockton, DA 95205-6232 <br /> '•. Toleph one4{2Qg)4G8-3420 Fax, (2t}9)46$-3#33 Web:T, . iaov.oi•c5lehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility <br /> Name: Inspection date: <br /> Facility Address: Service Request#: <br /> W. <br /> Onsite Service Technician's Name: t ervi�e TechniciaMnsttalle$Exp.Cate: Manufacturer Traini g: <br /> r rro V P'. 9 - 9- 1-10 <br /> SERVICE SERVICE, <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Madel: - -- C3 C31 hour hydrostatic C3 Incon TS-STS <br /> ❑ electronic Serial#: <br /> ❑ Pine test programmed ❑Caldwell System ❑C3ther <br /> Leak detector <br /> ❑ mechanical Model; Spill bucket ❑minimum 5 gallon <br /> ❑ ❑electronic Serial#: El 1 hour, hydrostatic ❑ Incon TS-STS <br /> ❑line test programmed Q Caldwell System ❑Other <br /> sensor 0.1 �. ! Primary piping testing at. <br /> positive shutdown Model: ❑ psi <br /> ❑fall safe Serial#: minutes <br /> r A (A l 0. <br /> sensor Secondary containment testing for; <br /> ❑ ❑positive shutdown Model: UDC(s) Piping <br /> ❑fail safe Serial#: Sump(s) UST(s) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by- <br /> ❑ ❑ positive shutdown Model: <br /> ❑fail safe Serial#; Note: Phase be awsre M 2'coft*m9m components are requirso to be tested upon <br /> ❑ NA instalk tom+,6 months akar,and every 36 montes thereafter. <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 LC letter 1SO-1) ❑ Other: see below . <br />