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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTM <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax.- (209) 468-3433 Web: www.sjgov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: I Inspection Date: <br />0yftqPL,4 <br />,,LV <br />Facility Address: Service Request #: <br />q93 D 41 Api'lZ�A s900�; 30U <br />Onsite Service Technician's Name: (CC Service Technician/installer Certification #: Manufacturer Training: <br />Fgef�kf.,�— �VOe4RCO LA -96 **PC VMT t� 17.5 -S - <br />EHI) Inspector: <br />EHD 23-04 <br />Rev 06/22/07 <br />SERVICE <br />Leak detector <br />Spill bucket El minimum 5 gallon <br />EKmechanical Model: 2-61) <br />El I hour hydrostatic 0 Incon TS -STS <br />0 electronic Serial #: o? o S 2-!5 -o <br />0 Caldwell System El Other <br />0 line test programmed <br />Spill bucket El minimum 5 gallon <br />Leak detector <br />1� <br />El mechanical Model: <br />0 Caldwell System El Other <br />El electronic Serial <br />Spill bucket 0 minimum 5 gallon <br />El line test programmed <br />El I hour hydrostatic El Incon TS -STS <br />Leak detector <br />0 Caldwell System 0 Other <br />i El mechanical Model: <br />Primary piping testing at: <br />0 electronic Serial <br />psi <br />El line testTrogrammed. <br />minutes <br />sensor <br />■ <br />0 positive shutdown Model: <br />Psi <br />0 fail safe Serial #: <br />minutes <br />F-1 NA <br />Secondary containment repairs for: <br />• <br />UDC(s) Piping <br />Sump(s) UST(s) <br />■ <br />Cold start of monitoring panel <br />■ <br />Corrosion protection <br />sensor <br />■ <br />El positive shutdown Model: <br />0 fail safe Serial <br />0 NA <br />Drop tube with mechanical overfill at 95% <br />Drop tube with mechanical overfill at 95% <br />EHI) Inspector: <br />EHD 23-04 <br />Rev 06/22/07 <br />SERVICE <br />Spill bucket El minimum 5 gallon <br />0 <br />El I hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System El Other <br />Spill bucket El minimum 5 gallon <br />0 <br />El I hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System El Other <br />Spill bucket 0 minimum 5 gallon <br />0 <br />El I hour hydrostatic El Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at: <br />El <br />psi <br />minutes <br />Secondary piping testing at: <br />0 <br />Psi <br />minutes <br />Secondary containment repairs for: <br />0 <br />UDC(s) Piping <br />Sump(s) UST(s) <br />0 <br />Cold start of monitoring panel <br />0 <br />Corrosion protection <br />ED <br />Other: see below <br />