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LU/U1/LUU9 THU 1b: 1S rklA LU94b2fS433 ********************* *** FAX TX REPORT *** ********************* TRANSMISSION OK Z)OU znu JOB NO. 2922 DESTINATION ADDRESS 919163731172 PSWD/SUBADDRESS ❑ electronic Serial #: DESTINATION ID ❑ line test programmed ST. TIME 10/01 16:12 USAGE T 01,05 PGS. 1 RESULT OK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT y' 600 East Main Street, Stockton, CA 95202-3029 ` Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.s6gov.org/ehd ehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERMICE REQUEST INSPECTION REPORT SERVICE Leak detector ® ❑ mechanical Model: ❑ electronic Serial #: ❑ ❑ line test programmed Leak detector ❑ ❑ mechanical Model: ❑ ❑ electronic Serial #: ❑ line test programmed Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ line test programmed sensor ❑ ❑ positive shutdown Model: ❑ ❑ fail safe Serial #: ❑ NA ❑ sensor ❑ ❑ positive shutdown Model: ❑ ❑ fail safe Serial #: ❑ NA sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: ❑ NA ❑ Drop tube with mechanical overfill at 95% ❑ Drop tube with mechanical overfill at 95% ❑ Overfill prevention (see LG letter 150-1) SERVICE Spill bucket ❑ minimum 5 gallon ❑ 1 hour hydrostatic ❑ Incon TS -STS Caldwell System ❑ Other Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other 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) ❑ Testing for the above components are next due by: Note: Please be aware that 2° containment components are required to be tested upon installation. 6 months after. and every 36 months thereafter. ❑ Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below 1