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o�qutN c <br /> ?•'�t''•o� SAN JOAQUIN COUNTY <br /> ^ter ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Y. Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.siaov.orcl/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> AT&T UE042 Thursday, April 19, 2012 <br /> Facility Address: Service Request#: <br /> 345 N. San Joaquin, Stockton TBA <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Tim Minard 15292650 12/9/2013 VR B36222 12/11/2013 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> 87 FILL sensor <br /> ❑ positive shutdown Model: VR 794380-208 Primary piping testing at: <br /> Q ❑ psi <br /> ❑fail safe Serial #: 917920 minutes <br /> ❑ NA <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: Please be aware that 21 containment components are required to be tested upon <br /> ❑ NA installation,6 months after,and every 36 months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% kElOother: <br /> start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% osion protection <br /> ❑ Overfill prevention (see LG letter 150-1) see below <br /> ❑X This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> The referenced sensor was replaced under emergency repair. Observed installation and functionality <br /> verification test on the new sensor. Passed. Sumbit three copies of the permit application and the <br /> appropriate fee to the EHD for this work within one business day. <br /> HI ILITY IS §Uq4Ee1rTO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EH In ec r• a ive Title: <br /> e03-0V UST SERVICE REQUEST INSPECTION REPORT <br /> 06/10 <br />