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Jul 29 10 01:07p Elite IV Contactors 12094616342 p.2 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone. (209) 468-3420 Fax. (209) 468-3433 Web: www.si>;ov-org?ehd <br />UNDERGROUND STORAGE TANK ST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: •Inspection Date: <br />—7 <br />Facility Address: Service Request <br />�1 160A/ <br />Onsite Service Technician's ame: [CC Service Technician/Installer Certification ft7Facturep.Trainipg: <br />6V <br />1 <br />ram 2 <br />SERVICE <br />ERVICE <br />Leak detector <br />❑ <br />0 mechanical Model: <br />low C <br />. - a d A" <br />0 electronic Serial #: <br />4,. 4 <br />N1.1 <br />0 line test proEammed <br />0 <br />Leak detector <br />0 mechanical Model: <br />C vy- I D -2 <br />vv J It) ?a <br />0 electronic Serial <br />0 <br />0 line test 2rogrammed <br />THIS FACILITY IS. SUBJECT TO REINSPIECTION AT ANYTIME AT EHD'S CURRENT HOORL* RATE. <br />. Leak detector <br />F1 <br />0 mechanical Model: <br />D <br />0 electronic Serial #:. <br />0 line test 2ro=ed <br />sensor <br />❑ <br />0 positive shutdown Model: <br />EHO 23-04 <br />El fail safe Serial <br />ONA . <br />❑ <br />sensor <br />❑ <br />0 positive shutdown Model: <br />0❑fail safe Serial <br />F] <br />0 NA <br />L 0 <br />sensor <br />El <br />0 positive shutdown Model: <br />* I safe 0 fai e Serial rr <br />0 NA <br />0 <br />Drop tube with mechanical overfill at 95% <br />tube with mechanical overfill at 95% <br />,ISEDrop <br />Overfill prevention (see LG letter 150-1) <br />Spill bucket 0 minimum 5 gallon <br />❑ <br />0 1 hour hydrostatic 0 Incon TS -STS <br />low C <br />. - a d A" <br />0 Caldwell System El Other <br />4,. 4 <br />N1.1 <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />C vy- I D -2 <br />vv J It) ?a <br />Spill bucket El minimum 5 gallon <br />0 <br />0 1 hour hydrostatic C1 Incon TS -STS <br />THIS FACILITY IS. SUBJECT TO REINSPIECTION AT ANYTIME AT EHD'S CURRENT HOORL* RATE. <br />El Caldwell System F1 Other <br />Primary piping testing at: <br />D <br />psi <br />minutes <br />Secondary piping testing at: <br />❑ <br />psi <br />EHO 23-04 <br />minutes <br />Secondary containment repairs for:. <br />❑ <br />UDC(s) Piping <br />Sump(s) UST(s) <br />Cold start of monitoring panel <br />F] <br />Corrosion protection <br />L 0 <br />Other: see below * , , .4- - k <br />"1-4. - <br />low C <br />. - a d A" <br />V9 r9,� <br />4,. 4 <br />N1.1 <br />-07- <br />''1. <br />C vy- I D -2 <br />vv J It) ?a <br />•0 t-,� <br />O'n o%�l <br />4- 441.,": 7�-C- <br />THIS FACILITY IS. SUBJECT TO REINSPIECTION AT ANYTIME AT EHD'S CURRENT HOORL* RATE. <br />=EHD lasppa-I <br />Title- <br />EHO 23-04 <br />k-" <br />