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Ul <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />X <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />SERVICE <br />Leak detector <br />El El mechanical Model: <br />El electronic Serial #: <br />El line test programmed <br />Spill bucket El minimum 5 gallon <br />Leak detector <br />El <br />0 mechanical Model: <br />0 Caldwell System 0 Other <br />El electronic Serial #: <br />Spill bucket 0 minimum 5 gallon <br />0 line test programmed <br />0 1 hour hydrostatic 0 Incon TS -STS <br />Leak detector <br />El <br />0 mechanical Model: <br />Primary piping testing at: <br />El electronic Serial #: <br />psi <br />0 line test programmed <br />minutes <br />sensor <br />El <br />[I positive shutdown Model: <br />UDC(s) Piping <br />0 fail safe Serial #: <br />Sump(s) LIST(s) <br />0 NA <br />Testing for the above components are next due by: <br />sensor <br />El <br />0 positive shutdown Model: <br />installation, 6 months after, and every 36 months thereafter. <br />0 fail safe Serial #: <br />old start of monitoring panel <br />0 NA <br />protection <br />sensor <br />❑ <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />11 NA <br />Drop tube with mechanical overfill at 95% <br />[ER] <br />Drop tube with mechanical overfill at 95% <br />0 <br />0 <br />Overfill prevention (see LIS letter 150-1) <br />SERVICE <br />Spill bucket 0 minimum 5 gallon <br />El El 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket El minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at: <br />El <br />psi <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) LIST(s) <br />❑ <br />Testing for the above components are next due by: <br />Note: Please be aware that 2* containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />old start of monitoring panel <br />XCorrosion <br />protection <br />F-1 <br />Other: see below <br />EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 11/17//08 <br />L. min <br />. MA WX <br />ORMA OWN Erm'4- <br />41 <br />C13 <br />EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 11/17//08 <br />