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-blk <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.sigov.org/eh <br />UNND STORAGE TANK UST) PROGRAM SERVICE R QUEST INSPECTION REPORT <br />Facility N e: Inspection Date: <br />70� <br />Facility Address: <br />L9 <br />Onsite Service Technician's Name: ICC §SsrrAcaejTeRhBkw <br />I ALP, <br />SERVICE <br />Service equest #: <br />r Certification Manufacturer Training: <br />2-/3 Y - <br />Spill bucket 0 minimum 5 gallon <br />❑ R I hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />- Spill bucket 0 minimum 5 gallon <br />❑ 0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System El Other <br />Spill bucket R minimum 5 gallon <br />El 0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at: <br />❑ psi <br />minutes <br />Secondary piping testing at: <br />❑ psi <br />minutes <br />Secondary containment repairs for: <br />❑ UDC(s) Piping <br />Sump(s) UST(s) <br />Cold start of monitoring panel <br />0 Corrosion protection <br />0 Other: see below <br />EHD 23-04 <br />0— nal)Oin'7 <br />I <br />Leak detector <br />El <br />El mechanical Model: <br />0 electronic Serial #: <br />0 line test programmed <br />Leak detector <br />El <br />0 mechanical Model: <br />0 electronic Serial #: <br />El line test proEammed <br />. Leak detector <br />El <br />0 mechanical Model: <br />0 electronic Serial #: <br />'El line test programmed <br />sensor <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />El NA <br />sensor <br />❑ <br />El positive shutdown Model: <br />0 fail safe Serial #: <br />DNA <br />sensor <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />0 NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />F1 <br />Drop tube with mechanical overfill at 95% <br />0 <br />Overfill prevention (see LG letter 150-1) <br />Service equest #: <br />r Certification Manufacturer Training: <br />2-/3 Y - <br />Spill bucket 0 minimum 5 gallon <br />❑ R I hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />- Spill bucket 0 minimum 5 gallon <br />❑ 0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System El Other <br />Spill bucket R minimum 5 gallon <br />El 0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at: <br />❑ psi <br />minutes <br />Secondary piping testing at: <br />❑ psi <br />minutes <br />Secondary containment repairs for: <br />❑ UDC(s) Piping <br />Sump(s) UST(s) <br />Cold start of monitoring panel <br />0 Corrosion protection <br />0 Other: see below <br />EHD 23-04 <br />0— nal)Oin'7 <br />I <br />