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06/28/2010 MON 10:59 FAX 2094683433 SJC EHD 0001 <br /> ..................... <br /> FAX TX REPORT <br /> TRANSMISSION OX <br /> JOB NO. 3485 <br /> DESTINATION ADDRESS 94661910 <br /> PSWD/SUBADDRESS <br /> DESTINATION ID <br /> ST. TIME 06/28 10:58 <br /> USAGE T 00' 27 <br /> PGS. 1 <br /> RESULT OK <br /> SAN JOAQUIN COUNTY <br /> r. 11��Tp— 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.sjgov.orn/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facil Name: Inspection <br /> Facility Ad-dress: Service Request#: <br /> I <br /> ew Loil <br /> Onsite Service Technician's Name: ICC Service hriiiian/Installer Exp.Date: Manufacturer Training: <br /> SERVICE SERVICE <br /> OLeak detector ❑ Spill bucket 0 minimum 5 gallon <br /> ffmechanical Model: 0 1 hour hydrostatic 0 Incon TS-STS <br /> electronic Serial#: 0 Caldwell System 0 Other <br /> 0 line test programmed <br /> Leak detector y Spill bucket 0 minimum 5 gallon <br /> ❑ 0 mechanical Model: A 0 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial#: 0 Caldwell System 0 Other <br /> 0 line test programmed I <br /> Leak detector _Spill bucket 0 minimum 5 gallon <br /> ❑ 0 mechanical Model: F1 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial#: 0 Caldwell System 0 Other <br /> 0 line test programmed <br /> sensor Primary piping testing at: <br /> El 0 positive shutdown Model: 0 psi <br /> 0 fail safe Serial#: minutes <br /> 0 NA <br /> sensor Secondary containment testing for: <br /> ❑ 0 positive shutdown Model: UDC(s) Piping <br /> 0 fail safe Serial#: Sump(s) LIST(s) <br /> 0 NA sensor El Testing for the above components are next due by: <br /> E] 0 positive shutdown Model: <br /> 0 fail safe Serial Note:Please be aware that 20 containment components are required to be tested upon <br /> El NA installation.6 months after,and every 36 months thereafter. <br /> E3 Drop tube with mechanical overfill at 95% El Cold start of monitoring panel <br /> 11 Drop tube with mechanical overfill at 95% 11 Corrosion protection <br /> 0 Overfill prevention(see LG letter 150-1) [1 Other: see below <br /> -A <br />