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)oAqulN ca <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEN <br />0 1 <br />{ 0 <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.orq/ehd <br />CQ�1 FOR�`P <br />Facility Name: <br />O Wrtm I r �'' I- <br />Inspection Date: <br />Z <br />i1 <br />❑ mechanical Model: <br />Facility Address: <br />0, 5D <br />BMW <br />Servicceee Request #: <br />act <br />o <br />J <br />Service Technician's Name: <br />rJoc,e_ <br />iii <br />ICC Service Technician/installer Exp. Date: <br />Manufacturer Training: <br />T.S <br />❑ line test programmed <br />Received B <br />01l-10­2_01 <br />s S! �-2, - l <br />SERVICE <br />O Wrtm I r �'' I- <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />BMW <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />iii <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />Received B <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />❑ <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />This UST facility is APPROVED to operate <br />SERVICE <br />O Wrtm I r �'' I- <br />Spill bucket ❑ minimum 5 gallon <br />W1 -hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />BMW <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />tl 1 + i� � � • 1 <br />❑ Caldwell System ❑ Other <br />iii <br />Primary piping testing at: <br />❑ <br />psi <br />Received B <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) UST(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 />❑ <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />❑ This UST facility is NOT APPROVED to operate <br />I V,IIIIIIIIIN In <br />O Wrtm I r �'' I- <br />BMW <br />% r <br />� c .� <br />tl 1 + i� � � • 1 <br />iii <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY <br />EHD Inspector: <br />Received B <br />,F <br />EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 4/30/12 <br />