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SMI 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;wwww.sigov.ora/chd <br /> dRGROVND.ST )RAGE TANK ST PROGRAM SERVICEUEST INSPECTION REPORT <br /> aty Nome: Inspection Date: <br /> Facility Address: Service Request N: <br /> 15,37.' roc d vioLy <br /> Onsite Service TecitNiclimpt Nelms: ICC Service Teehuicisn/BnstaBler Certification#E Manufacturer Trainl <br /> U1� vM �rS <br /> T (1AS+,J1) <br /> SER'V'ICE SERVICE <br /> Leak detector <br /> mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> .- ❑ El hour hydrostatic ❑ Incon TS-STS <br /> electronic Serial #: r <br /> ❑ line test ro ammed ❑ Caldwell System ❑ Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ <br /> 13 mechanical Model; .' ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ® electronic Serial#: 11 Caldwell System 11 Other <br /> Q line test 'to ammed ys <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ electronic Serial #: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test Ograrhrried ❑ Caldwell System ❑ Other <br /> sensor <br /> El positive shutdown Model: Primary piping testing at: <br /> ❑ ❑ fail safe Serial#: ® psi <br /> ❑ NA minutes <br /> sensor <br /> ® positive shutdown Model: Secondary piping testing at: <br /> ® ❑ fail safe Serial #; ® psi <br /> ❑ NA minutes <br /> sensor <br /> ❑ positive shutdown Model: Secondary containment repairs for: <br /> ® ❑ fail safe Serial #: ❑ -�UDC(s) Piping <br /> ❑ NA Sump(s) UST(s) <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention (sec LG letter 150-1) CJ Other: see below <br /> CL 64 z <br /> 1077. t- ®R <br /> THIS FACILITY IS SU13JECT TO REINSPECTION AT TtMe AT EHOIS CURRENT HOURLY RATE. <br /> EHD inspect®; Received lay—'.— Titic; <br /> -1023-04 <br />