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10 <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.sjgov.orw <br /> UNDERGROUND STORAGE TANK ESTJ PROGRAM SERVICE RE UEST INSPECTION REPORT <br /> f Facility Name: Inspection Date: <br /> LZ P__S Z I C/ /zoos <br /> Facility Address: Service Request#: <br /> Onsite Service Technician's Na e: C echniciaNlpstaller Certification#: Manufacturer Training: <br /> l /2e0 /®//a`i <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test proganimed <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket ❑ minimum 5 gallon <br /> ❑ ❑ electronic Serial : ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test ro ammed ❑ Caldwell System ❑ Other <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ® ❑ electronic Serial#: ❑ ❑ 1 hour hydrostatic El Incon TS-STS <br /> ❑ ro ammed ❑ Caldwell System ❑ Other <br /> line test <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial#: <br /> minutes <br /> ❑ NA <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: si 5 /2;S <br /> ❑ fail safe Serial#: p <br /> ❑ NA minutes i cf <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: UDC(s) Pi <br /> ❑ fail safe Serial#: ( ) pin g <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(see LG letter 150-1) ❑ Other: see below <br /> tz;53 PkLe <br /> tlCCLP <br /> e <br /> .S i <br /> THIS FACILITY IS OBJECT TO REINSPE ON AT ANY TIM IS CURRENT HOURLY E. <br /> EHD Ins Title: <br /> EHD 23-04 <br /> Rpv nA1'7?107 <br />