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SAN JOAQUIN COUNTY <br /> VENVIRONMENTAL HEALTH DEPARTMENTIS <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 rax:(209)468-3433 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> r-)VT1061 G45 1 LAUW 31--66 /07 <br /> FacTaity Address: F Service l4quesV#: <br /> Onsite Service Technician's Na e: ICC Service Technician/Installer Certification#: Manufacturer Training: <br /> I rqm� W- � <br /> VIWVKQ c <br /> SERVICE SERVICE <br /> -L� <br /> L Leak detector <br /> mechanical Model: Spill bucket D minimum 5 gallon <br /> Vw(j tjo %0) <br /> electronic Serial#: El F-1 I hour hydrostatic F-1 Incon TS-STS <br /> 0 line test prorammed El Caldwell System 0 Other <br /> Leak detector — Spill bucket El minimum 5 gallon <br /> * El mechanical Model: El El I hour hydrostatic El Incon TS-STS <br /> El electronic Serial #: 0 Caldwell System El Other <br /> 0 line test programmed <br /> I Leak detector Spill bucket 0 minimum 5 gallon <br /> * F� mechanical Model: 0 El 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial #: 0 Caldwell System 0 Other <br /> 0 line test programmed <br /> sensor positive shutdown Model: Primary piping testing at: <br /> F-1 El F-1 psi <br /> El fail safe Serial#: minutes <br /> El NA <br /> sensor Secondary piping testing at: <br /> 0 0 positive shutdown Model: El psi <br /> El fail safe Serial #: minutes <br /> El NA <br /> sensor Secondary containment repairs for: <br /> 0 positive shutdown Model: <br /> 0 El UDC(s) Piping <br /> El fail safe Serial#: <br /> 0 NA Sump(s) UST(s) <br /> D Drop tube with mechanical overfill at 95% 0 Cold start of monitoring panel <br /> 0 Drop tube with mechanical overfill at 95% 0 Corrosion protection <br /> 0 Overfill prevention(see LG letter 150-1) El Other: see below <br /> Ila JAIAV ,IAqj MAN I/Vill 6 AI(InU W AD txyldl�l <br /> IP&M,i'do rk,.� (Litm p <br /> THIS FACILITY IS SUBJECT TO REINSPECTIONT"YkMFWVHD,S CURRENT HOURLY RATE. <br /> EH Inspector: Received Title: <br /> EHD 23-04 <br /> 1/3/07 <br />