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SAN JOAQUIN COUNTY <br />4 4.01 <br />LNVIRONMENTAL HEALTH DEPARTMENT 0 <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgoy.org/eh <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: Inspection Date: <br />f,,A �j 1I j 7-009 <br />Facility Address: / Service Request #:q0 5+ockf-o� S Service/Request 5 <br />Onsite Service Technician's Name: ICC Service Technician/Installer Certification #: Manufacturer Training: <br />2 <br />s 0- C 015 -b L <br />Fr /A L .0 1"PA <br />Leak detector <br />■ r-1 mechanical Model: <br />■ electronic Serial #: <br />0 linetestprogrammed <br />Leak detector <br />■ <br />El mechanical Model: <br />0 electronic Serial #: <br />D line test programmed <br />Leak detecto■ r <br />0 mechanical Model: <br />E] electronic Serial #: <br />El line test programmed <br />sensor <br />0 positive shutdown Model: <br />El fail safe Serial #: <br />0 NA -- <br />sensor <br />■ <br />El positive shutdown Model: <br />11 fail safe Serial #: <br />DNA <br />sensor <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />0 NA <br />dj�ILSOI)Top tube with mechanical overfill at 95% <br />El I Overfill prevention (see LG letter 150-1) <br />1331"Mo <br />EvAnizzmaw 'WER-1 M, U.� <br />THIS FACILITY IS SUBACT TO REINSPEC VAE ATI':HD'S CURRENT HOURLY RATiii <br />E. <br />EHD hi <br />EHD 23-04 <br />Rev 06/22/07 <br />Spill bucket 0 minimum 5 gallon <br />2 <br />g3-1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />❑ <br />0 1 hour hydrostatic 0 Incon TS -STS <br />El Caldwell System El Other <br />Spill bucket 1:1 minimum 5 gallon <br />El <br />0 1 hour hydrostatic [I Incon TS -STS <br />n Caldwell System n Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment repairs for: <br />❑ <br />UDC(s) Piping <br />Sump(s) UST(s) <br />0 <br />Cold start of monitoring panel <br />0 <br />Corrosion protection <br />0 <br />Other: see below <br />1331"Mo <br />EvAnizzmaw 'WER-1 M, U.� <br />THIS FACILITY IS SUBACT TO REINSPEC VAE ATI':HD'S CURRENT HOURLY RATiii <br />E. <br />EHD hi <br />EHD 23-04 <br />Rev 06/22/07 <br />