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A. <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.sjgoy.org/ehd <br /> UNDERGROUND STORAGE TANK JUST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: I� Inspection Date: <br /> � --Q- 9'� <br /> Facility Address- Service Request#: <br /> Onsite Service Technician's Name: [CC Service Technician/installer Certification#: Manufacturer Trai in <br /> ® <br /> g <br /> VP ("eV#j <br /> SERVICE SERVICE <br /> Leak detector Spill bucket El minimum 5 gallon <br /> 0 0 mechanical Model: R El I hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial 0 Caldwell System 0 Other <br /> 0 line test pro.grammed <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> 0 0 mechanical Model: El El I hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial#: <br /> 0 line test roammed 0 Caldwell System El Other <br /> gr <br /> . Leak detector —Spill bucket 0 minimum 5 gallon <br /> 0 0 mechanical Model: 0 El I hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial <br /> 0 line test roed <br /> 0 Caldwell System 0 Other <br /> 2Eamm <br /> sensor Primary piping testing at: <br /> 0 El positive shutdown Model: ❑ psi <br /> F-1 fail safe Serial <br /> DNA minutes <br /> sensor Secondary piping testing at: <br /> 0 0 positive shutdown Model: F-1 psi <br /> 0 fail safe Serial #: minutes <br /> 0 NA <br /> sensor Secondary containment repairs for: <br /> 0 0 positive shutdown Model: El UDC(s) Piping <br /> 0 fail safe Serial#: Sump(s) UST(s) <br /> 1:1 NA <br /> F-1 Drop tube with mechanical overfill at 95% Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% El Corrosion protection <br /> 0 1 Overfill prevention(see LG letter 150-1) D 11 Other: see below <br /> ej I <br /> �/_o dl /j92- <br /> "LL Y_ MI-IS C-0 aSELL4 a2l <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHrspector: <br /> Received ByTitle: <br /> �7 <br /> EHD 23-04 <br /> Rev 06/22/07 <br />