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0 SAN JOAQUIN COUNTY ov <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�eh <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE R QUEST INSPECTION REPORT, <br /> Facility N Inspection Date: <br /> rh� M F141— - i I - 0 1151 <br /> Facility A&dress: PAM Service Request#:A-17 <br /> 10 <br /> On Service Tichnicin's Name: [CC Service Technician/installer CertifiLcation Z a7nfac Urr <br /> r Training: <br /> (ada ILL UT <br /> SERVICE SERVICE <br /> Leak detector Spill bucket El minimum 5 gallon <br /> �0 mechanical Model: El El I hour hydrostatic El Incon TS-STS <br /> electronic Serial <br /> 0 line test programmed El Caldwell System 0 Other <br /> Leak detector Spill bucket El minimum 5 gallon <br /> D El mechanical Model: 0 0 1 hour hydrostatic D Incon TS-STS <br /> El electronic Serial#: 0 Caldwell System F-1 Other <br /> 0 line test prolEarnmed <br /> Leak detector —Spill bucket 0 minimum 5 gallon <br /> 0 ❑ mechanical Model: ❑ 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial ❑ Caldwell System E] Other <br /> El line test programmed <br /> sensor Primary piping testing at: <br /> 0 F-1 positive shutdown Model: psi <br /> 0 fail safe Serial#: minutes <br /> El NA <br /> sensor Secondary piping testing at: <br /> El 0 positive shutdown Model: ❑ psi <br /> F� fail safe Serial #: minutes <br /> —1-0 NA <br /> sensor Secondary containment repairs for: <br /> 0 positive shutdown Model: ❑ UDC(s) Piping <br /> El fail safe Serial#: Sump(s) UST(s) <br /> DNA <br /> ❑ Drop tube with mechanical overfill at 95% R Cold start of monitoring panel <br /> El Drop tube with mechanical overfill at 95% 0 Corrosion protection <br /> El Overfill prevention(see LG letter 150-1) F1 Other: see below <br /> or <br /> THIS FACILIP IS SUBJECT TO REINSPECTION A Y TIME WH 'S CURRENT HOURLY RATE. <br /> jzD Insp or: et ed By: Title: <br /> A i <br /> L/23-04 <br /> 06/22/07 <br />