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r F '••Q SAN JOAQUIN COUNTY i ENVIRONMENTAL HEALTH DEPARTMENT 0� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone. (209) 468-3420 Fax: (209) 468-3433 Web: www, siUoy. orQ/ehd UNDERGROUND STORAGE TANK ( UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility Name: Inspection Date: LOOLZ Rip I — 3 QD19 Facility Address: t3 V Service Request #: �l 301E;s 0QW00C01P\ { vc some ooh- g Onsite Service Technician's Name: I ICC Service TechniclanNnstalier xp, Date: Manufacturer Training: L4 " t 0% 1 V — t 10 ^ - 1q SERVICE SERVICE Leak detector Spill bucket ❑ minimum • 5 gallon ❑ ❑ mechanical Model: ❑ O 1 hour hydrostatic 0 incon TS-STS Cl electronic Serial M 0 Caldwell System ❑ Other O line test programmed Leak detector Spill bucket ❑ minimum 5 gallon ❑ D mechanical Model: ❑ O 1 hour hydrostatic O incon TS-STS D electronic Serial #: ❑ Caldwell System 0 Other O line test programmed sensor Primary piping testing at: 13 positive shutdown Modelo ❑ psi O fail safe Serial #: O NA minutes sensor Secondary containment testing for: ❑ O positive shutdown Model: UDC(s) Piping 0 fail safe Serial #: Sump(s) UST(s) ❑ NA sensor ❑ Testing for the above components are next due by: ❑ 0 positive shutdown Model: 0 fail safe Serial M Nole: Please Be aware that 2" containment components are required to be tested upon ❑ NA InstalieUoa, 8 months atter, and every 38 months thereafter. ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection Overfill prevention (see LG letter 150-1 ) ❑ Other: see below ❑ This UST facility Is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate 1 ^ _ _ 1 I F.t) r `5 tiNewt 60 �0 v w ,, te It ` cL 4e o Q � r aP,t.�,d THIS F ILITY IS SUBJttT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE, LHD Inspector. Received By: Title: Gt. EHD 2344 �On 1 � o 1 ^ UST SERVICE REQUEST INSPECTION RQPORT 2ev 4130112 l Gam.