Laserfiche WebLink
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:ANrW sjgov_or�d <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> kkL Y N CC S/l-�/o <br /> Facility Address: Service Request#: <br /> I G (& G w Ati1 S 1ZLIG 5 3 I-7 Z <br /> Onsite Service Technician's Name: ICC Service Technician/[nstaller Certification#: Manufacturer Training: <br /> ,l3 k,6 S Z &-5 7 - c,(I * A Z 1469 <br /> SERVICE SERVICE <br /> 7LPT Leak detector <br /> 1:1 mechanical Model: g$0 Spill bucket El minimum 5 gallon <br /> El electronic Serial #: El ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ Caldwell System El Other <br /> ❑ line test programmed <br /> Leak detector <br /> El mechanical Model: Spill bucket El minimum 5 gallon <br /> F-1 ❑ electronic Serial #: El El hour hydrostatic ❑ Incon TS-ST <br /> ❑ line test programmed El Caldwell System El Other <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon-- <br /> • ❑ electronic Serial #: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> El fail safe Serial #: <br /> minutes <br /> 11 NA <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> El fail safe Serial #: <br /> minutes <br /> El NA <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: ❑ UDC(s) Piping <br /> ❑ fail safe Serial #: Sump(s) UST(s) <br /> ❑ NA <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention (see LG letter 150-1) ❑ Other: see below <br /> TGw� .w ad G 6P7 <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EH 'S CURRENT HOURLY RATE. <br /> EHD Inspector: R rved By: Title: <br /> M - AsC'� r� <br /> EHD 23-04 <br /> Rev 06/22/07 <br />