Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN"f <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.sjg_ov,org/e_hd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> --� - E -1-e L4 Az/6 C11 <br /> Facility Address: Service Request#: <br /> ZS Cove- C1Le) 'AzL(, Sr20US DCS <br /> Onsite Service Technician's Name: [CC Service Technieian/l staller Certification#: Manufacturer Training: <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ <br /> 7-1 electronic Serial #: ❑ El hour hydrostatic El Incon TS-STS <br /> ❑ line test ro rammed El Caldwell System ❑ Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket El minimum 5 gallon <br /> ❑ <br /> El mechanical Model: El El hour hydrostatic L1 Incon TS-STS <br /> El electronic Serial #: ❑ Caldwell System ❑ Other <br /> El line test programmed <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> El fail safe Serial #: <br /> ❑ NA minutes <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial #: <br /> F1 NA minutes <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 /> A V uy\- r v-,l'( &took G � <br /> 1 brM ,l Oro <br /> �-�► jaLren i 2 t-A <br /> 121 elle— <br /> THIS FACILITY IS SUBJECT TO REINSPE TION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> E nspectur: Received By: Title: T <br /> LIP) <br /> S 1�cttu Cjr 1��ti} <br /> EHD 23-04 <br /> Rev 06/22/07 <br />