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.www.sjgoy.org/chd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Aa e: <br /> I — 6� ke UV\ <br /> Facility Address: Service Request#: <br /> 2-� 7� Gv��J � � Loi . � u� i !�E 01-)t Ul 0 U <br /> Onsite Service Technician's Name: ICC Service Technician/installer Certification#: Manufafccttur�er Training: <br /> )9 <br /> SERVICE SERVICE <br /> Leak detector l Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: '� ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System kother <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> El electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> El electronic Serial #: ❑ Caldwell System ❑ Other <br /> line test programmed <br /> sensor primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial #: minutes <br /> ❑ NA <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial #: minutes <br /> ❑ 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% ❑ 1 Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% N11Corrosion protection <br /> ❑ Overfill prevention (see LG letter 150-1) ❑ Other: see below <br /> VWN r� e-t. L ft Nev j <br /> o�, n� . 1 � l U� 0/1 �r <br /> �b 6 �d �rr Ilt <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME HD'S CURRENT HOURLY RATE. <br /> EHD In ector: 116c ed By: Title: <br /> ti <br /> EHD 23-04 <br /> Rev 06122107 <br />