Laserfiche WebLink
EHi <br />Rei <br />SAN JOAQUIN COUNTY <br />ONVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202.3029 <br />Telephone: (209) 468-3420 Far: (209) 468_3433 Web: www.sjov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQST INSPECTI <br />Facility Namc: UE•N REPORT <br />Inspection Date: <br />Facility Address: <br />Onsite Service Technician's Name: <br />L LA -4p <br />SERVICE <br />ICC Service ,t. ie, Certificatit�n #: <br />/M4_;�mcz-c- --7— <br />Leak detector <br />❑ ❑ mechanical Model: <br />❑ electronic Serial #: ❑ <br />❑ line test programmed <br />Leak detector <br />❑ 11 mechanical Model: <br />❑ electronic Serial #: ❑ <br />line test programmed <br />Leak detector <br />❑ lJ mechanical Model: <br />❑ electronicSerial #: E] <br />❑ line test nrnPramrnPw? <br />__�� sensor <br />❑ ❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />sensor <br />❑ ❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />sensor <br />❑ ❑ positive shutdown Model.- <br />El <br />odel:❑ fail safe Serial # <br />❑ NA <br />JERI Drop tube with mechanical overfill at 95% <br />Drop tube with mechanical overfill at 95% <br />erfill prevention (see LG letter 150-1) <br />Service Request #: <br />S12� C) <br />Manufacturer Training: <br />SERVICE <br />Spill bucket <br />❑ I hour hydrostatic <br />❑ Caldwell System <br />Spill bucket <br />❑ 1 hour hydrostatic <br />© CaIdwell System <br />Spill bucket <br />❑ 1 hour hydrostatic <br />❑ Caldwell System <br />❑ minimum 5 gallon <br />❑ Incon TS -STS <br />❑ Other <br />❑ minimum 5 gallon <br />❑ Incon TS -STS <br />❑ Other <br />❑ minimum 5 gallon <br />❑ Incon TS -STS <br />❑ Other <br />Primary piping testing at: <br />5-0_ psi (04, "lie — *PsS <br />minutes <br />Secondary piping testing at: <br />❑ psi <br />minutes <br />Secondary containment repairs for: <br />® UDC(s) <br />Piping <br />Sump(s) UST(s) <br />Cold start of monitoring panel <br />Corrosion protection <br />❑ Other: see below <br />