Laserfiche WebLink
0 C, <br /> � <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.-(209) 468-3433 Web:www.s'(iov.orQ/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> ^',Lj& L- <br /> Facility Address: Service Request#: <br /> Onsite Ct4o <br /> Service Technician's Name: iCC Service Tech nicid n/I nrsta.11drExP. Date: Manufacturer Training: <br /> LAA4 ±Q�Lil I q —13 (4 2,0 <br /> SERVICE SERVICE <br /> Leak detector - Spill bucket El minimum 5 gallon <br /> F-1 0 mechanical Model: El 7 1 hour hydrostatic 0 Incon. TS-STS <br /> 0 electronic Serial 7 Caldwell System El Other <br /> 0 line test programmed <br /> Leak detector <br /> mechanical Model: Spill bucket El minimum 5 gallon <br /> El <br /> F71 El El 1 hour hydrostatic El Incon TS-STS <br /> E electronic Serial #: <br /> El Caldwell System El Other <br /> 0 line test programmed <br /> sensor <br /> positive shutdown Model: Primary piping testing at:❑ <br /> Ll fail safe Serial #: ❑ psi <br /> Ll NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ 11 positive shutdown Model: UDC(s) Piping <br /> L1 fail safe Serial #: Sump(s) UST(s) <br /> Ll NA <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ 11 positive shutdown Model: <br /> 0 fail safe Serial <br /> Note: Please be aware that 2'containment components are required to be tested upon <br /> 1:1 NA installation,6 months after,and every 36 months thereafter <br /> ❑ - Drop tube with mechanical overfill at 95% El Cold start of monitoring panel <br /> F71 Drop tube with mechanical overfill at 95% El Corrosion protection <br /> L1 Overfill prevention (see LG letter 150-1) Other- see below <br /> El This UST facility is APPROVED to operate This UST facility is NOT APPROVED to operate <br /> k� <br /> C) -LV1 Syll <br /> A, <br /> \1 9A.L-t 0 ST �U VV.,oz;j A&O'd, P-Aal (3L.L-4-jo <br /> 4rau <br /> E5--. -es�ed 'Wauvvi��� ot e)y,0,e a Y) LL-t <br /> I <br /> r-S ok a�vjo �WM6 a,)-Ld OSI ay)Y)Ltf ajr- o3 <br /> vvm O'Coad I-A!J G Essafv e_j CL* LbL!e "k,1"-L <br /> C )W <br /> MC <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector- Rq ived 13��y: Title; <br /> EHD 23-04 LIST SERVICE Rl INSPECTION REPORT <br /> Rev 4/30/12 tat <br />