Laserfiche WebLink
o.P4�1 N .o <br /> ?'�E •9 .— SAN JOAQUIN COUNTY -- <br /> r. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> , Pr. Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.siaov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> d l X06 b 31d3 <br /> Facility Address: Service Rbquest <br /> 162410 ( <br /> �(� 8 <br /> Onsite Service Technicians Name: ICC Se ce ec nician/Install r Exp.Date: Manufacturerrai mg: <br /> SERVICE SERVICE <br /> 15Z� Leak detector <br /> Xmechanical Model _Spill bucket LI minimum 5 gallon <br /> : �►t t( �p ��AOQ <br /> L1 electronic Serial #7 lo()51Z&� El Ll1 hour hydrostatic ❑ Incon TS-STS <br /> El line test programmed T � ❑ 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 /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fall safe Serial#: minutes <br /> ❑ NA <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Madel: UDC(s) Piping <br /> ❑ fail safe Serial#: Sump(s) UST(s) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by: <br /> ElLJpositive shutdown Model: <br /> ❑ fail safe Serial #: 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% ❑ 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 /> This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> THIS FACILITY IS SUBJECT TO REINSPECTION T ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD In or: Received QfA Title: <br /> V <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORI <br /> Rev 10/06/10 <br />