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.siaov.ore/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: InspectiOry�� <br /> Pm Ll /v <br /> Faci14 Address: Service/Request <br /> l#: <br /> Onsite Service Technician's Name: ICC Service Technicia Installer Certification#: Manufacturer Training: <br /> SERVICE SERVICE <br /> Leak detector Spill buc <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydro: <br /> ❑ electronic Serial #: ❑ Caldwell Sysi <br /> ❑ line test programmed F <br /> Leak detector <br /> ❑ mechanical Model: Spill buck <br /> ❑ ❑ electronic Serial #: ❑ ❑ 1 hour hydrost -- <br /> ❑ line test programmed ❑ Caldwell Syste L I <br /> fIF I rlG :'•LiY'T <br /> Leak detector .'rr.:sk :+UT ,1-11J'd l <br /> El mechanical Model: Spill bucke HF I: i ti. 2uti Hrr <br /> F-, ❑ electronic Serial #: ❑ ❑ 1 hour hydrosta <br /> ❑ line test programmed ❑ Caldwell Systen <br /> ensor U <br /> Primary piping test; <br /> ❑ <br /> El positive shutdown Mode1:7/l L13 M, ` 3�l ❑ psi <br /> ❑ fail safe Serial #: <br /> minutes <br /> sensor Llu:B? PILL. <br /> Secondary piping tes F`I f 11+f. ;�-irIF' <br /> ❑ positive shutdown Model: SE[ISUR OUT r;LHF:ri <br /> ❑ ❑ fail safe Serial#: ❑ psi HFk 10. _ao�i =J:�_s 4.1 <br /> ❑ NA minutes <br /> sensor <br /> ❑ positive shutdown Model: Secondary containme. <br /> ❑ <br /> El fail safe Serial ❑ UDC(s) Piping <br /> El NA Sump(s) UST(s) <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> [q= Dro, tube with mechanical overfill at 95% ElCorrosion protection <br /> Overfill prevention(see LG letter 150-1) ❑ Other: see below <br /> 1911 S 'i 11961z,114e4 <br /> M rl L r U IrZ i r\ t d IP tp 4 v <br /> r Wn, �n J C t (4-t-,, el—e-1 <br /> Its Ir\ jt)n/ f1- k1 POK <br /> A r I tl os &r'd`UI`t J <br /> THIS FACH 11YIS SUBJECT Td REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EH Inspector Re iv By: t Title <br /> EHD 23-04 <br /> Rev 06/22/07 <br />