Laserfiche WebLink
SAN JOAQUIN COUNTY i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sieov.orWehd <br /> UNDERGROUND STORAGE TANK ST PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspecti n Date <br /> NL6 Aft �n RM P� 2 s 09 <br /> Facility Address: ''II Servicd Request#: <br /> ,5'/1 Do S- <br /> 4PO,jZ <br /> Onsite service Technician's Name: ICC Servi a Technician nstaller Certification#: Manufacturer Training: <br /> 3 WIN r'AMS u b Dpw lz co <br /> SERVICE lit 3 SERVICE <br /> Leak detector <br /> ❑ mechanical Model: $ Spill bucket l�iminimum 5 gallon <br /> ❑ electronic Serial #: 1 hour hydrostatic ElIncon TS-STS <br /> ❑ line test programmed C ldwell System ❑ Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> El El mechanical Model: El ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test ro ammed <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 <br /> ❑ ❑ positive shutdown Model: 11 psi piping testing at: <br /> ❑ fail safe Serial#: p <br /> minutes <br /> ❑ NA <br /> sensor Secondary piping testing at: <br /> ❑ positive shutdown Model: psi <br /> ❑ fail safe Serial#: p <br /> minutes <br /> ❑ NA <br /> sensor <br /> : Secondary containment repairs for: <br /> ❑ positive shutdown Model <br /> ❑ <br /> El fail safe Serial 11 UDC(s) Piping <br /> Sump(s) UST(s) <br /> ❑ NA <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)r Other: see below 011 RQ <br /> Wk1 • cd, b XA i 6 -F c <br /> `i r a i 0 ted. L 1 <br /> ti1144r .h <br /> THIS FACILI IS SUBJECT TO REINSP ON AT ANY TIME AT EHD'S CURRENT HOURL RATE: <br /> E Inspector: Yv R eived B : I Title: <br /> EHD 23-04 <br /> Rev 06/22/07 <br />