Laserfiche WebLink
SAN JOAQUIN COUNTY 10 <br /> 4NVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Web:www sicov.org ehd <br /> UNDERGROUND STORAGE TANK ST PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Na / InspectionSte: <br /> — '2\3 D <br /> Facility Ad ss: Service R quest : <br /> SRU (q1 <br /> Onsite Servi a Technician's Name: ICC Service Technician/Installer Certification#: Manufacturer Training: <br /> ka 1 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> El line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ e ectronic Serial#: ❑ Caldwell System ❑ Other <br /> line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ 111 hour hydrostatic ❑ Incon TS-STS <br /> ❑ e ectronic Serial#: ❑ Caldwell System ❑ Other <br /> line test programmed <br /> sensor Primary piping testing at: <br /> ❑ ❑ p 3sitive shutdown Model: ❑ psi <br /> ❑ fit safe Serial#: minutes <br /> ❑ Is A <br /> sensor Secondary piping testing at: <br /> ❑ ❑ pDsitive shutdown Model: 5 psi <br /> ❑ f �it safe Serial #: minutes <br /> 11A <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ sitive shutdown Model: 0A UDC(s) Piping <br /> ❑ it safe Serial #: Sump(s) UST(s) <br /> ❑ A <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Ov ll prevention(see LG letter 150-1) ❑ Other: see below <br /> T So S <br /> IS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Insp or: Received By: Title: <br /> EHD 23-04 <br /> Rev 06/22/07 <br />