Laserfiche WebLink
10/05/2009_ MON 11:29 <br />FAX 2094683433 <br />********************* <br />*** FAX TX REPORT *** <br />********************* <br />TRANSMISSION OR <br />SJC EHD <br />2930 <br />JOB NO. <br />914082136012 <br />DESTINATION ADDRESS <br />PSWD/SUBADDRESS <br />DESTINATION ID 10/05 11:27 <br />ST. TIME 01'33 <br />USAGE T <br />1 <br />PGS. <br />RESULT OR <br />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.sjeov.orz/ehd <br />...,,,r,,..,, cL-Dvirr>, DF(li'FCT 1NCvrrTTnnr D1iUnDT <br />UNDERGROUND S'10KAtsL lAl` m VO i I ■ L"" <br />Inspection Date: <br />F 'lily Name: <br />1 A� ` <br />- J <br />Facility Address: <br />Service Request q: <br />OS�ga <br />I L Gl/ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />Onsite Service Technician's Name: ICC Service Techn cian/instalier Certification #: <br />Mas6et>,m Training <br />Leak detector <br />Spill bucket ❑ minimum 5 gallon <br />SERVICE <br />Spill bucket ❑ minimum 5 gallon <br />Leak detector <br />❑ Caldwell System ❑ Other <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ line test programmed <br />❑ Caldwell System ❑ Other <br />Leak detector <br />Spill bucket ❑ minimum 5 gallon <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <br />❑ Caldwell System ❑ Other <br />❑ line test programmed <br />Primary piping testing at: <br />Leak detector <br />psi <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <br />Secondary piping testing at: <br />❑ line test programmed <br />psi <br />sensor <br />minutes <br />❑ positive shutdown Model: <br />❑ <br />❑ fail safe Serial #: <br />UDC(s) Piping <br />❑ NA <br />Sump(s) UST(s) <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />2001 <br />SERVICE <br />Spill bucket ❑ minimum 5 gallon <br />❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum, 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment repairs for: <br />❑ <br />UDC(s) Piping <br />Sump(s) UST(s) <br />EJ Drop tube with mechanical overfill at95% Cold Ste ofmOfflh hf� def <br />C7 Drop tube with mechanical overfill W 95% <br />0 Overfill prevention (see LG letter 150-1) Con0S1011 j'ofCCf10 <br />P 11 <br />0 Other,'seobelow <br />