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.S'gov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> S S-ZFS-o$ <br /> Facility Address: Service Request#: <br /> 4 1,5 r �lZoczBC�o <br /> Onsite Service Technician's Name•. IC vice Technician/Installer Certification#: Manufacturer Training: str0� <br /> SERVICE SERVICE <br /> Leak detector 2L Spill bucket minimum 5 gallon <br /> El ❑ mechanical Model: El hour hydrostatic Incon TS-STS <br /> ❑ electronic Serial #: <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> Leak detectorLAA " - <br /> $7 Sgi�l bucket ,minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ 1 hour hydrostatic �jncon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> El 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 Primary piping testing at: <br /> El ❑ positive shutdown Model: ❑ psi <br /> 11 fail safe Serial #: <br /> ❑ NA minutes <br /> sensor Second piping testing at: <br /> ❑ Elpositive shutdown Model: Elp p g g <br /> si <br /> ❑ fail safe Serial#: p <br /> ❑ NA minutes <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: gt� g UDC(s) Pi <br /> ❑ fail safe Serial #: ( ) Piping <br /> ❑ NASump s) UST(s) <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 /> I '1/ cflt g 4 5 , ' <br /> 8 <br /> /l 4`s-rsP % <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Ins tor: I RWWed B : Titin. <br /> r <br /> EHD 23-04 <br /> Rev 06/22/07 <br />