Laserfiche WebLink
uV 11 <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.sigov.or-q/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPO] <br />if <br />Service Request#: <br />A Y-14) 6 6 <br />xp. 0 Date: Manufacturer Training: site Service Technician's Name: ICC Service Technicianlnstaller Exp. Date:. <br />I thr— " U 11 <br />I SERVICE 1 F SERVICE <br />E/111REW'. AM �Z v <br />Leak detector <br />■ <br />0 mechanical Model: <br />i <br />0 electronic Serial #: <br />Fri <br />t—lk" W"i <br />0 line test programmed <br />Leak detector <br />0 mechanical Model: <br />0 electronic Serial #: <br />test L)roqrammed <br />----D-Iine <br />Leak detecto■ r <br />0 mechanical Model: <br />17-1 electronic Serial #: <br />0 line test•r•• ramme <br />sensor <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />0 <br />0 NA <br />sensor <br />i 0 positive shutdown Model: <br />0 fail safe Serial #: <br />0 NA <br />sensor <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />El NA <br />Drop tube with mechanical overfill at 95% <br />Drop tube with mechanical overfill at 95% <br />E/111REW'. AM �Z v <br />Spill bucket 0 minimum 5 gallon <br />■ <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Fri <br />t—lk" W"i <br />Spill bucket 0 minimum 5 gallon <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />i 0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at: <br />psi <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) LIST(s) <br />0 <br />Testing for the above components are next due by: <br />Note: Please be aware that 20 containment components are required to be tested upon <br />installatio n, 6 months after, and every 36 months thereafter, <br />Cold start of monitoring panel <br />Cor osion protection <br />E/111REW'. AM �Z v <br />Fri <br />t—lk" W"i <br />Reteive,�By: <br />EHD 23-04 LIST SERVICE REQUEST INSPECTION REPORT <br />Re.v 11117!/08 <br />