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.sjgoy.org�e <br /> UNDERGROUND STORAGE TANK ]D PROGRAM SERVICE RE!2UEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> 41 <br /> Facility Address: Service RequWt-#--. <br /> A <br /> OnsiteSirvic'e Technician's Name: ICC Sen1wjim-hakianlInstaller Certification#: Map,a ff ytre r Training,- <br /> xv. <br /> SERVICE SERVICE <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> ❑ 0 mechanical Model: ❑ 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic <br /> Serial#: 0 Caldwell System 0 Other <br /> 0 line test programin e-d <br /> Leak detector -Spill bucket 0 minimum 5 gallon <br /> ❑ 0 mechanical Model: 0 0 1 hour hydrostatic El Incon TS-STS <br /> 0 electronic Serial #: <br /> 0 Caldwell System 0 Other <br /> 0 line test pro ed <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> mechanical Model: ❑ 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial#: 0 Caldwell System 0 Other <br /> 1 0 Une test programmed <br /> .:jsensor <br /> 7 ❑ Primary piping testing at: <br /> �VMpositive shutdown Model: bjqpsi <br /> F1 fail safe Serial#: <br /> 0 NA minutes <br /> sensor Secondary piping testing at: <br /> positive shutdown Model: <br /> 0 F1 - 'El psi <br /> 0 fail safe Serial#: <br /> minutes <br /> 0 NA <br /> sensor Secondary containment repairs for: <br /> 0 0 positive shutdown Model: ❑ UDC(s) Piping <br /> D fail safe Serial#: Sump(s) UST(s) <br /> DNA <br /> ❑ Drop tube with mechanical overfill at 95% 0 Cold start of monitoring panel <br /> 0 Drop tube with mechanicalpverfill at 95% 0 Corrosion protection <br /> 0 Overfill prevention(see LG letter 150-1) 0 Other: see below <br /> THKTAcILITY tS,SU1a4FCT TO REINSPECTION AT ANY/TIME,.AT EHO'S CURRENT-.HOURLY RATE. <br /> EHD ftTrtor: ReceirTitle: rr <br /> EHD 23-04 <br /> n_..nal'InIA17 I I I I I I <br />