COMPLIANCE INFO_2012-2018 - Laserfiche WebLink

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OAgU I!y O SAN JOAQUIN COUNTY Q' -+ ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.segov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Fa ci it Name: Inspection Date: 3 ❑ Facility Address: Service Request #: ^ A T3rxcY\ THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. Onsite Service Technician's Name: ICC Service Technician/installer Exp. Date: Manufacturer Training: V\rVA MOO z -',I -A- ❑ mechanical Model: SERVICE 01 UA Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. ❑ line test programmed Received Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ line test programmed sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: ❑ NA sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: ❑ NA sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: ❑ NA ❑ Drop tube with mechanical overfill at 95% ❑ Drop tube with mechanical overfill at 95% ❑ Overfill prevention (see LIS letter 150-1) ?� This UST facility is APPROVED to operate Si l El❑ 1 hour f- ❑ Caldwel Spr El 1 hour I ❑ Caldwe 11.1:16 Primary p ❑ psi Secondar 1279912 UI`40t-;;�L 2701 WEST r°IAE'ul L1`)r'1E ❑ Testing fc STOC'E'TO . [H y.,� F,. 1 9 508'353E?� -5001 04--23 15 1 0: 1 t, Note: Please t installation, 6 n ❑ Cold star Y3TEr"i T�"I'I_I ; REPt RT ❑ Corrosio - Other: sl Ing T(s) je by: tested upon ❑ This UST facility is NOT APPROVED to operate On - c� g 01 UA THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. EHD Inspector: Received Title`., EHD 23-04 Rev 4/30/12 UST SERVICE REQUEST INSPECTION REPORT