Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMA <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.orehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Nanieft• I Inspect' Wn JDate-, <br />rm&z <br />Facility A Service Request #: <br />oICC Service nician/Installer Certification #: Manufacturer Training: <br />nsiWr 01" _577�v <br />SERVICE <br />Leak detector <br />■ <br />El mechanical Model: <br />0 1 hour hydrostatic El Incon TS -STS <br />■ electronic Serial #: <br />0 Caldwell System 0 Other <br />0 line test programmed <br />Spill bucket 0 minimum 5 gallon <br />Leak detecto■ r <br />0 1 hour hydrostatic El Incon TS -STS <br />0 mechanical Model: <br />0 Caldwell System F1 Other <br />0 electronic Serial #: <br />— Spill bucket El minimum 5 gallon <br />El line test programmed <br />0 1 hour hydrostatic El Incon TS -STS <br />Leak detecto■ r <br />0 Caldwell System n Other <br />0 mechanical Model: <br />Primary piping testing at: <br />0 electronic Serial #: <br />psi <br />0 line test programmed <br />minutes <br />senso■ r <br />Secondary piping testing at: <br />0 positive shutdown Model: <br />psi <br />0 fail safe Serial #: <br />minutes <br />0 NA <br />Secondary containment repairs for: <br />sensor <br />UDC(s) Piping <br />1 0 positive shutdown Model: <br />Sump(s) UST(s) <br />F-1 fail safe Serial #: <br />Cold start of monitoring panel <br />DNA <br />Corrosion protection <br />El <br />Other: see below <br />■ <br />■ <br />Drop tube with mechanical overfill at 95% <br />• <br />Drop tube with mechanical overfill at 95% <br />Overfill prevention (see LG letter 150-1) <br />SERVICE <br />- Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic El Incon TS -STS <br />MMMAWAO! 0, <br />0 Caldwell System 0 Other <br />Spill bucket 0 minimum 5 gallon <br />0 <br />0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System F1 Other <br />— Spill bucket El minimum 5 gallon <br />0 <br />0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System n Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary piping testing at: <br />0 <br />psi <br />minutes <br />Secondary containment repairs for: <br />❑ <br />UDC(s) Piping <br />Sump(s) UST(s) <br />0_1 <br />Cold start of monitoring panel <br />161 <br />Corrosion protection <br />El <br />Other: see below <br />i 1114 7. PITY WN74 AdF/� <br />VAN <br />MMMAWAO! 0, <br />I - 41 <br />EHD 23-04 V <br />Rev 06/22/07 <br />