COMPLIANCE INFO_2006-2008 - Laserfiche WebLink

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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMEN 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility Name: K+ 0 C Inspection Date: t -2,4-° -7 Facility Address: TP -A(, -I 6w fl Service Request #: S20L)L{q 0 Onsite Service Technician's Name: ICC Service Technician/Installer Certification #: Manufacturer Training: uaf e S A KcA kt?, 5'L50'T3 k - u -v 94� ut SERVICE Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ line test programmed ❑ Leak detector ❑ ❑ mechanical Model: ector: I Rec ' By: ❑ electronic Serial #: ❑ ❑ line test programmed Leak detector ❑ ❑ mechanical Model: ❑ ❑ electronic Serial #: ❑ line test programmed Ott sensor �J�3 ❑ positive shutdown Model: X fail safe Serial #: ❑ NA ❑ sensor ❑ ❑ positive shutdown Model: ❑ ❑ fail safe Serial #: ❑ ❑ NA ❑ sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: ❑ NA ❑EOveDrop tube with mechanical overfill at 95% ❑ Drop tube with mechanical overfill at 95% ❑ rfill prevention (see LG letter 150-1) SERVICE Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ON AT ANY TIME AT EHD'S CURRENT HOURLY RATE. ❑ Caldwell System ❑ Other ector: I Rec ' By: Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Primary piping testing at: ❑ psi minutes Secondary piping testing at: ❑ psi minutes Secondary containment repairs for: ❑ UDC(s) Piping Sump(s) UST(s) ❑ Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below EHD 23-04 1/3/07 THIS FACILITY IS SUBJECT TO REI SPEC ON AT ANY TIME AT EHD'S CURRENT HOURLY RATE. EHD Ins ector: I Rec ' By: Titler._—/--� , EHD 23-04 1/3/07