COMPLIANCE INFO_2010-2018 - Laserfiche WebLink

Home Browse Search

O�QutlV Q ?•' ' o� SAN JOAQUIN COUNTY is ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 ;P Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd gGtP0 Facility Name: Inspection Date: Facility Address: Service Request #: Onsite Service Technician's Name: ICC Service Technician/installer Exp. Date: Manufacturer Training: l ❑ line test programmed ❑ WA SERVICE i; ' r Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: l ❑ line test programmed ❑ 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 LG letter 150-1) This UST facility is APPROVED to operate SERVICE i; ' r Spill bucket A minimum 5 gallon ❑ 1 hour hydrostatic ❑ Incon TS -STS Caldwell System ❑ Other l Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Primary piping testing at: ❑ psi minutes Secondary containment testing for: UDC(s) Piping Sump(s) UST(s) ❑ Testing for the above components are next due by: Note: Please be aware that 2° containment components are required to be tested upon installation, 6 months after, and every 36 months thereafter. ❑ Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below ❑ This UST facility is NOT APPROVED to operate r VOW., i .-.. , i; ' r l EHD p' • 51 1 W�/, WRA 0 _ EHD 23-04 Rev 10/06/10 UST SERVICE REQUEST INSPECTION REPORT