Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> e�ssw :e <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> Q�hio <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST <br /> EQUEST INSPECTION REPORT <br /> Facility ame: Inspection Date: <br /> u <br /> Facility Address: Service Requ #: <br /> 3 k <br /> Onsite Service Technician's Flame: ICC Service Technician/installer Exp. ate: Manufacturer Training: 17-311,53 <br /> c G / Gr l T /12 12 <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket [I minimum 5 gallon <br /> El ❑ electronic Serial:: El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test ro rammed El Caldwell System ❑ Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor _ s Primary piping testing at: <br /> [JI positive shutdown Model: s ❑ psi <br /> ❑ fail safe Serial#: minutes <br /> ❑ NA <br /> QC sensor i �JI' Secondary containment testing for: <br /> ( positive shutdown Model: r,.� -� - UDC(s) Piping <br /> ❑ fail safe Serial#- w r _ Sump(s) UST(s) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑ fail safe Serial#: Note: Please be aware that 2e containment components are required to be tested upon <br /> ❑ NA installation,6 months after,and every 36 months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention (see LG letter 150-1) Other: see belowezcy "- <br /> ❑ This UST facility is APPROVED to operate This UST facility is NOT APPROVED to operate <br /> GUI o- i �- QAP <br /> ® Y-.- <br /> Vr l i1 F- <br /> KQ, y d rR1�► �" ( ( � ( i <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT Y TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD In <br /> sp or: Received By: Title: <br /> EHD 23-04 L .. UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 ra <br />