COMPLIANCE INFO_2007-2010 - Laserfiche WebLink

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•. SAN JOAQUIN COUNTY • ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sgov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility Name: ') 0 L V Inspection Date: / /&o 7 Leak detector�lcy rY ❑ Facility Address: 3300 WCq'-'/00 - Service Request #: P,�' Onsiteervice Techmci n's Name: I�ct�� ICC Service Technician/Installer Certification #: T, 3�V '7A Manufacturer Tr fining: X 15�Z /est SERVICE Leak detector�lcy rY ❑ mechanical Model: c t - c1) ' N�',Q_/ , iW_2 I ❑ electronic Serial #: ❑ line test programmed ❑ Leak detector ❑ ❑ mechanical Model: T• ❑ electronic Serial #: ❑ ❑ line test programmed Leak detector ❑ ❑ mechanical Model: ❑ ❑ electronic Serial #: ❑ li2a test programmed (tiA sensor n 3 ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: A ICtTAA ❑ NA ❑ sensor X positive shutdown Model: Cold start of monitoring panel ❑ ❑ 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) u, II SERVICE Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ' N�',Q_/ , iW_2 I ❑ Caldwell System ❑ Other Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS / fir. �r� . � ❑ Caldwell System ❑ Other T• 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 RPv nSi99m7 061 ff"ffm'",� ' N�',Q_/ , iW_2 I / fir. �r� . � T• �r 0..0 EHD 23-04 RPv nSi99m7 061