COMPLIANCE INFO_2011-2016 - Laserfiche WebLink

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4�!N SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si4ov.orci/ehd aki li o RN Facility Name: wInspection l / Date: p Facility Address: 3-300 ® Service Request ,#: 617 o 3 On it Service Tephni ian's N me ICC Service T chniciantinstaller Exp.Date: Manufacturer Training: b A1161 SERVICE Spill bucket ❑ minimum 5 gallon Leak detector ® ❑ mechanical Model: ❑ Caldwell System ❑ Other ❑ electronic Serial #: Spill bucket ❑ minimum 5 gallon ❑ line test programmed ❑ 1 hour hydrostatic ❑ Incon TS -STS Leak detector ❑ ❑ mechanical Model: Primary piping testing at: ❑ electronic Serial #: psi ❑ line test programmed minutes sensor ❑ ❑ positive shutdown Model: UDC(s) Piping ❑ fail safe Serial #: Sump(s) UST(s) ❑ NA Testing for the above components are next due by: sensor ❑ ❑ positive shutdown Model: Cold start of monitoring panel ❑ fail safe Serial #: Corrosion protection ❑ NA see below I - )Mkf 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 EHD 23-04 Rev 4/30/12 M INSPECTION REPORT 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 ❑ 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 Ij(Other: see below I - )Mkf M INSPECTION REPORT