Laserfiche WebLink
®gqU I... <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.siaov.org/ehd <br /> 0 <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspectlo7Dao: <br /> Ci <br /> Facility Address: Service Request#: <br /> OPI:140 L.-Tra P9\fid 52D o e>q---7 <br /> Onsite Service Technician's Na e: ICC Se ice Technic<jntaller Exp. Manufacturer Training: <br /> q 2z/( <br /> G�za <br /> SERVICE SERVICE <br /> Leak detector —Spill bucket El minimum 5 gallon <br /> El 0 mechanical Model: El 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial#: 0 Caldwell System El Other <br /> 0 line test programmed <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> El 0 mechanical Model: El 0 1 hour hydrostatic 0 Incon TS-STS <br /> El electronic Serial#: <br /> El line test 0 Caldwell System 0 Other <br /> programmed <br /> Leak detector Spill bucket El minimum 5 gallon <br /> El El mechanical Model: El 0 1 hour hydrostatic El Incon TS-STS <br /> El electronic Serial #: 0 Caldwell System El Other <br /> El line test programmed <br /> - <br /> sensor❑ Primary piping testing at: <br /> 0 positive shutdown Model: El osi <br /> 0 fail safe Serial #: I-- <br /> 0 NA —minutes <br /> sensor Secondary containment testing for: <br /> El 0 positive shutdown Model: UDC(s) Piping <br /> El fail safe Serial#: Sump(s) UST(s) <br /> 0 NA sensor ❑ Testing for the above components are next due by: <br /> El El positive shutdown Model: <br /> El fail safe Serial #: Note: Please be aware that 2*containment components are required to be tested upon <br /> 0 NA I installation,6 months after,and every 36 months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% El Cold start of monitoring panel <br /> 0 - Drop tube with mechanical overfill at 95% E Corrosion protection <br /> El Overfill prevention (see LG letter 150-1) Other: see below <br /> W 2 e. &2. j q-m) 57E:7. <br /> THIS FACILITY IS SUBJECT TO REIPEC?ON pff pAY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD 2s.,— 1 Recei Title: <br /> InspectZA� . A <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 11/17//08 <br />