Laserfiche WebLink
oQ'•a`'''IM••c <br /> ' Q AN JOAUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)468-3433Web:www.sigov.org/ehd <br /> UNDERGROUND T AGE T (UST) PROGRAM SERVICEST INSPECTION REPORT <br /> RFaci <br /> Name: Ins ection Date: <br /> aw <br /> y Ad' ss: Service Request#: <br /> t�& d ilft* V qmmq lwoim @I <br /> Onsite Service Technician's me: I ICC Servible Technician/Installer Exp.D te: Manufacturer Training: <br /> '[(XA L2 <br /> 0&(D <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket ❑ minimum 5 gallon <br /> El ❑ electronic Serial:: El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test ro rammed ❑ Caldwell System ❑ Other <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket El minimum 5 gallon <br /> : <br /> ❑ <br /> El electronic Serial: ❑ El hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test ro rammed El Caldwell System ❑ Other <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket El minimum 5 gallon <br /> El ❑ electronic Serial:: ❑ El hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test ro rammed ❑ Caldwell System El Other <br /> )WA 1QP1 sor <br /> positive st own Model Primary piping testing at: <br /> hu <br /> El fail safe Serial #: psi <br /> NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model: UDC(s) Piping <br /> ❑ fail safe Serial #: 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 20 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 /> ro <br /> Drop tube with mechanical overfill at 95% ElCorrosion protection <br /> Overfill prevention (see LG letter 150-1) ❑ Other: see below <br /> MAP 4AI44- <br /> r G <br /> C <br /> f �S <br /> THIS OAC'ILITil IS SUBJIfCT TO REINSPECTION AT ANY TIME AT EH 'S CURRENT HOURLY RATE. <br /> EHD Ins r Receiv y Title: <br /> r <br /> EHD 23-04 ' UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 11/17//08 <br />