COMPLIANCE INFO_2011-2012 - Laserfiche WebLink

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u!N' SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 `P.. Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si-gov.org/ehd Facill"ame: Inspection Date: I tor ❑ Facility Address: ServicdRequest#: ❑ electronic Serial #: • • 1 , • Onsite Service Technician's Name: ICC Service . 'an/Installer Exp. Date: Manufacturer Training: ❑ Z4 z SERVICE Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: • • 1 , • ❑ line test programmed ❑ Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ ❑ line test programmed sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: ❑ NA )01 sensor ❑ ❑ positive shutdown Model: ❑ 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) This UST facility is APPROVED to operate SERVICE Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other • • 1 , • Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Primary piping testing at: ❑ psi minutes Seco dary containment testing for: UDC(S) Piping Sump(s) UST(s) )01 Testing for the above components are next due by: Note: Please le 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 ❑ Other: see below ❑ This UST facility is NOT APPROVED to operate I l • • 1 , • • MITI!� ....:. 6-1 VIII/ EHD 23-04 )® UST SERVICE REQUEST INSPECTION REPORT Rev 10/06/10