COMPLIANCE INFO_2011-2012 - Laserfiche WebLink

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'oRqu °n�•..co 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.sjgov.orq/ehd aGis oR�' Facility Name/: Inspection Date: / ❑ mechanical Model: - r% Facility Address: Service Request #: ❑ Leak detector El Onsite Service Technician's Name: ICC Service Technician/Installer fxp. Date: Manufacturer Training: ❑ ❑ line test programmed sensor SERVICE Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ line test programmed ❑ Leak detector El ❑ mechanical Model: REIM ❑ electronic Serial #: ❑ ❑ line test programmed sensor ❑ ❑ positive shutdown Model: r ❑ fail safe Serial #: ❑ NA 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 1 SERVICE 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 REIM Primary piping testing at: ❑ psi minutes Sepondary containment testing for: Ill:, 314 UDC(s)499,9/1.� Piping r Sump(s) UST(s) Testing for the above components are next due by: r, /16/11 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 ❑ Other: see below ❑ This UST facility is NOT APPROVED to operate EHD 23-04 ®d c� UST SERVICE REQUEST INSPECTION REPORT Rev 10/06/10 a s i�►i' l .► l �. . t REIM r MIMI nall EHD 23-04 ®d c� UST SERVICE REQUEST INSPECTION REPORT Rev 10/06/10