COMPLIANCE INFO_2009-2015 - Laserfiche WebLink

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'oPqu I,N, o0 SAN JOAQUIN COUNTY is a err— ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 `P Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd cet q�iiio Facility Name: u. f Inspection/Date: 1 ❑ ❑ mechanical Model: e Facility Addre : cA qvQ Service Request #: �ox&v Onsite Service Technician's Name: tfifa Leak detector ICC Service Technician/Installer Exp. Date: Manufacturer Training: g ..1 ❑ ❑ electronic Serial #: ❑ ❑ line test programmed SERVICE u. f Leak detector ❑ ❑ mechanical Model: e ❑ electronic Serial #: ❑ line test programmed ❑ Leak detector ❑ ❑ mechanical Model: ..1 ❑ ❑ electronic Serial #: ❑ ❑ line test programmed sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: ❑ NA 9 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 u. f Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS e ❑ Caldwell System ❑ Other Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS EHD —��IIW= ❑ Caldwell System ❑ Other ..1 ❑ Primary piping testing at: ❑ psi minutes Secondary containment testing for: UDC(s) Piping Sump(s) UST(s) 9 Testing for the above components are next due by: o4 46 due- 45 Awki - Note: lease be aware that 21 containment components are required to be test 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 ra MA l. -v. _�. u. f MAN, e EHD —��IIW= • i�. i ..1 ❑ EHD 23-04 Rev 10/06/10 UST SERVICE REQUEST INSPECTION REPORT