Laserfiche WebLink
Opqu I N•.0 <br /> �' E� '•9 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENO <br /> N: 18kast Hazelton Avenue, Stockton, CA 9520' 232 <br /> '�,. •.P Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sogov.org/ehd <br /> A�iFo <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date:, <br /> 2,C P(L.A '$ '�j-L�L-J-o ! 420113 <br /> Facility Address: Service Request#: <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ ❑ mechanical Model: Al hour hydrostatic Incon TS-STS t <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket ❑ minimum 5 gallon <br /> El ❑ electronic Serial:: El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed <br /> El Caldwell System El Other <br /> j sensor <br /> positive shutdown Model: 2© Primary piping testing at: <br /> El psi <br /> >Klail safe Serial#: <br /> ❑ NA minutes <br /> sensor Secondary containment testing for: <br /> Wpositive shutdown Model: 2C�� UDC(s) Piping <br /> ail safe Serial#: Sump(s) UST(s) <br /> ❑ NA <br /> CA sensor ❑ Testing for the above components are next due by: <br /> ositive shutdown Model: <br /> it safe Serial#: Note: Please be aware that 21 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 /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention (see LG letter 150-1) ❑ Other: see below <br /> This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> 'IV oC11)Y a <br /> �� ,i �I)n � I u <br /> -� dnA <br /> u as I. pati <br /> THIS FACILI IS SUBJECT TO REINSPECT N AT ANY E EHD'S CURRENT HOURLY RATE. <br /> EHD I tor. Rec ' itle: <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 4/30/12 <br />