Laserfiche WebLink
qu i r1+ c® <br /> SAN JOAQUIN COUNTY <br /> H < ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax: (209)468-3433 Web:www.sigov.org/ehd <br /> 4<<F®R� <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICET INSPECTION REPORT <br /> Facili Name: Inspection Date: <br /> I <br /> (c SW *-N <br /> Facility Address: Service Request#: <br /> W, U�qm S�- i <br /> . CA sPwSS18 - - , <br /> nsite Service Technician's me: ICC Service Technicia stall xp.Date: �Nlanu a rer Tr i ing: <br /> 6;� x-1401 <br /> t b �1 <br /> SERVICE VICE <br /> Leak detector <br /> El mechanical Model: Spill bucket El minimum 5 gallon <br /> El ❑ electronic Serial: El 1 hour hydrostatic ElIncon TS-STS <br /> ❑ line test ro rammed ❑ Caldwell System ❑ Other <br /> Leak detector <br /> El mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> El ❑ electronic Serial: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test ro rammed ❑ Caldwell System ❑ Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial : ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor <br /> ❑ positive shutdown Model: Primarps piping testing at: <br /> El 1:1 <br /> ❑ fail safe Serial #: minutes <br /> ❑ NA <br /> sensor Secondary containment testing for- <br /> El <br /> or:❑ ❑ positive shutdown Model: UDC(s) Piping <br /> ❑fail safe Serial #: Sump(s) UST(s) <br /> ❑ NA <br /> sensor Testing for the ae components are next due by: <br /> E-10 positive shutdown Model: 0?>- I V <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 /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention (see LG letter 150-1) ❑ Other: see below <br /> m 1AIEK 4k IROI I S <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT H 'S CURRENT HOURLY RATE. <br /> EHD Inspect r: Received By: Title: <br /> :010 11 1 <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 11/17//08 <br />