COMPLIANCE INFO_2008-2009 - Laserfiche WebLink

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SAN JOAQUIN COUNTY �.•� •.o ENVIRONMENTAL HEALTH DEPARTMENT N. 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si-ov.org/ehd 9�%FOtR� UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility Name: Inspection Date: _ Y4 Lfl ❑ Facility Address: Service Request #: Onsite Service Technician's Name: ICC Service Technician11 staller Exp. Date: JManufacturer Trainin • �'7 �p�4 ❑ Leak detector ❑ A 1W I / AG yn)ina t.61Wja / N�.1�h1z6 SERVICE Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: EHD Inspect r:cei ❑ line test programmed ❑ Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ ❑ line test programmed Leak detector ❑ ❑ mechanical Model: ❑ ❑ electronic Serial #: ❑ line test programmed sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: ❑ ❑ NA sensor ❑ ❑ positive shutdown Model: ❑ ❑ fail safe Serial #: FT ❑ 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) SERVICE T - q1 Spill bucket RVminimum 5 gallon ❑ Incon TS -STS j Caldwell System ❑ Other EHD Inspect r:cei 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 Primary piping testing at: ❑ psi minutes Secondary containment testing for: UDC(s) Piping Sump(s) UST(s) ❑ Testing for the above components are next due by: Note: Please be aware that 21 containment components are required to be tested upon installation, 6 months after, and every 36 months thereafter. ❑ Cold start of monitoring panel ❑ Corrosion protection FT Other: see below C1 THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. EHD Inspect r:cei e y: Title: EHD 23-04 Rev 11/17//08 IS UST SERVICE REQUEST INSPECTION REPORT