COMPLIANCE INFO_1999-2008 - Laserfiche WebLink

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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTME I r 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si-gov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility Name: Ins ection Date: �-3 ° �/ Leak detector VN ,0 mechanical Model: A-2,00 ❑ Facility Address: Service Request #: Eg v5 3)2 ) nsite Service Technician's Name: ICC Service Technician/Installer Certification #: Ma uMfac�turer Training: ❑ v SERVICE �L_.._. I[!. Leak detector VN ,0 mechanical Model: A-2,00 ❑ ❑ electronic Serial #7U5 141: ❑ line test pro ammed 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 #: ❑ ❑ NA ❑ sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: ❑ NA ❑ Drop tube with mechanical overfill at 95% EEDrop tube with mechanical overfill at 95% Overfill prevention (see LG letter 150-1) F.9 SERVICE �L_.._. I[!. 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 Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Primary piping testing at: ❑ psi minutes Secondary piping testing at: ❑ psi minutes Secondary containment repairs for: ❑ UDC(s) Piping Sump(s) UST(s) " ❑ Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below T1I , Aim. i I - �L_.._. I[!. V 4 , !G � ► . i ��WN, :.".i 1, a U EVI fILN1 THI� FACIP71S SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. ll Received B v EHD 23-04 Rev 06/22/07