Laserfiche WebLink
0 SAN JOAQUIN COUNTY 10 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> °yy 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ts: <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sidov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Facility res - Service Request#: <br /> Onsite Service Technician's Name: G2imchhician/lnsllaller Exp.Date: Manufacturer Training: <br /> Og1 - , -- �- LA <br /> SERVICE SERVICE <br /> VLeak detector Spill bucket ❑ minimum 5 gallon <br /> hanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ <br /> 1:1 mechanical Model: El F-11 hour hydrostatic ❑ Incon TS-STS <br /> El electronic Serial#: ❑ Caldwell System ❑ Other <br /> El line test programmed <br /> sensor Primary piping testing at: <br /> F-1El❑ positive shutdown Model: p <br /> si <br /> Elfail safe Serial#: minutes <br /> ❑ NA <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model: UDC(s) Piping <br /> ❑ fail safe Serial#: Surl UST(s) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑ fail 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 /> j <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT END'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received By: # Title: <br /> ia <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 4/30/12 <br />