Laserfiche WebLink
0 SAN JOAQUIN COUNTY is <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.s,I-ov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: �J Inspection Date: <br /> R ` <br /> Facility Add ss. Service Request#: <br /> 15 S 9,M 54 q-9 <br /> Onsite Service Technician me: ICC Service Tech cian/Installer Certification#: Manufacturer Training: <br /> `aN S --8 <br /> SER CE SERVICE <br /> Leak detector <br /> E] mechanical Model: Spill bucket 1:1 minimum 5 gallon <br /> ❑ ❑ electronic Serial ElEl1 hour hydrostatic 11 Incon TS-STS <br /> El line test ro ammed F-1 Caldwell System ❑ Other <br /> Leak detector <br /> El mechanical Model: Spill bucket F-1minimum5 gallon <br /> F-1 ❑ electronic Serial ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> El line test programmed <br /> 11 Caldwell System El 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 Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> El fail safe Serial #: <br /> minutes <br /> El NA <br /> sensor <br /> ❑ ❑ positive shutdown Model: ElSecond Secondary piping testing at: <br /> ❑ fail safe Serial #: p <br /> minutes <br /> El NA <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: ❑ UDC(s) Piping <br /> ❑ fail safe Serial #: Sump(s) UST(s) <br /> ❑ NA <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 /> AWAIfOr C& INJ <br /> LAY&4, me, 4vl- 4Q%im 43 f�e a= <br /> f 'Wi� <br /> i a►� 0— —f rN c ►e <br /> FACILI Y IS SUBJECT TO REINSPE ION AT ANY TIME AE D'S CURRENT HOURLY RATE. V <br /> EHD Ins Received By: Title: <br /> Ca <br /> EHD 23-04 <br /> Rev 06/22/07 <br />