COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

OAp U I N'•.0 SAN JOAQUIN COUNTY z • r-�r.— . Q' y ENVIRONMENTAL HEALTH DEPARTMENT N _ Y 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd cq�iFOR��P UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facili Name: L"t k" Insp tibn Date: Fadli ity Address: ,nService N , Request #: '�"F (Aisite Service TechniciName: �(W WAkAk w] -4,� I C Service TechnicianlinstallYMte: 0 WIU.4 Willufacturer Training: 4mf LVA SERVICE E WA ...II l W1,./OREINSPECTI�� 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% ❑ Drop tube with mechanical overfill at 95% ❑ Overfill prevention (see LG letter 150-1) This UST facility is APPROVED to operate SERVICE E WA ...II l W1,./OREINSPECTI�� 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 20 containment components are required to be tested upon installation, 6 months after, and every 36 months thereafter. Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below ❑ This UST facility is NOT APPROVED to operate —16 E WA ...II l W1,./OREINSPECTI�� T�IS FACILITY IS SUBJECT T •V -------- Received - - - EHDIll / ) �� UST SERVICE REQUEST INSPECTION REPORT Rev 4/30/12 j/ f/