Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)4683433 Web:www.sigooy.org/phd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date <br /> C—kATktr Iths (- 11/14,(6 <br /> Facility Address: Se vice Request#: <br /> Onsite Service Technician's Name: ICC Service Technician/instailer Certification#: Manufacturer Training: <br /> r gd V\./' S r .I,V0 <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket ;Krninimum 5 gallon <br /> ElElmm cechanic Serial : Al hour hydrostatic El Incon TS-STS <br /> ❑ line test programmed <br /> El Caldwell System Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: D Caldwell System ❑ Other <br /> ❑ line test programmed <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 /> 11 fail safe Serial #: <br /> minutes <br /> El NA <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> El fail safe Serial #: <br /> minutes <br /> ❑ NA <br /> sensor <br /> Secondary containment repairs for: <br /> El positive shutdown Model: <br /> ❑ <br /> El fail safe Serial #: El UDC(s) Piping <br /> El NA Sump(s) UST(s) <br /> Drop tube with mechanical overfill at 95% ❑ I 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 /> do <br /> jjTf To -) 11c�r� (or(,( <br /> SSv, pro 4o6 ;e,% cn 4 ,.a Ov <br /> Qr Y b j YlJ� t' All- <br /> &A W <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENY HOURLY RATE. <br /> EH spector: Rece By: Title: <br /> EHD 23-04 <br /> Rev 06122107 <br />