Laserfiche WebLink
OP.gU(N. C <br /> _. _�F�_ •� �„' SAN JOAQUIN COUNTY <br /> Q. Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> N. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ' P Telephone:(209)468-3420 Fax.(209) 468-3433 Web:www.siclov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> S" A TD q zo14- <br /> Facility Address: Service Request#: <br /> Z g LI-1 0 <br /> Onsite Service Te hnic" n'swNe: ICC Service Technicia nstaller ��x�p.ppate: Manufacturer Training: <br /> MarioSo�I �v oa�l�o llz��� <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket El minimum 5 gallon <br /> El ❑ electronic Serial:: ElEl1 hour hydrostatic ❑ Incon TS-STS <br /> El line test programmed <br /> ❑ Caldwell System El Other <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket ❑ minimum 5 gallon <br /> El : El El hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial: <br /> El line test programmed <br /> ❑ Caldwell System ❑ Other <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑fail safe Serial#: minutes <br /> ❑ NA <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model: UDC(s) Piping <br /> ❑ fail safe Serial#: Sump(s) 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 2°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 /> !E—OVerfill <br /> Drop tube with mechanical overfill at 95% E] DT I - V?- 9692 prevention (see LG letter 150-1) �. Other: see below V-T- 2 - VL 4710 0 <br /> ❑ This UST facility is APPROVED to operate I,q This UST facility is NOT APPROVED to operate <br /> IV <br /> AAA 64- leLka <br /> Ifs <br /> .-I 11 r� �j r <br /> r�h, <br /> V., #4P - O "' 'l��ic 1 t4&44 U <br /> ri <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. p <br /> EHD Ins ct r: p R e v Title: <br /> 0 / 1 7 C <br /> EHD 23-0 � <br /> �' q 'Q�W l09144'm 'q Yfa i y QC UST SERVICE REQUEST INSPECTION REPORT <br /> Rev4/30/12 nt <br />