Laserfiche WebLink
SAN JOAQUIN COUNTY 1..i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www-sigov.org/ehd <br /> 9�tFORN <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> 7 - 773 /v <br /> Facility Add Fess: Servi e R uest <br /> 2r �. ✓� !� <br /> Onsite Service Technician's Name: [cc Service TaChniclanlinstaiter Exp.Date: Nlandfacturer Training: <br /> SERVICE SERVICE <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 /> 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 /> rb , ,sensor p // <br /> tive shutdown Model: �/ 1— 20 Primary piping testing at: <br /> Elail safe Serial#: G I� —minutes <br /> ❑ NA <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model: UDC(s) Piping <br /> ❑ fall safe Serial#: Sump(s) UST(s) <br /> ❑ NA ❑ <br /> sensor Testing for the above components are next due by: <br /> El El <br /> positive shutdown Model: <br /> ❑ fad safe Serial#: Note: Please be aware that 2°oomainment 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 /> F-1Droptube with mechanical overfill at 95% ❑ Corrosion protection <br /> El 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 /> 1 <br /> JW,8-"CILIT-y IS SUBJECT TO REINSPECTr AT A Y TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD pe r' 71Recei Title: <br /> EHD 3-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/0600 <br />