INSTALL_2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT ❑ .This UST facility is APPROVED to operate SERVICE SERVICE ❑ ❑ 1 hour hydrostatic ❑ Incon T&STS Leak detector ❑ Caldwell System ❑ Other InspectionDateFacility : Address: mechanical Model: Onsite Service -fechnician 's Name: ICC Service Tech nician/I nstal ler Date: Manufacturer Trainingw 8 ❑ .This UST facility is APPROVED to operate SERVICE SERVICE ❑ ❑ 1 hour hydrostatic ❑ Incon T&STS Leak detector ❑ Caldwell System ❑ Other ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ psi ❑ line test programmed minutes 'II>BMW Leak detector t ❑ ❑ mechanical Model: FACILITY IS SUBJECT TO REINSPECTION ❑ electronic Serial #: Note: Please be aware that 20 containment components are required to be tested upon ❑ line test programmed ❑ Cold start of monitoring panel sensor Corrosion protection ❑ ❑ 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 Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon T&STS ❑ Caldwell System ❑ Other Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon T&STS ❑ Caldwell System ❑ Other Primary piping testing at: ❑ psi minutes 'II>BMW Secon a containment tes in for: UDC(s) �,�! Piping t _ Sump(s) UST(s) THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. 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 EHD 23-04 Rev 4/30/12 UST SERVICE REQUEST INSPECTION REPORT _ 'II>BMW A0% t k' THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. EHD Inspector: Received By: EHD 23-04 Rev 4/30/12 UST SERVICE REQUEST INSPECTION REPORT