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.sogov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility Name: mop inspection Date: cc1�a�2�I RAIN Falcility Address: t � Q IA JV 1 A u. 4-CCA Service Request #: (, / w L( Onsite Service Technician's Name: ICC Service Tech nician/Instai�. Date: Manufacturer Training: se, (;u vrola. a' -lb- Drauo-(-, _g - k I - SERVICE Leak detector El Elmechanical Model: Elelectronic Serial #: Elline test programmed Leak detector El Elmechanical Model: ❑ electronic Serial #: ❑ line test programmed sensor El Elpositive shutdown Model: Elfail safe Serial #: _ ElNA _ sensor El Elpositive shutdown Model: Elfail safe Serial #: ElNA sensor El positive shutdown Model: ❑ fail safe Serial #: ❑ NA F]Drop tube with mechanical overfill at 95% F-1Drop tube with mechanical overfill at 95% ElOverfill prevention (see LG letter 150-1) El This UST facility is APPROVED to operate SERVICE Spill bucket Elminimum 5 gallon ❑ El1 hour hydrostatic ElIncon T&STS ❑ Caldwell System ElOther Spill bucket Elminimum 5 gallon ❑ El1 hour hydrostatic ElIncon T&STS ElCaldwell System ElOther Primary piping testing at: ❑ psi minutes Secondary containment testing for: UDC(s) _ Piping Sump(s) (0Q-5 UST(s) Testin�e above components are next due by: &fA Note: Please be aware that 2° 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 RAIN ALI I P W0* at, ,PN AT ANfTIM AT EHD'S CURRENT HOURLY RATE, This UST facility is APPROVED to operate SERVICE Spill bucket Elminimum 5 gallon ❑ El1 hour hydrostatic ElIncon T&STS ❑ Caldwell System ElOther Spill bucket Elminimum 5 gallon ❑ El1 hour hydrostatic ElIncon T&STS ElCaldwell System ElOther Primary piping testing at: ❑ psi minutes Secondary containment testing for: UDC(s) _ Piping Sump(s) (0Q-5 UST(s) Testin�e above components are next due by: &fA Note: Please be aware that 2° 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 RAIN ALI I P W0* at, ,PN AT ANfTIM AT EHD'S CURRENT HOURLY RATE, This UST facility is NOT APPROVED to operate EHD 23-04 Rev 4/30/12 UST SERVICE REQUEST INSPECTION REPORT RAIN ALI I P W0* at, ,PN AT ANfTIM AT EHD'S CURRENT HOURLY RATE, EHD 23-04 Rev 4/30/12 UST SERVICE REQUEST INSPECTION REPORT