Laserfiche WebLink
OPp U I N••.0 <br /> ?'��_'P� SAN JOAQUIN COUNTY <br /> Q: a 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 /> oqc�ORN;P <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facili Name: Inspection Date: <br /> Facility Address: Service Request#: <br /> Oni te],Service Technician's Name: ICC Servi a Technician/Installer Exp. Date: Manuffaccttu-rer Training: <br /> 1 ► LES c 'j7— & 17. [- _ <br /> SERVICE SERVICE <br /> Leak detector �- Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical _ Model: ►4�� � .t LEI— ❑ ❑ 1 hour hydrostatic El Incon TS-STS <br /> electronic Z-f I Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector <br /> El mechanical Model: Spill bucket El minimum 5 gallon <br /> ❑ <br /> El electronic Serial: El El hour hydrostatic El Incon TS-STS <br /> El line test programmed <br /> ❑ Caldwell System ❑ Other <br /> sensor <br /> F-1 El positive shutdown Model: El psi piping testing at: <br /> El fail safe Serial #: p <br /> [I NA minutes <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 21 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 /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ 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 /> T FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD In eo : Received By: Title: <br /> E H D 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />