Laserfiche WebLink
SEP-17-2007 10: 10 Service Station Systems 408 938 eeee P.06 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL 14EALTH DEPARTMENT <br /> 600 East Main Strect,Stockton,CA 95202-3029 <br /> Telephone: (209)468-3424.Fax.(209)468-3433 Web:www.sjgov_or_/chd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Dice: <br /> Fac qty Addre : Servi e R nest#: <br /> 1 �� ,v. ' , , ( b' <br /> Onsite Service'rechniciad'b ante: ICC Service Tcchniciadlnstaller Certification#: Manufacturer Tran , <br /> SERVICE SERVICE <br /> Leak detector 4A� Spill bucket minimum 5 gallon <br /> mechanical Model: ?tiv [4 4PIJ hour hydrostatic O Incon TS-STS <br /> ❑ electronic Serial #: )4if 1i i t i� O Caldwell System C�Other <br /> ❑ line test programmed y <br /> Leak detector Spill bucket O minimum 5 gallon <br /> 0 Lei mechanical Model: y'(, ti t l�ul�) E7 1 hour hydrostatic ElIncon TS-STS <br /> ❑ electronic Serial t 171 't i1 i?�9 ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> tt d 0 mechanical Model: ❑ ❑ 1 hour hydrostatic C] Incon TS-STS <br /> El electronic Serial#: i c 1� <br /> l ❑ Caldwell System ❑ Other <br /> �� fq ❑ line test programmed <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> C1 fail safe Serial #: ._ minutes <br /> ❑ NA <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial #: <br /> - minutes <br /> ❑ NA <br /> sensor Secondary containment repairs for: <br /> ❑ LD positive shutdown Model: ❑ UDC(s) Piping ' <br /> El fail safe Serial #: Sump(s) UST(s) " <br /> ❑ NA <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 /> r <br /> Lt1 <br /> , t <br /> THIS FACILITY IS SUBJE TO REINSPECTION AT ANY TIME ATS EWD'S C. RRENT AOUkLY RATE. <br /> D Inspector: /i` Rcc cd By: Title: <br /> . .i .. <br /> 23-oa L <br /> '16122/07 <br />