Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN 1 <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.s1goy.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> UsA S ' cs Q <br /> Faci ity Address: Servi e R uest#: <br /> • c 5P056-10)1 <br /> Onsite Service Techni isName: ICC Service Technician/Installer Certification#: Manufacturer Tra nm <br /> I V l 51 Q 6 11 <br /> fit' 1` 1 (01 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket minimum 5 gallon <br /> mechanical Model: [vf NJ l hour hydrostatic ❑ Incon TS STS <br /> ❑ electronic Serial #: 0101/11191 ❑ Caldwell System C�Other I V <br /> El line test programmed �1/u'V` V4 IV( <br /> Leak detector19 Spill bucket minimum 5 gallon <br /> mechanical Model: JI ul�_ 1:1F-11 hour hydrostatic El minimum <br /> TS-STS <br /> El electronic Serial #: El Caldwell System El Other <br /> El line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> In mechanical Model: JVI/I V ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ��•'�c� <br /> El electronic Serial #: 1:1 Caldwell System El Other <br /> El line test programmed <br /> sensor <br /> El positive shutdown Model: Primary piping testing at: <br /> ❑ El psi <br /> El ['ail safe Serial #: <br /> ❑ NA minutes <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> El fall safe Serial #: <br /> ❑ NA minutes <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: ❑ UDC(s) Piping <br /> ❑ fail safe Serial #: <br /> El NA Sump(s) UST(s) <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 /> i• c G, t <br /> 2a ✓ <br /> 1 tit/� a ) UAL[ S <br /> S HI u a owh Oe <br /> w ✓ <br /> d k IMAk h I JA'[ <br /> Q� tevviewu p <br /> THIS FACILITY IS SUBJECT TO kEINSOEdTION AT ANY TIME A E D'S C RRENT IOUkLY RATE. <br /> EH Inspec ir. Rec rd Ciy: Title: <br /> EHD 23-04 <br /> Rev 06/22/07 <br />