Laserfiche WebLink
OAgU I N••.0 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N` 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sl4ov.or /q ehd <br /> C4�iFpRa�P <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Cruisers # 29 Thursday, July 21, 2011 <br /> Facility Address: Service Request#: <br /> 1131 W Lathrop Road, Manteca SR0062169 <br /> Onsite Service Technician's Name: ICC Service Technicianfinstaller Exp.Date: Manufacturer Training: <br /> Ceasar Rodriguz 18028973UT - 1/13/12 VR - 10/20/11, VMI - 12/11 <br /> SERVICE SERVICE <br /> Leak detector <br /> 11 mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ ❑ 1 hour hydrostatic ElIncon TS-STS <br /> Elelectronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor <br /> ❑ ❑ positive shutdown Model: ❑ Primary piping testing at: <br /> si <br /> ❑ fail safe Serial#: minutes <br /> ❑ NA <br /> 91 vacuum sensor Secondary containment testing for: <br /> ❑ positive shutdown Model: see below UDC(s) Piping <br /> ❑fail safe Serial#: See below 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 /> Vacuum sensor S5 - 91 product vacuum sensor, model # 332175-001, serial # 10460002 and S6 - 91 <br /> vent vacuum sensor, model # 332175-001, Serial #10198 was replaced. <br /> Verified functionality, positive shut down and fail safe. All passed. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT END'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received By: . rt Title: <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />