Laserfiche WebLink
Pqu1N <br /> o.• ' ' •.c SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> y. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c• P Telephone: (209) 468-3420 Fax:(209) 468-3433 Web:www.s*oov.org/ehd <br /> ORa� <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility ame: Inspection Date: <br /> Rill d0--- 1 L4 <br /> Facility Address: Service,Request#: <br /> Cr-Qt-q-- D 0 0 <br /> Onsite Service Technician's Name: I ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> SERVICE SERVICE <br /> Leak detector <br /> F-1 mechanical Model: Spill bucket El minimum 5 gallon <br /> L1E01❑ electronic Serial #: El hour hydrostatic ElIncon TS-STS <br /> L1 line test programmed <br /> El Caldwell System El Other <br /> Leak detector <br /> El mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ElEl❑ electronic Serial #: ❑ 1 hour hydrostatic ElIncon TS-STS <br /> El line test programmed <br /> El Caldwell System 1:1 Other <br /> sensor <br /> ❑ positive shutdown Model: Primary piping testing at: <br /> El <br /> El fail safe Serial #: El psi <br /> El 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 2°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 /> �. 166wry is APPROVED to operate is NOT APPROVED to operate <br /> L <br /> Q_ <br /> d O Rs L F it `r <br /> M41 11 U& S / <br /> }V,�& <br /> i ri <br /> O L f:rc Lid A n))a fi-:c Q &I , S <br /> THIS FACILITY IS SUBJE T TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD InspeftReceivelBy: <br /> / ! Title: <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 4/30/12 <br />