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.siggy.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Dte: <br /> /A4r ( D( h 1,ve0 bl I 0L> (61 <br /> Facility Address: Service Req st#: <br /> (o (21 PA-C�6 Av- � A6� vlkwlj SfZ00 S 0Z 7 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Certification#: Manufa turer Training: <br /> N k — <br /> SERVICE SERVICE <br /> Leak detector <br /> El mechanical Model: Spill bucket El minimum 5 gallon <br /> El ❑ electronic Serial El El hour hydrostatic ElIncon TS-STS <br /> El line test programmed <br /> F-1 Caldwell System ❑ Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial #: <br /> minutes <br /> El NA <br /> sensor Secondary piping testing at: <br /> ❑ positive shutdown Model: ❑ psi <br /> El fall safe Serial #: <br /> minutes <br /> El NA <br /> sensor <br /> El El positive shutdown Model: Secondary containment <br /> repairs for: Piping <br /> El fail safe Serial #: <br /> El NA a roSf—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 /> D(\ S i� V Pr i r 4 `r( 4 �2 <br /> -r1 -TP All tr L/i4S14W W A <br /> a1� "o Eump ks d- U ll 4!!�)�� <br /> P �W 31t ILA <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHDSpector: Received By: Title: <br /> V11"\ <br /> EHD 23-04 <br /> Rev 06/22/07 <br />