Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> E rxg� 5 AAoi6f */l# /01 <br /> Facility Address: Service Request#: <br /> 4101 s MAIN 5900-cZ6 7/ <br /> Onsite Service Technician's Name: ICC Service Technician/installer Certification#: Manufacturer Trqining: <br /> Mr�►2ro �.uctNo —ZS 2 — u.l 1/. Ll <br /> r� c� <br /> SERVICE SERVICE <br /> Leak detector <br /> El mechanical Model: Spill bucket El minimum 5 gallon <br /> ❑ ❑ electronic Serial El 1:11 hour hydrostatic ❑ Incon TS-STS <br /> El line test programmed <br /> ❑ Caldwell System ❑ Other <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket ❑ minimum 5 gallon <br /> El ❑ electronic Serial : ❑ El hour hydrostatic ❑ Incon TS-STS <br /> ❑ Caldwell System El Other <br /> El 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 <br /> El shutdown Model: Primary piping testing at: <br /> ❑ ❑ fail safe Serial #: ❑ psi <br /> minutes <br /> El NA <br /> sensor Secondary piping testing at: * PSL PIPE <br /> ❑ ❑ positive shutdown Model: //' Psi <br /> El fail safe Serial #: T p <br /> ❑ NA 0 minutes <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: UDC(s) p,G ►°IP Piping <br /> ❑ fail safe Serial #: <br /> ❑ NA 15Sf_sTr 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 /> L <br /> ill L <br /> OF <br /> s of otu,r <br /> THIS FACILITY IS SUBJECT TO REINSPECTI N AT AN IME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: � n' R v y: Title: <br /> Wo ` rf I/l <br /> EHD 23-04 <br /> Rev 06/22/07 <br />