Laserfiche WebLink
o quirt' e <br />SAN JOAQUIN COUNTY <br />' ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />_ Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: WWW. sigov org/ehd <br /><ixoat'� <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />)nsite Service Technician's Name: FCC Zervice Techniciart/insta <br />( This UST facility is APPROVED to operate <br />Date: Manufacturer Training: j <br />SERVICE <br />SERVICE <br />Spill bucket ❑ minimum 5 gallon <br />Leak detector <br />F]❑ <br />mechanical Model: <br />❑ Caldwell System ❑ Other <br />E01 electronic Serial #: <br />Spill bucket ❑ minimum 5 gallon <br />❑ line test ro rammed <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />Primary piping testing at: <br />❑ electronic Serial #: <br />psi <br />❑ line test programmed <br />minutes <br />sensor <br />Secondary containment testing for: <br />❑ positive shutdown Model: <br />UDC(s) Piping <br />❑ fail safe Serial #: <br />Sump(s) UST(s) <br />❑ NA <br />Testing for the above components are next due by: <br />sensor <br />Note: Please be aware that 2' containment components are required to be tested upon <br />installation, 6 months alter, and &Very 36 months thereafter. <br />❑positive shutdown Model: <br />Cold start of monitoring panel <br />❑ fail safe Serial #: <br />Corrosion protection <br />❑ NA <br />Other: see below <br />sensor <br />❑ positive shutdown Model: <br />O fail safe Serial #: <br />❑ NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Overfill prevention (see LG fetter 150-1) <br />( This UST facility is APPROVED to operate <br />Date: Manufacturer Training: j <br />SERVICE <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) UST(s) <br />❑ <br />Testing for the above components are next due by: <br />Note: Please be aware that 2' containment components are required to be tested upon <br />installation, 6 months alter, and &Very 36 months thereafter. <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />Other: see below <br />❑ This UST facility is NOT APPROVED to operate <br />EHD 23-04 <br />Rev 4/30112 UST SERVICE REQUEST INSPECTION REPORT <br />