Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL.HEALTH DEPARTMEN <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Facility Address: Service Request#: <br /> -?61 yos �7F 4VE_AJ&t,& -7/0? 5 P,*p©5_0 41? 3 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Certification#: Manufacturer Training: <br /> Gu Z. D�SI -uT �3a73� <br /> SERVICE SERVICE <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 /> 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 /> El fall safe Serial #: <br /> ❑ NA minutes <br /> sensor <br /> sitive shutdown Model: -71q-3910 ' 3Z3 Secondary piping testing at: <br /> 'fail safe Serial #: 7% 6f,7 ❑ psi <br /> L" <br /> ❑ NA minutes <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: ❑ UDC(s) Piping <br /> ❑ fail safe Serial #: Sump(s) UST(s) <br /> ❑ NA <br /> [E] <br /> Drop tube with mechanical overfill at 95% 11Cold start of monitoring panel <br /> Drop tube with mechanical overfill at 95% ElCorrosion protection <br /> Overfill prevention (see LG letter 150-1) ❑ Other: see below <br /> 4 <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME.AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: C��^ Rece' By: Title- <br /> EHD 23-04 <br /> 1/3/07 <br />