COMPLIANCE INFO_2006-2011 - Laserfiche WebLink

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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTS E 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd UNDERGROUND STORAGF TANK aTRT) PROCRAN4 cF.RVirrig 1D1l nrTT4'T r1\rc1131[FrTrinly u>�nnum Facility Name: f j Inspect�i^o�n Date: Facility Address: Service Request #: ❑ mechanical Model: Onsite Ser>svi_ce Technician's Name: ICC Service Technician/Installer Certification #: Manufacturer Training: ❑ ,.j jM SERVICE Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: 11 line test proEammed ❑ Leak detector ❑ ❑ mechanical Model: R ❑ electronic Serial #: ❑ ❑ line test programmed Leak detector O ❑ mechanical Model: ❑ ❑ electronic Serial #: ❑ line test programmed l 41( sensor ❑ ❑positive shutdown o eh T It ❑ fail safe Serial # " l P4 r El NA '� ❑ sensor ❑ ❑ positive shutdown Model: ❑ 1 ❑ fail safe Serial #: ❑ ❑ NA ❑ sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: ❑ NA Drop tube with mechanical overfill at 95% ❑ Drop tube with mechanical overfill at 95% ❑ Overfill prevention (see LG letter 150-1) SERVICE Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ANY TIME AT END'S CURRENT HOURLY RATE. ❑ Caldwell System ❑ Other R Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell. System ❑ Other -- Primary.piping testing.at,:_.._:.... — _.. ❑ psi minutes Secondarypiping testing at: ❑ psi minutes Secondary containment repairs for:. ❑ UDC(s) Piping Sump(s) UST(s) ❑ 1 Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below EHD 23-04 / f THIS FACILITY IS SUBJECT TO REINSPEdTIONNAT ANY TIME AT END'S CURRENT HOURLY RATE. EHD Inspector: / -,( R ived By: a Z Title: EHD 23-04 / f