COMPLIANCE INFO_2009-2014 - Laserfiche WebLink

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ORaU1N. C SAN JOAQUIN COUNTY Q- -� ENVIRONMENTAL HEALTH DEPARTMENT ` 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility Name: �-91I Ae il h 6 I i Inspection Date: 6-�] - I Facility Address: ❑ mechanical Model: Service Request #: Onsite Service Technician's Name: ICC Service Technicia /Installer Exp. Date: Manufacturer Training: Leak detector ❑ 7-, - to- �1 SERVICE I i Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ line test programmed ❑ Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ ❑ line test programmed z( sensor ❑ positive shutdown Model:�%�'"�� ❑ fail safe Serial #: ❑ NA Q, ❑ sensor ❑ ❑ positive shutdown Model: ❑ ❑ 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) This UST facility is APPROVED to operate SERVICE I i 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 ❑ Caldwell System ❑ Other Primary piping testing at: ❑ psi minutes Secondary containment testing for: UDC(s) Piping Sump(s) UST(s) ❑ Testing for the above components are next due by: Note: Please be aware that 21 containment components are required to be tested upon installation, 6 months after, and every 36 months thereafter. ❑ Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below ❑ This UST facility is NOT APPROVED to operate 1 TO I 1 � � S�� I '� . v�► r.� \ L . I i t. ♦ I i i r jUpiived By: \ WRX.440 MOORE �- EHD 23-04 Rev 10/06/10 UST SERVICE REQUEST INSPECTION REPORT