Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <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 /> ® ciW 05 <br /> Facility Address: Service Request#: <br /> Onsite Service Technician's Name: ICC Service Technician/installer Exp.Date: Manufacturer Training: <br /> S-T -, -311(d1 <br /> Vr / <br /> SERVICE SERVICE <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> ❑ El mechanical Model: El El 1 hour hydrostatic 0 Incon TS-STS <br /> • electronic Serial#: El Caldwell System El Other <br /> 0 line test programmed <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> ❑ 0 mechanical Model: El El 1 hour hydrostatic El Incon TS-STS <br /> • electronic Serial: <br /> El Caldwell System El Other <br /> 0 line test programmed <br /> sensor Primary piping testing at: <br /> El El positive shutdown Model: El psi <br /> El fail safe Serial#: minutes <br /> El NA <br /> — sensor Secondary containment testing for: <br /> El 0 positive shutdown Model: UDC(s) Piping <br /> 0 fail safe Serial#: Sump(s) LIST(s) <br /> El NA sensor E3 Testing for the above components are next due by: <br /> ❑ 0 positive shutdown Model: <br /> 0 fail safe Serial#: Note Please be aware that 2*containment components are required to be tested upon <br /> 0 NA I installation,6 months after,and every 36 months thereafter. <br /> F-1 Drop tube with mechanical overfill at 95% El Cold start of monitoring panel <br /> El Drop tube with mechanical overfill at 95% El I Corrosion protection <br /> El Overfill prevention (see LG letter 150-1) Other: see below \IVti <br /> 0 This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> 0011�11, 0('A r--1 Slkn Dot\" LUA )rrm <br /> 114- <br /> gar, <br /> cDpn M \1" Vic "Ass <br /> THIS FACILITY IS SUBJECT TO REINSPECTI AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector:k Receive y: Tit <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 4/30/12 <br />