COMPLIANCE INFO_2011-2015 - Laserfiche WebLink

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oQco.!?ly• c ?'' o SAN JOAQUIN COUNTY 2:. tri-_- . •G ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 .'c . `P•. Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sj og vora/ehd R�1FOR� Facil me: - C () 9A se; Leak detector Inspection Date: Facil' Address- ❑ 1 hour hydrostatic ❑ Incon TS -STS Service Request #: ❑ Caldwell System ❑ Other ❑ line test programmed Spill bucket ❑ minimum 5 gallon Onsite Se 'ce Technic•an s Name: ❑ ICC Seryce Technician Installer Exp. Date: Manufacturer Training: ❑ electronic Serial #: Primary piping testing at: � 4 Lj; Is :i IS/12,11S RIA&do J - ` 8 � SERVICE ❑ This UST facility is APPROVED to operate SERVICE Leak detector ❑ ❑ mechanical Model: ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ electronic Serial #: ❑ Caldwell System ❑ Other ❑ line test programmed Spill bucket ❑ minimum 5 gallon Leak detector ❑ ❑ mechanical Model: ❑ Caldwell System ❑ Other ❑ electronic Serial #: Primary piping testing at: ❑ line test programmed psi sensor ❑ ❑ positive shutdown Model: Secondary containment testing for: ❑ fail safe Serial #: UDC(s) Piping ump(s) UST(s) ❑ NA sensor ❑ ❑ positive shutdown Model: j dr �1 ❑ fail safe Serial #: Note: Pleale be aware that 2° containment components are required to be tested upon installation, 6 months after, and every 36 months thereafter. ❑ NA Cold start of monitoring panel sensor ❑ ❑ positive shutdown Model: Other: see below ❑ 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 f 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 f Primary piping testing at: ❑ psi minutes Secondary containment testing for: _ - - -PM red UDC(s) Piping ump(s) UST(s) 1111 T tin for to a ve com onents are next due by: j dr �1 Note: Pleale be aware that 2° 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 >r + f i , r f _ - - -PM red 1111 EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT Rev 10/06/10