COMPLIANCE INFO_2011-2015 - Laserfiche WebLink

Home Browse Search

°Qqu1� c SAN-JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT N l { 600 East 'Main Street, Stockton, CA 95202-3029 �q \� Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.orglehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT y :Facility Name: SERVICE Inspection Date.. Leak detector ❑ 1 hour hydrostatic F1Incon TS -STS ® li A Model: f` Spill bucket finimum 5 gallon Facility Address: Serial #: Service Request #: ❑ line test programmed p Leak detector Onsite Service Tec nlclan s Name. ❑ IGC Service Technician/installer Exp. Date: Manufacturer Tr inIng: q ❑ electronic Serial #: UDC(s) Piping This UST facility is APPROVED to operate r ire=.+• , � S� -a.' vr^._ tom; SERVICE SERVICE Spill bucket ❑minimum 5 gallon Leak detector ❑ 1 hour hydrostatic F1Incon TS -STS ® © mechanical Model: f` Spill bucket finimum 5 gallon ❑ electronic Serial #: ❑ line test programmed Leak detector Elpsi ❑ ❑ mechanical Model: ❑ electronic Serial #: UDC(s) Piping ❑ line test programmed Sump(s) UST(s) sensor for the above components are next due by: ❑ ❑ positive shutdown Model: installation, 6 months after, and every .:36 months thereafter::. ❑ fail safe Serial #: 171Corrosion ❑ NA ElOther: see below 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 r ire=.+• , � S� -a.' vr^._ tom; SERVICE I-J�,A- i Spill bucket ❑minimum 5 gallon ❑ ❑ 1 hour hydrostatic F1Incon TS -STS ❑ Caldwell System ❑ Other f` Spill bucket finimum 5 gallon :8� 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Primary piping testing at: Elpsi minutes Secondary containment testing for: UDC(s) Piping Sump(s) UST(s) F1Testing for the above components are next due by: Note: Please be aware that 21 containment components are required tobetested upon-- installation, 6 months after, and every .:36 months thereafter::. ❑ Cold start of monitoring panel 171Corrosion protection ElOther: see below ElThis UST facility is NOT APPROVED to operate I-J�,A- i EHD 23-o4 Rev 10(IWI0 )�y;"-z ; '� Title: - -^ UST SERVICE REQUEST INSPECTION REPORT I-J�,A- i i - .a.,«.. ^✓_.:,;;�, �,,�$_„.� , ,moi"� -� �.� THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. EHD }nspe ; Received EHD 23-o4 Rev 10(IWI0 )�y;"-z ; '� Title: - -^ UST SERVICE REQUEST INSPECTION REPORT