COMPLIANCE INFO_2010-2012 - Laserfiche WebLink

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PQU 1!y �o. ,E.coG SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT '. 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility N me:Inspection 81-ir Date: _1,-7-11 Facilit Fs: L Y2 e est #• / (� O tte Service T hnician's Name: �hA `� ❑ line test programmed ICC Service Tecpnician/Installer Exp. D e: Z� ;%�_ Mfa u rjr ' g V 33 ❑ ❑ mechanical Model: ❑ electronic Serial #: 3 SERVICE Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: WZ0 SAM ❑ line test programmed ❑ Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ ❑ line test programmed sensor ❑ ❑ positive shutdown Model: ❑ fail safe Serial #: mindmi El, NA sensor ❑ ositi e s utdown Model: ❑ ❑ ail 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 n.a SERVICE Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other WZ0 SAM Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Primary piping testing at: ❑ psi minutes Secondary containment testfor: ��pp UDC(s) I�ALIPiping Sump(s) UST(s) mindmi Testing for the above components are next due by: 11 NoteNote. Pl�a a that 20 containment components are required to be tested upon nstallation, 6 months after, and every 36 months thereafter. ❑ I Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below ❑ This UST facility is NOT APPROVED to operate A %A EHD 23104 'V V V UST SERVICE REQUEST INSPECTION REPORT Rev 10/06/10 WZ0 SAM WHEEM111 mindmi 11" EHD 23104 'V V V UST SERVICE REQUEST INSPECTION REPORT Rev 10/06/10