Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <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 /> VOLW 4-1,;t 7 0 r <br /> Facility Address: Service Request#: <br /> /001 200 3 <br /> Onsite Service Technician's Name: ICC Se ice Technician/Installer Certification#: Manufacturer Training: <br /> ►'`(� <br /> 52,5;Do - u 1 3,11-7# <br /> Swv <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector <br /> 11 mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ <br /> El electronic Serial ElEl1 hour hydrostatic El Incon TS-STS <br /> El line test programmed <br /> ❑ Caldwell System ❑ Other <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket El minimum 5 gallon <br /> : <br /> ❑ <br /> El electronic Serial El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ Caldwell System 11 Other <br /> ❑ line test programmed <br /> sensor <br /> El El positive shutdown Model: ElPrimary piping testing at: <br /> si <br /> El fail safe Serial #: p <br /> minutes <br /> El NA <br /> sensor <br /> Secondary piping testing at: q I �{�, <br /> ❑ ❑ positive shutdown Model: psi 5e4o^ r ' - t9-y <br /> ❑ fail safe Serial #: � <br /> ❑ NA minutes <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: ❑ UDC(s) Piping <br /> ❑ fail safe Serial #: Sump(s) UST(s) <br /> ❑ NA <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention(see LG letter 150-1) 01 Other: see below <br /> d <br /> THIS FACILITY IS SUBJECT TO REINSPECTION T AT EHD'S CURRENT HOURLY RATE. <br /> EHD inspector-AJ R I Title: <br /> EHD 23-04 <br /> Rev 06/22/07 <br />