COMPLIANCE INFO_2009-2015 - Laserfiche WebLink

Home Browse Search

Jul 29 10 01:08p Elite IV Contactors 12094616342 p.4 SAN JOAQUIN COUNTY Q; M ENVIRONMENTAL HEALTH DEPARTMENT ` 600 East Main Street, Stockton, CA 95202-3029 Telephone:'(209) 468-3420 Fax: (209) 468-3433 Web: www.sicioyora/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility Name: Leak detector Inspection Date: Facility Address: ,ter, � R• i ti fie ❑ mechanical Service Request #: �.,� �� OnsiteService Technician's Name: ICC Service Technicianllnstaller Exp. Date: Manufacture1r Training: ❑ ❑ line test ro rammed .s� z ❑ SERVICE Leak detector Spill bucket ❑ minimum 5 gallon ❑ ❑ mechanical Model: ❑ Caldwell System ❑ Other ❑ electronic Serial #: ❑ ❑ line test ro rammed Leak detector ❑ ❑ mechanical Model: THIS FACILITY IS SUBJECT TO REINSPECTION AT ANYTIME AT EHD'S CU T HOURkY'f2ATE. ❑ electronic Serial #: Primary piping testing at: .-. ❑ line test programmed psi Leak detector minutes ® ❑ mechanical Model: UDC(s) Piping ❑ electronic Serial #: ❑ ❑line test programmed La, sensor G:t,",Ai6y' t n Model: instaitat on, o mori hs after, and every 36 months thereafter. ❑ positive shutdown Cold start of monitoring panel ❑ ❑ fail safe Serial #: Other: see below ❑ NA _ sensor ❑ positive shutdown u^thhl...dAy" Model: ❑ fail safe Serial #: ❑ NA P sensor,y' W ❑ positive shutdown Model: "a4tIes ❑ 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) SERVICE Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ [neon TS -STS ❑ Caldwell System ❑ Other 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 THIS FACILITY IS SUBJECT TO REINSPECTION AT ANYTIME AT EHD'S CU T HOURkY'f2ATE. ❑ Caldwell System ❑ Other Primary piping testing at: ❑ psi minutes Secondary containment testing for: UDC(s) Piping Sump(s) UST(s) ❑ Testing for the above components are next due by: Note: Please be aware that 2° containment components are required to be tested upon instaitat on, o mori hs after, and every 36 months thereafter. ❑ Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below EHD 23-04 Rev 11/17/108 UST SERVICE REQUEST INSPECTION REPORT THIS FACILITY IS SUBJECT TO REINSPECTION AT ANYTIME AT EHD'S CU T HOURkY'f2ATE. EHD lnspector� ry . , /I ..° . Received � i � I .. Title: EHD 23-04 Rev 11/17/108 UST SERVICE REQUEST INSPECTION REPORT