Laserfiche WebLink
AquIN <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 468-3433 Web:www.si-gov.org/ehd <br /> q�%FpR� <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility,Name: Inspection Date(:: <br /> Facility Address: , Service Request#: <br /> X �'166 <br /> Onsite Service Tec nician's Nam ICC Service Technici Nlnstaller Exp.Date: Manufacturer Training: <br /> SERVICE SERVICE <br /> Leak detector e7 Spill bucket minimum 5 gallon <br /> ❑ ❑ mechanical Model: ] P hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: r` ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <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 /> sensor <br /> ❑ positive shutdown Model: Primary piping testing at: <br /> ❑ El psi <br /> ❑fail safe Serial #: <br /> El NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model: UDC(s) Piping <br /> ❑fail safe Serial#: Sump(s) UST(s) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑fail safe Serial#: Note: Please be aware that 2°containment components are required to be tested upon <br /> ❑ NA installation,6 months after,and every 36 months thereafter. <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) ❑ Other: see below <br /> This US�facililty is APPROVED to terata, ❑ This UST facility is NOT APPROVED to operate <br /> tj <br /> e <br /> THIS FACILITY IS SUBJEV TO REINS ON AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: R e B Title: <br /> 10 <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 4/30/12 <br />