Laserfiche WebLink
o�Q`'''I�• e <br /> ? ' P SAN JOAQUIN COUNTY <br /> Q za ENVIRONMENTAL HEALTH DEPARTMENT <br /> N �; .` 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.orq/ehd <br /> UNDERGROUND STORAGE <br /> g® GE TANK (UST) PROGRAM SERVICE REQUEST <br /> EQUST INSPECTION REPORT <br /> ILimFacility Name: Inspection Date: <br /> zfA tow vu <br /> Facility Address. Service Request#: <br /> i i t) Ob & �, <br /> Opsit ervice Technician's Name: ICC i e Tec nician/Installer Exp.Date: Ofla ufac'Ur r rain'ng:. <br /> SERVICE SERVICE <br /> Leak detector ,S <br /> ❑ mechanical Model: pill bucket minimum 5 gallon <br /> ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector <br /> ❑ mechanical Model: • pill bucket inimum 5 gallon <br /> ❑ ❑ electronic Serial#: 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> F?1I sensor a <br /> ❑ positive shutdown Model Primary piping testing at: <br /> psi <br /> ❑ fail safe Serial#: Elmi <br /> ❑ NA minutes <br /> sensori" Secondary containment testis for: <br /> ❑ positive shutdown Model: UDC(s) —I Piping <br /> ❑ fail safe Serial#: Sumps UST(s) <br /> ❑ NA <br /> sensor i! esting o he above components e d ue by: <br /> ❑ positive shutdown Model: IGr V 91-'q4WP6 <br /> ❑ fail safe Serial#-AM _„_ Note: Please be aware that 21 containment components are required to be tested upon <br /> NA installation,6 months after,and every 36 months thereafter. <br /> Br' ube with ni a ov I I at /o�141111 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 UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> I I <br /> 5 L <br /> 1 <br /> 6 <br /> STP 5um os <br /> THIS FACILITY IS SU JECT T6 REINSPECTION F ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EH In pectora Rec �y: Titl <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />