COMPLIANCE INFO_2011-2015 - Laserfiche WebLink

Home Browse Search

ul �• -' •a SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 P Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.orcl/ehd •Q�1FOfRC� Facility Name: ® Inspectio Date: ' j Facility Addressl L,Servi 46 raw quest #: I1 Onsite Service Technician's Name: ICC Servick Technician/Installer Exp. Date: Manufacturer Training: SERVICE I SERVICE ❑ This UST facility is APPROVED to operate Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ line test programmed ❑ Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ ❑ line test programmed sensor ❑ ❑ positive shutdown Model' ❑ fail safe Serial #: ❑ NA sensor ❑ ❑ positive shutdown Model: ❑ ❑ fail 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 ❑ This UST facility is NOT APPROVED to operate i a 111PA- /4 ti.'.Emu "11A 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 ❑ Caldwell System ❑ Other Primary piping testing at: ❑ psi minutes Secondary containment testing for: z 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 installation, 6 months after, and every 36 months thereafter. ❑ Cold start of monitoring panel ❑ Corrosion protection ❑ Other: see below ❑ This UST facility is NOT APPROVED to operate i a 111PA- /4 ti.'.Emu "11A i U`�— EHD 23-04 Rev 10/06/10 9M UST SERVICE REQUEST INSPECTION REPORT