Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />t' x <br />600 East Main Street, Stockton, CA 95202-3029 <br />telephone: (209) 468-3420 Fax: (209) 468-3433 Web: MME.sjgov.orC/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: InspecIflon Date: <br />FacilfffAddress: Service Request 4: <br />r nii� <br />6,10 <br />Onsite Service Techniclan's Name'. ICC Service TachnIclannnstaller Exp. Date: Manufacturer Training; 1. <br />0,� e <br />SERVOCE <br />Leak detector <br />El <br />El mechanical Model; <br />171 electronic Serial #: <br />El line test Rrogrammed <br />teak defectdr-' <br />171 <br />0 mechanical Model: <br />0 electronic Serial 9: <br />I C1 line test programmed <br />sensor <br />El <br />0 positive shutdown Model: <br />0 fail safe Serial P <br />0 NA -A <br />v, j, 4 <br />sensor <br />0 positive shutdown Model: <br />0 Nit safe Serial <br />El <br />13 NA <br />El <br />sensor <br />❑ <br />13 positive shutdown Model: <br />17-1 fail safe Serial #: <br />RaceiOed BY: r <br />0 NA <br />0 <br />Drop tube with mechanical overfill at 95% <br />11 <br />Drop tube with mechanical overfill at 95% <br />0 <br />Overfill prevention (see LG letter 150-1) <br />AD This UST facility Is APPROVED to operate <br />SERVICE <br />Spill bucket El minimum 5 gallon <br />1 hour hydrostatic 13 Incon TS -STS <br />om El Other j.j <br />0 Caldwell Systi <br />I a <br />Spill bucket 0 minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at: 12.VQ <br />psi <br />minutes lr"f <br />Secondary containment testing for: <br />UDC(s) Piping <br />v, j, 4 <br />Sump(s) 1.16T(s) <br />Testing for the above components are next due by: <br />Note: Please be awe that 2* containment components are requited to be tested upon <br />Installation, 6 niontl is after, and every 30 months thweafter. <br />El <br />Cold start of monitoring panel <br />El <br />Corrosion protection <br />THIS,,F#C,11-ITY IS SUBJECT TO REINSPECTION AT ANYTIME AT EHWS CURRENT HOURLY RATE. <br />Other see below <br />7 '77-77 <br />0 This UST facility Is NOT APPROVED to operate <br />EMI) UST SERVICE REQUEST INSPECTION REPORT <br />ROV10/013/1i) / <br />4. <br />v, j, 4 <br />yyc7 <br />THIS,,F#C,11-ITY IS SUBJECT TO REINSPECTION AT ANYTIME AT EHWS CURRENT HOURLY RATE. <br />EHD Inspector <br />RaceiOed BY: r <br />Titre: <br />EMI) UST SERVICE REQUEST INSPECTION REPORT <br />ROV10/013/1i) / <br />