COMPLIANCE INFO_2008-2010 - Laserfiche WebLink

Home Browse Search

PquIN SAN .IOAQUIN COUNTY 1101 ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 . Y. Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd .......... — �Q +T� UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility Name: L c Inspection Date: / ❑ mechanical Model: �7'�� - 7q S—/ co-- O. Facility Address: ❑ Leak detector Service Request #: ❑ mechanical Model: n!,-5ins ❑ electronic Serial #: ❑ Onsite Service Technician's Name: ICC Service Techn�cjan/Installer Exp. Date: Manufacturer Training: �• r�, �� , v fLe- SERVICE I 0-U- Leak detector ❑ ❑ mechanical Model: "ter 1,• � ❑ electronic Serial #: /f>, n -C111-ltd (,i. Dry- �nr. ❑ line test programmed ❑ Leak detector ❑ ❑ mechanical Model: n!,-5ins ❑ electronic Serial #: ❑ ❑ line test programmed Receiv Leak detector ❑ ❑ mechanical Model: ❑ ❑ electronic Serial #: ❑ line r rammed sensor 't V— -7 74-370-4 El positive shutdown Model: �l ❑ fail safe Serial #: Ltog7 4-9 ❑ 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) >9 �Ay SERVICE I 0-U- -� Spill bucket ❑ minimum 5 gallon -151 hour hydrostatic ❑ Incon TS -STS "ter 1,• � ❑ Caldwell System ❑ Other /f>, n -C111-ltd (,i. Dry- �nr. Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ji✓5� rtrwr�ar 54•S.�v L..��,. l ❑ Caldwell System ❑ Other n!,-5ins Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS Receiv ❑ Caldwell System ❑ Other Title: 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 20 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 0 EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT Rev 11 /17N08 I 0-U- ✓� lx. �v � 1 "ter 1,• � ill bur�iCs-� /f>, n -C111-ltd (,i. Dry- �nr. I�� /�5�i�fi 4es - - ji✓5� rtrwr�ar 54•S.�v L..��,. l ev de/ ,-- :54r; n!,-5ins O.. / w40- THIS FACILITY IS SUBJE& TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. EHD Inspect Receiv Title: 0 EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT Rev 11 /17N08