COMPLIANCE INFO_2002-2008 - Laserfiche WebLink

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6 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sj ov�.orWehd UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT Facility Name: �l NA Inspection Date: O Facility Ad re s: Lj"'J' Service Request #: On ke S rvice Tech Name: V. -Z • ICC Service Technician/installer Certification #: - �o �-o1 Mann ng: - 2 -Z-Z SERVICE L Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ line test programmed / 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 I I Drop tube with mechanical overfill at 95% 1 Drop tube with mechanical overfill at 95% ❑ Overfill prevention (see LG letter 150-1) SERVICE L Spill bucket minimum 5 gallon ❑ 1 hour hydrostatic Incon TS -STS Ifflu'RITEME, n%1111-1 LIFE F WN ❑ Caldwell System ❑ Other 11— Spill bucket 0 minimum 5 gallon ❑ 1 hour hydrostatic Ef 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 piping testing at: ❑ psi minutes Secondary containment repairs for: ❑ UDC(s) Piping Sump(s) UST(s) ❑ Cold start of monitoring panel Corrosion protection s ❑ Other: see below EHD 23-04 Co & W �� '�i1", fWT"rj�k � z" af \ Rev 06/22/07 �^ff GvV Ifflu'RITEME, n%1111-1 LIFE F WN -a 1' I . M., U111-19EW, MAMM,, Mix m. 1101 M� EHD 23-04 Co & W �� '�i1", fWT"rj�k � z" af \ Rev 06/22/07 �^ff GvV