Laserfiche WebLink
o¢qul�••c0 <br /> SAN JOAQUIN COUNTY <br /> 'y{ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sidov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> mcd 96.- <br /> Facility ddress: 11, Service Request M <br /> 245 kh2fl-t^ UVA rAW U <br /> Onsite Service Technician's Name: ICC ervice echniciValle4 <br /> ate: Manufacturer riming: <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical Model � 'I Spill bucket El minimum 5 gallon <br /> El El❑ electronic Serial 1-] 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test ro rammed El Caldwell System ❑ Other <br /> Leak detector <br /> Spill bucket El minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial : ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ electronic Serial #: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> qj F1 Ll sensor <br /> ❑ positive shutdown Model: Primary piping testing at: <br /> ❑ fail safe Serial# ❑ psi <br /> ❑ NA minutes <br /> nsor Secondary containment testing for: <br /> ❑ outown Model UDC(s) Piping <br /> ❑ fail safe Serial#: <br /> sitive sd <br /> Sump(s) UST(s) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑ fail safe Serial #: Note: Please be aware that 20 containment components are required to be tested upon <br /> ❑ NA installation,6 months after,and every 36 months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% ❑ 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 /> Oe <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EH 'S CURRENT HOURLY RATE. <br /> EHD Ins p r: Re y: T' <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 11/17//08 <br />