COMPLIANCE INFO_2009-2015 - Laserfiche WebLink

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0 SAN JOAQUIN COUNTY 10 ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigoy.org/ehd UNDERGROUND STORAGE TANK LUST) PROGRAM SERVICE R QUEST INSPECTION REPORT Facility Name: Inspection Date: u a I f- 1 .11 , e n, keCA C-1 V- K ri C, A Facility Address: Service Request #: 5 rZ 6 Onsite Service Technician'. N me: ICC Service Technician/installer Certification #: Manufacturer Training: 4, A C, C -Z 737 - 4r5 -5, "),0 0 -1124 y ce EHD 23-04 Rev 06/22/07 Leak detector n mechanical Model: 0 electronic Serial #: 0 line test ProRrammed ❑ Leak detector El 0 mechanical Model: 11 electronic Serial #: ❑ El line test proffammed . Leak detector 0 mechanical Model: ❑ 0 electronic Serial 10 line test 2roEammed --- sensor El 11 positive shutdown Model: D fail safe Serial #: El NA ❑ sensor El El positive shutdown Model: 0 0 fail safe Serial #: El DNA El sensor El 0 positive shutdown Model: 11 fail safe Serial #: DNA ❑ Drop tube with mechanical overfill at 95% El Drop tube with mechanical overfill at 95% El Overfill prevention (see LG letter 150-1) EHD 23-04 Rev 06/22/07 -7737 1 - Spill bucket 0 minimum 5 gallon I hour hydrostatic J9 Incon TS -STS 0 Caldwell System 0 Other Spill bucket El minimum 5 gallon ❑ 0 1 hour hydrostatic 0 Incon TS -STS 0 Caldwell System 0 Other - Spill bucket 0 minimum 5 gallon ❑ 0 1 hour hydrostatic 0 Incon TS -STS 0 Caldwell System 0 Other Primary piping testing at: ❑ psi minutes Secondary piping testing at: ❑ psi minutes Secondary containment repairs for: ❑ UDC(s) Piping Sump(s) UST(s) 0 Cold start of monitoring panel El Corrosion protection El Other: see below EHD 23-04 Rev 06/22/07