Laserfiche WebLink
i <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: <br /> IWO <br /> Inspection Date: 9 <br /> Facility Address: Service Request#: <br /> Onsite ervice Technician's Nam ICC Sery a Technician/Installer Certification#: Manuf cturer Training: <br /> � 3 7-12 <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket El minimum 5 gallon <br /> ❑ <br /> F-1 electronic Serial #: El El hour hydrostatic El Incon TS-STS <br /> El line test programmed <br /> El Caldwell System El Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor IN <br /> 0 positive shutdown Model:� `�- Primary piping testing at: <br /> ❑ psi <br /> fail safe Serial minutes <br /> ❑ NA <br /> d"IWIFensor i n► <br /> Secondary piping testing at: <br /> 1p positive shutdown Model: U� �$ ❑ psi <br /> J� %fail safe Serial #: -'(9 9 b 6 minutes <br /> ❑ NA <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: ❑ UDC(s) Piping <br /> ❑ fail safe Serial#: Sump(s) UST(s) <br /> ❑ NA <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 /> VeAel <br /> I NT <br /> oil �N <br /> YK rr as <br /> lftsWb 6In <br /> THIS FACILITY IS SUBJECT TO ROINSPECTION AT ANY TIMA AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: cei ed By: Title: <br /> EHD 23-04;.T <br /> Rav 06/22/07 <br /> I <br />