COMPLIANCE INFO_2011-2018 - Laserfiche WebLink

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�oP.OL "•.co SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si oA v.or /g ehd Facility Name: Inspection Date: ❑ L /31tz, Facility Address: Serviic�e Request {#: Onsite Service Technician's Name: Leak detector ICC Service Technician/Installer Exp. Date: Manufacturer Training: a Giurr.c. ❑ electronic Serial #: 1 / ��'-• SERVICE Leak detector ❑ ❑ mechanical Model: ❑ electronic Serial #: ❑ line test programmed G. 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 ❑ Drop tube with mechanical overfill at 95% ❑ Drop tube with mechanical overfill at 95% ❑ Overfill prevention (see LG letter 150-1) P102 This UST facility is APPROVED to operate SERVICE Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Spill bucket ❑ minimum 5 gallon ❑ ❑ 1 hour hydrostatic ❑ Incon TS -STS ❑ Caldwell System ❑ Other Wspi iping testing at: 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 ❑ This UST facility is NOT APPROVED to operate VIC EHD 23-04 ! UST SERVICE REQUEST INSPECTION REPORT Rev 10/06/10 rrrt+ri'" G. THIS FACILITY IS SUBJECT TO REINSPm• r EHD Ins• VIC EHD 23-04 ! UST SERVICE REQUEST INSPECTION REPORT Rev 10/06/10