COMPLIANCE INFO 2008-2012 - Laserfiche WebLink

Home Browse Search

MGNITq#ING SYSTEM CERTIFWATION MAKE 1 MODEL OF MONITORING SYSTEM: Veeder-Root TLS-350 CERTIFICATION 1 TEST DATE: January 8, 2009 A1. FACILITY A2. OWNER Name 7-Eleven Market#23681 Store#14117 Name 7-Eleven, Inc Address 2725 Country Club Lane,Stockton, CA 95201 Address P.O. Box 711, Dallas,TX 75221 Phone# 209-463-1259 Phone# 805-523-2949 Contact Jay Stemley Contact Shane Partridge A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 600 E.Main Street,Stockton,CA 95202 Address P.O. Box 1025,W.Sacramento,CA 95691 Notified January 6, 2009 Lic# 617238 A,B, Haz Inspector Ray Van Flue Contact Richard Walton Phone# 209-468-3439 Phone# 916-825-3203 B. INVENTORY OF EQUIPMENT TESTEDICERTIFIED (Check the appropriate boxes to indicate equipment inspectediserviced) — 61: TANKS Tank#1 (Product): Gasoline -91 Tank#2 (Product): Gasoline-87 ❑ In-Tank Gauging Probe Model: ❑ In Gauging Probe Model: J ■ Annular Space or Vault Sensor Model: 0794390-420 ■ Annular Space or Vault Sensor Model: 0794390-420 ■ Piping Sump I Trench Sensor(s) Model: 0794380-352 ■ Piping Sump I Trench Sensor(s) Model: 0794380-352 ❑ Fill Sump Sensor(s) Model- ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill I High-Level Sensor Model: ❑ Tank Overfill I High-Level Sensor Madel: ❑ Other {specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Tank#3 (Product): Tank#4 (Product): El In-Tank Gauging Probe Model: El In-Tank Gauging Probe Model: ELI Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump 1 Trench Sensor(s) Model: _ ❑ Piping Sump/Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill 1 High-Level Sensor Model- _ ❑ Tank Overfill I High-Level Sensor Model: Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Bz: DISPENSERSIUDC's Dispenser#: 1-2 Dispenser# ■ Dispenser Containment Sensor(s) Model: 0794380.208 ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Floats)and Chain(s) Dispenser#: Dispenser#: ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves Dispenser Containment Float(s)and Chains) ❑ Dispenser Containment Float(s)and Chain(s) Dispenser#: Dispenser#: ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s) C. CERTIFICATION I certify that the equipment identified in this document was inspectedlserviced in accordance with the manufacturers'guidelines. Attached to this Certification is information(e.g.manufacturers'checklists)necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports,I have also attached a copy of the report; (check all that apply): ■ System set-up ■ Alarm History Report � WALTON Signature: {1JtitJk u ENGINEERING,INC. Technician 1 Cert#: Bruce N.Stewart!A31131 5249892-UT Date: jat)ua17'8, 2009 D2006 Walton Engineering,Inc.