COMPLIANCE INFO 2013-2015 - Laserfiche WebLink

Home Browse Search

• ' P.O.Box 4208 Ailtechfttr ' Sonora 370 Ca:623541 A-Haz Phone:209-5353 2-7-7320 Compliance without Compromise Fax:209-533-2650 mail@alltechpetro.com MONITORING SYSTEM CERTIFICATION www.alltechpetro.com A. General Information Facility Name: Costco # 038 Stockton Date of Testing/Servicing: October 1, 2013 Facility Address:1616 W. Hammer Lane, Stockton CA Facility Contact Person: Raj Mohan (Ser. Sta. Supervisor); Facility Phone: (209) 478-2040 LIA: San Joaquin Health; Inspector: Garrett BAckus; LIA Phone: (209) 468-3448; LIA Fax: Make/Model of Monitoring System: Veeder-Root TLS-350 B. Inventory of Equipment Tested/Certified: Tank ID:Unleaded 87A Tank 1 Tank ID:Unleaded 87B Tank 2 Nin-Tank Gauging Probe. Model: Mag 1 ®In-Tank Gauging Probe. Model: Mag 1 ®Tank Annular Space Sensor. Model: 794380-301 ®Tank Annular Space Sensor. Model: 794380-301 ®Piping Sump Sensor(s). Model:857080-112 ®Piping Sump Sensor(s). Model: 857080-112 ®Fill Sump Sensor(s). Model: 794380-323 ®Fill Sump Sensor(s). Model: 794380-323 ®Fill Sump Annular Sensor. Model: 794380-304 ®Fill Sump Annular Sensor. Model: 794380-304 ®Electronic Line Leak Detector. Model: PLLD ®Electronic Line Leak Detector. Model: PLLD NTank Overfill/High-Level Sensor. Model:V-R Audible ®Tank Overfill/High-Level Sensor. Model:V-R Audible ❑ Fillspill Bucket Tested: ❑Pass ❑Fail ❑ Fillspill Bucket Tested: []Pass ❑Fail N Fire extinguishers ins ected and tagged: NOK ❑Not OK N Fire extinguishers inspected and tagged: NOK❑Not OK Tank ID: Unleaded 91 Tank 3 Tank ID: Fuel Additive Tank 4 N In-Tank Gauging Probe. Model: Mag 1 Nin-Tank Gauging Probe. Model: Mag 1 ❑Annular Space Sensor. Model:794380-301 NTank Annular Space Sensor. Model: 794380-302 ❑Piping Sump Sensor(s). Model:857080-112 NPiping/Fill Sump Sensor(s). Model: 794380-323 ❑Fill Sump Sensor(s). Model: 794380-323 ❑Piping/Fill Sump Annular Sensor. Model: 794380-304 N Fill Sump Annular Sensor. Model: 794380-304 ❑Mechanical Line Leak Detector. Model: Fe Petro ❑Electronic Line Leak Detector. Model: PLLD NTank Overfill/High-Level Sensor. Model:V-R Audible NTank Overfill/High-Level Sensor. Model:V-R Audible N Fillspill Bucket Tested: ❑Pass ❑Fail ❑ Fillspill Bucket Tested: []Pass ❑Fail N Fire extinguishers inspected and tagged: NOK ❑Not OK N Fire extinguishers inspected and tagged: NOK ❑Not OK Dispenser ID: 1&2 N Sump:NDry❑Water❑Product Dispenser ID: 3&4 N Sump: ❑Dry❑Water❑Product ®Dispenser Containment Sensor(s). Model: 794380-208 ❑Dispenser Containment Sensor(s). Model:794380-208 ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) N Fire extinguisher inspected and tagged: NOK []Not OK N Fire extinguisher inspected and tagged: NOK ❑Not OK Dispenser ID: 5&6 N Sump: NDry[-]water❑Product Dispenser ID: 7&8 N Sump: NDry❑Water❑Product N Dispenser Containment Sensor(s). Model: 794380-208 ❑Dispenser Containment Sensor(s). Model: 794380-208 ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) N Fire extinguisher inspected and to ed: NOK E]Not OK N Fire extin uisher inspected and tagged: NOK ❑Not OK Dispenser ID: 9&10 N Sump: NDry❑Water❑Product Dispenser ID: 118,12 N Sump: NDry❑Water[]Product N Dispenser Containment Sensor(s). Model: 794380-208 ❑Dispenser Containment Sensor(s). Model: 794380-208 ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) N Fire extinguisher inspected and tagged: NOK [:]NotOK N Fire extinguisher inspected and tagged: NOK E]Not OK Dispenser ID:Vent Stack N Sump:NDry❑Water❑Product Dispenser ID:Adtiv Vent N Sump:NDry❑Water❑Product ®Sump Containment Sensor(s). Model: 794380-323 ❑Sump Containment Sensor(s). Model: 794380-323 ®Sump Annular Sensor(s). Model: 794380-304 ❑Sump Annular Sensor(s). Model: 794380-304 N Fire extinguisher inspected and tagged: NOK ❑Not OK N Fire extinguisher inspected and tagged: NOK ❑Not OK C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is 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; H System set-up ®Alarm history report Technician: Date: 10/1/13 Certification: Veeder-Root 836878, Level 4 ICC UST Service Technician # 8146912-UT