Laserfiche WebLink
CONTINUED: • • <br /> Tank ID: 87 Tank ID: DIESEL <br /> ® In-Tank Gauging Probe. Model: MAG ® In-Tank Gauging Probe. Model: MAG <br /> ® Annular Space or Vault Sensor. Model: HI LOW ® Annular Space or Vault Sensor. Model: HI LOW <br /> ® Piping Sump/Trench Sensor(s). Model: ULS ® Piping Sump/Trench Sensor(s). Model: ULS <br /> ❑ Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: <br /> ® Mechanical Line Leak Detector. Model: STP MLD ® Mechanical Line Leak Detector. Model: STP MLD-D <br /> ❑ Electronic Line Leak Detector. Model. ❑ Electronic Line Leak Detector. Model: <br /> ® Tank Overfill/High-Level Sensor. Model: FLAPPER ® Tank Overfill/High-Level Sensor. Model: FLAPPER <br /> ❑ Other(specify equipment type and model in Section E on Page 2). ❑ Other(specify equipment type and model in Section E on Page 2). <br /> TanklD: DIESEL2 TanklD: DIESELS <br /> ® In-Tank Gauging Probe. Model: MAG ® In-Tank Gauging Probe. Model: MAG <br /> ® Annular Space or Vault Sensor. Model: HI LOW ® Annular Space or Vault Sensor. Model: HI LOW <br /> ® Piping Sump/Trench Sensor(s). Model: ULS ® Piping Sump/Trench Sensor(s). Model: ULS <br /> ❑ Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: <br /> ® Mechanical Line Leak Detector. Model: 99 LD 200 ❑ Mechanical Line Leak Detector. Model: <br /> ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: <br /> ❑ Tank Overfill/High-Level Sensor. Model: ❑ Tank Overfill/High-Level Sensor. Model: <br /> ❑ Other(specify equipment type and model in Section E on Page 2). ❑ Other(specify equipment type and model in Section E on Page 2). <br /> Dispenser ID: 1-2 Dispenser ID: 3d <br /> ® Dispenser Containment Sensor(s). Model: ULS ® Dispenser Containment Sensor(s). Model: ULS <br /> ® Shearvalve(s). ® Shearvalve(s). <br /> ❑ Dispenser Containment Float(s)and Chain(s). ❑ Dispenser Containment Floats)and Chain(s). <br /> Dispenser ID: 5-6 Dispenser ID: <br /> ® Dispenser Containment Sensor(s). Model: ULS ❑ Dispenser Containment Sensor(s). Model: <br /> ® Shearvalve(s). ❑ ShearValve(s). <br /> ❑ Dispenser Containment Floats)and Chain(s). ❑ Dispenser Containment Floal(s)and Chain(s). <br /> Dispenser ID: Dispenser ID: <br /> ❑ Dispenser Containment <br /> ❑ Dispenser Containment Sensor(s). Model: Sensor(s). Model: <br /> ❑ Shear Valve(s). ❑Shear Valve(s). <br /> ❑ Dispenser Containment Float(s)and Chain(s). ❑ Dispenser Containment Float(s)and Chain(s). <br /> `If the facility contains more tanks or dispensers,copy this form. Include information for every tank and dispenser at the facility. <br /> C.Certification-I certify that the equipment Identified in this document was inspected/serviced in accordance with the manufacturers' <br /> guidelines.Attached to this Certification is information(e.g.manufacturers'checklists)necessary to verity that this information is correct <br /> and a Plot Plan showing the layout of monitoring equipment.For any equipment capable of generating such reports,l have also attached a <br /> copy of the report;(check all that apply): ❑System set-up ❑Alarm history report <br /> Technician Name(print): FELIX RAMIREZ Signature: <br /> Certification No.: 5273934-UT License No: 08-1740 <br /> Testing Company Name: AFFORDA-TEST Phone No. (209)744-0113 <br /> Testing Company Address: 416 2 STREET GALT CA 95532 Date of Testing/Servicing: 05-15-13 <br /> Monitoring System Certification Page 2 of 5 2/21107 <br />