COMPLIANCE INFO_2018 - Laserfiche WebLink

Home Browse Search

y� UNDERGROUND STORAGE TANK OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT FORM (Page 1 of 1) Type of Action ❑ Installation Inspection ❑ Repair Inspection ®36 Month Inspection I. FACILITY INFORMATION CERS ID Date of Overfill Prevention Equipment Inspection 10642219 10/12/2018 Business Name(Same as Facility Name or DBA-Doing Business As.) Regional Transportation Center(Stockton RTD) Business Site Address City ZIP Code 2849 E. Myrtle St Stockton 95205 11. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Inspection(Print as shown on the ICC Certification.) Phone# Eric Mol card 209 367-4800 Ext. Contractor/Tank Tester License# ICC Certification# ICC Certification Expiration Date 774802 1 8881020 02/25/2019 Overfill Prevention Equipment Inspection Training and Certifications(List applicable certifications.) III. OVERFILL PREVENTION EQUIPMENT INSPECTION INFORMATION Inspection Method Used: ❑ Manufacturer Guidelines(Specify) ® Industry Code or Engineering Standard(Specify) PEI/RP1200-17 ❑ Engineered Method(Specify) Attach the inspection procedures and all documentation required to determine the results. #of Attached Pages: 11 Tank ID: (By tank number,stored product,etc.) T-1, 40k- Dsl T-2, 40k, Dsl T-3, 101k, Gas What is the tank inside diameter?(Inches) 120 120 92 Is the fill piping secondarily contained? ®Yes ❑ No ®Yes ❑ No ®Yes ❑ No ❑Yes ❑ No Is the vent piping secondarily contained? ®Yes ❑ No ®Yes ❑ No ®Yes ❑ No ❑ Yes ❑ No Veeder Root OPW Veeder Root Overfill Prevention Equipment Manufacturer(s) OPW Veeder Root OPW What is the overfill prevention equipment ® Shuts Off Flow ®Shuts Off Flow ®Shuts Off Flow ❑Shuts Off Flow response when activated? ❑ Restricts Flow ❑ Restricts Flow ❑ Restricts Flow ❑ Restricts Flow (Check all that apply.) ®AN Alarm 0 A Alarm 0 A Alarm ❑AN Alarm Are flow restrictors installed on vent piping? ❑Yes ® No ❑Yes El No ❑Yes ®No ❑Yes ❑ No At what level in the tank is the overfill prevention 106 106 80 set to activate?(Inches from bottom of tank.) What is the percent capacity of the tank at which 94 94 94 the overfill prevention equipment activates? Is the overfill prevention in proper operating ®Yes M Yes ®Yes ❑Yes condition to respond when the substance ❑ No ❑ No [01N o ElNo reaches the appropriate level? (Specify in section V.) (Specify in section V.) (Specify in section V.) (Specify in section V.) IV. SUMMARY OF INSPECTION RESULTS Overfill Prevention Inspection Results FF® Pass ❑ Fail ® Pass ❑ Fail I ® Pass ❑ Fail ❑ Pass Fail V. COMMENTS - .:.. All items marked"Fair'must be explained in this section. Any additional comments may also be provided here'- The following levels and percentages are for the testing with AN Alarm rocess� Tank 1: level = 100" and percent = 90% NOV 2 Tank 2: level = 100" and percent = 90% Tank 3: level = 77" and percent = 90% ENV is r,nnlnr'IPtT�'�L r' VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS INSPECTION I hereby certify that the overfill prevention equipment was inspected in accordance with California Code of Regulations,title 23,division 3, chapter 16,section 2637.2 and all the information contaip herein is accurate. UST Service Technician Signature 4 � If the facility has more compone an this f rm accommodates,additional copies of this page may be attached. CEPS=Cafifornia Environmental Reporting System ID=Identification,UST=Underground storage tank,ICC=International Code Council,AX=Audible and visual