COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

MONIT(-LING SYSTEM CERTIF- "SATION MAKE / MODEL OF MONITORING SYSTEM: Veeder Root TLS-350 CERTIFICATION /TEST DATE: June 12, 2009 At. FACILITY A2. OWNER Name Circle K#2701205 Name Circle K Stores, Inc. Address 16470 Cambridge, Lathrop,CA 95330 Address 495 East Rincon St.,Ste 150,Corona,CA 92879 Phone# 209-858-4116 Phone# 951.270-5183 Contact Rex Abacan Contact Rex Abacan 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 June 8, 2009 Lie# 617238 A,B,Haz Inspector Michelle Henry Contact Richard Walton Phone# 209468-3439 Phone# 916-825-3203 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) B1: TANKS Tank#1 (Product): Gasoline-87 Tank#2 (Product): ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794380401 ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump/Trench Sensor(s) Model: ❑ Piping Sump/Trench Sensoria) Model: ❑ FIII 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/High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Others cl ( pe fy equipment In Section E) Model: Tank#3 (Product): Tank#4 (Product): _ ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump/Trench Sensor(s) Model: ❑ Piping Sump/Trench Sensoria) Model: ❑ FIII Sump Sensoria) Model: ❑ FIII 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/High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model: ❑ Other (specify equipment In Section E) Model: ❑ Other (specify equipment in Section E) Model; B2: DISPENSERS/UDC's Dispenser#: Dispenser# ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensors) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chaln(s) ❑ Dispenser Containment Float(s)and Chain(s) Dispenser#: Dispenser#: ❑ Dispenser Containment Sensoria) Model: ❑ Dispenser Containment Sensogs) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chaln(s) ❑ Dispenser Containment Float(s)and Chairl Dispenser#: Dispenser III: ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Motlel: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chaln(s) El Dispenser Containment Float(s)and Chain(s) 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 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: ENGINEERING,INC. Technician/Cert#: Gerardo Guzman I B35394 5242481-UT Date: June 12, 2009 2006 Walton Engineering,Inc.