COMPLIANCE INFO 2004 - 2011 - Laserfiche WebLink

Home Browse Search

Jun 11 04 12:56a Mik- Dotten (209) 533-2650 P.1 17759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320; Fax: 209-533-2650 California Contractor 623541 A-Haz aRtech@getrocket.com MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Village West Marina Date of Testing/Senicing: June 8, 2004 Facility Address: 6649 Embarcadero Drive, Stockton CA 95217 Facility Contact Person: Mike Spence Contact Phone No.: 209-951-1551 Regulatory agency: San Joaquin Health; Inspector: Michelle Le ; Phone: 468-9847; Fax 468-3433. Make/Model of Monitoring System: Veeder-Root TLS 350i This test report is e: ® Preliminary Report (Unresolved Issues Exist) or a: ❑ Final Report (Facility was observed to be in Compliance) 3. Invents of E ui ment Tested/Certified: Tank ID: Regular Tank Tank ID: Diesel Tank ❑ In -Tank Gauging Probe. Model: None ❑ In -Tank Gauging Probe. Model: None ® Annular Space or Vault Sensor. Model: Float Switch ® Annular Space or Vault Sensor. Model: Float Switch ® Piping Sump / Trench Sensor(s). Model: Float Switch ® Piping Sump / Trench Sensor(s). Model: Float Switch ❑ Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ® Mechanical Line Leak Detector. Model: Red Jacket Diaph. ® Mechanical Line Leak Detector. Model: Red Jacket Diaph. ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ® Tank Overfill / High -Level Sensor. Model: Drop Tube ® Tank Overfill / High -Level Sensor. Model: Drop Tube ❑ Other ❑ Other Tank ID: Tank 1D: ❑ 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 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 Leal: Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill 1 High -Level Sensor. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other ❑ Other Dispenser ID: 1 ® Sump: ®Dry ❑Water ❑Product I Dispenser ID: 2 ® Sump: ®Dry ❑Water ❑Product ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model: ® Shear Valve(s) (Functional test) ® Shear Valve(s) (Functional test) ® Dis ser Containment Floats and Chain(s). ® Dis enser Containment Float(s) and Chains . Dispenser ID: 3 ® Sump: ®Dry ❑Water ❑Product Dispenser ID: ❑ Sump: ❑Dry []Water [-]Product ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model: ® Shear Valve(s) (Functional test) ❑ Shear Valve(s) (Functional test) ® Dis rser Containment Floats and Chain(s). ❑ Dispenser Containment Floats and Chains). Dispenser ID: ❑ Sump: []Dry ❑Water ❑Product Dispenser ID: ❑ Sump: ❑Dry []Water ❑Product ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s) (Functional test) ❑ Shear Valve(s) (Functional test) ❑ Di ser Containment Floats and Chain(s). ❑ Dispenser Containment Floa 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 Technician: Certification: Veeder-Root: 341-32-6743; Level 4. Mike Dotten, California Contractor License. No.: 623541 Page t of 3 03/01