COMPLIANCE INFO_2006 - 2018 - Laserfiche WebLink

Home Browse Search

JUL/15/2009/WED 12:24 PM NuStar Energy STKN FAX No, 2099430653 P. 001/006 07/15/2008 10:58 FAX 20D 744 0118 _ 9 0003wo Appendix VI JUL 15 2009 MONITORING SYSTEM CERTIFICATIONSAN JOAOU IN COUNTY For Use By All Jurisdictions Within the State of California FfI\JIRONMENTAL Authority Cited:Chapter 6.7,Health and Safety Code,Chepter 16,DIVWon 3,i"itle 23,Cafiforni�y�q b A�TmENT Regulations This form most be used to doeumod Leong and servicing of monitoring equipment A separate c&-miication or report must be prepared for each monitoring system control panel by the technician who perfomw the work.A copy of this form must be provided to the tank system owr:er/operator.The owner/operator must submit a espy of this Corm to the Ied agency rtgu;ating UST systems within 30 days or test data, A, Generallnfonnation Facility Name: NU STAR ENERGY Bldg Na: Ste Address: _3505.NAW ST City: STOCKTON CA Zip: 2M-6 - Facility Contact Parson' DAN Contact Phone No.: 2 949-S6B2 MakelModsl of Monitoring System Date of Tastingl6ervlckag: 9M512009 „ B. Inventory of EquiprnentTesbad/Certfied Check the apeLonate boxes to IndI ate s eoific QCMjxunent I >i/serviced: Tank!D: WASTE OIL Tank ID: NA Q In-Tank Gauging Probe. Model: ❑ In-Tank Gauging Probe. Modal: Annular Spars or Vault Sensor. Model: EIS ❑AnnutarSpace OrVault Sensor. Model; M Piping sump!Trench Sensor(s). Model: LILS ❑ Plpfig Sump I Trench Senscr(s), Model: Q FIII Sumpsensor(s). model: ❑ Fm Sump ssnsor(s). Mocel: Q Mechanical Wria Leak Detector. Model. ❑ Mechanical Lne Leak DetWa, Model: ❑ ElaCMonie Line Leak Detector. Modal: ❑ Electronic Llne Leak DetectoT, Model: ®Tank Overfill I High-Level sensor, Model: his ❑ Tank overfill I High-Laval Sensor. Modal; ❑ Other(specify equipmern type and model in Section E on Page 2), 11 Oft>cr(spe*aqutprrreA type and model In Section E on Page 2). Yank ID: NA Tank 1p: NA 0 In-Tank Gauging Probe Model, ❑ In-Tank Gauging Probe. Model: ❑Annular Spada or Vault Sensor. Model: p Annular Space or Vault Sarnsor. Mode. ❑ Piping Sump/Trench Sensor(s). Model: ❑ Piping Sump/Trench Semor(s). Model ©Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ❑Memamm Line Les*Detector. Modal: ❑ Mechanical Une LWk Detector. Model: _ Q Electronic Line Leak Delarctor. Modol: 0 Electronic Line Leak Detector. Model: El'[Tank Overfill/High-Laval Sensor. Model: _ ❑ Teak Ovedlp/H1gh-Level Sensor, Madel; IU Other(specify equipment type and model In Section E an Page 2). ❑ Other(specify equipment type and model in Section E on Page 2), Dispenser ID: NA D"riser)D: NA 0 Drapenser Containment Sensor(s). Model: ❑ Dispenser Contanment Serf Ws). Model: Sreai-Valvew, ❑ 8hearvalve(sy ❑ Disperasr Containment Floafts)and Chain(s). [1 Dispenser Containment Floats)and Cnain(s)- Dispenser ID: NA Dispenser D: NA d DlsptnswCoavavvnentSensor(s). Mode. ❑ Dispenser Corrtaanmontsensor(s). Model: ❑ StaearWdva(s). q Shearvalvt(s). Q Dispenser Gantalrvnent Float(s)and Chain(a). ❑ Dispenser Conta'rxnent Road(a)end Chain(s). Diapefwr ID, NA Dispenser ID: NA ❑DlspensarCcnNinment ❑ Dispenser Contai rriMtSenevr(s). Model: Sensor(s). Mcdei: ❑ Shearvaiva(s). ❑Shear Vrilve(s). p Dispenser Containment Floats)and Chain(s), ❑Visperiser Containment Float(s)and Chain(s). `If tha facility contain*more tanks or dispensers,copy this form. Induda infomiwbn tot avary tank end dfspenser at fhe fft, C.Certification-(car*that the equipment identified in this document was inspectedlserviced in aaeordaraa with the manufacturers) guldaknoe.Attached to this Carfification Is Information(e-g.manufactulnrs'chackliste)necessary to verify that this information is correct and a Plot Plan showing the layout of mcn)toring equlpMant.For any equipment capable of generating such reports,I have also atfacnsd a copy ofthe report; ®System sot-up g Alarm history report Tedan clan Name(prints; David A.Winkler Sl4nmre, Certification No.; 34976 License Na OTT 08 t 38 Testing Company Name: As<FORDA- Phone No. _(209)744 of 13 Testln9 Company Address: 410 2 ST GALT CA 95532 Data of Tasting/uervwtng: Monitoring System CarFficatbn page f aro 2/21/07