Laserfiche WebLink
MONITC ING SYSTEM CERTIF 'ATION <br /> MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS-350 <br /> CERTIFICATION / TEST DATE: August 24, 2007 <br /> Al. FACILITY A2. OWNER <br /> Name 99 Shell Name Angle Enterprises <br /> Address 7700 Moreland Court, Stockton, CA 95212 Address 35584 Conavan Lane, Fremont,CA 94536 <br /> Phone# 209-245-4026 Phone# 510-552-4822 <br /> Contact Balaji Angle I Contact Balaji Angle <br /> A3. C U P A A4. TESTING CONTRACTOR <br /> Name San Joaquin County Environmental Health Name Walton Engineering, Inc. <br /> Address 600 E. Main Street,Stockton,CA 95202 Address P.O. Box 1025,W. Sacramento,CA 95691 <br /> Notified August 21, 2007 Lic# 617238 A, B, Haz <br /> Inspector Toua Yang Contact Richard Walton <br /> Phone# 209-468-3439 Phone# 916-825-3203 <br /> B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) <br /> 131: TANKS <br /> Tank#1 (Product): Gasoline-87 Tank#2 (Product): Gasoline-91 <br /> ■ In-Tank Gauging Probe Model: 0847390-109 ■ In-Tank Gauging Probe Model: 0847390-109 <br /> ■ Annular Space or Vault Sensor Model: 0794380-303 ■ Annular Space or Vault Sensor Model: 0794380303 <br /> ■ Piping Sump/Trench Sensor(s) Model: 0794380-208 ■ Piping Sump/Trench Sensor(s) Model: 0794380-208 <br /> ■ Fill Sump Sensor(s) Model: 0794380-208 ■ Fill Sump Sensor(s) Model: 0794380-208 <br /> ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: <br /> ■ Electronic Line Leak Detector Model: 0848480-001 ■ Electronic Line Leak Detector Model: 0848480-001 <br /> ❑ Tank Overfill I High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model: <br /> ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: <br /> Tank#3 (Product): Diesel Tank#4 (Product): <br /> ■ In-Tank Gauging Probe Model: 0847390-109 ❑ In-Tank Gauging Probe Model: <br /> ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: <br /> ■ Piping Sump/Trench Sensor(s) Model: 0794380-208 ❑ Piping Sump/Trench Sensor(s) Model: <br /> ■ Fill Sump Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: <br /> ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: <br /> ■ Electronic Line Leak Detector Model: 0848480-001 ❑ Electronic Line Leak Detector Model: <br /> ❑ Tank Overfill/High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model: <br /> ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: <br /> 62: DISPENSERS/UDC's <br /> Dispenser#: 1 -2 Dispenser#: 3 -4 <br /> ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Dispenser Containment Sensor(s) Model: 0794380-208 <br /> ■ Shear Valves ■ Shear Valves <br /> ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s) <br /> Dispenser#: 5-6 Dispenser#: 7 -8 <br /> ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Dispenser Containment Sensor(s) Model: 0794380-208 <br /> ■ Shear Valves ■ Shear Valves <br /> ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chaln(s) <br /> Dispenser#: Vent box Dispenser#: <br /> ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Dispenser Containment Sensors) Model: <br /> ❑ Shear Valves ❑ Shear Valves <br /> ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s) <br /> C. CERTIFICATION I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers'guidelines. <br /> Attached to this Certification is information(e.g.manufacturers'checklists)necessary to verify that this information is correct and a Plot Plan showing the <br /> 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): <br /> ❑ System set-up ■ Alarm History Report <br /> �� � WALTON ----- -- <br /> Signature: Lam- ENGINEERING,INC. <br /> Technician I Celt#: Gerardo Guzman /B35394 5242481-UT Date: Atiol,Ist 24. 2007 <br /> ©2006 Walton Engineering,Inc. <br />