Laserfiche WebLink
01/62/1995 03:27 2897546722 CALAVERAS ENV HEALTH PAGE 02 <br />_ �%Joaitortng Systcm Certiacatlon <br />Faculty N=c: � t llatc .,s i cstrtrg. jervet s±i$: <br />D_ Results of TesEIWServicing <br />9 ---Uta the 1r-Mnr4se. rhPArnat. <br />yes <br />0 No' <br />--------- - <br />Is the snonito ' s stem a atrooa! per rnanufacnuer's specifications? <br />N Yes <br />® Nos <br />Is the audible matin o tional? <br />ltd Yes <br />® No, <br />Is the vixual alarm o rional? <br />a Yes <br />Cl Noe <br />Were all rentor visually ins ted. tested_ and confirmed operational? <br />(a Yes <br />t1 Noe <br />Were all scasots std probes remstalled pLoerl <br />Yes <br />® No' <br />is all mouitonag equiproem secured from unauthorized rmg? <br />Q Yes <br />0 No" <br />If alarms are relsyed to a remote motutorMS station, is all cornraunicauons equipmcut (e -g. modem) <br />® N(A <br />operat OZW? <br />5 'Yes <br />Q No, <br />If needed by any monitoring equipment, are replacement fuses andlor batteries available? <br />iv:A <br />® Yes <br />l] No- <br />For gtiessuriied piping systcins, does the turbine automatically sbut down if the piping secoadasy containment <br />0 N/A <br />monitoring system detects a leak, fabs to operate, or is electrically disconnected? if yes; which sensors initiate <br />po3rtlVC 3hut-&WD7 (Check all that apply) C3 SumplTremb Sensors; ® Dispenser Containment Scasors. <br />Did you cortflrttl positive, shtu-down due to leaks ,ad sensor failurddisconaccuon? ® Yes; L) No. <br />C1 Yes <br />0 Aro• <br />For monitoring systems that also serve as tank overfill warning devices, is the overfill warning alarm, visible <br />® NWA <br />and audible at the tank fin point(s) and operating properly? If so. at what petcrnt of tattle capacity docs the <br />aiarttt tri ? % <br />0 Yes° <br />®No <br />Was any mouiroring cquipmear replaced? If ycs, ideattfy specific sensors, probes, or other equipment replaced <br />and list the manufacturer name and model for all r laccsnent puts in Section E boiow. <br />t'lt Xes <br />a No <br />Was Avy sy=m sofm-areupgraded? If yes. idem Lify, the new version attanber in Secrion F. b-la,a. <br />Q Yes' <br />& No <br />Was liquid found inside any secondary contaimrxnr systems? (Check all char apply) 0 Product; O Water- if <br />yaIdescribe carries in section E. below. <br />- in Section k, below, describe now anti wren inese aeticleAC.teS were or will, oc coraecreu_ <br />Page 3 of this Certification most be completed and attached only if one or more of the foRe- tsg conditions are met: l.) In - <br />tank gauging equipment is awed to perform leak detection manitertug; 2.) Line Ieak detectors arc installed an ptping systems: <br />3.) Completion is required by your local agency that regulates UST systems. <br />CALM -01 <br />Page 2 <br />OHn3M <br />Z ' d <br />2b69- T Sir ( 602) umo.ag a t i.aeo e96:60 60 62 ReW <br />