COMPLIANCE INFO_2003-2009 - Laserfiche WebLink

Home Browse Search

MONI RING SYSTEM CERI6ICATION MAKE / MODEL OF MONITORING SYSTEM: Gilbarco EMC CERTIFICATION /TEST DATE: June 18, 2007 Al. FACILITY INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) 131: TANKS A2. OWNER A4. TESTING CONTRACTOR Name Quik Stop Market #124 Model: 0847390-109 Model: 0794390-409 Model: 0794380-208 Model: Model: Red Jacket FX Model: Model: Model: Name Quik Stop Markets, Inc. Address 505 N. Main Street, Manteca, CA 95336 Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 Phone # 510-657-8500 Contact Michael Karvelot Contact Michael Karvelot A3. C U P A INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) 131: TANKS A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Model: 0847390-109 Model: 0794390-409 Model: 0794380-208 Model: Model: Red Jacket FX Model: Model: Model: Name Walton Engineering, Inc. Address 600 E. Main Street, Stockton, CA 95202 Address P.O. Box 1025, W. Sacramento, CA 95691 Notified June 12, 2007 Lic # 617238 A, B, Haz Inspector Michelle Henry Contact Richard Walton Phone # 209-468-3439 Phone # 916-825-3203 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) 131: TANKS Tank #2 (Product): Gasoline - 87 ■ In -Tank Gauging Probe ■ Annular Space or Vault Sensor ■ Piping Sump / Trench Sensor(s) ❑ Fill Sump Sensor(s) ■ Mechanical Line Leak Detector ❑ Electronic Line Leak Detector ❑ Tank Overfill / High -Level Sensor ❑ Other (specify equipment in Section E) Model: 0847390-109 Model: 0794390-409 Model: 0794380-208 Model: Model: Red Jacket FX Model: Model: Model: Tank #1 (Product): Gasoline - 89 ■ In -Tank Gauging Probe Model: 0847390-109 ■ Annular Space or Vault Sensor Model: 0794390-409 ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: Vaporless 99LD-2000 ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: Tank #4 (Product): _ ❑ In -Tank Gauging Probe ❑ Annular Space or Vault Sensor ❑ Piping Sump / Trench Sensor(s) ❑ Fill Sump Sensor(s) ❑ Mechanical Line Leak Detector ❑ Electronic Line Leak Detector ❑ Tank Overfill / High -Level Sensor ❑ Other (specify equipment in Section E) Model: Model: Model: Model: Model: Model: Model: Model: Tank #3 (Product): Gasoline - 91 ■ In -Tank Gauging Probe Model: 0847390-109 ■ Annular Space or Vault Sensor Model: 0794390-409 ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: FE Petro STP -MLD ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: 132: DISPENSERS/UDC's Dispenser # : 3-4 ❑ Dispenser Containment Sensor(s) ■ Shear Valves ■ Dispenser Containment Float(s) and Chain(s) Model: Dispenser # : 1-2 ❑ Dispenser Containment Sensor(s) Model: ■ Shear Valves ■ Dispenser Containment Float(s) and Chain(s) Dispenser # ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ 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 �� ,�y,jM�,WALTON_ Signature: IJJK nCSC NGiNEC ING, MCs Technician / Cert #: Bruce N. Stewart / A31131 5249892 -UT Date: June 18, 2007