COMPLIANCE INFO_2011-2016 - Laserfiche WebLink

Home Browse Search

MONITRING SYSTEM CERTI ATION MAKE / MODEL OF MONITORING SYSTEM: Gilbarco EMC CERTIFICATION /TEST DATE: December 6. 2012 Al. FACILITY Name Olympian # 427 Address 3300 Waterloo Road, Stockton, CA 95205 Phone # 530-885-0401 Contact Amanda Appelt A2. OWNER Name Flyers Energy LLC. Address 2360 Lindbergh Street, Auburn, CA 95602 Phone # 530-885-0401 Contact Amanda Appelt A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Tank #1 (Product): Gasoline - 87 Name Walton Engineering, Inc. Address 1868 E. Hazelton Avenue, Stockton, CA 95202 In -Tank Gauging Probe Address P.O. Box 1025, W. Sacramento, CA 95691 Notified November 27, 2012 ■ Lic # 617238 A, B, Haz Inspector Jeff Wong Model: 0794390420 Contact Dulcinea Covan Phone # 209-468-8257 Piping Sump / Trench Sensor(s) Phone # 916-373-1166 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (check the appropriate boxes to Indicate equipment inspected/serviced) 81 - TANKS B2: DISPENSERS1UDC's Dispenser # : 1 ❑ Dispenser Containment Sensor(s) Model: _ ■ Shear Valves ■ Dispenser Containment Float(s) and Chain(s) Dispenser ❑ ■ ■ Tank #1 (Product): Gasoline - 87 Tank #2 (Product): Red Diesel ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390-420 ■ Annular Space or Vault Sensor Model: 0794390420 ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ■ Piping Sump / Trench Sensor(s) Model: 0794380-205 ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: FE Petro STP -MLD ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Tank #3 (Product): Diesel Tank #4 (Product): _ ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390-420 ❑ Annular Space or Vault Sensor Model: ■ Piping Sump / Trench Sensor(s) Model: 0794380-205 ❑ Piping Sump / Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: B2: DISPENSERS1UDC'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 •'- . \ Wit WALTON Signature: oL 01 ENGINEERING, INC. Technician / Cert #: Jessie Wadkins / B36391 5307886 -UT Date: December 6, 2012 Dispenser # : 1 ❑ Dispenser Containment Sensor(s) Model: _ ■ Shear Valves ■ Dispenser Containment Float(s) and Chain(s) Dispenser ❑ ■ ■ # : 2 Dispenser Containment Sensor(s) Model: Shear Valves Dispenser Containment Float(s) and Chain(s) Dispenser # : 3-4 ❑ Dispenser Containment Sensor(s) Model: ■ Shear Valves ■ Dispenser Containment Float(s) and Chain(s) Dispenser ❑ ■ ■ # : 5 Dispenser Containment Sensor(s) Model: Shear Valves Dispenser Containment Float(s) and Chain(s) Dispenser # : 7 ❑ Dispenser Containment Sensor(s) Model: ■ Shear Valves ■ Dispenser Containment Float(s) and Chain(s) Dispenser # : 8 ❑ 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 •'- . \ Wit WALTON Signature: oL 01 ENGINEERING, INC. Technician / Cert #: Jessie Wadkins / B36391 5307886 -UT Date: December 6, 2012