Laserfiche WebLink
A. General Information <br />Facility Name: Hammer 1-5 Arco Date of Testing/Servicing: 05/07/15 <br />Facility Address: 3250 Hammer Lane, Stockton CA 95209 <br />Facility Contact Person: Wes Parkinson Contact Phone No.: 209-474-9125 <br />Regulatory agency: San Joaquin Health; Inspector: Stacy Rivera; Phone: 209-468-9847; Fax 209-468-3433 <br />Make/Model of Monitoring System: Veeder- Root TLS -350 <br />B. Inventory of Eauinment Tested/Certified: <br />Tank ID: 87A <br />Tank ID: 87B <br />®In -Tank Gauging Probe. Model: Mag 1 <br />®In -Tank Gauging Probe. Model: Mag 1 <br />®Annular Space or Vault Sensor. Model: 794390-409 <br />®Annular Space or Vault Sensor. Model: 794390-409 <br />®Piping Sump Sensor(s). Model: 794380-208 <br />®Piping Sump Sensor(s). Model: 794380-208 <br />❑Fill Sump Sensor(s). Model: NONE <br />❑Fill Sump Sensor(s). Model: NONE <br />®Mechanical Line Leak Detector. Model: Red Jacket <br />®Mechanical Line Leak Detector. Model: Shared <br />❑Electronic Line Leak Detector. Model: NONE <br />❑Electronic Line Leak Detector. Model: NONE <br />®Tank Overfill/ High -Level Sensor. Model: Drop Tube <br />®Tank Overfill / High -Level Sensor. Model: Drop Tube <br />® Fills ill buckets tested ®Pass ❑Fail <br />® Fills ill buckets tested ®Pass ❑Fail <br />Tank ID: 91 <br />Tank ID: <br />®In -Tank Gauging Probe. Model: Mag 1 <br />El In -Tank Gauging Probe. Model: <br />®Annular Space or Vault Sensor. Model: 794390-409 <br />❑Annular Space or Vault Sensor. Model: <br />®Piping Sump Sensor(s). Model: 794380-208 <br />El Piping Sump Sensor(s). Model: <br />❑Fill Sump Sensor(s). Model: NONE <br />❑Fill Sump Sensor(s). Model: <br />®Mechanical Line Leak Detector. Model: FE Petro <br />El Mechanical Line Leak Detector. Model: <br />El Electronic Line Leak Detector. Model: NONE <br />❑Electronic Line Leak Detector. Model: <br />®Tank Overfill / High -Level Sensor. Model: Drop Tube <br />❑Tank Overfill / High -Level Sensor. Model: <br />® Fillspill buckets tested ®Pass ❑Fail <br />❑ []Pass ❑Fail <br />Vapor Condensate Sump: ®Dry ❑Water ❑Product <br />Piping Transition Sump: ®Dry ❑Water []Product <br />® Sensor(s). Model: 794380-208` <br />® Sensor(s). Model: 794380-208 <br />® Vapor Pot Sensor(s). Model: 794380-420 <br />Dispenser ID: 1&2 ® Sump: ®Dry ❑Water❑Product <br />Dispenser ID: 3&4 E Sump: ®Dry ❑Water ❑Product <br />®Dispenser Containment Model: Float and Chain <br />®Dispenser Containment Model: FloatandChain <br />® Shear Valve(s) (Functional test) <br />® Shear Valve(s) (Functional test) ; <br />®Dispenser Containment Float(s) and Chain(s). <br />Dispenser Containment Float(s) and Chain(s). <br />Dispenser ID: 5&6 ® Sump: ®Dry ❑Water ❑Product <br />Dispenser ID: 7&8 ® Sump: ®Dry ❑Water ❑Product <br />® Dispenser Containment Model: Float and Chain <br />® Dispenser Containment Model: Float and Chain <br />®Shear Valve(s) (Functional test) <br />®Shear Valve(s) (Functional test) <br />®Dispenser Containment Float(s) and Chain(s). <br />®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 <br />manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to 'verify that this <br />information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such <br />reports, I have also attached a copy of the report; (check a// that app/y): ®„System set-up ® Alarm history report <br />�9 <br />Signature of Technician: Date: 05/07/15 <br />Certification: ICC UST Technician # 8146912 -UT <br />Veeder Root # 836878 Level 4 ISD <br />