Laserfiche WebLink
v <br />Division of Keith A. Tallia, Inc. <br />STATE LICENSE No. 323417 <br />CLASSIFICATION: A-HAZ., C61D40 <br />STATE ENVIRONMENTAL ASSESSOR No. 01781 <br />Telephone: (209) 754-1808 <br />Fax: (209) 754-5726 <br />Post Office Box 950 <br />750 Industrial Way <br />SAN ANDREAS, CALIFORNIA 95249 <br />DISPENSER CONTAINMENT & MONITORING SURVEY <br />FACILITY NAME Norm's 76 <br />ADDRESS 633 E. Victor Rd., Lodi, CA 95240 <br />1)_ Is secondary containment present under all dispe <br />rs <br />(including satellite dispensers)? YES NO <br />(If the answer is NO to item 91, skip to the bottom of this <br />form.) <br />2). What type of material is the dispenser containment made <br />of? steel <br />Manufacturer Bravo <br />Model B-200 <br />3). If the dispenser containment is made of corrodib material, <br />is it catholically protected? YES NO <br />What method of corrosion protection? Insulating Coati <br />4). Is the dispenser containment continuously monitored <br />electronically or by a float mechanism in the bottom of the <br />secondary containment which trips the shear valve in e case <br />of a leak? YES NO <br />Manufacturer Bravo <br />Model B-200 <br />I James P Hesketh _ certify that I have completed <br />print name <br />this form to the best of my ability by way of physical inspection <br />of the dispenser containment areas. <br />Technician Signature <br />Technician Printed James P. Hesketh <br />Date 7/13/0Q <br />