COMPLIANCE INFO_2010 - Laserfiche WebLink

Home Browse Search

APR-30-2010 FRI 05: 43 PM P. 041 04/2B/2010 13:26 6613930 CHUCK HILL PAGE 02/07 MONITORINGSYSTETMCATIO or Use By All Jurkfiomr Within SCE ofCaftfornia Authority Ci cd'ChIPW$-7. Tfe,111h and WW Code;Chapter 16,DWslon 3, Fille 23,Calr&WW Crede OfRoplatiom This form must be used to doourim-vt testing and servicingmi riam M of monbi VIS equip? A t<taflt far cutch m by the technician who performe,the work. A copy of this lbrim must be proAded to the lank system Owncrloper=w. The ownedoperatar must submit a copy of this form to die local aMcy reptaLing UST$yVcrn,; within 30 dAYA of test date, A. General Imformation Facility Narne: _ Ttg2r Truck,91212 BI& L --No.: S1*Address: 3940 N_Tr&Cv-15Jvd city. ima -- — Zip: 953.04 Facility Contact Person: DebbieU-01a Contin Phone No.. X09-—9-8 3 2-S Q Q-16— MalcefModel Of Moviftoring System:_ Veeder-ftp_t_TLS 3SQ Dam of Te. 'cing. 4 QL0_10 B. JMventory of Egidpment TesteNCertiffed Check the a2EU2!kt_C b9=8 to Tan 1D.- Tanis IID: Q In-Tank Owging Probe. MOW: M In-Tank C-a-zing Probe. Model, 13 Annuiar Spam or Vault Sensor. Model- U Annular Space or Vault Senscm Me": D Piping Smp/Trench Scriscir(S)- Model- C1 Piping Sump 1'riench Smmr(s). Model: U Fill Sump Sema(s). mwcl. Q Ump Sm"s). Modef: 13 h4echmic&J Line Leak Deteator. Me"; Q Mectimical Line Lea DaWctor. Model' 3 F.1 is Line]Awk DetecMr. Madel: 13 Mectronic:Line Leak Detector. Model: 0 Tank Overfill I go-Level Senser. Model: 0 Tank Overfill!High-Level Senior. Model, 0 Otho ecify a qujpnx-ntiype and model in Section Bon F 2 Ll Other(Mecffl ent and mold in Section S LL an am a. Tank ID: Tank til.til. 13 fn-Tank Gziugmg Probe- Model: Ll In-1-MA 415raugfng Pwb� Model: 13 Annular Space or Vault Sensor. Model: 0 Annular Space or Vault Sansor. Madel: Cl Piping Sump f Dowh Sensor(s). Model- Ea Piping Surnp I Trench Sawr(4 Model. 0 Pill Sum sm"s). Model-. Q Fill Sixnp Smwor(z). Model: C2 Mcchanical Line lank Doinctor Modcl: U Mechanical Linc Leak Dcteaor Model: M Electronic LinaboakDelector- Model: C2 Electronic Unc Leak Detector- Model; M Tank Overfill 1 ffigh-Level Sensor; Model: Cl rant,Overfill I Iffigh-Lcvol Scuor. Model: 0 QdW(pm*equipmeni Mmatid model in Sactim I.on 0 Otho =a W2 4nd model in Section E on Pn-=4 Dispenser 111)----1_2 - 13A mptivier tv! 13- A U Dispenser Containment S"Wr(%). Model: 13 Dispcn=Contahuncut3cn.%o*). Model; a Shear Valve(s). 0 Show Valvc(4 -132�ggser ConvinmotF)QWand Chain(!). M OL12M Containment FloWs)and Chad- Dbpcnmr ID.- 14- 15A IV: J,5-=--16A C3 Dispenser coradnment Sensor(s). Model: 0 Di Ser 00ritainment Swsoc(s3 Model' 0 Shear valve(s). 13 sbear Valve(s). IR Ria� ,22U!!tmnentnDs and Chaina. go caviainment ldicWand Cw"Ks� Dispenser IID-—-16--17A pts n),... 17 - 18 Q DfSvmrq%� Model- M Disowim Containment Scrisar(s). MOW. 0 Shear valveW. td Shear VALVC(s). 0 DiF4=conw;n1erre Flow(s)and Chain(s) a cat Fleas)mid Chitin(S)- *1 F the facility contains more tanks.or dWcmmm copy Us jbm. rncludc information for zvcry tank and dispenser A the kcithy. C. Cordecation - i cartify that the upipment identined in thh dmmmerit w= inspected&mviced in accordanee with the maeofttax,eW gakleuncs6. 4tto4**4 to this Cereflettios is information(e g.;nzPvfWdurcW checkftb) necemiry to verify ftt tWrs informatim is correct and 2 Pkd P%n showing the tflaMot of monitoring equ"eat For any equipment capable of generaftg such repoM I have 2kve sftehad a copy of the report;(c*mk&V that opp&)-* 0 SYMM set-Zip 0 Alarm histairy ir"rit Technician Name(prlmt): y0tan Certification No.: --- -- ,A25577 Ucettst-- No.:880430 Testing Company NmT= 12130 5X=M2, LLQ Phone No.: 888-700-EPIC Testing Company AAlrem -11.0.121 Elgxhill Dr. _S14119-J-5-0-- Date QfTestinw5crvicinz: 010212019 U"36-IM Pa"104 Rev.PSAMI