COMPLIANCE INFO_2010-2018 - Laserfiche WebLink

Home Browse Search

MONITORING SYSTEM CERTIFNATIOW """ MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 SEP 2 5 2014 CERTIFICATION /TEST DATE: September 11, 2014 Ai. FACILITY A2. OWNER ENVIHONMENTAL HEALT Name Teichert Mobile Equipment Name Teichert Construction DEPARTMENT Address 120 Frank Circle, Stockton, CA 95206 Address P.O. Box 15002, Sacramento, CA 95851 Phone # 916-366-8631 Phone # 916-386-3767 Contact Steve Schamaun Contact Steve Schamaun A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 1868 E. Hazelton Avenue, Stockton, CA 95202 Address P.O. Box 1025, W. Sacramento, CA 95691 Notified August 26, 2014 Tank #1 (Product): C-1 Diesel Lic # 617238 A, B, Haz Inspector Stacy Rivera Model: Contact Veronica Freltas Phone # 209-468-8257 Phone # 916-373-1166 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to Indicate equipment Inspected/serviced) B1: TANKS Tank #1 (Product): C-1 Diesel Tank #2 (Product): C-2 Gasoline - 87 ❑ In -Tank Gauging Probe Model: 0 in -Tank Gauging Probe Model: 0847390-109 Annular Space or Vault Sensor Model: 0794390-409 0 Annular Space or Vault Sensor Model: 0794390.409 Piping Sump / Trench Sensor(s) Model: 0794380-208 0 Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: ■ Electronic Line Leak Detector Model: 0848480-001 Electronic Line Leak Detector Model: 0848480-001 ❑ Tank Overfill / High -Level Sensor Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: 0 Other (specify equipment in Section E) Model: 0847390-109 Tank #3 (Product): WO -7 Used Oil Tank #4 (Product): Lub-30 30 Oil In -Tank Gauging Probe Model: 0847390-107 ❑ In -Tank Gauging Probe Model: Annular Space or Vault Sensor Model: 0794390.409 0 Annular Space or Vault Sensor Model: 0794390-420 ❑ Piping Sump / Trench Sensor(s) Model: ❑ Piping Sump / Trench Sensor(s) Model: Fill Sump Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ 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: 0847390-107 ❑ Other (specify equipment in Section E) Model: 132: DISPENSERS/UDC's Dispenser # : North Dispenser # : South Dispenser Containment Sensor(s) Model: 0794380-208 Dispenser Containment Sensor(s) Model: 0794380-208 Shear Valves Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : Dispenser # : ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chaln(s) ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : Dispenser # ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ 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 th 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 Q Q __ WALTON Signature: a� ENGINEERING, INC, Technician / Cert #: Jessie Wadklns / B35391 5307886 -UT Date: September 11, 2014