COMPLIANCE INFO_2017-2018 - Laserfiche WebLink

Home Browse Search

Ah MONITORING SYSTEM CERTIFICA MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 017 4 ?017 CERTIFICATION /TEST DATE: June 9, 2017 A1. FACILITY Name Quik Stop Market #125 Address 1580 W. Main Street, Ripon, CA 95366 A2. OWNER �(�V ONMEN TAL HEALIH Name Quik Stop I ar�efs, �ncK r �, n Address 4567 Enterprise Street, Fre'Q ; Y► 5+463 Phone # 510-657-8500 Phone # 510-657-8500 Contact Roger Batra Contact Debbie Markovich 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 May 24, 2017 Lic # 617238 A, B, Haz Inspector Yes Contact Veronica Freitas Phone # 209-468-3442 Phone # 916-373-1166 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) B1: TANKS Tank #2 (Product): 91 Tank #1 (Product): 87 ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: • Annular Space or Vault Sensor Model: 0794390-409 M Annular Space or Vault Sensor Model: 0794390-409 • Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: 0 Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: E Mechanical Line Leak Detector Model: VMI 99LD-2000 0 Mechanical Line Leak Detector Model: Red Jacket FX ❑ 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: I ❑ Other (specify equipment in Section E) Model: Tank #4 (Product): Tank #3 (Product): Diesel ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: • Annular Space or Vault Sensor Model: 0794390.409 ❑ Annular Space or Vault Sensor Model: • Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ 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: 62: DISPENSERS/UDC's Dispenser # : 1-2 Dispenser # : 3-4 ❑ 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) Dispenser # : 5-6 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) 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 ! WALTON �JC�fj V� Signature: ENGINEERING, INC. Technician / Cert M Scott Beall / B46116 8319310 Date: June 9, 2017 v zuv wa¢on tngmeenng, mc.