COMPLIANCE INFO_1997-2012 - Laserfiche WebLink

Home Browse Search

e p y PETRO-T#HZI MONITORING SYSTEM CERTIFICRTION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code, Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. A stearate certification or report must be prepared for each monitoring Ustem control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: UNITED PARCEL SERVICE Date of Certification/Testing Services: 6!712007 Site Address: 1532 NORTH BROADWAY City/State: STOCKTON, CA Zip: 95205 Facility Contact Person: HE AN MEYER- PLANT ENGINEERING Contact Phone No.: (916) 373-4002 Make of Monitoring System: VEEDER-ROOT TLS -350 Model No.: 0847090-022 Serial No.: UNAVAILABLE B. Inventory of Equipment Tested/Certified *If the facility contains more tanks or dispensers, copy wis toren. mcmae mIormla ion w, cvcty uum MAA ulapa mow. — ...., --.- 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 the 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): i System set-up 0 Alarm history report Technician: Dan Zeman Signature Company Name: PE O-TECHZ Environmental Services Company Address: P.O. Box 1 Paradise CA 95967-2941 Company Phone and Fax No.: (530) 680-2905 Fax: (530) 872-8648 SWRCB Tank Tester License No.: # 98-1535 Veeder-Root Certification No.: # 006-05-1363 Exp.: 4/2008 ICC, CA UST Service Technician Certification No.: 5243781 -UT Date/Time of Certification Services:6/7/2007 aa, 2:00 nm Inspector Present (Name): Raj- S.J. Co. E.H.D.