Laserfiche WebLink
C. Certification- I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' <br />guidelines. Attached to this Certification is a Plot Plan showing the layout of monitoring equipment. For any equipment capable of <br />generating such reports, I have also attached a copy of the report; ® System set-up E] Alarm history report <br />Technicia <br />Certification: Veeder-Root: B36877 Level 4 <br />ICC Cert: 815215 -UT <br />8/30/12 <br />P.D. Bax 4208 <br />Sonnra CA c)S370 <br />AlitechPetr" B- <br />Ca: 623541 A -H,%7 <br />Phone: 2C 9-53 2-73 2 a <br />compliance, without Compromise <br />Fox: 249-533-2510 <br />ma IQalt-:AchpP.ttrc.com <br />vj,,fjtay.alt chpetrc.cam <br />MONITORING SYSTEM CERTIFICATION <br />A. General Information <br />Facility Name: Arco #5450 Date of Testing/Servicing: August 30, 2012 <br />Facility Address:1617 W. Fremont St., Stockton CA 95203 <br />Facility Contact Person: Karen Facility Phone: <br />209-462-1617 <br />LIA: San Joaquin County EHD;Inspector:Stacy Rivera;LIA Phone: ; LIA Fax: <br />Make/Model of Monitoring System: Veeder-Root TLS -350 LIA email; srivera@sjcehd.com <br />B. Inventory of Equipment Tested/Certified: <br />Tank ID: T1 Regular Master <br />Tank ID: T2 Regular Syphon <br />® In -Tan k Gauging Probe. Model: Mag 1 <br />®In -Tank Gauging Probe. Model: Mag 1 <br />®Annular Space Sensor. Model: 794380-409 <br />®Annular Space Sensor. Model: 794380-409 <br />®Piping Sump Sensor(s). Model: 794380-323 <br />®Piping Sump Sensor(s). Model: 794380-323 <br />®Fill Sump Sensor(s). Model: 794380-323 <br />®Fill Sump Sensor(s). Model: 794380-323 <br />®Electronic Line Leak Detector. Model: V -R PLLD <br />❑ Line Leak Detector. Model: <br />®Tank Overfill/ High -Level Sensor. Model: V -R Audible <br />®Tank Overfill / High -Level Sensor. Model: V -R Audible <br />® fills ill Bucket Tested: ®Pass ❑Fail <br />® Fills ill Bucket Tested: ❑Pass ®Fail <br />Tank ID: T3 Premium Tank <br />Tank ID: <br />® In -Tank Gauging Probe. Model: Mag Plus <br />❑ In -Tank Gauging Probe. Model: <br />®Annular Space Sensor. Model: 794380-409 <br />❑Annular Space Sensor. Model: <br />®Piping Sump Sensor(s). Model: 794380-323 <br />❑Piping Sump Sensor(s). Model: <br />®Fill Sump Sensor(s). Model: 794380-323 <br />El Fill Sump Sensor(s). Model: <br />®Electronic Line Leak Detector. Model: V -R PLLD <br />❑ Line Leak Detector. Model: <br />®Tank Overfill / High -Level Sensor. Model: V -R Audible <br />❑Tank Overfill/ High -Level Sensor. Model: <br />® Fillspill Bucket Tested: ®Pass ❑Fail <br />❑ Fillspill Bucket Tested: ❑Pass ❑Fail <br />Dispenser ID: 1&2 ® Sump: ®Dry ❑Water [—]Product <br />Dispenser ID: 3&4 N Sump` ®Dry ❑Water ❑Product <br />® Dispenser Containment Sensor(s). Model: 794380-323 <br />®,Dispenser Containment Sensor(s). Model: 794380-323 <br />® Shear Valves Functional test <br />®Shear Valves Functional test <br />Dispenser ID: 5&6 ® Sump: ®Dry ❑Water []Product <br />Dispenser ID: 7&8 Z Sump: NDry ❑Water ❑Product <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />® Shear Valve(s) (Functional test) <br />1 ® Shear Valve(s) (Functional test) <br />C. Certification- I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' <br />guidelines. Attached to this Certification is a Plot Plan showing the layout of monitoring equipment. For any equipment capable of <br />generating such reports, I have also attached a copy of the report; ® System set-up E] Alarm history report <br />Technicia <br />Certification: Veeder-Root: B36877 Level 4 <br />ICC Cert: 815215 -UT <br />8/30/12 <br />