COMPLIANCE INFO_2000-2007 - Laserfiche WebLink

Home Browse Search

MONITSRING SYSTEM CERTIWATION MAKE / MODEL OF MONITORING SYSTEM: Gilbarco EMC CERTIFICATION / TEST DATE: Auqust 21, 2007 A1. FACILITY INVENTORY OF EQUIPMENT TESTED/CERTIFIED A4. TESTING CONTRACTOR A2. OWNER San Joaquin County Environmental Health Name Miramar Enterprises Address Name Angle Enterprises Address 1605 S. EI Dorado Street, Stockton, CA 95206 August 9, 2007 Address 35584 Conavan Lane, Fremont, CA 94536 Phone # 209-245-4026 Contact Phone # 510-552-4822 Contact Balaji Angle 916-825-3203 Contact Balaji Angle A3. C U P A INVENTORY OF EQUIPMENT TESTED/CERTIFIED A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 600 E. Main Street, Stockton, CA 95202 Address P.O. Box 1025, W. Sacramento, CA 95691 Notified August 9, 2007 Lic # 617238 A, B, Haz Inspector Ray von Flue Contact Richard Walton Phone # 209-468-3439 Phone # 916-825-3203 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) B1: TANKS Tank #1 (Product): Gasoline -87 Tank #2 (Product): Gasoline -91 ■ In -Tank Gauging Probe Model: 0847390-109 ■ In -Tank Gauging Probe Model: 0847390-109 ■ Annular Space or Vault Sensor Model: 0794390-420 ❑ Annular Space or Vault Sensor Model: ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: Vaporless 99LD-2000 ■ Mechanical Line Leak Detector Model: Vaporless 99LD-2000 ❑ 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: Tank #4 (Product): Tank #3 (Product): ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump / Trench Sensor(s) Model: ❑ Piping Sump / Trench Sensor(s) Model: ❑ 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: ❑ 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: 0847990-001 ■ Dispenser Containment Sensor(s) Model: 0847990-001 ■ Shear Valves ■ Shear Valves ■ Dispenser Containment Float(s) and Chain(s) 0 Dispenser Containment Float(s) and Chain(s) Dispenser # : 5-6 Dispenser # : ■ Dispenser Containment Sensor(s) Model: 0847990-001 ❑ 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. I 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): ■ Svstem set-up ■ Alarm History Report WALTON Signature: �• ENGINEERING, INC. Technician / Cert #: Gerardo Guzman / 635394 5242481 -UT Date: August 21, 2007