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COMPLIANCE INFO_2019
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2300 - Underground Storage Tank Program
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PR0231784
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COMPLIANCE INFO_2019
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Last modified
6/28/2021 4:52:23 PM
Creation date
9/14/2020 11:36:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2019
RECORD_ID
PR0231784
PE
2361
FACILITY_ID
FA0003834
FACILITY_NAME
PACIFIC AVE CHEVRON
STREET_NUMBER
6633
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
097-410-48
CURRENT_STATUS
01
SITE_LOCATION
6633 PACIFIC AVE
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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UNDERGROUND STORAGE TANK <br />GPH = Gallons Per Hour, Y = Yes, N = No, NA = Not Applicable, VPH = VacuumlPressurelHydrostatic, ID = Identification <br />MONITORING SYSTEM CERTIFICATION FORM (Page 5 of <br />6) <br />Xil. LINE LEAK DETECTOR TESTING <br />❑ Check this box if line leak detectors (LLD) are NOT installed. (Do not complete this section.) <br />This section must be completed if LLDs are installed. <br />Y <br />N <br />NA <br />Was a leak simulated to verify LLD performance? <br />(Check all that apply.) Simulated leak rate verified: 0 3 GPH ❑ 0.1 GPH ❑ 0.2 GPH <br />Was the testing apparatus properly calibrated? <br />For emergency generator tank systems, does the LLD create an audible and visual alarm when a leak is detected? <br />For mechanical LLDs, does the LLD restrict the flow through the pipe when a leak is detected? <br />For electronic LLDs, does the turbine automatically shut off when a leak is detected? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test?❑X <br />For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? <br />Were all items on the equipment manufacturer's maintenance checklist completed?0 <br />Were all LLDs confirmed operational within regulatory requirements? <br />any answer of "N" above, describe in Section Xlll how and when these Issues were or will be corrected. <br />N <br />❑ <br />❑ <br />❑ <br />❑ <br />X <br />Q <br />0 <br />❑ <br />❑ <br />Q <br />❑ <br />El❑ <br />❑ <br />Q <br />❑ <br />❑ <br />❑ <br />El <br />XIII. COMMENTS <br />XIV. VACUUM / PRESSURE / HYDROSTATIC MONITORING EQUIPMENT <br />❑ Check this box if VPH monitoring is NOT used. (Do not complete this section.) <br />This section must be completed if VPH monitoring is used to perform leak detection monitoring. <br />TESTING <br />System Type (Mark all that apply.) ❑ Vacuum ❑ Pressure ❑ Hydrostatic <br />Sensor ID <br />Component(S) Monitored By This Sensor <br />Sensor Functionality <br />Test <br />Interstitial Communication <br />Test <br />❑ Pass <br />❑ <br />Fail <br />❑ Pass <br />❑ <br />Fail <br />❑ Pass <br />❑ <br />Fail <br />❑ <br />Pass <br />❑ <br />Fail <br />❑ Pass <br />❑ <br />Fail <br />❑ <br />Pass <br />❑ <br />Fail <br />❑ Pass <br />❑ <br />Fail <br />❑ <br />Pass <br />❑ <br />Fail <br />❑ Pass <br />❑ <br />Fail <br />❑ <br />Pass <br />❑ Fail <br />❑ Pass <br />❑ <br />Fail <br />❑ <br />Pass <br />❑ Fail <br />❑ Pass <br />❑ <br />Fail <br />❑ <br />Pass❑ <br />Fail <br />❑ Pass <br />❑ <br />Fail <br />❑ <br />Pass <br />❑ Fail <br />❑ Pass <br />❑ <br />Fail <br />[:]Pass <br />❑ Fail <br />❑ Pass <br />❑ <br />Fail <br />❑ <br />Pass <br />❑ Fail <br />❑ Pass <br />❑ <br />Fail <br />❑ <br />Pass <br />❑ Fail <br />El Pass ❑ <br />How was interstitial communication verified? F Simulated Leak at Far Ends of the Interstitial Space ❑ <br />❑ Other Describe the method in section XV below. ❑ <br />Was the vacuum or pressure restored to operating levels in all interstitial spaces? ❑ Yes ❑ No (Describe the reason <br />For any answer of "Fail' above, describe in Section XV how and when these issues were or will be corrected. <br />Fail ❑Pass ❑ Fail <br />Visual Inspection <br />Gauge <br />in section XV below.) <br />XV. COMMENTS <br />
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