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COMPLIANCE INFO_2022
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0516526
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COMPLIANCE INFO_2022
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Last modified
2/15/2023 2:37:41 PM
Creation date
6/13/2022 10:29:34 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0516526
PE
2361
FACILITY_ID
FA0012659
FACILITY_NAME
LOVES COUNTRY STORES OF CALIFORNIA #223
STREET_NUMBER
1553
STREET_NAME
COLONY
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
24534024
CURRENT_STATUS
01
SITE_LOCATION
1553 COLONY RD
P_LOCATION
05
P_DISTRICT
005
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 7. LINE LEAK DETECTOR TESTING <br /> FMC-heck this box if line leak detectors ARE NOT installed. (Do not complete this section.) <br /> Simulated release rate verified: (Check all that apply.) Yes No NA <br /> 0 3 GPH © 0.1 GPH ® 0.2 GPH <br /> Has the testing apparatus been properly calibrated? 191 ❑ ❑ <br /> For emergency generator tank systems, does the LLD create an audible and visual El <br /> El <br /> alarm when a leak is detected? <br /> For mechanical LLDs, does the LLD restrict the flow through the pipe when a E <br /> release is detected? <br /> For electronic LLDs, does the turbine automatically shut off when a release is © 0 r <br /> detected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the ❑] <br /> monitoring system is disabled or disconnected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the <br /> monitoring system malfunctions or fails a tightness test? <br /> For electronic LLDs, have all accessible wiring connections been visually inspected ❑ ❑ <br /> 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? 0 ❑ <br /> LLD ID LLD Model Lines Monitored Pass Fail <br /> 87 99 LD 2000 87 LINE 0 Q <br /> 91 9 LD 2000 91 LINE ❑✓ <br /> DIESEL 9 LD 2000 DIESEL TRUCK 0 Q <br /> DIESEL 9 LD 2000 DIESEL AUTO ❑ <br /> © 0 <br /> ® 0 <br /> 0 <br /> © 0 <br /> 0 � <br /> Describe all answers marked "No"or "Fail"and proposed remedy in Section 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 4 of 6 <br />
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