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COMPLIANCE INFO_2023
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231906
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COMPLIANCE INFO_2023
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Last modified
12/28/2023 11:26:19 AM
Creation date
1/10/2023 9:09:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0231906
PE
2361
FACILITY_ID
FA0003776
FACILITY_NAME
KWIK SERV LODI BW 113*
STREET_NUMBER
420
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06202042
CURRENT_STATUS
01
SITE_LOCATION
420 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\bmascaro
Tags
EHD - Public
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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 7. LINE LEAK DETECTOR TESTING <br /> f ❑ Check 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 /> ® 3 GPH ❑ 0.1 GPH [10.2 GPH <br /> Has the testing apparatus been properly calibrated? ® ❑ ❑ <br /> For emergency generator tank systems, does the LLD create an audible and visual ® ❑ 11alarm when a leak is detected? <br /> For mechanical LLDs, does the LLD restrict the flow through the pipe when a ® ❑ ❑ <br /> release is detected? <br /> For electronic LLDs, does the turbine automatically shut off when a release is <br /> CK <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 /> monitorings stem 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? ® ❑ ❑ <br /> Were all LLDs confirmed operational within regulatory requirements? ® ❑ ❑ <br /> LLD ID LLD Model Lines Monitored Pass Fail <br /> E MECHANICAL 87 ® ❑ <br /> MECHANICAL 91 ❑ <br /> MECHANICAL DSL ® ❑ <br /> MECHANICAL E85 X ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <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 />
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