COMPLIANCE INFO 1994-2010 - Laserfiche WebLink

Home Browse Search

Jan 23 06 08:13p Mille Dotten 209-533-2650 p.l • it c 17759 Buttercup Circle, Sonora, CA 95370 LanPhone: 209-532-7320; Fax: 209-333-2650 California Contractor 623541 A-Haz alltech@getrocket.com MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Madsen's Sunrise Dairy Date of Testing/Servicing: January 6, 2006 Facility Address: 239 S. Stockton St., Ripon CA 95358 Facility Contact Person: Bob Madsen Contact Phone No. Make/Model of Monitoring System: Incon 1000 B Inventory of Equipment Tested/Certified: 599-3041 Tank ID: Regular Compartment Tank ID: Premium Compartment ❑ In -Tank Gauging Probe. Model: None ❑ in -Tank Gauging Probe. Model: None ® Annular Space or Vault Sensor. Model: Optical sensor ® Annular Space or Vault Sensor. Model: Shared w/ 87 ❑ Piping Sump / Trench Sensor(s). Model: None ❑ Piping Sump / Trench Sensor(s). Model: None ❑ Fill Sump Sensor(s). Model: None ❑ Fill Sump Sensor(s). Model: None ❑ Mechanical Line Leak Detector. Model: None ❑ Mechanical Line Leak Detector. Model: None ❑ Electronic Line Leak Detector. Model: None ❑ Electronic Line Leak Detector. Model: None ® Tank Overfill / High -Level Sensor. Model: Drop Tubes ® Tank Overfill / High -Level Sensor. Model: Drop Tube ❑ Other ❑ Other Tank ID: Diesel Compartment Tank ID: ❑ In -Tank Gauging Probe. Model: None ❑ In -Tank Gauging Probe. Model: ® Annular Space or Vault Sensor. Model: Shared w/ 87 ❑ Annular Space or Vault Sensor. Model: ❑ Piping Sump / Trench Sensor(s). Model: None ❑ Piping Sump / Trench Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: None ❑ Fill Sump Sensor(s). Model: ❑ Mechanical Line Leak Detector. Model: None ❑ Mechanical Line Leak Detector. Model ❑ Electronic Line Leak Detector. Model: None ❑ Electronic Line Leak Detector. Model: N Tank Overfill/ High -Level Sensor. Model: Drop Tube ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other ❑ Other - Dispenser ID: 1 ® Sump: ®Dry ❑Water ❑Product Dispenser ID: 2 ® Sump: ®Dry ❑ Water ❑Product N Dispenser Containment Sensor(s). Model: Float Switch N Dispenser Containment Sensor(s). Model: Float Sw. ❑ Shear Valve(s) (Functional test) ❑ Shear Valve(s) (Functional test) ❑ Dispenser Containment Floats and Chain(s). ❑ Dispenser Containment Floats and Chain(s). Dispenser ID: 3 N Sump: ®Dry [:]Water ❑Product Dispenser ID: ❑ Stump: ❑Dry []Water ❑Product ® Dispenser Containment Sensor(s). Model: Float Sw. ❑ Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s) (Functional test) ❑ Shear Valve(s) (Functional test) ❑ Dispenser Containment Float(s) and Chain(s). ❑ Dispenser Containment Float(s) and Chain s). Dispenser ID: ❑ Sump: ❑Dry ❑ Water ❑Product Dispenser ID: ❑ Sump: ❑Dry ❑ Water ❑Product ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Scnsor(s). Model: ❑ Shear Valvc(s) (Functional test) ❑ Shear Valve(s) (Functional test) ❑ Dispenser Containment Floats and Chain(s). ❑ Dis nser Containment Floats and Chain(s). C. Certification - 1 certify that the equipment identified in this document was inspected/aervieed in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Pian showing the layout of monitoring equipment. For any equipment capable of generating such reports, 1 have also attached a copy of the r port; (check p!/ that apptr): ❑ System set-up ❑ Alarm history report Technician: 11K6 9e,Z`6 Certification: Incon: Level 3; 030822980 Mike Dotten, California Contractor License. No.: 623541 LCC UST Technician cert# 5259412 UT Page 1 of 3 03101