COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

,-N SAVO Site Location: County: • Environmental Management Pacific Region 0 P.O. Box 5095 Room 3E000 San Ramon, CA 94583 UST S AST MONITOR CERTIFICATION FORM PACIFIC BELL 1812 COLEY AVENUE ESCALON SAN JOAQUIN Make & Model of Monitor System(s): Serial # of Monitor System(s): Tank 1D # Type of Tank: (Single Wall or Double Wall) UST or AST Tank Material (Composit, Fiberglass, etc.) Contents of Tank: Capacity of Tank: Type of Product Line: (Gravity, Suction, Pressure) Type of Piping: (Single Wall or Double Wall) ALL SYSTEMS Annular Space Sensor: Fill Sump Sensor: Piping Sump Sensor: Piping Trench Sensor: Dispenser Containment Sensor: Other Types (Sensors): Testing Date: Next Due Date: TanklD(S): 08-01-00 08-01-01 794 CLLC Code: ESCLCAI I Geo Parcel: UG -010 Site Contact: BRIAN BOOKMAN Site Contact Phone #: 209-472-3138 VEEDER ROOT TLS -2501 16144 Tank 1 Tank 2 Tank 3 Tank 4 794 DW -UST COMP DSL 500 SUCTION DW Tank 1 Tank 2 Tank 3 Tank 4 Sensor Type (Float, Discrim, etc. YES PASS FLOAT YES PASS FLOAT Compartmented Tank(s) Type of Overfill Protection (mechanical, electronic, ball float) ELECTRONIC Type of Spill Containment (Make & Model) 5 GALLON EBW FOR PRESSURE TYPE SYSTEMS ONLY Tank 1 Tank 2 Tank 3 Tank 4 Is Mechanical Line Leak Detector Present & Tested?: Does the Turbine Shut -Doom if System Detects a Leak?: Does Positive Shut Down Occur if Monitor System is turned off?: ALL SYSTEMS In -Tank Gauge Present Probe Type and Type of Leak Detection (Ex. .2 gph). Does the Monitoring System have Audible & Visual Alarms? Is the Monitoring System installed to prevent unauthorized tampering?: Is the Monitoring Devices operable as per manufacture's specifications? YES CAP.2 YES YES YES Testing Company: TAIT ENVIRONMENTAL SYSTEMS Date: 08-01-00 Technician: BRANDON HAM (Pri Name) t j Certified Testers ID #: 39-3435 �Wrv1 (Signature)