COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

.asc Environmental Management P.O. Box 5095 Pacific Region Room 3E000 San Ramon, CA 94583 UST & AST MONITOR CERTIFICATION FORM Site Location: PACIFIC BELL 7717 S. MCKINNLEY STOCKTON County: SAN JOAQUIN Make & Model of Monitor System(s): Serial # of Monitor System(s): Tank ID # Type of Tank: (Single Wall or Double Wall) UST or AST Tank Material (Composite, 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: Testing Date: Next Due Date: 08-03-01 Tank ID(s): 807 CLLC Code: SKTNCA14 Geo Parcel: UE -148 Site Contact: KATHY HALLIGAN Site Contact Phone #: 209-4744514 VEEDER ROOT TLS -350 70743727705001 Tank 1 Tank 2 Tank 3 Tank 4 807 DW -UST COMP DSL 2014 SUCTION DW Tank 1 Tank 2 Tank 3 Tank 4 Sensor Type (Float, Discrim, etc. YES PASS FLOAT YES PASS FLOAT Other Types (Sensors): i Compartmented Tank(s) Type of Overfill Protection (mechanical, electronic, ball float) Type of Spill Containment (Make & Model) FOR PRESSURE TYPE SYSTEMS ONLY ELECTRONIC AND MECHANICAL EMCO WHEATON 5 GALLON Tank 1 Tank 2 Tank 3 Tank 4 Is Mechanical Line Leak Detector Present & Tested?: Does the Turbine Shut -Down if System Detects a Leak?: Does Positive Shut Down Occur if Monitor System is turned off?: ALLSYSTEMS In -Tank Gauge Present Probe Type and Type of Leak Detection (Ex. .2 gph). YES MAG .2 Does the Monitoring System have Audible & Usual Alarms? YES Is the Monitoring System installed to prevent unauthorized tampering?: YES Is the Monitoring Devices operable as per manufacture's specifications? YES Testing Company: TAIT ENVIRONMENTAL SYSTEMS Date: 08-03-00 Technician: BRANDON HAM t Certified Tester(Pame Tester's ID #: 39-3435 ) t� (Signature)