COMPLIANCE INFO_2016 - 2018 - Laserfiche WebLink

Home Browse Search

I MONITORING SYSTEM CERTIFICATION IL " I " `'"I MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 JAN 0 4 2016 CERTIFICATION /TEST DATE: December 17, 2015 At. FACILITY NER HEALTH DEPARTMENT Name Colonial Energy #40135 Colonial Energy, LLC. Address 192 Lathrop Road, Lathrop, CA 95330 EAd,"I.7s 2860 N. Santiago Blvd. 2nd Floor, Orange, CA 92867 Phone# 209-858-4998 ❑ 714-761-5426 Contact Station Manager Victor Hassan Annular Space or Vault Sensor Model: 0794390-420 Dispenser Containment Sensor(s) Model: 0794380.208 A3. C U P A Model: A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 1868 E. Hazelton Avenue, Stockton, CA 95202 Address P.O. Box 1025, W. Sacramento, CA 95691 Notified 0 Lic # 617238 A, B, Haz Inspector Victoria McCarthney Contact Veronica Freitas Phone # 209.468.8257 Phone # 916-373-1166 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspecteNserviced) 61: TANKS Tank #1 (Product): Gasoline - 87-1 Dispenser # : 3-4 Tank #2 (Product): Gasoline - 87.2 Dispenser Containment Sensoria) Model: 0794380-208 ❑ In -Tank Gauging Probe Model: Shear Valves ❑ In -Tank Gauging Probe Model; ❑ Dispenser Containment Float(s) and Chain(s) Annular Space or Vault Sensor Model: 0794.190-420 M Annular Space or Vault Sensor Model: 0794390-420 Dispenser Containment Sensor(s) Model: 0794380.208 Piping Sump/ Trench Sensor(s) Model: 0799980.209 M Piping Sump/ Trench Sensor(s) Model: 0799994209 Shear Valves FIII Sump Sensor(s) Model: 6794986208 ❑ FIII Sump Sensoria) Model: 0799980.208 ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: Shear Valves Electronic Line Leak Detector Model: 0848484W7 ❑ Electronic Line Leak Detector Model: Dispenser Containment Float(s) and Chain(s) ❑ Tank Overfill / High -Level Sensor Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment In Section E) Model: Tank #3 (Product): Gasoline - 91 Tank #4 (Product): Diesel ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: Annular Space or Vault Sensor Model: 0794990.420 Annular Space or Vault Sensor Model: 0794390420 Piping Sump/ Trench Sensors) Model: 0791980.208 Piping Sump/ Trench Sensor(s) Model: 0794384208 FIII Sump Sensor(s) Model: 0794380.208 FIII Sump Sensor(s) Model: 0799984208 ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: Electronic Line Leak Detector Model: 08484804M Electronic Line Leak Detector Model: 0848/84001 ❑ Tank Overfill/High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment In Section E) Model: 02; Dispenser # : 1-2 Dispenser # : 3-4 E Dispenser Containment Sensoria) Model: 0794380-208 Dispenser Containment Sensor(s) Model: 0794380.208 Shear Valves Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chaln(s) Dispenser # : 5-6 Dispenser # : 7-8 E Dispenser Containment Sensor(s) Model: 0794380.208 Dispenser Containment Sensor(s) Model: 0794984208 Shear Valves Shear Valves ❑ Dispenser Containment Float(s) and Chaln(s) ❑ Dispenser Contalnment Float(s) and Chaln(s) Dispenser # : 9-10 Dispenser # : 11-12 Dispenser Containment Sensor(s) Model: 0794380408 Dispenser Contalnment Sensoria) Model: 079/884208 Shear Valves Shear Valves ❑ Dispenser Containment Floats) and Chaln(s) ❑ Dispenser Containment Float(s) and Chain(s) C. CERTIFICATION I certify that the equipment Identified In this document was Inspected/serviced 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 Plan showing th layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check all that apply ■ System set-up ■ Alarm History Report WALTON Signature: .�� Technician /Cert#: Jessie Wadkins I B353915307886 -UT Date: DecomhCf 172015