Laserfiche WebLink
MONI RING SYSTEM CERT CATION <br />MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 <br />CERTIFICATION /TEST DATE: January7,2015 <br />Al. FACILITY <br />A2. OWNER <br />Name Tower Mart # 104 <br />dame Tower Energy Group, Inc. <br />Address 192 Lathrop Road, Lathrop, CA 95330 <br />Address 1983 West 190th Street, Torrance, CA 90504 <br />Phone # 209-8584998 <br />Phone # 916-285-7402 ext 100 <br />Contact Desiz Burns <br />Contact Mark Vasey <br />A3. C U P A <br />A4. TESTING CONTRACTOR <br />Name San Joaquin County Environmental Health <br />Name Walton Engineering, Inc. <br />Address 1868 E. Hazelton Avenue, Stockton, CA 95202 <br />Address P.O. Box 1025, W. Sacramento, CA 95691 <br />Notified Deecember 23, 2014 <br />Lic # 617238 A, B, Haz <br />Inspector Yes <br />Contact Veronica Freitas <br />Phone# 209-468-8257 <br />Phone# 916-373-1166 <br />B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (check the appropriate box" to indicate equipment lnspecteruservlced) <br />B1: TANKS <br />Tank #1 (Product): Gasoline - 87 -1 Tank #2 (Product): Gasoline -87-2 <br />❑ In -Tank Gauging Probe Model:❑ In -Tank Gauging Probe Model: <br />■ Annular Space or Vault Sensor Model: 0794390420 ■ Annular Space or Vault Sensor Model: 0794390420 <br />■ Piping Sump I Trench Sensor(s) Model: 0794380.208 ■ Piping Sump / Trench Sensor(s) Model: 0794380.208 <br />■ Fill Sump Sensor(s) Model: 0794380.208 '�■ Fill Sump Sensor(s) Model: 0794380-208 <br />❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: <br />■ Electronic Line Leak Detector Model: 0848480-001 ❑ Electronic Line Leak Detector Model: <br />❑ Tank Overfill i High -Level Sensor Model: ❑ Tank Overfill I High -Level Sensor Model: <br />L ❑ Other (specify equipment in Section E) Model: ` ❑ Other (specify equipment in Section E) Model <br />Tank #3 (Product): Gasoline - 91 <br />Tank #4 (Product): Diesel <br />❑ In -Tank Gauging Probe Model: <br />❑ In -Tank Gauging Probe Model: <br />■ Annular Space or Vault Sensor Model: 0794390420 <br />■ Annular Space or Vault Sensor Model: 0794390420 <br />■ Piping Sump I Trench Sensoria) Model: 0794380-208 <br />■ Piping Sump I Trench Sensor(s) Model: 0794380.208 <br />■ Fill Sump Sensor(s) Model: 0794380.208 <br />■ Fill Sump Sensor(s) Model: 0794380.208 <br />❑ Mechanical Line Leak Detector Model: <br />❑ Mechanical Line Leak Detector Model: <br />■ Electronic Line Leak Detector Model: 0848480-001 <br />■ Electronic Line Leak Detector Model: 0848480-001 <br />❑ Tank Overfill I High -Level Sensor Model: <br />III <br />❑ Tank Overfill I High -Level Sensor Model: <br />❑ Other (specify equipment in Section E) Modal: _- <br />❑ Other (specify equipment in Section E) Model: <br />812: DISPENSERS/UDC's <br />Dispenser # : 1-2 <br />Dispenser # : 3-4 <br />■ Dispenser Containment Sensor(s) Model: 0794380.208 <br />■ Dispenser Containment Sensor(s) Model: 079MO-208 <br />■ Shear Valves <br />■ Shear Valves <br />❑ Dispenser Containment Float(s) and Chains) <br />❑ Dispenser Containment Float(s) and Cham(s) <br />Dispenser#: 5-6 <br />Dispenser#: 7-8 <br />■ Dispenser Containment Sensoria) Model: 0794380-208 1 <br />■ Dispenser Containment Sensor(s) Model: 0784380.208 <br />■ Shear Valves <br />■ Shear Valves <br />❑ Dispenser Containment Float(s)-and Chain(s) -.- <br />❑ Dispenser Containment Float(s) and Chain(s) <br />_-. _._�, <br />Dispenser#-,. - 9-10 <br />Dispenser#: ---11-12 <br />■ Dispenser Containment Sensor(s) Model: 0794380-208 <br />■ Dispenser Containment Sensor(s) Model: 0794380.208 <br />■ Shear Valves <br />■ Shear Valves <br />❑ Dispenser Containment Float(s) and Chain(s) <br />❑ Dispenser Containment Float(s) and Cham(s) J <br />C. CERTIFICATION I certify that the equipment Identified in this document was inspected/serviced In accordance with the manufacturers' guldelines. <br />Attached to this Certification Is Information (e.g. manufacturers' checklists) necessary to verity that this information is correct and a Plot Plan showing the <br />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): <br />■ System set-up ■ Alarm History Report <br />�i WALTON <br />Signature: ➢ le a NG. TfHiiG. January 7, 2015 <br />:2 <br />Technician l Carl #: Thomas Steiger A3106018156310 Date: <br />261d W.11— ,.,,i,..en.,,. i.,. <br />