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MONITIQ&ING SYSTEM CERTI*ATION <br /> CERTIFICATION / TEST DATE: Jul 27, 2009 <br /> Al. FACILITY A2. OWNER <br /> Name 7-Eleven Market#2368/Store#32190 Name 7-Eleven, Inc <br /> Address 4943 South State Route 99,Stockton,CA 95206 Address P.O. Box 711, Dallas,TX 75221 <br /> Phone# 209-939-0679 Phone# 805-523-2949 <br /> Contact Jay Stemley Contact Shane Partridge <br /> D. RESULTS OF TESTING /SERVICING <br /> Make/ Model of Monitoring System: Veeder-Root TLS-350 <br /> Software Version Installed: <br /> Complete the following checklist: <br /> ❑ Yes ❑ No. Is the audible alarm operational? <br /> ❑ Yes ❑ No Is the visual alarm operational? <br /> ❑ Yes ❑ No" Were all sensors visually Inspected,functionally tested,and confirmed operational? <br /> ❑ Yes ❑ No' Wereall Is <br /> installed at lowest point of secondary containment and positioned so that other equipment <br /> will not inWo re with their proper operation? <br /> ❑ Yes ❑ No If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modems) <br /> ❑ NIA operational? <br /> ❑ Yes ❑ NO' For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑ NIA monitoring system detects a leak,fails to operate,or is electrically disconnected? If yes:which sensors Initiate <br /> positive shutdown? (check all that apply) ❑ Sumprrrench sensors; ❑ Dispenser Containment Sensors. <br /> ❑ Yes ❑ No' Did you confirm positive shut-down due to leaks and sensor failure/disconnection? <br /> ❑ Yes ❑ No- For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no <br /> ❑ NIA mechanical overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank <br /> fill point(s)and operating properly? If so,at what percent of tank capacity does the alarm trigger? _% <br /> ❑ Yes• ❑ No Was any monitoring equipment replaced? If yes,Identify specific sensors,probes,or other equipment replaced <br /> and list the manufacturer name and model for all replacement parts in Section E,below. <br /> ❑ Yes• ❑ No Was any liquid found inside any secondary containment systems designed as dry systems? <br /> (Check all that apply) ❑ Product; ❑ Water. If yes,describe causes in Section E,below. <br /> ❑ Yes ❑ No Was monitoring system set-up reviewed to insure proper settings? Attach set-up reports,if applicable. <br /> ❑ Yes ❑ No- Is all monitoring equipment operational per manufacturer's specifications? <br /> In Section E below, describe how and when these deficiencies were or will be corrected. <br /> E. COMMENTS <br /> ©2006 Walton Engineering,Inc. <br /> Page 2 of 3 <br />