COMPLIANCE INFO_2016 - 2018 - Laserfiche WebLink

Home Browse Search

MONITORING SYSTEM CERTIFICATION MAKE/ MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 MAY 3 1 2016 CERTIFICATION /TEST DATE: Ma 26, 2016 Al. FACILITY Name 7 -Eleven Market #2368/ Store #17647 A2. OWNER Name 7 -Eleven, Inc Address 1048 West Yosemite, Manteca, CA 95336 Address P.O. Box 711, Dallas, TX 75221 Phone# 209-239-2329 Phones 805-523-2949 Contact Stephen Boyd Contact Stephen Boyd A3. C U P A 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 May 23, 2016 Lic # 617238 A, B, Haz Inspector Elena Manzo Contact Veronica Freitas Phone # 209-468-3442 Phone # 916-373-1166 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to Indicate equipment inspected/servicech B1: TANKS Tank #1 (Product): Gasoline - 87 Tank #2 (Product); Gasoline - 91 ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: 0 Annular Space or Vault Sensor Model: 079439W W 0 Annular Space or Vault Sensor Model; 0791990409 ■ Piping Sump/ Trench Sensors) Model: 0794990.208 ■ Piping Sump / Trench Sensor(s) Model: 0794380.208 ❑ Fill Sump Sensoria) Model: ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ 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): _ Tank #4 (Product): ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump/ Trench Sensor(s) Model: ❑ Piping Sump/ Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensors) Model: ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: _ ❑ Electronic Line Leak Detector Model: ❑ 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: B2: DISPENSERS/UDC-8 Dispenser # : 1-2 Dispenser # : 3-4 0 Dispenser Containment Sensor(s) Model: 0791990-209 ■ Dispenser Containment Sensor(s) Model: 0794980-308 0 Shear Valves ll/ Shear Valves ❑ Dispenser Contelnment Float(s) and Chaln(s) ❑ Dispenser Containment Float(s) and Chaln(s) Dispenser # : Dispenser #: ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chaln(s) ❑ Dispenser Containment Floats) and Chaln(s) Dispenser # : Dispenser # : ❑ Dispenser Containment Sensoria) Model: ❑ Dispenser Containment Sensoria) Model: ❑ 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 InspecleNservlced in accordance with the manufacturers' guldellnes. 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 WALTOH_ ____ _ _. Signature: ENGINEERING, INC. Technician / Cert #: Jessie Watlkins / 835391 5307886 -UT Date: May 26, 2016