Laserfiche WebLink
F11/02/1995 83:2/ 2091546722 CALAVERAS ENV,FEALTH PAaE 02 <br />,Mooilorins System Certification <br />Facility Name: �1t7 ►�� �✓( D.Itc Vi icstmgiaetvtctn 3 <br />D. Results of Testing(Servicing <br />!"n rnnt►e► the rflli-4- rh►r4eH.r- <br />Yes <br />D No` <br />Is the monitoring system o2erzuoful per manufacturer's speclf7can ns <br />Yes <br />O No' <br />Is the audible alarm o nonal?,21 _ — <br />Yes <br />❑ No' <br />13 the visual alarm aperntional? <br />Yes <br />D No' <br />Were all sensors visusily Las red, tested and confirmed o ranonal? <br />Yes <br />Q No' <br />Were all sensors and probes rcoasLallcd properly? <br />Yes <br />O No* <br />Is all mouitonnK c ur menu secured from unauthorized ring? <br />D Yes <br />❑ No" <br />_ <br />If alarms are relayed to a remote rnonitormg station, is all curnm=canons equipment (e.g modern) <br />NIA <br />operational? <br />R Ycs <br />❑ No` <br />If needed by any monitonng equipment, are replacement fuses and/or batteries avaiiable? <br />yr"cs <br />❑ No- <br />For pressurized prputg systems, does the turbine automatically shut down if the piping sccondzry conlainrntu <br />❑ NIA <br />monitoring system detects a Irak, falls to operate, or is ciecttically disconnected' If yes: which sensors initiate <br />positive slut -down? (Check all that apply)ump/Trencb Sensors; Z Dispenser Containment Se asors. <br />Did you confirm positive shut -down dac to& Mdscissor failure/disconnection? Ycs; O No. <br />❑ Yes <br />Q No' <br />For monitoring Systeme that also serve as tame overfill wattling deVrces, is ibe overfill wwuing alarm visibic <br />�d' N/A <br />and audible at the tank fill points) and operartog properly? If so. at what percent of tank capacity docs The <br />alarm to et? u�. <br />❑ Yes' <br />No <br />Was any monitoring equipmeot replaced? If yes, identify specific sensors, probes, or other equipment replaced <br />and list the manufacturer name and model for all replacement puts m Sccnoa E. below. <br />Q Yes <br />No <br />Was any system softwareupgraded? If es, identify the new version number m Secnon E. below <br />❑ Ycs• <br />No <br />Was Iigwd found inside any secondary conta==nt systems? (Check all char apply) D Product; O Water. it <br />describe causes in Section E. below. <br />In Section E below, describe how and when these deficiencies were or will be corrected_ <br />E. Commeuta- <br />Page 3 of this Certificadon trust be completed and attached or+ly if one or more of the following conditions are met: 1.) In - <br />tank gauging equipment Es used to perform leak detection monitoring; 2.) Linc leak detectors arc installed on pipine systems: <br />3.) Completion is rcquired by your local agency that regulates UST systems. <br />C LLSt o► Page 1 061231" <br />2'd 2i?E9-19.17 (602) urnoJE atuue0 e86:0T 60 TT unr <br />