Laserfiche WebLink
10/06/2011 08:11 2099316743 waterloo Food Mart #0720 P.010/015 <br />Nov 04 10 07:33a Elite V Contactors 120946'-142 p.2 <br />Appendix VI <br />(Curries ur murriturilly SystenZ Certification form and U3T Monitoring Plot Pian avoiloblo at h�12-�/Avww-wsterboarde_ea_gov_) <br />I; - <br />MONITORING SYSTEM CERTIFICATION <br />For Use By All Jursdicaoas "hin Me State of Califamsa <br />rtuurvrrrj-uasvac: r✓naptLr-c..,� rt�tar ana c:.aror�- vwacg a:tsor�rpm� `ar ot,J i..r. s, rtr„ ss, c�,�.--..rte cti.�., ..,� <br />Regu atioRs <br />Thio f..rtn -0 b rrco.-f to tO flno and QArvi,ino of mnnitnrina w-priMPnt A c&ttarnte certification or rsoort roust be orenared for <br />eacti montodna system control panel by the technician who per omis the work. A copy of this form must be provided to the tank System <br />vr.••..ahN.%"'��r_ -rno mmoe•epuweor moot ovtxnh n Dopy or a�:o term to ahs Nowt .,�......�- ...a.. r..e:, ,y a.t94• .: y<b:-.... •.-a.:., on �r ., � :,r ...�.: I .er. <br />Osr.aral h:Ear,nO; o <br />Facility Natnec s Bt Y: g No-: <br />CdaA,,rw, 43eh V,fi _irh!T: K rIC'.tTlt.._L i.1.L_•C��if!1 J ZID: 5X6 <br />Jf A <br />Fnaillty Cont of P—_ f <br />/ % <br />- rti.nCSY.•t YT`.ro iUn - (�l�. <br />MakelModel of Menlorino Systems: <br />.... <br />Date of Testingrzwvidng: l lSGS1LS.— <br />Ch*f--k thea <br />Tank W: <br />Tank M: <br />! Irt-Tank Gwa"rcia Probe. <br />Mode -)Oct(3 <br />u iri-Tank Gdudria robe. <br />Model �6� 7 r %d! <br />C Annular Gr�&G6 *t Vaiult ta"14mr, <br />Model: <br />O Annular EPao+- or Vault P—ar. <br />Modok 'f - <br />r Frmina Sumo 1 Trenerl Serlsor(s), <br />Model: <br />C Piping Sumn !Trench Sensor►sl. <br />Model - <br />c: Fal Swap Ser+sor(s). <br />Mrdel: 1 <br />+3 Fits Sunk+ SPn (.c) <br />Mcxt~iI• - / -• <br />C Me&anirat kine Lead Detector. <br />model; <br />3 Medianica3 Line Leak Detector. <br />Motlat <br />74ank t"}var Faiigh�.eve� nsar <br />r_r„k� <br />Model. <br />, rr,,,....: .. t- r 1.f1—m., <br />lank Qvefiif % 1- ch Leval 59nsor_ <br />M�NnI• /.f .L <br />Model <br />C QthBr r ent arc4 model in Section E on PaQ0 2),3 <br />Cnttet ( ati mens a and model in Section r on P 2)_ <br />Tanir in. <br />Tank Irk. <br />- In-Tm* Gauging Pmbo_ <br />Model: <br />n In -Tank Gauging PrOL9. <br />Mow:._._ <br />ar.rrdnrgnry <br />AArvir+l,--,..___ <br />ii amtrilx Cn9r•o nr vsraf Satwtr <br />W.Hol• <br />= Pip)ng Sump / Trench Sentmr(a)- <br />Mcdet: <br />c Piping Sump / Trortch Senscr(a). <br />Modol: <br />i RU Sumo Senwrfsl_ <br />Model: - _ <br />! Pill Sumo Sensor(sl. <br />Model: _. <br />•�1� :J L• ._ L . _C <br />clecirortiC line l.93k Detector_ <br />Madel: <br />G E1ewonic Line Leak Detector_ <br />Model: <br />r Tnnk rk,erFBi / Wlofr l eA t Cenenr <br />M.xia!• <br />n T-1- /l—.4W / t-Gah.! rnacJ Ci nenr <br />iAnriel• <br />SRear VSIYe(Sy, ..., - <br />Shear Valv9(S). <br />-- -- - - -- - <br />C C)iSOB:1SBr Containment %1021 S) and Chan S). <br />v <br />] CFloatf51 and Crain(5 - <br />Dispenser 1D. <br />DispenserID: <br />�C C3LgxxmAr Containment Sensorls). <br />r <br />Mockab , <br />l Dispenser Containment Sensor(;)- <br />ModeL 2r <br />l4-�ri11.661•`n:-.yall <br />_ <br />- - - <br />Q. Cart fication - I certiry mal Me equiiru�lr idcrrditxt In ttgs document was mspectedfse"Icvd. Us accordarroe Wttti the manig2au/ferR' <br />_ _ •nr�. r.." -�- _�� ,F_ � �-..t :+rr-..e.�.t.... y..s�...... f--. �•.;� <br />�' <br />r._ .. .--'i -¢r-• -`----._�_._ <br />� <br />�1_�_�._....__'..�__...__ ._-.-.-- <br />T u'ti"r „'i�r..,,r � .. q,nr,.� ,!/ ...�lb:st 'I ti <br />r' .A...T.:� _ -. .:t•tvr.. <br />s4 •, _ :9>s.i�.� .:. . � :y/.:::: b - ;a i [7 • - - - - <br />Monitals,mg 5". om Csrtification <br />Page t of Q <br />12107 <br />1 2/21/07 <br />