COMPLIANCE INFO_2010 - 2012 - Laserfiche WebLink

Home Browse Search

Apr 27 ?2 12:24p Reliable PetroleurrA 209-845-8953 p.2 MONITORING SYSTEM CERTIFICATION For Ui e By gill Jurisdictions Within the State ofCalrfornra Authority Cited. apter 6.7.HealtJ:and Safety Code;Chapter 16,Dirisior,3, Title 23 Ca1t{ornia Code 6 ri?6gulatioes This form mast be used to ocument testing and servicing of monitoring e(uipmert. A arale mrtiEication or rc ort mu t be re tired f r each monitorings em co trot el by the technician-who performs the work. A copy of this fornt trust be provided to the tank stern owner/operator. The owner/operator must sul'mit a copy of this form to he local agency regulating UST systems within 30 days Ci test date. A. General Information 836'ity Name: Arco Site Address: 1711 E. osemite Ave. 31 dg. o.: City: Manteca Faciiily Contact Person: Sonnie Contact Phone No.: (209) 451 41 MakefModel of Monitorin System: Veeder Raot TLS-350 Date of.Testing,Se.rvicin : 3/2712012 B. Inventory of Eqa pmentTested/Certified Check thea ro riatr bores t igdicate s ecific a of anent iss ected/serviced: Tank ID: T1: 87 Tank ID: T2: 89 ®In-Tank Gacging Probe. Model: 847390-109 ® In-Tank Gauging Probe. Model; 8473 109 ®.Annular Sp„,•.-or Vauit Sens F. Meeet: 79439040q ®Ai Annular r Spwp,Tteneh Sensor } Model: 79438Q•323 0 Annular Spaca or Vault sensor. Model; 79439 Aog ®Fill Sum senso s;,. ®pipine Sump;Trench Sehsor(sj. Model: 794M -323 P Model: 794380-3,23 19 FAA Sump SensWs). Model: 7943 -323 Mechanical Line Leak Detect r. hfodel; Fl:STP MLD ®Mechanical Line Leak Detxto- Model- 991-0- 000 ❑ Electronic rine Leak Detecto Model; F-1 Electronic Linc Leak Detector. Model ❑yank Overfill!High-Level S nor. Model: ❑ Tank Overfill! C Other(specifyequipmcrt type d model in 5ecteon l un Pager)_ Iiigh Leve[Sensor. Model: ❑ Other(sp_cify equipment type and model in Section ort page 2). Tank ID: T3: 91 Tank ID: iZ In-Tank Gauging Prnbe. Model: 847390-109 ❑In-Tank Ceugittg probe. Model ®.4nrattar Spate or Vault 5enso kfodel: 794390-409 Q Annular Space or Vault Sensor. Model: ® i'ipi tg Sump/Trench Sensor(%). Model: 784380-323 ❑ Piping Sump,'Trench Semor;sl. Model; l$j Fill Sump Sensor(s) Model: 794384.323 ❑ Fill Sump SC MOF(S). Model: ®4ieehanical Line Leak Detecto , V4odzk: 991-0-2000 ❑ Mochanical Line Ieak Detect5r. Motk:l: ❑Electronic Linc Leak IXzeetor. Model: ❑Electronic Line Lcak Detccror. )1�odCl: 0 TartkOvzrfill f t{igtt-Leve]Senior tiloLcl: T [�Ctrher{specify equipment ❑Tank Overfill;High-Love]Sensor. 3elodol: P type and model in Section t;on Page 2). ❑Other(soeciih,equipment type ar,d model in Section Dispenser ID: 1&2 ER DispenserContsinmertt Senna Dispenser ID: 394 r{). Model: 794380-323 0 Dispenser Containment Scnsor(s). A4odet: 7943 323 13 Shtw valve(s). ®Shear Val�e(s). ©Dispen;crConlainmeru Floar(s)and Chain(s). (Dispenser Containment Float(s)andChaiti(st. .Dispenser ID: 58th j Dispenser ID: T&8 ®Dispenser Coutainmcns 5cnsor{ v(qL 794380J23 ®Sh=Valve{s). ® hear s«C(s). mmtSersoKs). 7.9odel: 79438 323 ❑DisprnserCtxt:ainment Flaat(s) Chair(s). ®Shear Valve(s). Q Dispenser Containment Floats)and Chain(s). Dispenser 1D: 9$10 ; 118r1 Dispenser ID: 'i3&14; 15&16 ®DispertserCbntainmerttSzttot(s. �1LLiel: 79438D,323 ®DispetwerContainment Sensor(s). 1lodcl: 79438 -323 ®Shear Valvefs}. ❑DispenserContainmcntFloa4s) Chair.fs). ®Shear Valve(s}, ❑Dispcnscr Containment Fioa4s)and Citairtfsl. *If the facility contains more tan s or dispensers,enpy this form_ Include information far every tank and dispznser at the facili C. Certification - I cc ify that the equipment identified in this document was iuspectedlserviced in ordance with the manufacturers' guideline' Attached to this Certification is information (e.g. tta2nufActurers' checklists) necess ry to verify that this information is correct an a Plot Plan showing the layout of maniforing egvi ntent For any equi trent capa of generating srch reports,f have also attach a copy of tic report-,(check art(kat apptv): System sed-tr p I�Alarm hi for r rt Technician Name(print): G aclalo a Sanchez Signature�/� Certification ldo.: A301313 'r License.No.: 883706 Testing Company-Name: Reliable Petroleum Services, Inc. Testing Company Address: 1 930 Horseshoe Rd.Oakdale, Ca.95381 phone No,:(209) 845-858 Date of TestinWServicin : 3/27/2012 j Page 1 of 4 Rev(2/08)