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Chat9 ' l P.O. Box 13059 <br /> Sacramento, CA 95813-3059 <br /> l PrecisionTank Testing <br /> License No. 73CA 800=660-9443 <br /> 848 <br /> NEV 800-949-9443 <br /> (916) 927-1557 <br /> Fax: (916) 927-7345 <br /> MONITORING SYSTEM EQUIPMENT CERTIFICATION <br /> Date of Testing/Servicing: Facility Name: 4001 4114clHoielAIL T,%. <br /> Vte.Address: F .. F �rimtifi f�V City Ly Zip: qS. yo <br /> Fapility-Contact Person: Contact Phone No.: e <br /> Make/Model of MonitoringSystern(s): 'Rob,9A) X76 5 Location of Control Panel(s): i3t_cz> <br /> Make todel of Line Leak Detector(LLD): LLD Leak Threshold: g.p.m, <br /> r' ,system is operable per manufacturer's specifications? <br /> O <br /> f . ` °' w . is pper=at opal? <br /> is opetam'onal? <br /> yes ' [] oto. A4®nt e►ri :g systern is secured from unauthorized tampering? <br /> ❑' Yes ❑ No* For pressurized piping systems,do the turbines automatically shut do Am if the monitoring system detects a leak, <br /> 1A fails to operate,or is electrically disconnected? If yes,which monitoring devices initiate positive shut-down? <br /> ❑ Yes ❑ I:'o* For monitorin.g systems which serve as ta_--k overfill warning devices, does the overfill warning function operate <br /> Gr'9%p I properly? If so,at what percent of tank capacity does the alarm trigger? % <br /> In the comments sootion below,describe how and when these deficiencies will be corrected. <br /> qh#*. ',.ta q Palate b®res<to indicate specific equipment inspected,'serviced: <br /> Tank` `o.: Tank ID Isro.: Tank ID No.: Tank ID No.: <br /> uiar pace Sensor Q <br /> Annular pace Sensor Annular Space Sensor Annular Space Sensor <br /> iging Sump Sensor ❑ Piping Sump Sensor ❑ Piping Sump Sensor O Piping Sump Sensor <br /> ❑ In-Turk Gauging Probe ❑ In•Tank Gauging Probe O In-Task Gauging Probe ❑ in-Tani:Gaugin Probe <br /> a Dispenser Containment Senso(s) ❑ Dispenser Containment Sensors) ❑ Disperser Containment Sensor ) ❑ Dispenser Contunment Sensor(a) <br /> Q Mechanical Lint Leak Detector ❑ Mechanical Line Leak Detector ❑ Mechanical Line Leak Detector ❑ Ai-_ -1.1 ca!Line Leak Detector <br /> ❑ Electronic Line Leak Detector ❑ Electronic Line Leak Detector ❑ Dc=renic Line Leak Detector ❑ Electronic Line Leak Detector <br /> Cerl�rmcttts• <br /> I certify that the equipment identified abode was inspected/serviced in accordance with manufacturers' guidelines. Attached <br /> to this Certification is information (e.g. manufacturer's checklists, etc.) necessary to verify that the above information is <br /> eorvleet,and to deseribe any repairs,replacement,or recalibration of equipment <br /> TIMS IS N.OT A SIGNED,CERTIFIED COPY OF THIS REPORT&WILL NOT BE ACCEPTED <br /> Y S+ , - p :CTS A CERTIFIED COPY WITH TESTORS SIGNATURE WILL BE FORWARDED <br /> t <br />