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COMPLIANCE INFO_2009-2014
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231331
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COMPLIANCE INFO_2009-2014
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Last modified
1/4/2021 1:20:05 PM
Creation date
6/3/2020 9:44:05 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2009-2014
RECORD_ID
PR0231331
PE
2351
FACILITY_ID
FA0000513
FACILITY_NAME
LODI MEMORIAL HOSPITAL
STREET_NUMBER
975
Direction
S
STREET_NAME
FAIRMONT
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
03107039
CURRENT_STATUS
01
SITE_LOCATION
975 S FAIRMONT AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2351_PR0231331_975 S FAIRMONT_2009-2014.tif
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EHD - Public
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0 <br /> IV, <br /> m D <br /> D. Results of Testing/Servicing .« rE' <br /> Software Version installed: 130. <br /> NOV 10 2014 <br /> Complete the followingchecklist: <br /> ® Yes ❑ No' is the audible alarm operational? <br /> ® Yes ❑ No' is the visual alarm operational? L N °I H,U N 11A t?a"7(A. Ll H <br /> ® Yes ❑ No' Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> ® Yes [I No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment wi not`irite ere wi(h eir proper <br /> operation? <br /> ❑ Yes ❑ No' if alarms are relayed to a remote monitoring station,is all communications equipment(e.g.,modem)operational? <br /> 0 N/A <br /> ❑ Yes ® No" For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, <br /> ❑ N/A fails to operate, or is electrically disconnected? If yes:which sensors initiate positive shut-down? (Check all that apply) ❑ Sump/Trench <br /> Sensors; ❑Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑Yes; ❑No. <br /> ® Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.,no mechanical overfill prevention valve is <br /> ❑ N/A installed),is the overfill warning alarm visible and audible at the tank fill point(s)and operating properly? If so,at what percent of tank capacity <br /> does the alarm trigger? 90% <br /> ❑ Yes ® No Was any monitoring equipment replaced? If yes,identify specific sensors,probes,or other equipment replaced and list the manufacturer name <br /> and model for all replacement parts in Section E,below. <br /> []Yes* ® No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) <br /> ❑Product; ❑Water. If yes,describe causes in Section E,below. <br /> ® Yes ❑ No` Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports,if applicable <br /> ® Yes ❑ No` Is all monitoring equipment operational per manufacturer's specifications? <br /> •In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> Monitoring System Certification Page 2 of 4 2/21/07 <br />
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