COMPLIANCE INFO_2009-2011 - Laserfiche WebLink

Home Browse Search

Monitoring System Certification For Use By All Jurisdictions Within the State of California Authority Cited.,Chapter 6.7,Health and Safety Code;Chapter 16,Division 3, Title 23, Califamia Code of Regulations This form must be used to document testing and servicing of monitoring equipment.A separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work.A w of is o mus a pro i e an s s m er o era or.The owner opera r mus su mi a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility: BP Arco Address:3425 TRACY BLVDCi :TRCY Bid No: 02093 A FacilityContact Person:Victoria Garcia Contact Phone No:209-835-1605Zi : 953761722 Make/Model of Monitoring System:Veeder Root TLS 350 Service Date:01/09/2009 B. inventory of Equipment Tested/Certified Check the appropriate boxes to Indicate specific equipment Inspected/serviced: Tank ID:87 Main Tank ID:87 Slave ®In-Tank Gauging Probe Mode1:847390-107 In-Tank Gauging Probe ®Annular Space or Vault Sensor Model:847390-107 Model:794390-407 ®Annular Space or Vault Sensor Model:794390-407 ®Piping Sump!Trench Sensor(s) Model-794380-323 ®Piping Sump J Trench s Sensor ®Fill Sump Sensor(s) ( ) Mode1:794380-323 Mode1:794380-323 ®Fill Sump Sensor(s) Model:794380-323 ❑Mechanical Line Leak Detector Model: ❑Mechanical Line Leak Detector Model: ®Electronic Line Leak Detector Model:PLLD ®Electronic Line Leak Detector Model:PLLD ®Tank Overfill/High Level Sensor Model:790091-001 ®Tank Overfill/High Level Sensor Mode1:790091-001 ❑Other(Specify equipment type and model in Section E on Page 2) ❑Other(Specify equipment type and model in Section E on Page 2) Tank ID:87 Siphon Tank ID:91 ®€n-Tank Gauging Probe Mode1:846390-107 e ®In-Tank Gauging Probe Model:847390-107 ®Annular Space or Vault Sensor Model:794390.407 ®Annular space or Vault Sensor Model:794390-407 ®Piping Sump/Trench Sensor(s) Model:794380-323 ®Piping Sump/Trench Sensor(s) Model:794380-323 ®Fill Sump Sensor(s) Model:794380-323 ®Fill Sump Sensor(s) Model:794380-323 ❑Mechanical Line Leak Detector Model: ❑Mechanical Line Leak Detector Model: ❑Electronic Line Leak Detector Model: ®Electronic line Leak Detector Model:PLLD ®Tank Overfill/High Level Sensor Model:790091-001 ®Tank Overfill/High Level Sensor Model:790091-001 ❑Other(Specify equipment type and model In Section E on Page 2) ❑Other(Specify equipment type and model in Section E on Page 2) Dispenser ID: 1 &2 _ Dispenser ID: 5&6 ®Dispenser Containment Sensor(s) Model:794380-323 ®Dispenser Containment Sensor(s) Model:794380-323 ®Shear Valve(s) ®Shear Valve(s) ❑Dispenser Containment Float(s)and Chain(s) ❑Dispenser Containment Float(s)and Chain(s) Dispenser ID:3&4 Dispenser iD: 7&8 ®Dispenser Containment Sensors) Model:794380-323 ®Dispenser Containment Sensor(s) Model:794380-323 ®Shear Valve(s) Shear Valve(s) ❑Dispenser Containment Float(s)and Chain(s) ❑Dispenser Containment Float(s)and Chain(s) Dispenser ID: Dispenser ID: ❑Dispenser Containment Sensor(s) Model. ❑Dispenser Containment Sensor(s) Model: ❑Shear Valve(s) ❑Shear Valve(s) ❑Dispenser Containment Float(s)and Chain(s) ❑Dispenser Containment Float(s)and Chain(s) If the facility contains more tanks or dispensers,copy this form.Include information for every tank and dispenser at the facility. C.Certification-I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers guidelines.Attached to this Certification is Information(e.g.manufacturers'checklists)necessary to verify that this information Is correct and a Plot Plan showing the layout of monitoring equipment.For any equipment capable of generating such reports,I have also attached a copy of the report;(check all that apply): ®System set-u ®Alarm history report Technician Name(Print): Steve Graham Si nature: Certification No:A24322 License No:588098 Testing Company Name:TAIT ENVIRONMENTAL Phone No: (714)560-8222 SERVICES Paoe 1 of 4