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�1 <br />U Emironmer1tal Management P.O. Box 5095 <br />Pacific Region Room 3E909 <br />San Ramon, CA 94583 <br />Testing Date: 08-04-00 <br />Next Due Date: 08-04-01 <br />Site Location: PACIFIC BELL Tank ID(s): 795 <br />124 W. ELM STREET <br />LODI <br />County: SAN JOAQUIN <br />Make & Model of Monitor System(s): <br />Serial # of Monitor System(s): <br />Tank ID # <br />Type of Tank: (Single Wall or Double Wall) UST or AST <br />Tank Material (Composit, Fiberglass, etc.) <br />Contents of Tank: <br />Capacity of Tank: <br />Type of Product Line: (Gravity, Suction, Pressure) <br />Type of Piping: (Single Wall or Double Wall) <br />ALL SYSTEMS <br />Annular Space Sensor: <br />Fill Sump Sensor: <br />Piping Sump Sensor: <br />Piping Trench Sensor: <br />Dispenser Containment Sensor: <br />CLLC Code: <br />Geo Parcel: <br />Site Contact: <br />Site Contact Phone #: <br />VEEDER ROOT TLS -2501 <br />LODICA01 <br />UE -020 <br />KATHY HALLIGAN <br />209-4744514 <br />Tank 1 Jank 2 Tank 3 Tank 4 Sensor Type <br />Float, Discrim, etc. <br />YES PASS FLOAT <br />YES PASS FLOAT <br />YES PASS IFLOAT <br />Other Types (Sensors): Compartmented Tank(s) <br />Type of Overfill Protection (mechanical, electronic, ball float) <br />Type of Spill Containment (Make & Model) <br />FOR PRESSURE TYPE SYSTEMS ONLY <br />Is Mechanical Line Leak Detector Present & Tested?: <br />Does the Turbine Shut -Down if System Detects a Leak?: <br />Does Positive Shut Down Occur if Monitor System is turned off?: <br />ALL SYSTEMS <br />In -Tank Gauge Present Probe Type and Type of Leak Detection (Ex. .2 gph). <br />Does the Monitoring System have Audible & Visual Alarms? <br />Is the Monitoring System installed to prevent unauthorized tampering?: <br />Is the Monitoring Devices operable as per manufacture's specifications? <br />Date: <br />Certified Tester's ID #: <br />YES CAP .2 <br />YES <br />YES <br />YES <br />Testing Company: TAIT ENVIRONMENTAL SYSTEMS <br />Technician: BRANDON HAM <br />t Nam ) <br />rf, gamn <br />(Signature) <br />