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COMPLIANCE INFO_2019
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231309
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COMPLIANCE INFO_2019
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Last modified
11/24/2021 10:39:38 AM
Creation date
8/20/2020 3:55:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2019
RECORD_ID
PR0231309
PE
2361
FACILITY_ID
FA0003756
FACILITY_NAME
KISHIDA, GEORGE INC
STREET_NUMBER
1725
STREET_NAME
ACKERMAN
STREET_TYPE
DR
City
LODI
Zip
95240
APN
06219001
CURRENT_STATUS
01
SITE_LOCATION
1725 ACKERMAN DR
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM <br /> VI. INVENTORY OF EQUIPMENT CERTIFIED <br /> A separate Monitoring System Certification Form must be prepared for each monitoring system control panel. <br /> Make of Monitoring System Control Panel Model of Monitoring System Control Software Version Installed <br /> OMNTEC Panel <br /> O E L8000 <br /> Check the appropriate boxes to indicate specific equipment inspected/serviced. <br /> Monitoring Device Used Device Model# Monitoring Device Used Device Model# <br /> TANK ID: DSL-1 TANK ID: DSL-2 <br /> (By tank number,stored product,etc.) (By tank number,stored product,etc.) <br /> ® In-Tank Gauging(SW Tank) mag ® In-Tank Gauging(SW Tank) mag <br /> ® Annular Space or Vault Sensor optic ® Annular Space or Vault Sensor split <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Product Piping Product Piping <br /> ® Mechanical LLD FXIDV ® Mechanical LLD FXIDV <br /> ❑ Electronic LLD ❑ Electronic LLD <br /> ❑ VPH Sensor(Piping) ❑ VPH Sensor(Piping) <br /> ® Sump Sensor optic ® Sump Sensor optic <br /> ❑ VPH Sensor(Sump) MR <br /> Sensor(Sump) <br /> Fill Piping <br /> ❑ VPH Sensor(Piping) Sensor(Piping) <br /> ❑ Sump Sensorp Sensor <br /> ❑ VPH Sensor(Sump) Sensor(Sump) <br /> Vent Pipinging <br /> ❑ VPH Sensor(Piping) Sensor(Piping) <br /> ❑ Sump Sensorp Sensor <br /> ❑ VPH Sensor(Sump Sensor(Sump <br /> vapor Reci in I Vapor Recovery Piping <br /> ❑ VPH Sensor(Piping) ❑ VPH Sensor(Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor(Sump) ❑ VPH Sensor(Sump) <br /> Monitoring Device Used Device Model# Monitoring Device Used Device Model# <br /> TANK ID: TANK ID: <br /> (By tank number,stored product,etc.) (By tank number,stored product,etc.) <br /> ❑ In-Tank Gauging(SW Tank) In-Tank Gauging(SW Tank) <br /> ❑ Annular Space or Vault Sensor Annular Space or Vault Sensor <br /> ❑ VPH Sensor VPH Sensor <br /> Product Piping Product Piping <br /> ❑ Mechanical LLD ❑ Mechanical LLD <br /> ❑ Electronic LLD ❑ Electronic LLD <br /> ❑ VPH Sensor(Piping) ❑ VPH Sensor(Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor(Sump) ❑ VPH Sensor(Sump) <br /> Fill Piping Fill Piping <br /> ❑ VPH Sensor(Piping) ❑ VPH Sensor(Piping) <br /> ❑ Sump_Sen sor EI Sump Sensor <br /> ❑ VPH Sensor(Sump) ❑ VPH Sensor(Sump) <br /> Vent Piping Vent Piping <br /> E] VPH Sensor(Piping) VPH Sensor(Piping) <br /> ❑ Sump Sensor Sump Sensor <br /> tEoVPH <br /> H Sensor(Sump VPH Sensor(Sump <br /> Recovery Piping Vapor Recovery Piping <br /> H Sensor(Piping) ❑ VPH Sensor(Piping) <br /> mp Sensor ❑ Sump Sensor <br /> Sensor(Sump) ❑ VPH Sensor(Sump) <br />
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