COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT FORM (Page 1 of 1 ) Type of Action ❑ installation Inspection ❑ Repair Inspection ® 36 Month Inspection 1. FACILITY INFORMATION CERS ID Date of Overfill Prevention Equipment Inspection 10181331 1 /23/2019 Business Name (Same as Facility Name or DBA-Doing Business As.) BFS Tracy Inc. (Valero # 3698) Business Site Address City ZIP Code 153 E . 11 th St. Tracy 195376 II, UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Inspection (Print as shown on the ICC Certification.) Phone # Guadalupe Sanchez 925 470 - 0803 Ext. Contractor/Tank Tester License # ICC Certification # ICC Certification Expiration Date 1005444 5250451 4/8/2019 Overfill Prevention Equipment Inspection Training and Certifications (List applicable certifications.) Veeder Root A30138 Ex[Areso 10/30/2019 111. OVERFILL PREVENTION EQUIPMENT INSPECTION INFORMATION Inspection Method Used: ® Manufacturer Guidelines (Specify) Veeder Root (Overfill Protection Testing CFR-201 &02AI ❑ Industry Code or Engineering Standard (Specify) ❑ Engineered Method (Specify) Attach the inspection procedures and all documentation required to determine the results. # of Attached Pages: 7 Tank ID: (By tank number, stored product, etc.) T1 : 87 Syphon T2 : 87 Master T3 : 91 What is the tank Inside diameter? (inches) 96 96 96 Is the fill piping secondarily contained? ® Yes ❑ No ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No Is the vent piping secondarily contained? ❑ Yes ® No ❑ Yes ® No ❑ Yes ® No ❑ Yes ❑ No Veeder Root Veeder Root Veeder Root Overfill Prevention Equipment Manufacturer(s) What is the overfill prevention equipment ❑ Shuts Off Flow ❑ Shuts Off Flow ElShuts Off Flow ❑ Shuts Off Flow response when activated? ❑ Restricts Flow ❑ Restricts Flow ❑ Restricts Flow ❑ Restricts Flow (Check ad that apply) ® AN Alarm ® AN Alarm ® AN Alarm ❑ AN Alarm Are flow restrictors installed on vent piping? ® Yes ❑ No ® Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No At what level in the tank is the overfill prevention 81 81 81 set to activate? (Inches from bottom of tank.) What is the percent capacity of the tank at which 90 90 90 the overfill prevention equipment activates? is the overfill prevention in proper operating ® Yes ® Yes ® Yes ❑ Yes condition to respond when the substance ❑ No ❑ No ❑ No ❑ No reaches the appropriate level? (Specify in section V.) (Specify in section V.) (Specify in section V.) (Specify in section V.) IV. SUMMARY OF INSPECTION RESULTS Overfill Prevention Inspection Results ® Pass ❑ Fall ® Pass ❑ Fall ® Pass ❑ Fail ❑ Pass ❑ Fall V. COMMENTS All items marked "Fail' must be explained In this section. Any additional comments may also be provided here. i a, r VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS INSPECTION ` 1 hereby certify that the overfill prevention equipment was inspected in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637.2 and all the information contained herein is accurate. UST Service Technician Signature i r� Cr If the facility has more components than this form accdfrimodates, additional copies of this page may be attached. r.FRR a raii&unia Fnu&nra RomMim ttiratarn in a W arMrA*%n I LCT a 1 Irvimywu mrt c*x tank Irr. a intaenaflnnai r"10 rot mrll AN Ao A110 Am vicj al i e