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COMPLIANCE INFO_2021
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231470
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
12/22/2021 2:06:42 PM
Creation date
1/8/2021 2:27:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231470
PE
2361
FACILITY_ID
FA0003911
FACILITY_NAME
VAN DE POL ENTERPRISES INC
STREET_NUMBER
816
Direction
E
STREET_NAME
FRONTAGE
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
26102010
CURRENT_STATUS
01
SITE_LOCATION
816 E FRONTAGE RD
P_LOCATION
05
P_DISTRICT
005
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 />7. LINE LEAK DETECTOR TESTING <br />❑ Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) <br />Simulated release rate verified: (Check all that apply.) <br />Yes <br />No <br />NA <br />❑✓ 3 GPH ❑ 0.1 GPH ❑ 0.2 GPH <br />87 LINES <br />0 <br />❑ <br />Has the testing apparatus been properly calibrated? <br />0 <br />❑ <br />❑ <br />For emergency generator tank systems, does the LLD create an audible and visual <br />❑ <br />❑ <br />0 <br />alarm when a leak is detected? <br />❑ <br />For mechanical LLDs, does the LLD restrict the flow through the pipe when a <br />0 <br />❑ <br />❑ <br />release is detected? <br />❑ <br />❑ <br />For electronic LLDs, does the turbine automatically shut off when a release is <br />❑ <br />❑ <br />0 <br />detected? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the <br />❑ <br />❑ <br />0 <br />monitoring system is disabled or disconnected? <br />❑ <br />❑ <br />For electronic LLDs, does the turbine automatically shut off if any portion of the <br />❑ <br />❑ <br />0 <br />monitoring system malfunctions or fails a tightness test? <br />❑ <br />For electronic LLDs, have all accessible wiring connections been visually inspected <br />❑ <br />❑ <br />0 <br />for kinks and breaks? <br />❑ <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />0 <br />❑ <br />❑ <br />Were all LLDs confirmed operational within regulatory requirements? <br />0 <br />1 ❑ <br />❑ <br />LLD ID <br />LLD Model <br />Lines Monitored <br />Pass <br />Fail <br />87 <br />99LD2000 <br />87 LINES <br />0 <br />❑ <br />91 <br />RED JACKET <br />91 LINES <br />0 <br />❑ <br />DSL <br />RED JACKET <br />DSL LINES <br />0 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Describe all answers marked "No" or "Fail" and proposed remedy in Section 9. <br />List all monitoring equipment either replaced or repaired in Section 9 <br />Page 4 of 6 <br />
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