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COMPLIANCE INFO_2021
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231906
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COMPLIANCE INFO_2021
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Last modified
1/12/2022 4:38:57 PM
Creation date
1/11/2021 9:57:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231906
PE
2361
FACILITY_ID
FA0003776
FACILITY_NAME
KWIK SERV LODI BW 113*
STREET_NUMBER
420
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06202042
CURRENT_STATUS
01
SITE_LOCATION
420 W KETTLEMAN LN
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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F. In-Tank Gauging I SIR Equipment: ® Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ® Yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ® Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ® Yes ❑ No* Was accuracy of system product level readings tested? <br /> ® Yes ❑ No* Was accuracy of system water level readings tested? <br /> ® Yes ❑ No` Were all probes reinstalled properly? <br /> ® Yes ❑ No` Were all items on the equipment manufacturers maintenance checklist completed? <br /> *In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed, <br /> Complete the following checklist: <br /> • Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br /> ❑ N/A Simulated leak rate: ®3 g.p.h.; ❑0.1 g.p.h; ❑0.2 g.p.h. <br /> ® Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> 9 Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ® Yes ❑ No* For mechanical LLDs,does the LLD restrict product Now it it detects a leak? <br /> ❑ NIA <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ® N/A <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system Is disabled or disconnected? <br /> ® N/A <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> ® NIA <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ® NIA <br /> ® Yes ❑ No" Were all items on the equipment manufacturers maintenance checklist completed? <br /> *In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H, Comments: <br /> Monitoring System Certification Page 3 of 4 2/21/07 <br />
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