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Facility Name: VERIZON-RIPON RSU <br />D. Tank Top/Associated Hardware: <br />General Notes: <br />Dipstick: YES <br />OK <br />Annular Space Lid/Cap/Seals: <br />OK <br />Manhole Street Lid-Bolts/Seals: <br />N/A <br />Manhole Ports/Seals: <br />N/A <br />E. Fill Buckets: <br />General Notes: <br />Lid/0-Ring: <br />OK <br />Drain Valve: <br />OK <br />Cap -O -Ring: <br />OK <br />Cap Adaptor: <br />OK <br />Drop Tube: <br />N/A <br />Mechanical Overfill Valve: <br />N/A <br />Striker Plate Confirmed? <br />N/A <br />I Report Number: 10 t v 123-004 I Date] <br />Tank I I Tank 2 1 Tank 3 <br />F. Sumps/Annular/Trenches: General notes: <br />General Cleanliness: <br />Sump Riser/Tank Collar Connection penetrations: <br />Sump Shields/Water Tight Lids/"Hat"or "Plugs"? <br />Piping Visual Inspection: <br />Conduit, J Box, Seal Offs, Inspection: <br />Probe/Cap Wire Condition: <br />In Tank Water Eliminator: <br />G. Dispenser: N/A <br />OK <br />N/A <br />N/A <br />OK <br />OK <br />OK <br />N/A <br />Pump I <br />Dispenser Pan <br />Dispenser Piping: <br />Dispenser Impact Valve Location and operation <br />Nozzle Condition and Operation: <br />Nozzle Hose Condition and Operation: <br />Hose Retractor Condition and Operation: <br />Does Emergency shut off switch work? ( Refueling Site Only) <br />Is The Electronic In -Line Leak Detector Present and Tested? <br />Does Turbine Shut Down if System Detects a Leak? <br />Does Positive Shut Down Occur If Monitoring System is Turned Off? N/A <br />Slab Condition: OK Notes: <br />Traffic Condition: NONE Notes: <br />Rainlirrigation Run Off: NONE Notes <br />Photos Taken? NO Notes: <br />Monitoring Equipment Certified? YES Notes: <br />Certified tester's I D#: 546025990 <br />Pump 2 I Pump 3 <br />21, 2003 <br />Tank 4 <br />Pump 4 <br />Signature Of Certified Technician:Nesting Company: Sunwest Engineering Constructors, Inc. <br />Printed Name Of Technician: RUDY ALM 'LAN Telephone: 562-663-1319 <br />All Certification Data Must Be Attached To Verify Above Information <br />