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-Jun 11 04 12:32a Mik- Dotten (2041 533-2650 p.l <br />All ' c t --" <br />17759 Buttercup Circle, Sonora, CA 95370 <br />Phone: 209-532-7320; Fax: 209-533-2650 <br />California Contractor 623541 A-Haz <br />aRtech@getrocket.com <br />MONITORING SYSTEM CERTIFICATION <br />A. General Information <br />Facility Name: Get -n -Go Mart Date of Testing/Servicing: June 10, 2004 <br />Facility Address. 574 Grant Line Road, Tracy CA 95376 <br />Facility Contact Person: Satnam Singh Contact Phone No.: 833-3416 <br />LIA: San Joaquin; Inspector: Steven Shih; LIA Phone: 468-9850; LIA Fax: 468-3433P <br />Make/Model of Monitoring System: Veeder-Root TLS 350 <br />This test report is a: ® Final Report (Facility was observed to be in Compliance) or a: ❑ Preliminary Report (Unresolved Issues Exist) <br />B. Inventory of Equipment Tested/Certified: <br />C6ecktheappropriate boxes to indicatespecific equipment inspected/serviced: <br />Tank ID: 87 Regular Tank <br />Tank ID: 91 Premium Tamk <br />® In -Tank Gauging Probe. Model: Mag 2 <br />® In -Tank Gauging Probe. Model: Mag 2 <br />® Annular Space or Vault Sensor. Model: Wrap Around <br />® Annular Space or Vault Sensor. Model: Wrap Around <br />® Piping Sump / Trench Sensor(s). Model: Float Sw. <br />® Piping Sump / Trench Sensor(s). Model: Float Switch <br />❑ Fill Sump Sensor(s). Model: <br />❑ Fill Sump Sensor(s). Model: <br />® Mechanical Line Leak Detector. Model: FE Petro <br />® Mechanical Line Leak Detector. Model- FE Petro <br />❑ Electronic Line Leak Detector. Model: <br />❑ Electronic Line Leak Detector. Model: <br />® Tank Overfill / High -Level Sensor. Model: Drop Tube <br />® Tank Overfill / High -Level Sensor. Model: Drop Tube <br />❑ Other <br />❑ Other <br />Dispenser ID: 1&2 ® Sump: ®Dry ❑Water ❑Product <br />Dispenser ID: 3&4 ® Sump: ®Dry ❑Water []Product <br />® Dispenser Containment Sensor(s). Model: Float Switch <br />® Dispenser Containment Sensor(s)_ Model: Float Switch <br />® Shear Valve(s) (Functional test) <br />® Shear Valve(s) (Functional test) <br />❑ Di Contauunent_Float(s) and Chains . <br />❑ Dispenser Containment Floats and Chains . <br />Dispenser ID: 5&6 ® Sump: ®Dry ❑Water ❑Product <br />Dispenser ID: 7&8 ® Sump: ®.Dry ❑Water ❑Product <br />® Dispenser Containment Sensor(s). Model: Float Switch <br />® Dispenser Containment Sensor(s). Model: Float Switch <br />® Shear Valve(s) (Functional test) <br />® Shear Valve(s) (Functional test) <br />❑ Dispenser Containment Float s and_Chain s . <br />❑ Dis enscr Containment Float(s) and Chain(s). <br />Dispenser ID: ❑ Sump: ❑Dry ❑Water ❑Product <br />Dispenser ID: ❑ Sump: ❑Dry ❑Water (]Product <br />❑ Dispenser Containment Sensor(s). Model: <br />❑ Dispenser Containment Sensor(s). Model: <br />❑ Shear Valve(s) (Functional test) <br />❑ Shear Valves) (Functional test) <br />❑ Dispenser Containment Floats and Chain(s). <br />❑ Dispenser Containment Float(s) and Chain(s). <br />Comments: <br />C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the <br />manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this <br />information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such <br />reports, I have also attached a ropy of the report; (check all that apply): ® System set-up ® Alarm history report <br />Technician: Mike Dotten <br />Certification: Veeder-Root: 341-32-6743; Level 4. <br />Page 1 of 3 03101 <br />