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6/5/200:58 PM FAOM: Fax Alltech TO: 468-3433 P 001 OF 003 <br /> Alltech <br /> 17759 Buttercup Circle, Sonora, CA 95370 <br /> Phone: 209-532-7320; Fax: 209-533-2650 <br /> California Tank Tester: 90-1068 <br /> California Contractor 623541 A-Haz <br /> alltech@mlode.com com <br /> MONITORING SYSTEM CERTIFICATION <br /> A. General Information <br /> Facility Name:Emil's Food and Liquor Date of Testing/Servicing:April 15,2002 <br /> Facility Address: 1405 California Street,Escalon CA 95320 <br /> Facility Contact Person:Phil Contact Phone No.: 838-7674 <br /> Make/Model of Monitoring System:Gilbarco Tank Monitor 3 <br /> B. Inventory of Equipment Tested/Certified: ®Multi-compartment tank;®Single annular sensor. <br /> Check the appropriate boxes to Indicate specific equipment ins serviced: ®Pass ❑Fail <br /> Tank ID:Regular Compartment Tank ID:Premium Compartment <br /> ®In-Tank Gauging Probe. Model:Mag 1 ®In-Tank Gauging Probe. Model:Mag 1 <br /> ❑Annular Space or Vault Sensor. Model: ❑Annular Space or Vault Sensor. Model: <br /> ®Piping Sump/Trench Sensor(s). Model:VR Non-Discrim. El Piping Sump/Trench Sensor(s). Model:VR Non-Discrim. <br /> ❑Fill Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: <br /> ®Mechanical Line Leak Detector. Model:RJ XL ®Mechanical Line Leak Detector. Model:RJ XL <br /> ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: <br /> ®Tank Overfill/High-Level Sensor. Model:Drop Tube ®Tank Overfill/High-Level Sensor. Model:Drop Tube <br /> ❑Other ❑Other <br /> Tank ID:Diesel Compartment Tank ID: <br /> ®hi-Tank Gauging Probe. Model:Mag I ❑In-Tank Gauging Probe. Model: <br /> ❑Annular Space or Vault Sensor. Model: ❑Annular Space or Vault Sensor. Model: <br /> 21 Piping Sump/Trench Sensor(s). Model:VR Non-Discrim. ❑Piping Sump/Trench Sensor(s). Model: <br /> ❑Fill Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: <br /> ®Mechanical line Leak Detector. Model:RJ XL ❑Mechanical Line Leak Detector. Model: <br /> ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: <br /> ®Tank Overfill/High-Level Sensor. Model:Drop Tube ❑Tank Overfill/High-Level Sensor. Model: <br /> ❑Other ❑Other <br /> Dispenser ID:1&2®Sump:®Ihy❑Water❑Product Dispenser ID:3&4®Sump:®Dry❑Water❑product <br /> ❑Dispenser Containment Smsor(s). Model: ❑Dispenser Containment Sensor(s). Model: <br /> ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) <br /> ®Dispenser Containment Float(s)and Chain(s). E Dispenser Containment Float(s)and Chain(s). <br /> Dispenser ID: ❑Sump:❑Dry❑Water❑Product Dispenser ID: ❑ Sump:❑Dry❑Water❑Product <br /> ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: <br /> ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) <br /> ❑Dispenser Containment Float(s)and Chain(s). ❑Dispenser Containment Float(s)and Chain(s). <br /> Dispenser ID: ❑Sump:❑Dry❑Water❑Product Dispenser ID: ❑Sump:❑Dry❑Water[]Product <br /> ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: <br /> ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) <br /> ❑Dispenser Containment Float(s)and Chain(s). ❑Dispenser Containment Float(s)and Chain(s). <br /> C. Certification-I certify that the equipment identified in this document was inspected serviced in accordance with the manufacturers' <br /> guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is <br /> correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports,I have also <br /> attached a copy of the report,(check all that apply): ❑System set-up ❑Alarm history report <br /> Technician: Mike Dotten,California Tank Tester License.No.:90-1068 <br /> Certification:Veeder-Root:341,32-6743;Level 3. <br /> Page 1 of 3 03101 <br />