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0 0 So Tank 3 Tank 4 Sensor Type (Float, Discrim, etc. Envlronment3i Management P.O. Box 5095 Pacific Region Room 3E000 San Ramon, CA 94583 UST & AST MONITOR CERTIFICATION FORM FLOAT Testing Date: 08-04-00 Next Due Date: 08-04-01 Site Location: PACIFIC BELL Tank ID(s): 795 124 W. ELM STREET CLLC Code: LODICA01 LODI Geo Parcel: UE -020 County: SAN JOAQUIN Site Contact: KATHY HALLIGAN Site Contact Phone #: 209-474-4514 Make & Model of Monitor System(s): VEEDER ROOT TLS -2501 Serial # of Monitor System(s): 22065 Tank ID # Type of Tank: (Single Wall or Double Wall) UST or AST Tank Material (Composit, Fiberglass, etc.) Contents of Tank: Capacity of Tank: Type of Product Line: (Gravity, Suction, Pressure) Type of Piping: (Single Wall or Double Wall) ALL SYSTEMS Annular Space Sensor: Fill Sump Sensor: Piping Sump Sensor: Piping Trench Sensor: Dispenser Containment Sensor: Other Types (Sensors): Tank 1 Tank 2 Tank 3 Tank 4 795 DW -UST COMP DSL 4016 SUCTION DW Tank 1 Tank 2 Tank 3 Tank 4 Sensor Type (Float, Discrim, etc. YES PASS FLOAT YES PASS FLOAT YES PASS FLOAT Compartmented Tank(s) Type of Overfill Protection (mechanical, electronic, ball float) Type of Spill Containment (Make & Model) FOR PRESSURE TYPE SYSTEMS ONLY ELECTRONIC 5 GALLON POMECO Is Mechanical Line Leak Detector Present & Tested?: Does the Turbine Shut -Down if System Detects a Leak?: Does Positive Shut Down Occur if Monitor System is turned off?: Tank 1 Tank 2 Tank 3 Tank 4 ALL SYSTEMS In -Tank Gauge Present. Probe Type and Type of Leak Detection (Ex. .2 gph). YES CAP .2 Does the Monitoring System have Audible &Visual Alarms? YES Is the Monitoring System installed to prevent unauthorized tampering?: YES Is the Monitoring Devices operable as per manufacture's specifications? YES Testing Company: TAIT ENVIRONMENTAL SYSTEMS Date: 08-04-00 Technician: BRANDON HAM =I Certified Testers ID #: 39-3435 (Signature)