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02-14-05 08:26am From-TAIT ENVIROKNTAL 714-560-8237 T-764 P-01/06 F-670 u mom% IYJRING• SYSTEM CERTIFICATION Fbr Me By 191r lupi tdietions Mftn the Sate c?f Calt p Authority Cited; Chapter 6.7,7dewlth and Srfsty Code;Chaprer 16,Division 3, title 23, Crallforrrta Code gf Regulations This form mtutbe ueedto document testing and servicing of a:ortitoring equipment.A eel?Veto be nrel2sed fnr each ragnitcring syltern control panel by the technician wi-A performs the work. A copy of this formmustbe provided to the tank system ovmer/operator. The owatf/operator roust subteA n copy of ibis form to the local agency regulatsng UST systema within 30 dart's of test date. A_ General Information Foci tyNarne: ARlrO PRODUCTS COMPANY _-` since StatiouNo.: 11493" Site Addnss: 16 E HARDING WAY Citg_ STOCKTON FacilityCorrtacL errors;__,_ 11.^ c ef' _..don tectPh-=tNo:.__.,_ 2 t�`•� 33� akemllodel of'Montte 5 tem: V' 77 � � �'f", D$te ofTes'au�/S'ervice:. 1-19'�D B. Inventory of Equipment Teste&Certifed Check the VpMd&Xw to indicab Mecirk ' mext' ctedlseMee& T atilt IDS Tank M: TsakCtau r-^rrobe; Model: Tw._9 u :__ Model:_ '.s�inugla3rum�JTrenchSerso:�sZ__._: Mader Anulaa--orv-nu-u-S-.enaor M- adel:SpaoeorVauUSeuor: Model: Model � Modl W illSumpssaaorr s_ _ Mode: eohaaiealLine Leaknetector- Model echanic l a LeakDetector. -Modek . etronic Line:Leak Detector Model Leak Detector � Model: 440 �....__—_ ._. ..._ _ . ...__.., . a�o�- _._._. aryko+rezfi111Hi level Sensor: Model - e _ ;gh-levelSereor _ j-llilodeL pOthei,5 ec' a ui .t e and model inSectioa on P e� or,S e OfEs •and model in Section E mime e 2 Tank LD: o W Tank Twik ( �I�Ter�kGauglxi�,Probe;,. _•._. ... Modal: --_�T+P� _.-._._. _..._ ........._. __. - anas s a - - -� T_ obey. _: Mockl: rmi;derSpaeo orvauttSensor: _Model: Ick o Space orVeuhS nor ` Model _ i�SumpRrenchSeasor��_ _Model• 79;/ .- i�,iagS—plTreaoh'Sensor(s?: � Model: insLunpSassaor�)� -- . Model: ? s Sens?:CSS.__._ eah�gioalI�eLook Detector. Model' echaaicelLine_l..eekDetectos. l�dodsl:- etuonic Line Leak Detector Model: ctrorno Lune LeakDeteetor l�dodel Tankovelfiurri •levelSaasor: Model • �arslcOver»1fF1i lev_elSeneor: •__AQodal_:. ,,.,____.u.... ........_.. --•--.�.......,. . _._._.._ _....__.....___.. .... ._. pother,Specequip.Me and modal in Section Eon Page 2 Other S ec" e e and model inSeetion Eon Pa e 2 ser iD: _W Dir enserID_ _.__•.- L �t eziserContainmentSew s : Model: �5' ( enser Coatnmr?tentSensors: Model' 7..^.l��tr o�c �' _.... - eafV01V s . __. __._......_.._._.. hear Vnl.e(s�,:........... �� -- - - Buser Conttinmetit Flagg find C s �T1is eraser Containment Flo s aril C e lel .. ser ID: ... ,... .. �._ �a 1 ' enserConteirsmerttSenso s Model:7�� _ Scr.®ars• R�lo erlserContasnment_ .. ,..�....,......_ __.. ;.�....,_,.r,_, Dire eraser C o27tnitiment Fla a and Ch l a ' Omer fie) -.-----d O -.._.. .._;.........._..... V M... cmteirunen:Floa s andCh a i eraser ID: .f?a eziserCorstairsmerstSeriso s� Model: ._.....----- ..,_.'-_-.'._...-a._.. s `.. ..�..-. . . r' `er►ser�"`ou)tainmentFlo..s. epenmarCdt-Aatrxraen Sensors' M del_ 9 R. Puee, _ _ . Y. g % enstrCoutainmenxtM an Ch Li and Ch ' s if the fvABty contain more tanks or dispensers,copy this form. ,nelud*inforratUon for every tank and dispenser at this ftaty. C. C ertifn ation•I cert4 that the equipment sdeRdfed in this be mem wss hopecteiheavieei in arceriance with the manuEwfimm' guidejUm, AtiacUd a ab Certifumdon is ln8ermadon(%g.mauu£aotttsers'c)rck1bV)rreoesseay as verify teat this iT&rftmdon is correct and a Piot Plm slowing the hyemt of maaitering a tr sent. For any a mem capable otgencndng such repert>ti I hsc abs atbdched a cojy pr,tlse�port (Ch"A all Ant applJA; y, sXsties setup._ l� akisat� _.._ --- Techn.cwnNemc 77-2 W , - Cettiftcetior+No•: 0477 i License No.: ,TestingCemp nvName; TAITENVIR NUENTALSYSTEMS PhoneNo.: 14,50.8222 pegs 1 of 3 03101