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Apr-28-03 03: 04P Wool Oil , Inc - 209 `8 0755 P - 06 _ <br /> MONPI'ORING SYSTEM CERTM 'ATION <br /> For(ler ByAll JwiswW ora iiN=the Slate ofCalMr/a <br /> Ar Ow*Cited-Chepler 67.NeaM and Salty Code,C�16.Dtvbbm 3. Tide 23,Cal#arrm Code ofRegrlattaa <br /> This form mug be used to dowment Ws ng and servicing of monaning egaipm oL-A,mWe a catificam or report mud be weomed <br /> for each moRmrina OMbm cooftol Md by the brLnicin who pafixms the work A copy of this form o . be povided to the table <br /> system owncdop t stor The owwdopentor most sdimit a copy of this foam In We kcal agency mgnlstiog UST systems within 30 <br /> days of test dam. <br /> & Gmaa!Information <br /> Facility Now /�f- gYlAP-,l `K Bld&No.. <br /> Site Addmss: �i � s� /✓ /,dvV 4s coy: <br /> S RX t ZDA / 2tp: 2S�/ <br /> FlidlityCootactPasoo: YV�eKE F_[ . fRSTOwI Cocoa Phone No.: <br /> MakdModel of Monitoring System 7W C 00 1(t PJ (l Data of TestirwSavicing: -V-19-10-5- <br /> IL Inventory of Egopmett Ted <br /> tlechSa M=jaft ba t0 bank specilk eon <br /> Task m: 1 L D'e Taakm: <br /> Olo-TtakOmipatPrahc. Madak=_ LG OLTaskGarBigl'm6e. Model: <br /> O Aenithr Spce ar Vooeh Seesaw- Model _$____ Q AowWw Sparc ar Vveh Sensor- ModeL <br /> t]P*igSMO/TnuchSesu(s} Modal h U pipkgSame/Ttcw*Sm=(s} Mod& <br /> O Fin Sump Senww(s)- Modrt A O Pell Sooap Seme(a} Medd: <br /> O aaeehekW tine talc Dpalor. Modal- O sewer Lim teak Ddaea. Model: <br /> O Electronic lam ask Dessau_ aaOdeL' 0 Els ffook tine Look Dcwck r. Medd: <br /> 0 Thsk OmM I W*b4, :rd Savor Medd 1-� 13 Timk Oratif I tT*4jmd S==- MoaeL <br /> U Otho d mood:satin•E e 2 13 06w ad.sad:Sectio.E m 2 <br /> TankUk _ Trkvk <br /> 0 ho-TvakOar®ottProbe. tdodrl O In-TLakCwO8ftEl Pmhn Moret <br /> SCOW Mod& <br /> O AwAIw Spae ar V.sk Sear. Madel `[ . ( El�ytiq/IZYmch Bevans} Mudd= <br /> uPiping SyympITlechSam% Mold= w aF�sampsesons} Model= <br /> Q Fm Sump Sema(*} haodnt <br /> d Mochrid tare Leak Ddac7or. Niodrt - n Mocbwkd Lim La kDd edw Model: <br /> t] I eLAWLakDdecaor. Dlodd: nJ n- 13ElacbevicLiaLokDc/mm- Mo6.�t <br /> U Took OveroILTide-l. Senna. Model- OltiekOra®/Ff [.esd9e®or. Modck <br /> O OAraad amdd m <br /> is Seon E an PwM 21. U er odand roti:satisa E e 2 <br /> pSesu(s} Moan No N o>l tbriaooats®ansl- btodd: <br /> Vrvns} %Toler Vvlsa(v} <br /> Caaraiumaar s � s Canr�+r sad s <br /> Dispewar Mr Mad <br /> d: <br /> Dipissar w Cl � <br /> O DLlpesaC=Nbw wsmsa(s} Model eN£ O sp®amiooet5mm(s} el ni0 �� <br /> Vdse{s} eB'9rs Vdwa(* <br /> OoaYinlocot - s std s <br /> Dtale•ar®: -� Dbpems Uk <br /> 13 DitpefiteromlSMfor(s} Mudd: nl i— ^'C El Dapana�Smm(s} Un": •,"e' <br /> VaNe(s} Vgv(s} <br /> OosdwwAl wd CbNK4 <br /> �Ifdreficdtf aromadsardnpmras.aapycussxr iarideie6m Ibrmltataddnpmsaatftbo'6ty- <br /> hiwtl4d:ihl dets�at soon bVedaa unimd:aomrinwm wah the=Mv% been' <br /> C. Cerfj{eation-1 aertlh Het the�d d o tUbts)aOeww 7 oo verso tb d this iaforooatloa b <br /> pvddnoo. Atoll" to tide C*rd8cJ*& s l :irmOvs (0.4 a '�,eoet cook of <br /> rgmtr lMveala <br /> M I—sella Plot Phe rMrrisg tbe kpsat of atomwieg ala4mst- of;l_ <br /> attached a copy of the report;(Chea e/�t�bl: o Spteo M"p {! <br /> Technician Nance(print), Bruce Hoagland Signonn�CrTrj . <br /> CntiSatim No- License-Nn: 805705 <br /> Phone No-k209 724-9420 <br /> Testing Company Naooe: <br /> Site Addeass: <br /> acts n q el A ♦h.- re os1nt_ Doe ofTestk&ISwieit kU-Z-1-0-2 <br /> Page 1 of 3 Oleat <br /> Monitoring System Certification <br />