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Jun 14 05 10: 09p Mis Dotten 1200 533-2650 p. 1 w �+ V 17759 Buttercup Circle, Sonora, CA 95370 Phone: 2019-532-7320; Fax: 209-533-2650 California Contractor 623541 A-Haz alltech@getrocket.com MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Linden Associated Growers Date of Testing/Servicing: May 26,2005 Facility Address: 14175 E.Hwy 26,Linden CA 95326 Facility Contact Person: Charlie Busalacchi Contact Phone No.: 209-9314800 Regulatory agency: San Joaquin Health; Inspector:John Jackson,Plione: 468-3440;Fax 468-3433 Make/Model of Monitoring System: Veeder-Root ILS-250 This test report is it: ❑Preliminay Report nresolved Issues Exist or a_M Final Re ort acifi was observed to be in Compliance) Tank ID:Gasoline Compartment Tank ID:Diesel Compartmant E ❑In-Tank Gauging Probe. Model:None ❑In-Tank Gauging Probe. Model:Noise M Annular Space or Vault Sensor. Model:Float Switch M Annular Space or Vault Sensor. Model:Shared with Gas side ❑Piping Sump/Trench Sensor(s)_ Model:None ❑Piping Sump/Trench Sensor(s). Model:None a ❑Fill Sump Sensor(s). Model:None ❑Fill Sump Sensor(s). Model:None is El Mechanical Line Leah Detector. Modal:Nona ❑Mc t hanical Line Leak Detector, Model:None ❑Electronic bine Leak Detector. Model:None ❑Electronic Line Leak Detector. Model:None M Tank Overfill/Iiigh-Level Sensor, Model:Drop Tube M Tank Overfill/High-Level Sensor. Model:Drop Tube M Fillspill buckets tested ❑Pass MFail M Fillsliill buckets tested ❑Pass MFail Other ❑Other Tank ID: Tank 1D: ❑In-Tank Gauging Probe. Model: ❑In-Tank Gauging Probe. Model: ❑Annular Space or Vault Sensor, Model: ❑Annular Space or Vault Sensor. Model: ❑Piping Sump/'french Sensor(s). Model: ❑Piping Sump l Trench Sensor(s). Model: ❑Fill Sump Sensor(s). Model: ❑lilt Sump Sensor(s). Model: ❑Mechanical Line Leak Detector. Model: ❑Mechanical Lime Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ❑Tank Overfill/I-figh-Level Sensor. Model: ❑Tarok Overfill/High-Level Sensor. Model: ❑Fillspill buckets tested ❑Pass ❑Fail ❑Fillspill buckets tested ❑Pass ❑Fail ❑Other ❑Other Dispenser ID:Gas M Sump:®Dry[]Water❑Produc€ Dispenser ID: Diesel Z Sump:ZDry❑Water❑Product M Dispenser Containment Sensor(s). Model:Float SW. Z Dispenser Containment Sensor(s), Model:Float Switch Shear Valve(s) (Functional test) ❑Shear Valvc(s) (Functional test) ❑Dii iscr Containment Float(s)and Chains Q Containment Floa€(s)and Chains. Dispenser ID: ❑Sump:❑Dry❑Water❑Product — — Dispenser ED: ❑Sump:❑Dry❑Water❑Product El Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) ! ❑Dis nser Contai uvent Flo<at(s and Chains . L]Dis eraser Containment Float(s)and Chains . Dispenser ID: ❑Sump:❑Dry❑Water❑Product Dispenser ID: ❑Sump:[]Dry❑Water❑Product ❑Dispenser Containment Scmsor(s). Madel: ❑Dispenser Contaimnent Sensor(s)- Model: ❑Shear Valves) (Functional test) ❑Shear Valve(s) (Functional test) ❑Dis nser Containment Floats and Chain(s). ❑Dispenser Containment Float(s)and Cliain(s . C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' -guidelines- Attached to this Certification is information (e.g. manufacturers' checklists)necessary to verify that this information is correct and a Plat Plan showing the layout of monitoring equipment For any equipment capable of generating such reports,I have also attached a cpp�thhc ort (cheelr all thal apply): ❑ System set-up ❑Alarm history report Technician: M�_ _Mike Dotten,California Contractor License.No.:623541 - Certification:Veeder-hoot: 341-32-6743;Level 4. ICC UST Technician#5259412 — U-r Page 1 of 3 03101