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FE8-02-2005 15:48 SERVICE STATION SYSTEM 408 971 0135 P.03 <br /> FEE-02-200n 10 :74 AM . Die ID dmno I. ., <br /> kB-01-2005 ig:ie '7ERVICE STATION SYSTEM 4W 971 0135 P.02 <br /> Monitoring System Equipment Certification <br /> For Use By.417Jurtadictione)slrhin The Stan ofCaty"on da <br /> AvdWRY Cited:Chapter 6.9,Health and SOly Code: Chapter 16.Division 3, 2V4e 23. Cal#bmia Cade ni Regulations <br /> This form taut be used to doa:emart tcoong and aef ociug of mtwitoriag egoipmem.A aso(tmtq Wificatiou u muu be <br /> Vftllcdlbr0rAM=bijmz -stem m=l by the to tieian who gerlbrme the work.A copy of this firm must be Provided <br /> to the tank*sum owntr/opetakr, The owna/operator roust submit a copy ofthis Porn to the local agency tegalamlg UST system <br /> within 30 days of teat date. <br /> A. Gen"Informodon <br /> FWWW Hama:3SflAlW*1760 Bldg.No.: <br /> Site Aa&cu;_ 2008 Cour"Club Blvd.@ Dolan Ave City; Stockton, CA zip: 932011. <br /> [+aeiu(y Contact Pts nt a / st o v Contact Phone No.: (209)461-6656 <br /> Mak&?&dalofMomitotfagsystem: V/RTLS-349 Data of TestW&$e;vicing: V W5- <br /> S. Inventory of$gtdpaent Te5ted/Cerahed ( r <br /> rMrv.na anwme.e./w iwma Ea Wk.to.a„vte.eq�tostntLrpeoaNeewkadf 1 � �?�`�' <br /> TanklUs __ TadcID: <br /> o Inix.wfw—r-, -... aoa i s . u l err [lone+. e 1 <br /> 0 <br /> Q piping saw 1l7ench5ei:oc(>} `.:cwt G 4iogSvmplTtrdc6Seator(.), Wdml: 7 <br /> Z fiQStamp Scewr(sl UWak t p 1`111sumpaawrb} b(adei; I <br /> 0 Uwhmkat LhtLakpaenasr, moot 1 p Irke6anical S:+aLeskDN.n•ny. ri•:e�:; a <br /> Q 1patlmnk Linc Lcalr Dabanr Model: — Q ( OLiM S,en#7hYtelar. Stedal' T <br /> p Tank O.mill%Righ'Tmd Srn.or. Ndel-a 0TaaltOaedai`,iusi•..cVC:a.^•y ,.r ... <br /> D OWer(speeifyequiprtWtt bre sad credal in Sectbn Enq Pala } © (fther(apearly+qulpmamtypa std nodal in toeuonaen e2 <br /> Tank ED., rsakm <br /> p !n- p <br /> C3 Ann terbpamervmdk Bepwx. Msdadt • d Awtaarapace ur Vaoi[5.:naw ..;;!.k 1 <br /> a lViel Sump Wrench Senr[r(g1. b 44 i p piplea9em kTNMh UeW(a} Madel_ <br /> n FW Ivor Saxz ) tNadeh r El Pal Rump am or(4 Madel: + <br /> p MAahrnkW line LwkDi*¢ .. Msdd: 1 E3Atrahaeloaf Line Leal:De!e6'w+r <br /> o 8leabode Lin LmkDerpmen Madel' 4 ❑ W*Awhic line leak Deteukr. Llodcl: <br /> C Tmk 0wa•9atHi Leval 4m . modak I pianletYuafih1 a--.= V_._:n ,• ^•�•�— <br /> 13 Othu(�SY wulp✓>�Hpe ane modal in iaaaon E ou I� tiE% (y cater f 106C4equipma wa,and INV"in Saxlantten vane 2 <br /> La$Qr mt <br /> apauor lin n . t ..y �iver Can knmcnte,w+. - <br /> ShrtVdva(a} � -• Eor Vyvp(+} <br /> D Dl+eeaaevCoeWntneotFloa:iY)and Ch5I9;=:. W '.,Jispenae Cuapd7npMttgnat(+)aedCMm(n), <br /> .. <br /> ✓...�:� -.. ... ^:mer ID <br /> Q D7asana++Lb r u 0•Yllmrn.a Cee nt root s e: <br /> E3 5hae V■!w(a)- p Sen_V,t n(a). <br /> p EtlapewrCoeuiamatuplaaep)ao en.tn(.} p r)irpm tSrrptae_=n;--l.T)x ChAc e=} <br /> iZ tA:peA>er uoaim:•ri[ii[iixi:::�: ...... � ,.i�anr•Cen mama emw 4 '!��_ y <br /> 15 Ibaar Valve(s} <br /> p DlapwerCeetalemeotpbat(s)atWChain(e} p Dtwama co[tnlnmomPlate WwdChain <br /> (sb <br /> 'ifflw fialitY'annmkra regtp ktlllaor itparoes,appy Wier terN. aintarm.doa lbreveq tadsmd dhglMletuaq lkoilid <br /> C. Certi6e"on- I arab that at <br /> m+aaykamaraaoldoaaaAttaeled08d1bCerla'.a=_ <br /> fdermaeea a eae+ectad a I9ot ton Wowisq tIa laYomotmefmrlg W�t><.Por arty eq�aut wp.hle al��at/�:t6t��h <br /> npmgrhaw aYsaeee►Jaattp/n[tia; ruAM as aareppy): p.er+k.m aro-ap �'✓ LYI�_ <br /> Temhaidaallow(prlm):SStFRandylN Sip*we: <br /> CtX1i9Cadon No.: Licame.No.; 1051714 a <br /> T --^- --- •'^_ :son Sta.$re. PhoaeNo.: (toe)971-24(8 <br /> Site Address: =08 CoYnby Club BNd.a Delano Ave �n r ui Tiatinp/Setviclug; 1/79165 <br />