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MONIT(�ING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Si afore: Facility Name:YELLOWFREIGHT Bldg. No.: Site Address: 1535 E. PESCADERO AVE City: TRACY I Zip: 95304 Facility Contact Person: SCOTT COVEY Contact Phone No.: (951) 522-5110 Make/Model of Monitoring System: VEEDER ROOT 350 1 Date of Testing/Servicing: NOV 20, 2007 B. Inventory of Equipment Tested/Certified Cheek the annronriate hoxes to indicate snecific enuinment insnected/serviced: Tank ID: WASTE OIL #1 Si afore: Tank ID: WASTE OIL #2 Certification No: A26642 Z In -Tank Gauging Probe. Model: MAG Z In -Tank Gauging Probe. Model: MAG Z Annular Space or Vault Sensor. Model: 303 Z Annular Space or Vault Sensor. Model: 303 Z Piping Sump / Trench Sensor(s). Model: 208 Z Piping Sump / Trench Sensor(s). Model: 208 ❑ Fill Sump Sensor(s). Model: _ ❑ Fill Sump Sensor(s). Model: _ ❑ Mechanical Line Leak Detector. Model: _ ❑ Mechanical Line Leak Detector. Model: _ ❑ Electronic Line Leak Detector. Model: _ ❑ Electronic Line Leak Detector. Model: Z Tank Overfill / High -Level Sensor. Model: FLOAT Z Tank Overfill / High -Level Sensor. Model: FLOAT ❑ Other(specify equipment a and model in Section E on Pae 2). ❑ Other(specify equipment a and model in Section E on Page 2). Tank ID: ANTI - FREEZE Tank ID: GEAR OIL Z In -Tank Gauging Probe. Model: MAG Z In -Tank Gauging Probe. Model: MAG Z Annular Space or Vault Sensor. Model: 409 Z Annular Space or Vault Sensor. Model: 303 Z Piping Sump / Trench Sensor(s). Model: 208 Z Piping Sump / Trench Sensor(s). Model: 208 ❑ Fill Sump Sensor(s). Model: _ ❑ Fill Sump Sensor(s). Model: _ ❑ Mechanical Line Leak Detector. Madel: _ ❑ Mechanical Line Leak Detector. Model: _ ❑ Electronic Line Leak Detector. Model: _ ❑ Electronic Line Leak Detector. Model: _ Z Tank Overfill / High -Level Sensor. Model: FLOAT Z Tank Overfill / High -Level Sensor. Model: FLOAT ❑ Other(specify equipment a and model in Section E on Pae 2). ❑ Other (specifZ equipment a and model in Section E on Pae 2). Dispenser ID: _ Dispenser ID: _ ❑ Dispenser Containment Sensor(s). Model: _ ❑ Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s). ❑ Shear Valve(s). ❑ Dispenser Containment Floats and Chain(s). ❑ Dispenser Containment Floats and Chain(s). Dispenser ID: _ Dispenser ID: _ ❑ Dispenser Containment Sensor(s). Model: _ ❑ Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s). ❑ Shear Valve(s). ❑ Dispenser Containment Floats and Chain(s). ❑ Dis enser Containment Floats and Chain(s). Dispenser ID: Dispenser ID: _ ❑ Dispenser Containment Sensor(s). Model: _ ❑ Dispenser Containment Sensor(s). Model _ ❑ Shear Valve(s). ❑ Shear Valve(s). ❑ Dispenser Containment Floats and Chain(s). ❑ Dispenser Containment Floats and Chain(s). *If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification - I certify that the equipment identified in this document was inspected/smiced in accordance with the manufacturers' guidelines. Attached to the Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check all that apply): Z System set-up Z Alarm history report Technician Name (print): MIKE LAWRENCE Si afore: Certification No: A26642 License: 803705 Testing Company Name: TANK-TEK ENVIRONMENTAL CORPORATION I Phone No: (707) 446-6151 Address: 607 ELMIRA RD, PMB 336, VACAVILLE, CA 95687 Date of Testing/Servicing: I NOV 20, 2007 Page I of 4 Monitoring System Certification