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MONITSRING SYSTEM CERTIWATION <br /> CERTIFICATION / TEST DATE: February 17, 2010 <br /> Al. FACILITY A2. OWNER <br /> Name Fast Lane Lathrop Name Christina Gill <br /> Address 116 E.Roth Road, Lathrop,CA 95330 Address 111 Healdsburg Avenue, Healdsburg, CA 95448 <br /> Phone# 707-431.0541 Phone# 707-431-0541 <br /> Contact Christina Gill contact Christina Gill <br /> D. RESULTS OF TESTING /SERVICING <br /> Make / Model of Monitoring System: Veeder-Root TLS-350 <br /> Software Version Installed: 326.01 <br /> Complete the following checklist: <br /> ■ Yes ❑ No* Is the audible alarm operational? <br /> ■ Yes ❑ No* Is the visual alarm operational? <br /> ❑ Yes ❑ No* Were all sensors visually Inspected,functionally tested,and confirmed operational? <br /> ❑ Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment <br /> will not Interfere with their proper operation? <br /> ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modems) <br /> ■ NIA operational? <br /> ❑ Yes ❑ No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑ NIA monitoring system detects a leak,fails to operate,or is electrically disconnected? If yes:which sensors initiate <br /> positive shutdown? (check all that apply) ❑ Sumplrrench sensors; ❑ Dispenser Containment Sensors. <br /> ❑ Yes ❑ No Did you confirm positive shut-down due to leaks and sensor failumidisconnection? <br /> ■ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no <br /> ❑ NIA mechanical overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank <br /> fill point(s)and operating properly? If so,at what percent of tank capacity does the alarm trigger? 90% <br /> ❑ Yes* ■ No Was any monitoring equipment replaced? If yes,identify specific sensors,pror other equipment replaced <br /> and list the manufacturer name and model for all replacement parts in Sectionlow. <br /> ❑ Yes* ■ No Was any liquid found Inside any secondary containment systems designed as;- <br /> dryystems? <br /> (Check alt that apply) ❑ Product; ❑ Water. If yes,describe causes in Sectibelow. <br /> ■ Yes ❑ No- Was monitoring system set-up reviewed to Insure proper settings? Attach setports,If applicable. <br /> ■ Yes ❑ No* Is all monitoring equipment operational per manufacturer's specifications? <br /> In Section E below, describe how and when these deficiencies were or will be corrected. <br /> E. COMMENTS <br /> ©2006 Walton Engineering,Inc. <br /> Page 2 of 3 <br />