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MONITS3ING SYSTEM CERTI%CATION CERTIFICATION / TEST DATE: February 17, 2010 Al. FACILITY A2. OWNER Name Fast Lane Lathrop Name Christina Gill Address 116 E. Roth Road, Lathrop,CA 95330 Address 111 Healdsburg Avenue,Healdsburg,CA 95448 Phone# 707-431-0541 Phone# 707-431-0541 Contact Christina Gill Contact Christina Gill F. IN-TANK GAUGING / SIR EQUIPMENT: ❑ Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gaugung equipment is used to perform leak detection monitoring. Complete the following checklist: ❑ Yes ❑ No* Has all Input wiring been Inspected for proper entry and termination,Including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes visually Inspected for damage and residue buildup? ❑ Yes ❑ No" Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? In Section H below, describe how and when these deficiencies were or will be corrected. G. LINE LEAK DETECTORS (LLD): ❑ Check this box if LLDs are not installed. Complete the following checklist: ❑ Yes ❑ No* For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? ❑ WA (check aff that apply) Simulated leak rate: ■ 3g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. ❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ❑ Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? ❑ WA ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ NIA or disconnected? ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions ❑ NIA or fails a test? ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually Inspected? ❑ NIA _ ❑ Yes ❑ No" Were all items on the equipment manufacturer's maintenance checklist completed? * In Section H below, describe how and when these deficiencies were or will be corrected. H. COMMENTS ©2006 Walton Engineering,Inc. Page 3 of 3