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MONITIQSING SYSTEM CERTIFWATION MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS-350 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 A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 600 E. Main Street,Stockton,CA 95202 Address P.O.Box 1025,W.Sacramento,CA 95691 Notified February 11,2010 Lic# 617238 A,B,Haz Inspector Michelle Henry Contact Richard Walton Phone# 209-468-3439 Phone# 916-825-3203 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (check the appropriate boxes to indicate equipment inspected/serviced) 131: TANKS Tank#1 (Product): Tank#2 (Product): Gasoline-91 ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump/Trench Sensoria) Model: ❑ Piping Sump/Trench Sensors) Model: ❑ FIII Sump Sensors) 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: ❑ Tank Overfill/High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ■ Other (specify equipment in Section E) Model: Tank#3 (Product): Diesel Tank#4 (Product): ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump/Trench Sensor(s) Model: ❑ Piping Sump/Trench Sensor(s) Model: ❑ FIII Sump Sensor(s) Model: - L1 Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: FE Petro STP-MLD ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: _ ❑ Tank Overfill I High-Level Sensor Model: ❑ Tank Overfill f High-Level Sensor Model: —� ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: E12: DISPENSERS/UDC's Dispenser#: Dispenser#: 1 ❑ Dispenser Containment Sensors) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chaln(s) ❑ Dispenser Containment Float(s)and Chains) Dispenser#: Dispenser#: ❑ Dispenser Containment Sensors) Model: ❑ Dispenser Containment Sensor(s) Model: El Shear Valves ❑ Shear Valves E] Dispenser Containment Float(s)and Chain(s) ElDispenser Containment Float(s)and Chain(s) Dispenser#: Dispenser# ❑ Dispenser Containment Sensors) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(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 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): ■ System set-up ■ Alarm History Report Signature: ENGINEERING,INC. Technician/CertM Jessie Wadkins 1835391 5307886-UT Date: Fi',hlllaCy 17, 2010 ©2006 Walton Engineering,Inc.