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MONITOWG SYSTEM CERTIFICATION MAKE / MODELIFF MONITORING SYSTEM: Veeder-*t TLS-350 CERTIFICATION / TEST DATE: February 17, 2010 A2. OWNER At. FACILITY Name Christina Gill Name Fast Lane LathropCA 95448 116 E.Roth Road,Lathrop,CA 95330 Adtlress 111 Healdsburg Avenue,Healdsburg, Address phone# 707-431-0541 Phone# 707-431-0541 Contact Christina Gill Contact Christina Gill Aa. TESTING CONTRACTOR A3. C U P A Name Walton Engineering, Inc. Name San Joaquin County Environmental Health Address 600 E. Main Street,Stockton,CA 95202 Address P.O.Box 1025,W.Sacramento,CA 95691Lic# 617238 A,B,Haz Notified February 11,2010 Contact Richard Walton Inspector Michelle Henry Phone# 916-825-3203 Phone# 209-ABA-3439 DEli: TANKS Tan B. INVENTORY OF EQUIPMENT TESTEDICERTIFIE -- — --- Tank#2 (Product): Gasoline-91 Tank#1 (Product): Model: ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe f-1AnnularSpace or Vault Sensor Model: El Annular Space or Vault Sensor Model: ElPiping Sump 1 Trench Sensoria) Model: Model: ❑ Piping Sump/Trench Sensor(s) ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensoria) Model: ❑ _ F-1 Mechanical Line Leak Detector Model: Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Moder. C3Electronic Line Leak Detector Model: ❑ Tank Overfill I High-Level Sensor Model: ❑ Tank Overfill I High-Level Sensor Model: Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Tank#4 (Product): _ Tank In-Tank(Product): DieselC3 In-Tank Gauging Probe AnC1 Annular Space or Vault Sensor Model:Model: [I Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ piping Sump/Trench Sensoria) Model: ❑ Piping Sump/Trench Sensor(s) Model: Model: Model: ❑ Fill Sump Sensor(s) El Fill Sump Sensor(s) Mechanical Line Leak Detector Model: ■ Mechanical Line Leak Detector Model: FE Petro STP-MLD ❑ Electronic Line Leak Detector Model: 11Electronic Line Leak Detector Model: ❑ Tank Overfill)High-Level Sensor Model: ❑ Tank Overfill 1 High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Bz: DISPENSERSIUDC's Dispenser# Dispenser#: ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves � ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Floats)and Chain(s) Dispenser# Dispenser#: Model: ❑ Dispenser Containment Sensoria) Model: [I Dispenser Containment Sensoria) ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment FlGat(s)and Chains ❑ Dispenser Containment Floats)and Chain(s) Dispenser# Dispenser#: Model: Model: ❑ Dispenser Containment Sensor(s) ❑ Dispenser Containment Sensor(s) ❑ Shear valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chains ❑ Dispenser Containment Floats)and Chain(s) C. CERTIFICATION I certify that the equipment identified in this document was inspectedlserviced in accordance with the manufacturers'guidelines. Attached to this Certification is information(e.g.manufacturers'checklists)necessary to verity that this information is correct and a Plot k all that apply): e llayout of monitoring equipment. For any equipment capable of generating such reports,I have al also attached History Report report; ■ System set-up 1LaW.�\ W nn WALTON Signature: Q O aX — ENGINEERING,INC. Date: February 17, 2010 Technician I Cert M Jessie Wadkins/B35391 5307886-UT 9$2006 Walton Engineering,Inc.