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MONITWING SYSTEM CERTIWATION MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS-350 CERTIFICATION / TEST DATE: December 28, 2009 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 UP 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 December 22,2009 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) B1: TANKS Tank#1 (Product): Gasoline-87 Tank#2 (Product): Gasoline-91 ■ In-Tank Gauging Probe Model: 0846390-109 ■ In-Tank Gauging Probe Model: 0846390-109 ■ Annular Space or Vault Sensor Model: 0794380.303 ■ Annular Space or Vault Sensor Model: 0794380303 ■ Piping Sump I Trench Sensoria) Model: 0794380.208 ■ Piping Sump I Trench Sensoria) Model: 0794380-208 ■ FIII Sump Sensors) Model: 0794380-208 ■ Fill Sump Sensoria) Model: 0794380-208 ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ■ Tank Overfill I High-Level Sensor Model: 0846390-109 ■ Tank Overfill I High-Level Sensor Model: 0846390-109 ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Tank#3 (Product): Diesel Tank#4 (Product): Vent Box ■ In-Tank Gauging Probe Model: 0846390-109 ❑ In-Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794380-303 ❑ Annular Space or Vault Sensor Model: ■ Piping Sump/Trench Sensoria) Model: 0794380-208 ■ Piping Sump/Trench Sensoria) Model: 0794380-208 ■ Fill Sump Sensors) Model: 0794380.208 ❑ Fill Sump Sensoria) 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: 0846390.109 ❑ Tank Overfill/High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: 62: DISPENSERS/UDC's FDpenser#: 1 -2 Dispenser#: 3-4 Dispenser Containment Sensoria) Motlel: 0794380-208 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ShearValves ■ ShearValves Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chains) Dispenser#: 5-6 Dispenser#: 7-8 ■ Dispenser Containment Sensors) Model: 0794380-208 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Shear Valves ■ Shear Valves ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s) Dispenser#: 9-10 Dispenser#: 11 -12 0 Dispenser Containment Sensoria) Model: 0794380-208 ■ Dispenser Containment Sensoria) Model: 0794380-208 ■ 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 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 WALTOH Signature: CNGMEEnING.INC. Technician/Can M Gerardo Guzman I B35394 5242481-UT Date: Decemhei2B, 2009 ------------- ©2006 Walton Engineering,Inc.