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7149792615 of 028 a.m. 10-2-20-2014 5114 Appendix V1 C : (Copies of Monitoring System Cerfification fort and UST Manhoring Plat Plan available at hap:!/www.watcrboerds.m.gav.) MONITORING SYSTEM CERTIFICATION OCT 2 0 2014 For Use By All Jurisdictions Within the State of California Atrtltoriy Cited:Chapter 67,Heafth and Safety Code{Clmper 16,Division 3,Tale 23,California Code ofRegdadans�y�\/�p This form must be used n document testing and servicing of monitoring equipment A separate certification or report musf_eprcpa QWA,EkNTAL HEALTH monitoring system control panel by the technician who performs the work.A copy of ft form must be provided to the tank systema� ra6os.i�The. ownedopennor must submit a copy afthis form to the local agency regulating UST systems within 30 days of test date. t51 ENVT A. General Information Facility Name: Pacific Gas and Fl ecbic Company Building No.: PGE095 Site Address: 4040 WEST LANE City: STOCKTON Zip: 95204 Facility Contact Person: Alex Steele Contact Phone No.: 916.439-3477 Make/Model of Monitoring System: Veeder Root TLS-350 Date of Testing/Setvicing:9/16/2014 B. Inventory of Equipment Tested/Cenified Check the appropriate boxes to Indicate specific equipment Inspected/serviced: Tank ID:TI:Unleaded Tank ID: T2:Diesel F In-Tank Gauging Probe. Model: r In-Tank Gauging Probe. Model: F Annular Space or Vauk Sensor. Model:794390-420 F Annular Space or Vauk Sensor. Model:794390420 F Plping Sump/Trench Scnsor(s). Model:794380.208 F PipmgSump/Trench Sensor(s) Model:794380-208 F Fill Sump Seeor(s). Madel: r Fig Sump Sensor(s). Model: r Mechanical line Leek Detector. Model: r Mechanical Line Leak Detector. Model: F Electronic Line Leak Detector. Model:Red Jacket F Electronic Line Leak Deector. Model:Red Jacket r TankOvafill/(sigh-Level Sensor. Model: r- Tank Overfill/High-Level Sensor. Model: F Other(specify equipment type and model in Section E an Page 2). r Other(specify equipment type and model in Section Eon Page 2). Took ID: Waste Oil Tank ID: Hydralc Fluid F In-Tank Gauging Probe. Model r In-Tank Gauging Probe. Model: F Annular Space or Vault Sensor. Model:794390-420 F Annular Space or Vauk Sensor. Model:794390-420 F Piping Sump/Trench Samor(s), Model:794380-208 r Piping Sump/Trench Sensm(s). Model: r Fig Sump Sensor(s). Model: r Fig Sump Sensor(s). Model: r Mechanical Line Leak Detector Model: r Mechanical Line Leak Detector. Model: r Electronic Line Leak Detector. Model: r Electronic Line Leak Detector. Model: F Tank Overfill/High-Level Sensor. Model:794390420 F Tank Overfill/High-Level Sensor. Model:794390420 r Other(specify equipment type and model in Section E on Page 2) r Other(specify equipment type and model in Section E on Page 2) Disposer In:Unleaded 1-2 Dispenser ID: Diesel F Dispenser Containment ScmcKs). Model: 794380-208 F DispenserComahnmentScn Xs). Model: 794380-208 r Shear Valve(s). r Shear Valve(s). r Dispenser Containment Flost(s)and Chain(s). r Dispenser Containment Floa(s)and Cham(s). Dispenser In: Unleeded34 Disposer ID: F Dispenser Contahment Sen®t(s). Model: 794380-208 r Dispenses Conmvmrenl Sensen(s). Model: r Shear Valve(s). r Shear Veive(s). r Dispenser Containment Fiaa(s)and Chain(s). r Dispemer Containment Floa(s)and Chain(s). -If ole facility cunaias rm a looks or dispensers,copy the from.Include infornmion forevery tank and dignnser at the facility. C. Certification-I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines.Attached tothis Certification is foformatinn(cg.manufacturers'checklists)necessary to verify that this information is correctand 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;Icheck all tlmtapp/J) : F System set-up F Alarm history report Technician Name(prim): Vicar Guarem Signature: 4� Certification No.: B36532 License.No_ 588098 Testing Company Name: TAIT ENVIRONMENTAL SERVICES Phone No.: 71456D-BM Testing Company Address: 213150UTnWP0Nr M1Ve AN KCA9ta6 DateofTesting/Servicing: 9/18/2014