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MONTTGRING SYSTEM CERTIFICATION For Use By All ,hvisdictions 94thin the Slate of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, 71tle 23, California Code of R gulah'op-u This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be -prepared for each monitoring system controljanel by the technician who performs the work A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. _General Info_rm_atio_ n Facility Name: BP WEST COAST PRODUCTS. LLC -- 88#: 12186 j _Site Address: , 3212 N CALIFORNIA City: I ST ON iZip_-195204 ---) Foci ContactPeraon _;. �.-',*jA%Q 5c-ke-4ee_, Contact Phone No.: ZOO -S-65 7 - - Mnke/Model ofMonitoringSystem: %jee-0ea-R4At TLS 3S-r�R%5 -GP r Date of Testing/Service: ;(to-/ Z- - o S B. Inventory of Equipment TestedlCertified Check the riate boxes to indicate cific a mext eeted/serviced: T ank ID: 1 8 7 Tank ID: 7 Vechamical Gnu ' Probe: Model: V173O -1'0 n-TenkO gProba: Model: $ 3 9o- o'Sp ac a or V cult S ensor: i Model- Q i7 0 Annular S ac a or V ault S ens or Model: e - um /french Sensor e : ` Model• . r{�SO-206 i in Sum /Trench Sensors . Model: c 'gp -Lam'8 p Sensor (s): Model: SSP �- Zo8 ill Sump Sensor (s): I Model } S o -zC"y LineLookDetector.�Model: echanic al line Leak Detector. i Model: ctronic Line Leak Model: �-Model: I - T' eetronic Line Leak Detector. I�eod 1 lnkOve !.Model: Ove Model: 1750 PV(-6oC er S ec' a %i . tvpe and model in Section E on Page 2 or, Spec& Spec'a w . t e and model inSection E on Page 2 T ID: --- 1 Tank ID: Tank Gougi:�gProbe_ Model: QO - o-Tank0au ' gFrobe_ Model: AnnulnrSQace orVaultSens or: _ Model: ' - L(c>j nnular Space or Vault Sensor Model: ingSump/Trench_Sens or(s): __Model: - W6 ing Sum lTrenchSensor (s): 1 Model: i1lS Sensor s): _ ' Model: o -ZP$ ill Sump Sensors : Model echanicalLine Leak Detector. Model: echanicalLine LeekDeta ctor_. Model: ectronic Line Leak Detector Model: : R-1, T ectsonic Line Leak Detector Model: ankOverffi I N I -I 18 rMar: Model: ?9Q0}/ -o0/ nnkOverlr1UHi -level Sensor: Model _ Other,S2eceS142.type and model in Section E on Page 2 Other S ec' e . =a and model in Section E on Pa e 2 V'Sheau ' :_ _ ' L Dis enser ID: �� S Containment Sensors: Model: 2n5 Dispenser ContainmentSenso s : Model: Zd8 ves . hear Valve sContainmentFloa s and Ch ' s is enser ContainmentFloa s and Chain(s) DispenseriD:_ ' DispenserID:_ fispenserContainmentSensors: Model,ZO$_DispenserContainmentSensos,$)Model:hear Valve(s) Shear Valvre s�. —� _ _ [e} is eraser Containment Flo!!Q) and Ch ' s is eraser Containment Flo e s and Ch ' s Dispenser ID: _ -C. enser ID: Dis enserContainment Sensors: Model: - Zo is�easerContainment Sens o s): Model: h'DarValy s�^v ^^ She arVnly s . enser Containment Flo s and Ch ' s is enser Containment Flo! s and Ch ' s "Uthe facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at this facility. C. Certification -I certify than the equipment identified in this documentwas inspected/seniced in accordance with the manufacdoen' guidelines. Attached to this Certification is information (e.& manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment For any utpment capable of generating such reports, I hm Ww attached a copy of the re-, �choc_k all that ): �Sysiera set-up _ Alarm hisior�r Technician Name_ �� rCtvr:d,, Signature: -- T - License —No.: I Cert�cntiurallo.: �, oo(� d c-r�o�� i- _- �Tartigg.COmpanyNome: TAIT ENVIRONMENTAL SYSTEMS Phone No.: (71-4 560-8222 Pap I of 3 03/01