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JUN-03-2009 09 :06 AM GETTLER-RYAN INC. 925 551 4770 P. 02 MONITORING SYSTEM CERTIFICATION F,w Ukc l31';1li durisdiction.s Within the,:Srute of Cijh1urnia .-iurhoril.v Cites/. Chapter 6.", Fleuhlr orad Scr1c'n ('rale; Chapicr /0. /.)it ixion J. Title'3 (gulf/nr'niu(.'ode(?I Rcgulationk I'his furan must he used to document (esi and sen icing of monitoring eyuiprncnl. A_ _t14!41t.Llliittiun or re tort nG a(• ire ued_fi}> y monitoripS s_ystern contcthe lechniciun who performs tllc v.urk, A ropy of Dhis form moist he provided io the tank sy.rstcm nttner.operai The m%ner operator must sli it a ropo (,f This foam to the local acenc\ regulating l`S I ;%sterns a ithin 30 dans of test data A. General Information Facility Name: Arco AmPm 92186 —_- Bldg. No.: Site Address: 3212 N. California St. City: Stockton, Ca _ -_ Zip: Facility Contact Verson: Kevin Vo_ -----..__._..---......--- ---_ — Contact Phone No.: (209) 941-2694 Make'Model of Monitoring System: TLS-350 E)Ittc of Testing/Servicing: 5122/009__- B. Inventory of Equipment Tested/Certified Check the a t ro riate buses to indicates ecine equipment ins tretedrservlced Tank ID,_T-1 87 Master --_ _ —�— 'Tank it): _T-2_87 Schon i I ank Gauging Probe. Moolel 846390-109 M In-I unk(V;ucginn Probe Modul 846390-1_09 Annular Space or Vault Sensor. Madel 794390-409 ® Annular,pace or Vault s-owir Model 794390409_- (�Piping Sump/ I'reneh Sensors) Model 794380-3_23 (E Piping�nnip t I rench.Sensm(sl Madel 794380-323 FiItSump Sensor(s) Model 794380-323 — Z Fili Sump Sensor(,r Model 794380-323 ❑ Mechanical Line Leak Detector Mid. L _ ❑ Mccl>>uuuQ l inc Lcak Ucncchrr Modica ® liiertronie Linc Lcak r3ctcctur S4c"1c1 CPT - ® I-lcctrorm Linc Lea:I)O"lor. NI0dC1 CPT C]frisk O)or►ill/Ifigh-bevel Sensor. Model ❑ I'cutk I NCtfill/I ilull-i sect Sensor. Model ❑Other(specify equipmcnt type and rnodcl in Section t'.on Page 2 s. (w]Usher(;pecii equipment type and modes in Scctum 1- on Pew 2)! rr�wr�eriviurww�ua.r®a. w.9...•�..�.�.......rya.aw..rww�+�s��w Tank it): T•3 91 -- ®in-iwik Guuginp Probe. Model 846390-109 -_ [] In-I ink( turg,ng Probe Model ®Annular Sii or Vault Sensor. Model 794390-409 ❑ Annular~pace or VJUIt Sensor. Model: ® Piping Sump/ I'ronch SCIISUr(5) Modcl 794380-323 _ _ ❑ Pipin Sump' I'renelt SCnsdr(S). Mudd hill Sump Serisor(s) Mi-del: 794380-323 ❑ Fill tiunlr S4nso-00 Model --- ❑Mechanical Linc Lcak Dewor Model ❑ 41cc)tanicnl Ano I cal, lktcctor Model ®tarctronic Linc leak Detector. Modrl: CPT__-_-- - ---- [] l.lectronrc I 111 Lcak I)uteeh r Nlodcl ❑Tank(Ivo-ill/Iiigh-Level Sensor Madel _ ❑ Dank(!vcrlill i High-Level Sensur. Model [ Other(specitj equipmcnt typo and model in Section E.on Pape') -- G Usher(.pacilj equ(puunt tvhe and model in Scction Fon Pago:) uar�xrarwauwxurwrma:� .....�.�nMe.r..rounam.rrM..rwr..wn.nn.�+�'+�r Dispenser ID' 1 /2 _ Dispenser ID 3 14 ® Dispenser CIomainment Sensor(s) Model 794380-323 - _ Z I)isp4n•c:r t.'unt:unmrnt Scnsnr(s). Model 7943113 Z Shear Valvetsi -� Z ~lime Vn1%e("1 �� w ❑Dispenser Containment Flnitt(s)and Chain(s) ❑ Dispertscr('unu+foment Floausl and Chain(s). i.....�...o. �..�m..�----... ...�.r.. ..m rrwr.wn..r+- «+.....�.Y.r....r Dispenser Ip: 5/6 Dispenser ll), 7 /8 _ �___ _ ®i)ispcnscr(.'onttantnent.Scnsnr(s,) -'Model: 794380-323 �T ® DispenserContaimnentticnsot(s1 Model 794380.323 Shear Valvcol ----~ ® Shcur Vavos) [� Dislxnacr('ontaintnent Float(s)and Chain(s). [] Dispisnser(.'antainmcrtt 1-I0311s)and Chain(s). �'le-.. �-IrilAllliiitll � Dispenser ID: _--_--_-- _— Dispenser ID' ❑ DispenserConlainmcnt Scnvor(s1. Model: -_ 0 Dispenser('nntairmwnt Scnsor(s) Modri I [J Show Vallois) ❑ .Shear ValWsl. ❑ Dispenser Containment Floats)and Chain(s) [j Dispenser t ontainrncm iand C'hainls?�N , •If the fRcility contains more tanks or dispensers. cop\ this loam, Include information for wens tank anti dispenser at the facility C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guldellnos. Attached to this Certification is Information (e.g. manufacturers' checklists) neee"ali to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equi ment capable of yentrating such reports.I have also attached a copy of the report: (check(1/1 that apph'): System set-up Alarin history report Technician Name(print): _PeteGarcia- - _ -- - - Signature: Certification No.: A23970 _ ._ License. No.: 220793. Testing C'omparty Name: Gettler-man Inc. Phone No.: (825) 951-4771 —__- -- -_ Testing Company Address 6747 Sierra Ct,LDublin, Ca gate of-restingrSrrvicing: 5/2212009- Page 1 of 3 Rvv(21119)