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MONITOONG SYSTEM CERTIFIC0I0N <br /> For Use By All Jurisdictions Within the State of California <br /> Authority Cited: Chapter 6.7, Health and Safety)Code; Chapter 16, Division 3, Title 23, California Code of Regulations <br /> This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared <br /> for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank <br /> system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 <br /> days of test date. <br /> A. General Information <br /> Facility Name: ARCO PRODUCTS COMPANY Service Station No.: 6313 <br /> Site Address: 1 100 S MAIN STREET City: MANTECA Zip: 95337 <br /> Facility Contact Person: C H 0/S AloL, L— Contact Phone No.: _!�_c 3 —,2 3 y — ?e;� <br /> Make/Model of Monitoring System: 1AEEJ)17,rk -5 Date of Testing/Service: V1 p <br /> B. Inventory of Equipment Tested/Certified <br /> Check the appropriate boxes to indicatespecific equipment ins ected/serviced: <br /> Tank ID: an TID: <br /> 2 n-Tank Gauging Probe: Model: � -`i G - o Tank Gauging Probe: Model: 8L-/ <br /> Q� pular Space or Vault Sensor: Model: 7c;- 0 _ c, pular Space or Vault Sensor Model: 7 yq eo - <br /> QPiping Sump/Trench Sensor(s): Model: %�i�/ <br />