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MONITORING SYSTEM CERTIFICATION For Use By All Jurisd,,chons 44thin the Spate of California .9uthori.y Cited: Chapter 6.7, Health and Safety Code;'Chapter 1 d, Division 3, Tl'tle 23, Cah.fibrnia Code of ReRulzmow This form must be used to document testing and servicing of monitoring equipment.A separate certification or re�orL must be pry tired for each monitoring system control panel 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 Information FacilityName: . ARCO PRODUCTS COMPANY Service SLationNo.: 6313 Site Address: 1100 S MAINST _EET... TR . City. MANTECA .-.:__ - .. _......._. ..__ Zsp: .95337 FnctlityContact Person: "U� 5 . � Contact PhoneNo.; jam --..._. MakelAllodel of MonitoringSyetem _ _ U l� ?L S 3SV Date of Testinglservlce: B. Inventory of Equipment Tested/Certified Check the riate boxes to Wicata s1pecific e ' "tent ected/semced. Tank ID: TanklD: .n Tankt}sugingProba: _ __. Model- f0iZr, kGa LgirlgProbe:� _ .Model: 7 PFiWU - -- e5pace at Vault Sensor: Model 9a cfjerSpaca aultSensor Model:Sensor(e): ModoL �- SumpJTrenchSensor(s� ,Model•utnpSensor(s) Modermp Sensor(s); .._. _._:.Model: echnntcall.irl Leak Detector Modeiocao nicalLine LeakDetector. Model:or»c Line LeakDetector Model nic Line Leak Detector MoOPerfl]/H level SensorModel.- — _- -.._. _ ._ . - - _ s09S c?o:/ __. ver�igh-leyel Sensor ModelOther,S ec' a .t e and model in Section E on Pa e 2 Specify a ui .t3Me and model in Section E on Page 2 Tank?D: Tank M: Tank Gauging Probe: _ Model: 2.390 lo In-TankGau gProbe: Model: nn7.u'S.,paceorVaultSensor. Model-' 39oso� ArmulnrSpaceor_VnvltSensor Model: ..... _ __ .__ ... QPpingSump/TrenchSensor(s}: _Model D� ipingSumpfl'renchSensor(s): Model [ ill Susr�Sensor(s) _ Model. '79 �= ill Sump Sensor(s}._ Model echaracnlLmeLenkDetector Model :D MechanicalL�neLeakDetector Model ___..�. ---. . ------.._ }�Irlectrcr Lrne Lank Detector Model. Electronic Line Leak Detector Model: pTarlkOvarrilUHighlevelSansor: IugodaL- �1cu9�-oes•% _nnkOverE111Higk>-lavelSensor Model ,..... - pOther,Spec' equip.t e and model in Section E on Pa e 2 Other,S ec' e t e and model in Section E on Page 2 d Dis serlD: /—Z Dis ser ID: — ,3—y auserContairm►entSensors: Model 79 enserContainment Sens or(s): Model: Shear Velva(s). he ValveSs�_ nDis ense'r Containment Flo! s1 and Ch ' s Dispenser Containment Floa s and Gh ' s Dispenser ID: Dis nsatID: enserContainment Sensors: Model: -.>cj,/ ^ enserContainment Sens os(s): Model: She ar V alve(s). he ar V alve(.) s1',-ViDisperlser . aDis enser Containment Flo and Cil_ s CoritairunentFloa sand Ch s Dis ser ID: Dis nser ID: iL eriserContainmentSensozs: Model: 7 enserContainmentSenso s Model: _ . ... ShenrVelve(s). _ - SheazValveSs). . .-. . ._•---_- QDis enserContainmentFloa s and Ch ' s x Dis enserContainmentFloa s and Ch ' s *If the facility contains more tanks or digpensers, copy this form. Include information for every tank and dispenser at this facility. C. Certification-I certify that the eq*ment identf5ed is this docwnent was inspected/serviced in accordance with the xmnuFach ers' pWelines. Attach to this Cerdfcation is infornatisn(e.g. xtanuhcturen'chec)dists)necessary to verify that this ixhnnation is cornet and a Plot Plan showing the layout of mmnitorixg a meat For any meat capable of generating such reports,I bele alae attachel a of the ort; 6check a!!Stat apply': ism set histo oro _ may--... aP. ' _ ._Ys iT P . Technician Name Tint : - -- _ .. _(P . ) ��. l G '�E 6G Signatuze: _ - - - — Certification No.: Q 7 7 y License No.: 09 A TestcigCompanyNnme: TAITENVIRONMENTAL SYSTEMS Phone No.; (71560-8Z2'1 Pagel of 3 03101