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May 02 12 01:28p Reliable PetroleumA 209-845-8953 p.2 A40NITORING SYSTEM CERT FICATION For We authority Cited; stapler 6?, Neal h andSaf�Code, Chaplerionshl 5, D> s the on 3. Tu,e 23, California Code Re This `vim must be used t docuetent ;es:ing and Remicine of rnonitorin u; ^lent_ A s ate certiricatjon or gulaared nit rip s stem cepa anel by the technician who performs the-or A c py oftnis roar.crust be provided to the tank System okrner/operator. The owner/operator musts omit a aoP)•of;his form to the local agency regulating UST systers within 3D dash of test dot m be roared for each A. General Inform tion Facility Name: Arco Site Address: 1100 S. airs St Bing NO.: Facility Contact Person: essie City; Manteca ip: 95337 MakefModel of Monitor' g System; weederRoot TLS-350 Contact Phone No.: 209) 609 197 B. Inventory of Eq ipment Tested/Certified Date ofTesting/Ser„ic' 31+3012012 ~ Cheek the a riate boxes t eradicate s cific i oral ins etedlrcrvectd: Tank ID- T1:87 ®In Tank Gauging Tack 1D: T2: 91 g b Probe. Mode]: 847390.1 D9 ®AnnutarSpece or vault Sens Model: 794390-409 ®In-Tank Gacging Probe. Model, 154 lots Z Piping Sump!Trench Sensor s) Model 794380-323 ®Annular Space ar Vault Sensor. Mm d: 79438 09 ®.'ill Sump Sensor(s). ?Model: 794380-323 ®Prping Sump!;Tench Seasons). �4todel: 79438 323 ®klcc!-.anical ljne Leak Detect r. ®Fi]1 Sump Sensor(s). McdeJ: 79438 323 ylodcl: 991-[3-2004 ®Mechanical Line Leak Detector. Yodel: FES -F*23 ❑FJxt;onic Line leak lactecto Model: t�Tank overfill l Jiigh-icvel Se sur. LC N1ode1: ❑Electronic Line lcal DeuctOf. Model: Other(specify equ4mat C)•n and model in Section Eon Page 2). Q rank O.erfill!High-Level Sensor. Model ❑Other(spocify t:quipmcni Rupe and model in Scollop o�Page il. Tank ID: T3: 89 2 fn-Tank Gauging Pro.o. Tank ID: Model: 84739D-109 0.Annular Space or Vault Scnso Yodel: 7 ❑'^Tek Gauging Probe. Model: 80-323 ®Piping Sump J Trench Scnorfs �4edet: 794380J [1 Annuls Spxe or Vaull Sensor, 23 )t4odcl: 794380321 3imp Sonsor(s). ElPiping Sump i french Sensen.'s i. Model: Madel: ------ ZMechanical lire Leak Dare:,r . 3700cl: F8 STP-MLD ❑"'II Sump Sensor(s). hlccel: ❑ Mechanical Linc Leak Dctcc,or Model: f:cc Vonic Line l,;.al;Detector. Model: Ll❑Tank Ovcrfill l fhO-L;vei Srn ior. Modet: ❑E'ectronic lire I.e;zk Detector, Modei. ❑otter(specify ecq rproern type d model in Seclion E c Page ❑Tank Overfill/High-Level Sensor. Madel: ee 2). ❑O:her(specify-q:' mem Dispenser ID: 182 p )x orad model in Secpon an Page 2). ($Dispens-r ContaitetttmDispenser ID: 3$4 SaL-cT( )_ h7odel 794360-323 iD Shear Valvo(s). ® Dispenser Ccntainment Sernson;s)_ R•lodd: 19498 3 ❑Dispcneer Contaemment F1oar(S) d Chain(s). �i Shear Valve(%). ❑Dispenser Contxinmenz rloairs and Chaim;s). Dispenser IU: 5$6 Z Dispenser Containment Senscr( Model 790380-323 Dispenser ID: 7&8 ® Shear vzlve(s). Dispenser Containrreni Sensun;s). Model: 79438 23 ❑Disp riser Containment Flo at(sj, ndChain(s1. ®Shcar Valve(s). ❑Dispenser Containment Hoan;s)and Charms). Dispenser ID: 9&10 ®l7isF:ruer Containment Sense—. ML%,jcl: 794380-323 Di,penser]D: 19$12 *Sl'ear Varve(s), IID Cispcmer Con;ammeni&nsor(s). Model. 79438D 323 V Dispenser Coruainmurt Float(s)and Chain(s i. Z sh--ar Valve(e,i. Dis on •If�e facility comai-ts more tan or dispensers,copy the form. Include irformaton foC��am a,k and dispenser at the facia C. Cer ification - I certify that the equipment identified in this document ivas inspected,rservieed in 2 cord$nce with the manafactarers' guidelines Attached 10 this Certification is information (e.g. manufarturers' checklists) necessa to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capab of generating such 7eports,I have also attached a coPy of the repor-,(check all Thal aFplr): System set-up ®Alarm hi ory report Techn;cian Name(print): GL adalu Sanchez n CertificationNo.: A30138 Signature: License.No.: 863706 ` Testing COmpanv Name: Reliable Petroleum Services, Inc. Phone e• (209` 845-658 Testing Company Address: 1'1930 Horseshoe Rd. Oakdale, Ca.95361 Date of Testing;'Serv;r:in : 313012012 Page i of 4 R-,v(21N)