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06/29/2005 13:55 2099519352 VILLAGE WEST MARINA <br />Mar 03 05 08t 10p .l �r Dotton r._...�.�� �.- 12( 533-2650 <br />17759 Buttercup Circle, Sonora, CA 95370 <br />Phone: 209--532-7320; Fax: 209-533-2550 <br />California Contractor 623541 A-l�aa <br />alltacki ftetrocket.com <br />NjTOR1NG SYSTEM CERTIFICATION <br />PAGE 07 <br />.k. General Information <br />Facility Name: VIU&Ze West Marian Date of "T'csungiScn,icing: June 8, 2001 <br />Facility Addrear: 6649 Embarttadero Drive, Stockton CA 9521"1 <br />Facility coutaot Pervert: Mika Spence Contact. Phone No.. 209-961-1551 <br />Regulatory agency: San Joaquin Health; Inspoctor. Michelle Le ; Phone: 468-91447: Fax 468-3433. <br />Mick /Model of Monitoring SyUM: Viceder-Root TIS 3501 <br />TYIs SCAR report Is a: ® Prtliminsry Report (Uoresotved Issues Exist) or n: 0 Final Report (Facility was obiervod to be in Compliance) <br />B. Lnventnry of E ui ment Tcsted/Certified: <br />Tank ID: Regitlur Tank <br />'funk W: Diesel T>,nk <br />❑ In-Tturk Osuging Probe. Model: lion: <br />0 In -Taal Gaugirrp Promo. Modcl: I iaiw <br />* Annular Space or Vault Sensor. Model' i ltwt Switch <br />l@ .'tnnuinr Space or 'Jauit Sensor. Model: Flog Swatch <br />® Piping Sump / Trench Smsor(s). Model: Float Switch <br />Yipi ig sump! Trumh 3at.•cor(s). Modcl: Float Switch <br />❑ Fill Sump Sraxcxr;v). Model: <br />❑ Fili Sump Senson;s), Model; <br />® mcau tical Iard 1Kak Dettxtor. Model: Red Juket Dia ph. <br />0 Mochanical Linc leak "Mcm'. ModeJ' RO Jacket Dilll)h, <br />❑ Elactronic Lina Leak Detector. Model: <br />0 I'lactrowc Liui Leak Detector, Model <br />l�Tani; Ovatill / High -Level Sensor. Model: Drop'Iubr <br />0 "tank Overriil r Hip -Level SM30r. Modcl- tkup Tulle <br />Other <br />titlicr <br />Tank ilk <br />Tunk ill <br />❑ In -Tank Gauging Prokv. Model- <br />0 in -Tank Gausting Pmtw. )Qode): <br />❑ Annulsr Spars or Vault Sensor. Model. <br />❑ Annulnr Space u Vault Sen=, Model: <br />0 Piping Stag I Tratch Sonet). Modol: <br />❑ r'ipiog Sump t Ti%mch Senors). Model: <br />❑ Fill Sump Sensor(%), bfodel.- <br />❑ 10I Sump Scnsvrts) Model: <br />❑ Mm4nical Lina Leak Detector. Model: <br />C] M=hwucal Linc Lcak Dctc ctor. Modcl: <br />0 Elecu-0aic Lute Leak Dttet1or. Model: <br />0I-lectronic Line Leal: Detector, Madel: <br />C]'1'=k overfill I high-14vel Senwr- Model: <br />0 Turd Seraor. Model' <br />p(har <br />U Other <br />Dispeoxer IM 10 Sump: ®Ary OWater OProduct <br />pispenier ID: 2 0 Sump' ®Dry ❑Water ❑Product <br />Q DisptYltrorCaafttittrpaut Scrusor(s j Madel: <br />0 Dispcnser Comainment Smoa(s). Model: <br />• Shear Valve(s) (Functional test) <br />(D Shear VaIve(s) (F cuic6ozWI test) <br />® Di Aar Contai=tont F s and Llainta), <br />®J1 nscr Conwinmcnl F1oa x and ctwin(a . <br />Dispenser ID: 3 2 Sump: C@Lhy (]Watar ❑F'tcdAat <br />Dispenser M O Surtip: OOry []Water :]Product <br />❑ Di%partwr Cantatnawttl Setutor(sj Model: <br />0 Djgx scr Containment S.mwr(s). Motel: <br />0Shear Valve(s) (Funawnol test) <br />❑ Shear Valve(s) (Functional test) <br />fh Containtnau Flaa s and Chains , <br />Dis user Contaittmew floe s and Chain(s). <br />Ditptatwr ID: [3 Sump, O1)ry ❑Wal --r []Product <br />Dispenser ID: ❑ Sunup: (]Ary OWatcr ❑Product <br />0 Dispema Contuinwaestt StnWs} Model: <br />0 Dislwnscr Contairwwrit Senxetts} Model: <br />CJ Spar Vslw(s) (Functional toss) <br />❑ shear V4)VC(tt) (I_'uncuon:il t(;al) <br />Dis <br />pTwr Containment Float (&) and Chai 'A). <br />0 Dispenser Conwlttrtteni Float(i) and Chain a . <br />C. Certification • I cartify that the equiprttaat iciontinod in this dacuntcnt was inspected/serviced in accordant with tbo <br />aranutlactamrs' gubklina. AttaRctuul to this CartJflt:utlun is (nt'orrputitut (e.g. tuanu(actutvnc' chetkhJU) ntcaswry W verify that this <br />Infortandon is correct end a Plot Plan 64uw4ryt thr Iuyrout of monitoriN uyui wont. For ani• equipment otpebla of gatwrallag such <br />rtporM I have oiso attached s copy of rht report; (cAwck aJ! rlua upyfy): Systern set-up MAlarm history report <br />Mike Dotten, California Contractor Lieenttc, No,: 623541 <br />7echnit l,ta: 1' <br />Ccrtlikaidon. Vecder-Root: 342-32-6743i Level a. <br />Page I ut 3 P.1.'al <br />