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Alltech Petro Inc. <br /> P.O. Box 4208, Sonora, CA 95370 ` <br /> Phone: 209-532-7320; Fax: 209-533-2650 <br /> California Contractor 623541 A-Haz 1 <br /> alltechmail(wme.com <br /> MONITORING SYSTEM CERTIFICATION <br /> A. General Information <br /> Facility Name:Village West Marina Date of Testing/Servicing: March 25,2010 <br /> Facility Address:6649 Embareadero Drive,Stockton CA 95217 <br /> Facility Contact Person:Mike Spence Contact Phone No.:209-951-1551 <br /> Regulatory agency:San Joaquin Health;Inspector:Garrett Backus;Phone:468-9847;Fax 468-3433. <br /> Make/Model of Monitoring System: Veeder-Root TLS 3501 <br /> B. Inventory of Equipment Tested/Certified: <br /> 'hank ID: Premium Tank Tank ID: Diesel Tank <br /> Elin-TankGauging Probe. Model:None ❑In-Tank Gauging Probe. Model:None <br /> ®Annular Space or Vault Sensor. Model:794380-344 ®Annular Space or Vault Sensor. Model:794380-344 <br /> ®Piping Sump/Trench Sensor(s). Model:794380-208 ®Piping Sump/Trench Sensor(s). Model:794380-208 <br /> ❑Fill Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: <br /> ®Mechanical Line Leak Detector. Model:VMI LD-2000 ®Mechanical Line Leak Detector. Model:VMI LD-2000 <br /> ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: <br /> ®Tank Overfill/High-Level Sensor. Model:Drop Tube ®Tank Overfill/High-Level Sensor. Model:Drop Tube <br /> ❑Other ❑Other <br /> Tank ID: "lank ID: <br /> ❑In-Tank Gauging Probe. Model: ❑In-Tank Gauging Probe. Model: <br /> ❑Annular Space or Vault Sensor. Model: ❑Annular Space or Vault Sensor. Model: <br /> ❑Piping Sump/Trench Sensor(s). Model: ❑Piping Sump/Trench Sensor(s). Model: <br /> ❑Fill Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: <br /> ❑Mechanical Line Leak Detector. Model: ❑Mechanical Line Leak Detector. Model: <br /> ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: <br /> ❑Tank Overfill/High-Level Sensor. Model: ❑Tank Overfill/High-Level Sensor. Model: <br /> ❑Other ❑Other <br /> Transition Sump: E Sump:®Dry❑Water❑Product Dispenser ID: ❑Sump:❑Dry❑Water❑Product <br /> ®Sump Containment Sensor(s). Model:794380-208 ❑Dispenser Containment Sensor(s). Model: <br /> ❑Shear Valvc(s) (Functional test) ❑Shear Valve(s) (Functional test) <br /> ❑Dispenser Containment Float(s)and Chain(s). ❑Dispenser Containment Float(s)and Chain(s). <br /> Dispenser ID: 10 Sump:®Dry❑Water❑Product Dispenser ID:2® Sump:®Dry❑Water❑Product <br /> ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: <br /> ®Shear Valves) (Functional test) ®Shear Valve(s) (Functional test) <br /> ®Dispenser Containment Float(s)and Chain(s). ®Dispenser Containment Float(s)and Chains. <br /> Dispenser ID:3❑ Sump:®Dry❑Water❑Product Dispenser ID: ❑ Sump: ❑Dry[]Water❑Product <br /> ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: <br /> ®Shear Valves) (Functional test) ❑Shear Valve(s) (Functional test) <br /> ®Dispenser Containment Floats and Chain(s). ❑Dispenser Containment Float(s)and Chain(s). <br /> C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the <br /> manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this <br /> information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such <br /> reports,I have also attached a copy of the report;(check all that apply): ❑System set-up ❑Alarm history report <br /> Page 1 of 3 03/01 <br /> Technician: Date:3/25/10 <br /> Certification:Veeder-Root B36878,Level 2/3 <br /> ICC UST Service Technician#8005930-UT <br />