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Jun 09 03 11 : 39a Mike Dotten 209-533-2650 P. 1 AlItec 1.7759 Buttercup Circle, Sonora, CA 95370 . Phone: 209-532-7320; Fax: 209-533-2650 California Contractor 623541 A-Haz alltech@getrocket.com MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Village West Marina Date of Testing/Servicing:June 5,2003 Facility Address: 6649 Embarcadero Drive,Stockton CA 95217 Facility Contact Person: Mike Spence Contact Phone No.: 209-951-1551 Make/Model of Monitoring System:Veeder-Root TLS 3501 B. Invento of Equipment Tested/Certified: Tank ID:Regular Tank Tank ID:Diesel Tank ❑In-Tank Gauging Probe, Model:None ❑In-'rank Gauging Probe. Model:None ®Annular Space or Vault Sensor. Model:Float Switch ®Annular Space or Vault Sensor. Model:Float Switch ®Piping Sump/Trench Sensor(s). Model:Float Switch ®Piping Sump/Trench Sensor(s). Model:Float Switch ❑Fill Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: ®Mechanical Line Leak Detector. Model:Red Jacket ®Mechanical Line Leak Detector, Model:Red Jacket ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ®Tank Overfill/High-Level Sensor. Model:Drop Tube E Tank Overfill/High-Level Sensor. !Model:Drop Tube ❑Other ❑Other Tank ID: Tank ID: ❑In-Tank Gauging Probe. Model: ❑In-Tank Gauging Probe. Model: ❑Annular Space or Vault Sensor. Model: ❑Annular Space or Vault Sensor. Model: ❑Piping Sump/Trench Sensor(s). Model: ❑Piping Sump/Trench Sensor(s). Model: ❑Fill Sump Sensor(s). Model: ❑Pi I I Sump Sensor(s). Model: ❑Mechanical Line Leak Detector. Model: ❑Mechanical Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ❑Tank Overfill/High-Level Sensor. Model: ❑Tank Overfill/High-Level Sensor. Model: ❑Other ❑Other Dispenser ID: I ❑Sump:❑Dry❑Water❑Product Dispenser ID:2❑ Sump:❑Dry❑Water❑Product ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) ❑Dis enser Containment Float(s)and Chain(s). ❑Dispenser Containment Floats and Chain(s). Dispenser ID: ❑Sump:[]Dry[]Water❑Product Dispenser 1D: ❑ Sump:❑Dry❑Water[]Product ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) ❑Dispenser Containment Float(s)and Chain(s). ❑Dis enser Containment Floats and Chain(s). Dispenser ID: ❑Sump:[]Dry❑Water❑Product Dispenser ID: ❑ Sump:❑Dry❑Water❑Product ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) ❑ Dispenser Containment Float(s)and Chain (s). ❑Dis enser Containment Floats and Chain(s). C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g.manufacturers'checklists)necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports,I have also attached a copy of the report;(check all Thal apply): [I System set-up [I Alarm history report Technician: 1/a& Mike Dotten,California Contractor License.No.:623541 Certification: Veeder-Root:341-32-6743;Level 3. Page 1 of 3 03101