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POB 36 26515 N. SACTO. BL. Continuous Monitoring, <br /> Af foriba- THORNTON, CA. 95686 Device Certification <br /> 209 794-0102 800 524-9087 <br /> TESTDATE <br /> SITES U L -7& U G A s <br /> OPERATOR S4,090 OWNER U,01-rQ G45 <br /> SITE ADDRESS 4SC> V t4 A IR'f"E�Z- `I' ADDRESS PO 136'1 It 36 <br /> c `i Ft A �►' C4 g S 3 7 g <br /> PHONE (_7ol) 9;6 :S q$ -71 PHONE <br /> MAKE AND MODEL OF MONITORING SYSTEM CSI L-ICA R C-C) C,yn e <br /> )R uA L SLA (' <br /> Contents of Tank <br /> Capacity of Tank 20000 10000 <br /> Type of Product Line: (Gravity, Suction, Pressure). '? P <br /> INDICATE LOCATION OF THE MONITORING SENSORS TESTED BY PLACING A YES OR NO IN APPLICABLE BOX: <br /> Annular Space Sensor RLi L ;2- <br /> u <br /> L <br /> Sump Sensor ,,L <br /> 11L 3�y <br /> Dispenser Containment Sensor L S L L7 L_ <br /> i <br /> Electronic Overfill I Level Q 7a gd' goa S <br /> Electronic In-Line Leak Detector )�j <br /> Mechanical Line Leak Detector y Y <br /> In Tank Gauging Device Tlr� (-AG 2 �y731°► 392 I <br /> INDICATE THE FOLLOWING BY PLACING A YES OR NO IN APPLICABLE BOX: <br /> Does the monitoring system have audible and visual alarms? Y y <br /> Does the turbine automatically shut-down if the system detects <br /> a leak, falls to operate or is electronically disconnected? 1 <br /> Is the monitoring system installed to prevent unauthorized tampering? <br /> Is the monitoring system operable as per the manufacturer's specifications? <br /> Which continuous monitoring devices initlate positive shut-down of the turbine? ►n C 1 ` <br /> CERTIFIED TESTERS ID# <br /> SIGNATURE OF CERTIFIED TECHNICIAN <br /> PRINTED NAME OF CERTIFIED TECHNICIAN �(� 1 m /r�a <br />