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MONIT ING SYSTEM CERTI ATION CERTIFICATION /TEST DATE: May 26, 2009 Al. FACILITY A2. OWNER Name Quik Stop Market #132 Name Quik Stop Markets, Inc. Address 3555 W. Hammer Lane, Stockton, CA 95219 Address 4567 Enterprise Street, Fremont, CA 94538 Phone s 510-657-8500 Phone # 510457-8500 Contact Michael Karvelot Contact Michael Karvelot F. IN -TANK GAUGING / SIR EQUIPMENT: ■ Check this box If tank gauging Is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment Is installed. This section must be completed if in -tank gaugung equipment is used to perform leak detection monitoring. COmDiete the followinq checklist: ■M I* In Section H below, describe how and when these deficiencies were or will be corrected. I G. LINE LEAK DETECTORS (LLD): ❑ Check this box If LLD& are not installed. Complete the following checklist: ■ Yes ❑ No For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ Yes ❑ No * Has all Input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ No * Were all tank gauging probes visually Inspected for damage and residue buildup? ❑ Yes ❑ No' Was accuracy of system product level readings tested? ❑ Yes ❑ No' Was accuracy of system water level readings tested? ❑ Yes ❑ No * Were all probes reinstalled property? ❑ Yes ❑ No * Were all Iterns on the equipment manufacturers maintenance checklist completed? ■ NIA ■M I* In Section H below, describe how and when these deficiencies were or will be corrected. I G. LINE LEAK DETECTORS (LLD): ❑ Check this box If LLD& are not installed. Complete the following checklist: ■ Yes ❑ No For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ WA (check all that apply) Simulated leak rate: ■ 3 g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. ■ Yes ❑ No * Were all LLD* confined operational and accurate within regulatory requirements? ■ Yes ❑ No " Was the testing apparatus property calibrated? ■ Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow If It detects a leak? ❑ NIA ❑ Yes ❑ No' For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ■ NIA ❑ Yes ❑ No " For electronic LLDa, does the turbine automatically shut off if any portion of the monitoring system is disabled ■ NIA or disconnected? ❑ Yes ❑ No * For electronic LLDs, does the turbine aut nutically shut off if any portion of the monitoring system malfunctions ■ WA or fails a test? ❑ Yes ❑ No " For electronic LLDs, have all accessible wiring connections been visually inspected? ■ WA ■ Yes ❑ No " I Were all items on the equipment manufacturers maintenance checklist completed? ' In Section H below, describe how and when these deficiencies were or will be corrected. H. COMMENTS Page 3 of 3