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MONITC#ING SYSTEM CERTIFWATION MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 CERTIFICATION /TEST DATE: January 29. 2009 Al. FACILITY Name Quik Stop Market #132 Address 3555 W. Hammer Lane, Stockton, CA 95219 Phone # 510-657-8500 Contact Michael Karvelot A2. OWNER Name Quik Stop Markets, Inc. Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 Contact Michael Karvelot A3. C U P A ❑ A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Annular Space or Vault Sensor Name Walton Engineering, Inc. Address 600 E. Main Street, Stockton, CA 95202 ❑ Address P.O. Box 1025, W. Sacramento, CA 95691 Notified January 29, 2009 Model: Lic # 617238 A, B, Haz Inspector None Tank Overfill / High -Level Sensor Contact Richard Walton Phone # 209-468-3439 Phone # 916-825-3203 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspectediserviced) 131: TANKS Tank #1 (Product): Gasoline - 87 ❑ In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390-409 ■ Piping Sump I Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: Tank #3 (Product): Gasoline - 91 ❑ In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390-409 ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: Tank #2 (Product): Gasoline - 89 ❑ In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390-409 ■ Piping Sump I Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill I High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: Tank #4 (Product): ❑ In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390-409 ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill I High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: 132: DISPENSERS/UDC's Dispenser # : 1 -2 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : 5 - 6 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : 3-4 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : 7 - 8 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Dispenser Containment Float(s) 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 that apply): ■ System set-up ■ Alarm History Report -- WALTON Signature: �— 9 � ENGINEERING. INC. Technician I Cert #: Gerardo Guzman I B35394 5242481 -UT Date: Jan uary29, 2009