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• MONITORING SYSTEM CERTIFICATION For Use By All Aurisdiations Volthin the Mate of California Authority Cited:Chapter 6.7,Health and Sgfatr Code;Chapter 16,Division 3, 71de 23, California Coda of Regulations This form must be used to document testing and servicing of monitoring equipment.A separate certification or re og rt must be 32repared for each Monitoring lystem control ganel by the technician who performs the work A copy of this form trust be provided to the tank system owne0operator. The ownedoperator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information FacilityName_ ! BP WEST COAST PRODUCTS.LLC 3 . _—I SS#: 16080 j Site Address: 85 E LOUISE AVENUE Cit LATHROP I Zi 95330 — Facih Contact Parson: ��\ - Contact Ph MekelModel of Monitorin�System ?� Tl� � i Date of TestingJService: y B. Inventory of Equipment Tested/Certified Check the riate boxes to indicate eci$c e ' arext' ected/semced: Tank ID: Tank ID: It ankGaugs gn Probe: I Model: Tal*GougingProbe: Model: ular Space or Vault Sensor. I Model: anular S ace or Vault Sensor Model:ingSump/TrenchSensor s�! Model: Sum renchSensors : Model:Sum Sensor•. Model 4 ills Sensors : jModel: chanicalLineLeakDetector. !_Model: echanicalLineLeakDetect.or. I Model:tronic Line Leak Detector 1 Model: ectronic line Leak Detector Model: kOvat illiHi -level Sensor I Model: Q k29- verfiM4i level Sensor: Model: 'ece .t e andmodel in Section Eon Pa e 2 Specify ..t e and model in Section Ron P e 2 Tank ID: TaukID: n-Tank Gauging Probe: _ _1 Model: Ain, ankG3au ' Probe: -Model rmularS ace orVaultSensor: Madel: nnularS ace or Vault Sensor Model:Sum renchSensors : �Modet in S renchSensors : Model: ill Sum SensoT_C�) Model: lls Sensor s : Model: echatrical Line Leak Detector. + Model- _axgechanicalLineLook Detector, Model: ectronic Line Leak Detector _' Model: WAectronic Line Leak Detector Model• arkOverfdVHigh-levelSen_sor: Model:_7%XM_a:�l W OverfxlV -level Sensor: 1 Model Other, SpecfK Spec' equip. e and model in Section Eon Pa a MOther,SEectZ egk.type and model in Section Eon Page 2 Dis enser ID: C§-hear er ID: is enser Containment Sensors:- Model: _ nserContainmentSans s : Model: 4 SheerValve sZ_ Vah► s .enserContainmentFlo a andCh ' s nser Containment Floa s and Ch ' s Di"enserlD: _ Dis enserID_: ise nserContainmentSensors: Model: — r DispenserContair=entSenso s Model: �-------^---- Dis enser Containment Floa s and Ch ' s is enser Containment Floa s and Ch ' s Dispenser ID: Dis enser ID: enserCo_ntainmentSensors: ! Model: ispenserContainment Sensor+(s): j Model• ,ShearVaiv s ._ t ShearValy s . --��-- enserContairunentFlo a andCh ' s is enserContainmentFloa s nndCh ' s *If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at this facility. C. Certification-I certify that the equipmeat identified in this document was ingw1ed/sen4ced in accordance with the manufacbsma' gugelines. Attached to this Certification L in rotation(e.g. maaufactmen'checklists)necessary to verify that this inbun don is cornet and a Plot Plan showing the hyout of monitoring uipmeai. For anyrAl=histo t capal+le of geaeratitq suck reports,I Inealso attached a copy of the!!pert• ch ek all that apply): System set- ortTechnicianNa -� Certification No.: - 4l License No.: Tastin�Coni1j re_ i TAIT ENVIRONMENTAL SYSTEMS j Phone No.: 1_(714)560-9222 Page 1 of 3 03101