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MONITORING SYSTEM CERTIFICATION FAMWe By All Juni s in the State of Callibmia Asak Authority Cited:Chapter 6 7, and Safety ,Chapter 16,tJivi ' 3 Title 23,Ca/' Cade of Regulations This form must be used to document testing and servicing of monitoring equipment. M more than one monitoring system control panel is installed at the facility,a separate certification or report must be prepared for each monitoring system control Panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/ or. The owner/operator must submit a copy of this fatty to the focal agency regulating LIST systems within 30 days of ted date. A Infoirmation Facility Name: ARCO#2093 CCI 8022760 : TRACY CA Zip:95376 Site Address: 3425 TRACY BLVD Contact Phone No: 835-1605 Date of Testing/Service: 01/11/2006 Facility Contact Person: MANAGER Make/Model of Monitoring System:V.R.TLS-350PLS Work Order Number: 2240291 S.Inventorir of Equipment TesteNCertOW Check the appropriate boxes to indicate specific equipment inspected/serviced Tank ID: 1-91 Tank ID: 2-87 MAST X in-Tank Gauging Probe. Model: MAG X In-Tank Gauging Probe. Model: MAG X Annular Space or Vault Sensor. Madel: 407 Annular Space or Vault Sensor. Model: 407 XPiping Sump/Trench Sensor(s). Model: 208 Piping Sump/Trench Sensor(s). Model: 208 X Fill Sump Sensor(s). Model: 208 Fill Sump Sensor(s). Model: 208 Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: V.R.PLLD X1 Electronic Line Leak Detector. Model: V.R.PLLD Tank Overfill/High-level Sensor. Model: Tank Overfili/High-Level Sensor. Model: Other(specify equipment type and model in Section E on page 2). Other(specify equipment type and model in Section E on page 2). Tank ID:19U= Tankl - X In-Tank Gauging Probe. Model: MAG In-Tank Gauging Probe. Model: MAG X Annular Space or Vault Sensor. Model: 407 Annular Space or Vault Sensor. Model: 407 X Piping Sump/Trench Sensor(s). Model: 208 Piping Sump/Trench Sensor(s). Model: 208 X Fill Sump Sensor(s). Model: 208 Fill Sump Sensor(s). Model: 208 Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector. Model: V.R.PLLD Electronic Line Leak Detector. Model: V.R.PLLD Tank Overfill/High-Level Sensor. Model: Tank Overfill/High-Level Sensor. Model: Other(specify equipment type and model in Section E on page 2). Other(specify equipment type and model in Section E on page 2). Dispenser : 1/2 Dispenser I /4 _ Dispenser Containment Sensor(s) Model:208 X Dispenser Containment Sensor(s) Model:208 X Shear Valve(s). X Shear Valve(s) Dispenser Containment Float(s)and Chain(s). Dispenser Containment Float(s)and Chain(s). Dispenser ID: 5/6 Dispenser ID: 7/8 ® Dispenser Containment Sensor(s) Model:208 71 Dispenser Containment Sensor(s). Model:208 ® Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s)and Chain(s). Dispenser Containment Float(s)and Chain(s). Dispenser ID: Dispenser ID: ® Dispenser Containment Sensors) Model: Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s). Shear Valve(s). ❑ Dispenser Containment Float(s)and Chain(s). Dispenser Containment Float(s)and Chain(s). *If the facility contains more tanks or dispensers,copy this form.Include Information for every tank and dispenser at the facility. C. Cer0cadon 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' lists)necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment.For any eqtAprnent capable of generaft such reports,I have also attached a copy of the(Check all that apply): ❑System set-up ®Alarm history report Technician Name(print): JOEY MESA Signature: % Certification No.: 006-05-1532 License.No.: Testing Company Name:Tanknology Phone No.: (800)800-4633 Site Address: 8501 N.MoPac Expressway,suite 400,Austin,TX 78759 Date of Testing/Servicing: 01/11/2006 Monitoring System Certification Page 1 of 3 Based on CA form dated 03/01