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. OF CALIFORNIA <br />17��'Doolitte Dr. <br />San Leandro, CA 94577 ^ <br />Monitor Certification <br />Inspection <br />FACILITY <br />STAT ION <br />� <br />ADDRESS ' x—_ <br />DEALER <br />DATE �� �7-^' <br />TYPE OF INSPECTION <br />Annual <br />Perm1t <br />Recheck <br />Leak <br />This letter terbfies that the monitor(s) is/are in plate, the probes are in the correct position and the operation <br />of system is functioning. <br />� <br />TYPE AND MODEL OF MONITOR <br />_ <br />SYSTEM FUNCT1011 - ~ <br />ANNULAR SPACE IN -TANK <br />TAW PASS FAIL N/A PASS FAIL N/A <br />q2 Product <br />87 <br />�Product <br />Diesel <br />Waste Oil <br />Other <br />Comments: <br />PRODUCT LINES PASS FATL N/A <br />92 Product <br />87 Product <br />Di esel <br />Other <br />Page I of 2 <br />° <br />