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Aug 2913 04:45a Reliable Petroleum 2098458953 p.2 0e8/29/2013 11:16RM FAX 925238 Guadalupe Sanchez 00001/0010 MONITORING SYSTEM CERTIFICATION Fw Use Ar Ad Juriadtertions Within the State of California Authority Cited. Chapter 6.7, Health and Safety Cads; Chapter 76, bivisfon 3, Trufe 23, Cell i►►7afa Code of Regulations This form must be used to document testing and servicing of monitoring rttuiptncat. A scMAS ccilificaatiop or eepaM must be p fgt sA211 moniu-mri_.�? .>P s R ti c tr+�j valxel by the technici8n who performs the work. A copy of this [form mug be pmvided to Uu tank system owner(opomor. The owner/operator roust subunit a copy of this form to the local agency regulating UST systcros within 30 days of test date. A. Generallaformatiou Facility Nance: StaWvWde Pettmlleum fValgrol, _ Bldg. No.: Site Address: 1700 E. Yosemite Avg. City' mo teca. Ca. Zip: 95336 Facility Cmtwt Person: Sonny Cuntxct I'hvneho.: L4") -230-8999 Maks /Model of Monit(ning System: Veeder-Root TLS -350 nate of Testing{Sarviiciug: 7 013 $. Inventory of Equipment Tested/Ceirt ficd Check t[ae a rhte boxca to iodacak a iT a ul eat ler r ser vicced; Tank ID: T1: 87 Tank m• T2: 91 D in -Tank Gauging probe. Model: El in -Tank iiaugbtg Probe. Model: 0 Annular Space or Vault Ste. Model: 794M-420 0 Pipi»g Sump 1 Trench Seraogs). Model'. 7943W ® Annular Space or Vault Sensor. Modal: 794300-420 -2N N ❑ pin Sump sensm(s). Model: ® Airing Sump / Trench Sensot(s), Moda 7 9 Mechanical Lime Leak Detector. Model: VM WLD 2000 ❑ Fill S Sensor( &). Sump Sense � . 0 Meebanical Lim Leah Detector. Modem; Mudd: VM1 SOLD -2000 Q Electronic Line J 901K Deme=. Model: (j Elcommic Linc Leek rkacclor, Maid: ❑ Tank Overfill I high -Level Sensor. Modet 0 Other (specify cquiprnent type aid model is Section L• on Pogo 2), ❑ Tank Overfill / High -Leve! Sensor. Mould: ❑ Other (specify equipment type and mudel in Secdion F. on Pap 2). Tank ID: -Tank ID• C In-Taak Gauging Probe. Wild: ❑ in Tank Gauging Probe. Model: (� Annular Space or Vault Sensor. Model: ❑ Annulir Space or Vault Sensor, Model: ❑ Piping Sunrp1'r=ch Ssosor(s). Model: ❑ Piping Sump /Taench Sanwr(s). yla>dal: C1 Fill Sump Sem;or(s). Model' ❑ Pali SwapS ensar(s}• Model: ❑ Meehnnicat Line Leak Detector, Modal: ❑ Mechanical Line Leak Detector. Model: ❑ Flearonte Linc Leak Demaor. Model: Q kicceonic Line i cak Detector. Mo dei: ❑ Tank Overfill I liigh i vvet Sensor. Model: ❑ Other (specify cquipmeat type in Set Q Tmale Overfill I High•t.wel Sensor. Model: and model b on page 2). • Q Other —ify equipment b'Pc etd nurdol in Sxtion Eon Paget). 1a4v2 Dispenser IB: U4 — � l)ispca r Conta0;ot Seasons). Model: 794380.208 ® Dispenser Containmwat Scnsa(s). : 794380,208 0 Shear valvc(s). IN Shear vaive(s). ® Dispcatsor ContainnieJu r70840) and Chain(s), ❑ I)jsp=M Coatairun nrr Float(s) and Chain(s). Dispenser TD: S86 Dispenser I@: Y&S 19 Dispenser Coratnin-11 fiensar(sy. Model: 784380.208 ISI Dispae Containment Senser(s). Model: 79QW20k 0 Shear valves), 0.51mr Yadve(s). 13 Disimmot Containment float(s) and Chain(s). ❑ Dispenser Containment float(,,) and Chuin(s). Dispenser ID: DbapenserIIl- �i Dirpeaua r Creaatainme�ie Sex,sor(s). model: 0 Dispenser Containment Smsor(s). Model: ❑ Shear Valve($), ❑ Shear vaive(s), ❑ Dispenser Cnotainment Flostt(s) and Chains}. 0 Dispenser Containmot noat(s) andchaiaa(,,). 41fthe facility contains more tanks or dispensers, copy this roan. include iahrmation for every tank and dispenser at the facility. C. Ce cation - i certify that the equipment identified in tkq document was inspectedfserviced in acmrdana with the manufacturers' goldllilfaes. Attached to this Certification is information (e g. manufacturers' checklist) necessary to verify that this information p correct and a Plat Flan showing file ky®at of monitoring equipment. icor 60ry equipmegt capable of generating Bach reports, I have also ottatisw a copy or the report; (check all Mar apply): to System set-up ® Alarm history report Technician Name (yttizltkGundalupe Sanchez Signatures-�.,.-.�,e Certification No.: A30138 License. No.- 883706 Tusting Company Name: Reftabte Petroleum Services, Inc. Phone No,: (209} -8686 Testing CoMpany Address: 19930 Horseshoe Rd. Oakdale, C,&95361 Dee of'restinWServicing; 7/2912013 Fagc 1 of 4 Rev (2108)