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ONIT NG SYSTEM CERTIFICA N Por I ser By All hirisdic tionIIs idtin line Stand of ( alifirrniu t ttithoritr ('itcrcl: C'hcrliter (i_ IIcalth anciSaILtr Cocle, ( 'hi rhter 10. Oivi-sioti 3 title 23, Culi%)rnia C'mh of ReQulutions Ihis form 1111N he wccl to docunteni teaing and se%icing of monitoring ectuipnient. 1 > rate, cel ncati:>n or_�jrt must he prepared for each t3tlnitorin,g ; ,t u»ccmtrolp�nnel b} the technicia ll ,silo perturms fire ccork. :% copy of this torm mint he provided to the tank ,, stem oscncroperator. I it,: esysncr0rp'Mtor mint IUhmiI <t copy of thi, turns to the IkICal algencti T.c, 11 t,iing (S I s stem..v ithin 3(1 dans of test date_ A. (seneralInformation I'acility Name: SHELL 131dg. No� Site address: 341 E. MAIN C us. RIPON Zip: 95366 Facility Contact Person: ANGLE Contact Phone No.: (209) 559-4544 Make Model of ,%9onitoring System: SIMPLICITY� Date of FestimgServicing: 4(2312009 B. inventor, of Equipment Tested/Certified Check the appropriate boxes to Indicate specific equitlonent inspected arviced: rank ID 87 If { 'rank ID 91 ® In -I nnk h ul In, i'r, he Modcl MAG -1 11 In -Lank (1,111-1112 ['rob_ Model MAG -1 © :�%nnular Space nr V cult Vcnax �Alodct. BRINE Z Annular Sp actor Fault' ecnsor Model. BRINE � l ® D'ipuig Sump I rcnch Sensor(o Modcl_ 208 ® P!ping sump i rcnah 'wnl or(s) Model 208 F11 ill Stnnp Scnsor(,) Model j bill Sump Sanwrls) Anode! I ❑ Mcehatnic al i int Lcal, Detector Model ❑ Mcchanlcal I int I cal, Detector Model ©Electrons I ane t cal. Dcic-tor V odcl PLLD ® I lectronlc Line I cal, Detector Model. ll ❑ Lank t herfrll I iii -h -I cccl Senl or, Modcl ❑ I ank t )ccrlill f itch I c el Sensor Model ❑ Udicrtspccth cywpm ni 1cpc and inodvi in sc ri. n I oll 1 a c'1 El Ahcr (spcc3ti cyulpiricnt tspa and ntodei in Sccnon Ion E a c'i Tank ill - _— -- - - Tank ID: -- Cl In auk C w its Probe Model i ❑ (n -rank C niiiing I'rohe Model ❑ lnnular Sp a c ,r 4 cult senusr \1odel ❑-lltnul a vPace or Vanit Scnaor 'slodel: (❑ I Ipuni snap f ranch senhorrsr Model ❑('rein sump ' I rCneh bcm.Zr(� Modcl ❑ I IIs Suntta Scnxu>1_ Model ❑Fill Sump Sensclr(s) Model ❑ V'tCcliamcal I.nle I.cal, Dcic;Clor Model I 31 ❑ \'lcrharilCal I.Inc I cal, I lctcoor_ Modcl. _- ❑ Ilectamic Linc Leak Detc-ctor Atoday. i ❑ t;lectronu t int teak Detector. Model )� ❑ lank CRcrfrll High-] cccl Sensor Modcl 1 . rank (hertill / Ninth -Leval Scnsor. V9odel Cl OdWr 1,pCel14 Cllnipment tope and inodcl in Scction i. can Pa8c 1) ❑ ()neer t�pecit\ equipmew htic and model In lecuon 1. on t aH.c 2) I Dispenser ID 1-2 Dispenser iD 3-4 ® DispenserC onlainlncin,cross) Model 321 ® Dispen.crtontanInle Scn,or(sl Model: 321 b'ahus) ® "hical, Vako,1 ❑ Dlspcmer ( ontainincrit loatO and Chain(,) tin(;) ❑ Dispenser Cont iinnient Ph it(s) and C h alnh) _41-— i Dispenser ID 5-6 '1 Dispenser ID 7-8 ©Q Dispenser( cntanuncnt S;n-,rri,) Model: 321 Q 1)ispcnscrClsntainnicni wn,or(,) Model 321 ® "heir Vahet ) gg S ® ',hear \, }l c(s) 3 ❑ Dlpcn; cr ( ontaillrovill i lo"itl ) and ( h iltv'). ❑ Ditipcn cr ( ont ainiocnl Floln(O and ( harms) i -) Dispenser ID Dispenser ID: h� ❑ I)isticnsci Containment scnsorts)_ Modcl: -- ❑ Dnpcnscl Cnnttinancni Sensor(,) Model: ❑ Shear GalcC(') ❑ Shc.ar Vahe;s ❑ Dlspcn,cr t Inttinrncnt r loafO and ( hain(st_ (❑ Dispenwr ( ontainnlent I loal(sl'Ind Chain(,). *tt t4ic I<tcihls colxains nusrc tanks or dispensers_ cors till, lirrm. lnclucic illtunrn;nion fix escrs tank & dispenser at the 1 Icilih C. Certification - I certify that the equipment identified in this document was ins pec tedlserviced 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 erating such reports, 1 have also attached a copy of the report; (check all that aiuplt'): ❑ system set-up ❑ Alarm y report Fechnician Name rind: Heath A McEver Signature: Certification No.: A27562 --------- - __-- Testing Com any Name: SST -Service Station Testing Phone No.: (209"45-5577 Festin, Company Address: PO Box 31465 Date ofTeshn 'Servicin- 4123/2009 Page 1 of 3 Rev (2,'08)