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i7759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320; Fax: 209-533-2650 California Tank Tester: 90-1068 2005 OCT 21 PM 137 California Contractor 623541 A-Haz r alltech@mlode.com mlode.com c 1 1"J U T EFIV!k0 4 FUDA. T A L ,� A I f i 011 r T` I--PrJT MONITOR&6 SVS�' h4 CERTIFICATION A. General Information Facility Name: Olympian Oil Cardlock Date of Testing/Servicing: JAUMP 5 Facility Address: 983 Moffat Blvd., Manteca CA 95336 Facility Contact Person: Nick Bokides Contact Phone No.: (209) 649-3808 LIA: San Joaquin; Ray von Flue Make/Model of Monitoring System: Veeder-Root TLS -350 B. Inventory of Equipment Tested/Certified: Check thea ro ' to boxes to indicate Nneific NMir2eRt ins cted/servieed: Tank ID: Supreme Compartment Tank ID: Regular Compartment M In Tank Gauging Probe. Madel: Mag i ® In -Tanis Gauging Probe. Model: Mag 1 M Annular Space or Vault Sensor. Model: Float Switch (Shared) ® Annular Space or Vault Sensor. Model: (Shared) M Piping Sump / Trench Sensor(s). Model: Liquid sensor ® Piping Sump / Trench Sensor(s). Model: Liquid sensor O Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: 1@ Mechanical Line Leak Detector. Model: Red Jacket XL ® Mechanical Line Leak Detector. Model: Red Jacket XL O Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector_ Model: M Tank Overfill / High -Level Sensor. Model: Drop Tube ® Tank Overfill / High -Level Sensor. Model: Drop Tube Other ❑ Other Tank ID: Diesel Tank tD: ® In -Tank Gauging Probe. Model: Mag 1 ❑ In -Tank Gauging Probe. Model: ® Annular Space or Vault Sensor. Model: Float Switch O Annular Space or Vault Sensor. Model: ® Piping Sump / Trench Sensor(s). Model: Liquid sensor ❑ Piping Sump / Trench Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: [] Fill Sump Sensor(s). Model: ® Mechanical Line Leak Detector. Model: Red Jacket XI. ❑ Mechanical Line Leak Detector. Model: O Electronic Line Leak Detector. Model: ❑ EIectronic Line Leak Detector. Model: M Tank Overfill / High -Level Sensor. Model: Drop Tube ❑ Tank Overfill / High -Level Sensor. Model: D Other ❑ Other Dispenser ID: 1&2 MPD M Sump: ®Dry OWater OProduct Dispenser ID. 3&4 MPD M Sump: ®Dry []Water []Product M Dispenser Containment Sensor(s). Model: Liquid sensor M Dispenser Containment Sensor(s). Model: Liquid sensor M Shear Valve(s) (Functional test) ® Shear Valve(s) (Functional test) ❑ Dis nser Containment Float(s) and Chain(s). ❑ Dis user Containment Float(s) and Chain(s). Dispenser ID: 5 M Sump: ®Dry []Water []Product Dispenser ID: 6 M Sump: MDry []Water []Product M Dispenser Containment Sensor(s). Model: Liquid sensor M Dispenser Containment Sensor(s). Model: Liquid sensor M Shear Valve(s) (Functional test) M Shear Valve(s) (Functional test) O Dispenser Containment FI s and Chad s)_ ❑ Di!nser Containment Float(s) and Chain(s). Dispenser ID: 7 M Sump: Wry OWater OProduct Dispenser ID: O Sump: []Dry OWater []Product N Dispenser Containment Sensor(s). Model: Liquid sensor ❑ Dispenser Containment Sensor(s). Model: x M Shear Valve(s) (Functional test) ❑ Shear Valve(s) (Functional test) O Di nser Containment Floats and Chain(s). ❑ Dis user Containment Floats and Chain(s). C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attacked to this Certification is information (eg. 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 generating such reports, l have also attached a copy of the report; (check all that apply): ® System set-up ® Alarm history report Technician: / i Mike Dotten, California Contractor License 623541 A -Naz Certif►cation: Veeder-Root:006-05-0789 ; Level 4. ICC UST Technician # 5259412 -UT Page I of 3 06/05