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Jun 17 05 06:27p Mike Dotten Allttecz 17759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320; Fax: 209-533-2650 California Tank Tester: 90-1068 California Contractor 623541 A-Haz alltech@mlode.com (209) 533-2650 A. General Information Facility Name: Olympian Oil Cardloek Date of Testing/Servicing: June 9, 2005 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 the appropriate boxes to indicate specific equipment inspected/serviced: p.5 50 Tank ID: Regular Compartment Tank ID: Supreme Compartment M In -Tank Gauging Probe. Model. Mug 1 M In -Tank Gauging Probe. Model: Mag 1 M Annular Space or Vault Sensor. Model: Float Switch (Shared) ® Annular Space or Vault Sensor. Model: (Shared) ® Piping Sump / Trench Sensor(s). Model: Liquid sensor ® Piping Sump / Trench Sensor(s). Model: Liquid sensor ® Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ® Mechanical Line Leak Detector. Model: Red Jacket XL ® Mechanical Line Leak Detector. Model: Red Jacket XL ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ® Tank Overfill / High -Level Sensor. Model: Drop Tube ® Tank Overfill / High -Level Sensor. Model: Drop Tube ❑ Other ❑ Other Tank ID: Diesel Tank ID: ® In -Tank Gauging Probe. Model: Mag 1 ❑ In -Tank Gauging Probe. Model: ®Annular Space or Vault Sensor. Model: Float Switch ❑ 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 XL ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ® Tank Overfill / High -Level Sensor. Model: Drop Tube ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other ❑ Other Dispenser ID: 1&2 MPD M Sump: ®Dry ❑ Water ❑Product Dispenser ID: 3&4 MPD M Sump: MDry ❑Water []Product ® Dispenser Containment Sensor(s). Model: Liquid sensor Dispenser Containment Sensor(s). Model: Liquid sensor M Shear Valve(s) (Functional test) ® Shear Valve(s) (Functional test) ❑ Dis user Containment Float s) and Chain(s). ❑ Dis nser Containment Floal and Chain(s). Dispenser ID: 5 ® Sump: ®Dry ❑Water ❑Product I Dispenser ID: 6 ® Sump: ®Dry []Water ®Product ® Dispenser Containment Sensor(s). Model: Liquid sensor M Dispenser Containment Scnsor(s). Model: Liquid sensor M Shear Valve(s) (Functional test) M Shear Valvc(s) (Functional test) ❑ Di enser Containment Float s and Chain(s). ❑ Dispenser Containment Floats and Chain(s). Dispenser ID: 7 M Sump: ®Dry ❑Water ❑Product Dispenser ID: ❑ Sump: ❑Dry ❑Water ❑Product ® Dispenser Containment Sensor(s). Model: Liquid sensor ❑ Dispenser Containment Sensor(s). Model: x ® Shear Valve(s) (Functional test) ❑ Shear Valve(s) (Functional test) ❑ Dispcnser Containment Float(s) and Chains . ❑ Dis cnser Containment Float(s) and Chain(s). C. Certification - 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' 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, I have —also � attached a copy of the report; (check all that apply): ® System set-up ® Alarm history report Technician: / �'l�2(<C �' Mike Dotten, California Contractor License 623541. A-Haz Certification: Veeder-Root:006-05-0789 ; Level 4. ICC UST Technician # 5259412 -UT Page 1 of 3 06105