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Jul 14 03 05:28p Ch rity Miles [20 533-2650 p.l AlItech 17759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320• Fax: 209-533-2650 Cafifornia Tank Tester: 90-1068 of ; California Contractor 623541 A-Haz P., alltech@mlode.com 1 A. General Information Facility Name: Olympian Oil Cardlock Date of Testing/Servicing: July 11, 2003 Facility Address: 983 Moffat Blvd., Manteca CA Facility Contact Person: Nick Bokides Contact Phone No.: 234-1256 L1A: 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 eauinment inspected/servieed: Tank ID: Regular Compartment Tank ID: Supreme Compartment ® In -Tank Gauging Probe. Model: Mag 1 ® In -Tank Gauging Probe. Model: Mag 1 ® 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 I ❑ 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: R 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 ® Sump: ®Dry ❑Water ❑Product Dispenser ID: 3&4 MPD ® Sump: ®Dry ❑Water ❑Product ® Dispenser Containment Sensor(s). Model: Liquid sensor ® Dispenser Containment Sensor(s). Model: Liquid sensor ® Shear Valve(s) (Functional test) ® Shear Valve(s) (Functional test) ❑ Dispenser Containment Float(s) and Chain(s). ❑ Dispenser Containment Floats) and Chain(s). Dispenser ID: 5 ® Sump: ®Dry []Water ❑Product Dispenser ID: 6 ® Sump: ®Dry ❑Water ❑Product ® Dispenser Containment Sensor(s). Model: Liquid sensor ® Dispenser Containment Sensor(s). Model: Liquid sensor ® Shear Valve(s) (Functional test) ® Shear Valve(s) (Functional test) ❑ Dis user Containment Float(sj and Chain(s). ❑ DispLnser Containment Ftoats) and Chain(s). Dispenser ID: 7 ® 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) ❑ Dis enser Containment Float(s) and Chain(s). ❑ Dispenser Containment F1oat(9 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 alsp attached a copy of the report; (check all Heat apply): ® System set-up ® Alarm history report Technician: Wf4e Mike Dotten, California . CA !•t :�C.�'O (k Certification: Veeder-Root: 341-32-6743; Level 3. 623 S4 ! A - t+A Z Page 1 of 3 03101