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.:. i A • �. Al. FACILITY B1; TANKS A2. OWNER lame Olympian # 487 Tank #1 (Product): Gasoline - 87 Name Flyers Energy LLC. Address 983 Moffat Blvd., Manteca, CA 95336 Address 2360 Lindbergh Street, Auburn, CA 95602 Phone # 630-885-0401 ❑ Piping Sump I Trench Sensor(s) Model: Phone # 530.885.0401 Contact Amanda A eit ❑ Fill Sump Sensor(s) Model. Contact Amanda A elm A3. C U P A ❑ Mechanical Line Leak Detector Model: A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 1868 E. Hazelton Avenue, Stockton, CA 96202 Address P.O. Box 1025, W. Sacramento, CA 95691 Notified October 7, 2013 Tank #3 (Product): Lie # 617238 A, B, Haz Inspector Elena Manzo ❑ in -Tank Gauging Probe Model: Contact Dulclnea Coven Phone # 209.468-8257 Phone # 918-373-1168 B. INVENTORY OF EQUIPMENT TESTEDICERTIFIED (Check the appropriate boxes to Indicate equipment Inspectediserviced) B1; TANKS _ .-- Tank #2 (Product): Tank #1 (Product): Gasoline - 87 ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump I Trench Sensor(s) Model: ❑ Piping Sump I Trench Sensors) Mode! ❑ Fill Sump Sensors) Model: ❑ Fill Sump Sensor(s) Model. ■ Mechanical Line Leak Detector Model: VMI SOLD -2000 ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model. ❑ Tank Overfill i High -Level Sensor Model: ❑ Tank Overfill l High-Lovel Sensor Model: ❑ Other (specify equipment In Section E) Model: ❑ Other (specify equipment In Section E) Model: Tank #3 (Product): Tank #4 (Product): ❑ In -Tank Gauging Probe Model: ❑ in -Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump I Trench Sensor(s) Model: © Piping Sump I Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensors) Model ❑ Mechanical Line Leak Detector Model. ❑ Mechanical Line Leak Detector Model ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill I High -Level Sensor Model: [I Tank Overfill I High -Level Sensor Model: ❑ Other (specify equipment In Section E) Model. ❑ Other (specify equipment In Section E) Model: 132: DISPENSERS/UDC's .. ...... ... ...... Dispenser #: _._....._. _.. -'---._.— ......_.. _.......—_... Dispenser # ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chains) Dispenser # : ❑ Dispenser Containment Sensor(s) Model: Dispenser # : ❑ Dispenser Containment Sensors) el: - -- ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chaln(s) _ :. ❑ Dispenser Containment Floats) and Chains) Dispenser #: Dispenser # ; ❑ Dispenser ContainmentSensor(s) Model: _ ❑ DispensercontalnmentSensor(s) eI: ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) C3 ShearValves NMENrA ❑ Dispenser Containment Float(s) end C. CERTIFICATION I certify that the equipment Identified In this document was Inspectedlearviced 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_ Signature: Water -- Technician I Cert #: Jessie Wadkins J 8363916307888 -UT WLTON --- ttamNEERINn, INC. Date: October 10, 2013 1