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MONITO-RING SYSTEM CERTIFItATIONI"k.&�A
<br /> MAKE/ MODEL OF MONITORING SYSTEM: Veeder-Root TLS-350 JUL 2 2 2016
<br /> CERTIFICATION /TEST DATE: July 21, 2016
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<br /> Al. FACILITY A2. OWNER
<br /> Name Flyers#487 Name Flyers Energy LLC.
<br /> Address 983 Moffat Blvd.,Manteca,CA 95336 Address 2360 Lindbergh Street,Auburn,CA 95602
<br /> Phone# 530-885-0401 Phone# 530-885-0401 '
<br /> Contact Amanda Appelt Contact Amanda Appelt
<br /> ri A3. C UP A A4. TESTING CONTRACTOR
<br /> . Name San Joaquin County Environmental Health Name Walton Engineering,Inc.
<br /> Address 1868 E.Hazelton Avenue,Stockton,CA 95202 Address P.O.Box 1025,W.Sacramento,CA 95691
<br /> Notified July 6,2016 Lic# 617238 A,B,Haz
<br /> Inspector Aris VelosoContact Veronica Freitas
<br /> Phone# 209-468 3442 6
<br /> Phone# 916 373 11 6
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<br /> B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced)
<br /> 131: TANKS
<br /> Tank#1 (Product): Gasoline-87 Tank#2 (Product): Gasoline-91
<br /> ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model:
<br /> ■ Annular Space or Vault Sensor Modei: 0794390420 ❑ Annular Space or Vault Sensor Model:
<br /> ■ Piping Sump I Trench Sensor(s) Model: 0794380-208 ■ Piping Sump/Trench Sensor(s) Model: 0794380-208
<br /> ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model:
<br /> r. ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ■ Mechanical Line Leak Detector Model: VMI 99LD-2000
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<br /> El Line Leak Detector ModeEl Electronic Line Leak Detector Model:
<br /> ❑ Tank Overfill/High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model:
<br /> ❑ Other (specify equipment in Section E) Model ❑ Other (specify equipment in Section E) Model
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<br /> Tank#3 (Product): Diesel Tank#4 (Product):
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<br /> Elin-TankGauging Probe Model: ❑ In-Tank Gauging Probe Model:
<br /> ,, ■ Annular Space or Vault Sensor Model: 0794390-420 ❑ Annular Space or Vault Sensor Model:
<br /> `,_. ■ Piping Sump/Trench Sensor(s) Model: 0794380-208 ❑ Piping Sump/Trench Sensor(s) Model:
<br /> x ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model:
<br /> ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ❑ Mechanical Line Leak Detector Model
<br /> ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model:
<br /> ❑ Tank Overfill/High-Level Sensor Model: ? ❑ Tank Overfill/High-Level Sensor Model:
<br /> ❑ Other (specify equipment in Section E) Model ❑ Other (specify equipment in Section E) Model
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<br /> 132: DISPENSERS/UDC's
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<br /> Dispenser#: 1-2 Dispenser#: 3-4 �'
<br /> ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Dispenser Containment Sensor(s) Model: 0794380-208
<br /> ■ Shear Valves ' ■ Shear Valves
<br /> ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chains)
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<br /> Dispenser#: 5-6 Dispenser#: 7-8
<br /> ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Dispenser Containment Sensor(s) Model: 0794380=208
<br /> ■ Shear Valves ■ Shear Valves
<br /> ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s)
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<br /> Dispenser#: 8 Sat Dispenser#
<br /> ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Dispenser Containment Sensor(s) Model:
<br /> ■ Shear Valves ❑ Shear Valves =”
<br /> El Dispenser Containment Float(s)and Chains) E]
<br /> Containment Float(s)and Cham(s)
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<br /> C. CERTIFICATION I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers'guidelines. `
<br /> Attached to this Certification is information(e.g.manufacturers'checklists)necessary to verify that this information is correct and a Plot Plan showing th
<br /> 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
<br /> ■ System set-u,. Alarm Histo Report
<br /> . MW-?'Aft", Him
<br /> WALTON
<br /> Signature: N tNEEnINd,Inc,
<br /> Technician/Cert M Jessie Wadkins I B35391 5307886-UT Date: July Zli 2016
<br /> ©2016 Watton Frigtneering,Inc.
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