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405/14A2008 21:42 FAX 2095332650ALL eCL I Muni Naidu Q001 P 0 IWD MAI t@ t�Inc. .vtx 17759 Buttercup Circle, Sonora, CA 95370 MAY 15 2008 Phone: 209-532-7320; Fax: 209-533-2650 lit id ";G California Tank Tester: 90-1068 SAN JOAQUIN COUNTY ENVIRONMENTAL 'CEiN,,y' California Contractor 623541 A-Haz HEALTH DEPARTMENT n , mike(alltechpetro.com N�'�,a MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Mossdale Arco Date of Testing/Servicing: April 28, 2008 Facility Address: 444 Mossdale Rd., Lathrop CA Facility Contact Person: Nick Bokides Contact Phone No.: (209) 649-3808 LIA: Inspector: Muniappa Naidu Make/Model of Monitoring System: Veeder-Root TLS -350 B. Inventory of Equipment Tested/Certified: Check the appropriate boxes to indicatespecific equipment inspected/serviced Tank ID: 87 Compartment Tank ID: 91 Compartment ® In -Tank Gauging Probe. Model: Mag 1 ® In -Tank Gauging Probe. Model: Mag L ® Annular Space or Vault Sensor. Model: VR Float Switch ®Annular Space or Vault Sensor. Model: (Shared) ® Piping Sump / Trench Sensor(s). Model: VR 794380-208 ® Piping Sump / Trench Sensor(s). Model: VR 794380-208 ❑ Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ® Mechanical Line Leak Detector. Model: VMI 99LD-2000 ® Mechanical Line Leak Detector. Model: VMI 99LD-2000 ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: N Tank Overfill / High -Level Sensor. Model: OPW Drop Tube ® Tank Overfill / High -Level Sensor. Model: OPW Drop Tube ❑ Other ❑ Other Tank ID: DSL Compartment Tank ID: ® In -Tank Gauging Probe. Model: Mag 1 ❑ In -Tank Gauging Probe. Model: ® Annular Space or Vault Sensor. Model: (Shared) ❑ Annular Space or Vault Sensor. Model: ® Piping Sump / Trench Sensor(s). Model: VR 794380-208 ❑ Piping Sump / Trench Sensor(s). Model: El Fill Sump Sensor(s). Model: F] Fill Sump Sensor(s). Model: N Mechanical Line Leak Detector. Model: VMI 99LD-2000 ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ® Tank Overfill / High -Level Sensor. Model: Emco Drop Tube ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other ❑ Other Dispenser ID: 1&2 N Sump: ®Dry ❑Water ❑Product Dispenser ID: 3&4 N Sump: ®Dry ❑Water ❑Product ® Dispenser Containment Sensor(s). Model: VR 794380-208 ® Dispenser Containment Sensor(s). Model: VR 794380-208 ® Shear Valve(s) (Functional test) ® Shear Valve(s) (Functional test) ❑ Dis nser Containment Floa s and Chains . ❑ Dis22nser Containment Flocs and Chains . Dispenser ID: 5&6 N Sump: NDry ❑Water ❑Product Dispenser ID: 7&8 N Sump: ®Dry []Water ®Product ® Dispenser Containment Sensor(s). Model: VR 794380-208 ® Dispenser Containment Sensor(s). Model: VR 794380-208 ® Shear Valve(s) (Functional test) ® Shear Valves) (Functional test) ❑ Dispenser Containment Floats and Chain(s). ❑ Dis nser Containment Floa s and Chain(s). Dispenser iD: 9&10 N Sump: NDry ❑Water ❑Product Dispenser ID: 11&12 ® Sump: ®Dry ❑Water ❑Product ® Dispenser Containment Sensor(s). Model: VR 794380-208 ® Dispenser Containment Sensor(s). Model: VR 794380-208 N Shear Valve(s) (Functional test) ® Shear Valve(s) (Functional test) ❑ Dis nser Containment Floats and Chain(s). ❑ Dis nser 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 Digitally signed by David Hanson Technician: Date: 2008.05.03 10:31:39 -07'00' Certification: Veeder-Root # B35639 Expiration: 10/24/2009 ICC UST Technician #8003789 -UT Expiration: 2/9/2010 Page I of 3 06/05