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MONITORING SYSTEM CERTIMATIONL-AL"""" ` MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 8 ?_014 CERTIFICATION / TEST DATE: February 18. 2014 A1. FACILITY A2. OWNER _ V is jW9 Vs. HFAffN DEpAftTMENT Name Olympian # 427 Name Flyers Energy LLC. Address 3300 Waterloo Road, Stockton, CA 95205 Address 2360 Lindbergh Street, Auburn, CA 95602 Phone # 530-885-0401 Phone # 530-885-0401 Contact Amanda Appelt Contact Amanda Appelt A3. C U P A INVENTORY OF EQUIPMENT TESTED/CERTIFIED (check the appropriate boxes to Indicate equipment inspected/serviced) A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health #1 (Product): Name Walton Engineering, Inc. Address 1868 E. Hazelton Avenue, Stockton, CA 95202 ❑ In -Tank Gauging Probe Model: Address P.O. Box 1025, W. Sacramento, CA 95691 Notified February 17, 2014 Lic # 617238 A, B, Haz Inspector Jeff Wong ❑ Contact Dulcinea Covan Phone # 209-468-8257 Electronic Line Leak Detector Model: Phone # 916-373-1166 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (check the appropriate boxes to Indicate equipment inspected/serviced) 61: TANKS Tank #1 (Product): Tank #2 (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: 0794390-420 ❑ ❑ Piping Sump / Trench Sensor(s) Model: Fill Sump Sensor(s) Model: ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: j EIElectronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Tank #3 (Product): Red Diesel Tank #4 (Product): Diesel ❑ In -Tank Gauging Probe Model: l In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390-420 j ■ Annular Space or Vault Sensor Model: 0794390-420 ■ Piping Sump / Trench Sensor(s) Model: 0794380-205 ■ Piping Sump / Trench Sensor(s) Model: 0794380-205 ❑ ❑ ❑ ❑ ❑ Fill Sump Sensor(s) Model: Mechanical Line Leak Detector Model: Electronic Line Leak Detector Model: Tank Overfill / High -Level Sensor Model: Other (specify equipment in Section E) Model: ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor 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 Chain(s) Dispenser # Dispenser # : El Dispenser Containment Sensor(s) Model: El Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(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 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 Piot 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 WALTON Signature: ENGINEERING, INC. Technician / Cert #: Chris Kuykendall / B42243 8161927 Date: February 18, 2014