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a..r-0%r®I` Ir'f % <br />MONITORING SYST&I CERTIFICATION -rage 1 "M"wiftlaw <br />MAKE / MODEL OF MONITORING SYSTEM: Gilbarco EMC F r 2 Q 2013 <br />CERTIFICATION /TEST DATE: December 17, 2013 <br />Al. FACILITY A2. OWNER <br />Name Olympian # 427 Name Flyers Energy LLC. HEALTH DERARTMENT <br />Address 3300 Waterloo Road, Stockton, CA 95205 Address 2360 Lindbergh Street, Auburn, CA 95602 <br />Phone # 530-885-0401 Phone # 530-885-0401 <br />Contact Amanda Appelt contact Amanda Appelt <br />B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (check the appropriate boxes to Indicate equipment Inspected/serviced) <br />Bi (Continued): TANKS <br />v _Now 0.— - <br />Tank #5 (Product): Tank #6 (Product): <br />❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: <br />❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: <br />❑ Piping Sump / Trench Sensor(s) Model: ❑ Piping Sump / Trench Sensor(s) Model: <br />❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: <br />❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: <br />! <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: <br />�4 <br />Tank #7 (Product): Tank #8 (Product): <br />❑ in -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: <br />❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: <br />❑ Piping Sump / Trench Sensor(s) Model: ❑ Piping Sump / Trench Sensor(s) Model: <br />❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: <br />❑ Mechanical Line Leak Detector Model: ❑ 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: <br />B2: (Continued) DISPENSERS/UDC's <br />Dispenser # : 9-10 <br />Dispenser # : 11 <br />❑ Dispenser Containment Sensor(s) Model: <br />❑ Dispenser Containment Sensor(s) Model: <br />Shear Valves <br />0Shear Valves <br />Dispenser Containment Float(s) and Chain(s) <br />0 Dispenser Containment Float(s) and Chain(s) <br />Dispenser # : <br />Dispenser # : <br />❑ Dispenser Containment Sensor(s) Model: <br />❑ Dispenser Containment Sensor(s) Model: <br />❑ Shear Valves <br />❑ Shear Valves <br />❑ Dispenser Containment Float(s) and Chain(s) <br />❑ Dispenser Containment Float(s) and Chain(s) <br />Dispenser # : Dispenser # <br />❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: <br />❑ Shear Valves ❑ Shear Valves <br />❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) <br />Dispenser # : Dispenser # <br />❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: <br />❑ Shear Valves ❑ Shear Valves <br />❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) <br />Dispenser # : Dispenser # <br />❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: <br />❑ Shear Valves ❑ Shear Valves <br />❑ Dispenser Containment Float(s) and Chains) ❑ Dispenser Containment Float(s) and Chain(s) <br />Dispenser # : Dispenser # <br />❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: <br />❑ Shear Valves ❑ Shear Valves <br />❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) <br />v zo93 wanon engmeenng, Inc. <br />Page la of 3 <br />