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JUN-20-2008 10 :47 AM GETTLER—RYAN INC. 925 551 4770 P. 02 MOINAORINGSYSTEM Cl: RTI .ATI N k'or Use lay All durisdie ions Within the state of C'alijrrnia Authority Oled:C'hapier 6-7. Health and Sgre{t'('odo, Chapter 16, l)Nivion 3, Title 23, C.'al{l`rarnia Code q-Rei clarions chis farm must be used to document testing and WrviCing of monitoring equipment, ,A separate ce Igg�it11 or resort must�pW fot each m rin ti t c nl tanel by the techniciltn who pertbrms the work, A cop)•ol'thiS I'Ornt must he provided to the tank system owner .opCrator, The owner/operator must submit a copy of this form to the local nt:enCy regulating I:S'!'s%1stcros within,i()days of test dttt`, A. General Information Facility Name Arco AM PMBldg. Site Address: 3426 Tracv Blvd _- _.� City: Trac►� _ _ ___� � tip: Facility Contact Person: __ _ Contact Phone No.. Make/Model of Monitoring5 eder Root TLS 350 m- -� � � System:stem: �.VeDate of Testing/Servicin�,: 6/3/2008 __ 'B. Inventory of Equipment Tested/Certified —� Check the aegropriate boxes to Indicate 92!eitle a ui ment ins eeted/uer-viced: [E] ank ID: T-2 Master Middle Tank ID: In-Tank Clauging Pmhe, Model ❑In,lank(iauging Probe. Model:Annular Space or Vault Sensor. Mndct ❑Annular Space or Vault Sensor, Mtxicl: .._.__._. Piping Sump/'French Senso(s) Model: 7_94380-323 ❑Piping Sump/Trench Semor(s). Memel: Q Fill Sump Sensrrrs), Mohs": ❑Dill Sump Sensor(%), Modcl; ❑Mechanical tine Leak Mtcetor. Model; --- ® Mechanical Line teak ucteutor, Model: — ❑Electronic bine Leak Nt.�ctor, Model: _ I lectror is Linc Ixak I)eteett)r. MOW: []Tank Overfill/High-hovel Sensor, Model: -- ❑ I'ank()vertill/iligh-1 cvcl Scns(ir, Model: []Other(specify equipment type and model in Section F nn Pagc 2). ❑Other(specify equipment tyre and model in Seotion fon Page,A). Tank Its: Tank iD, ❑In-Tank-Gauging Probe. Model: ® In-Tank(;auging Probe. Model: ❑Annular Spasx or Vault Sensor, Model' ❑Annular Space or Vault Sensor. Model: ❑Piping Sump/')'rcnch Sensor(t). Model: Piping Sump�T'rench Senmr(s). Model: [�Fill Sump Sensor(s). Model: - �]bill Sump Sensnr(s). Model, _ ®Mechanical Unc Leak Mtector. Model: � C3 Mechanical Linc Leak r o"mr. Model; ❑F:Icctonic line leak llctcctor, Model: — ❑F:tectrunic Lin`Leak Detecnor. Model: ®'rank Overfill/High•tevel Sensor. Model: ❑ Tank Ovcrtill/Iligh-level Sensor. Model; M. ❑Other(specify equipment type and model in Suction F on Page 2). a Other t spccilj-equipment type and model in Section L on Page'I. Dispenser ID: Dispenser iD• ❑0ispenwr Containmcnt Sensor(%). Madel: [] Dispcnwr Cmitainrncnt Scnsor(s), Model: - ❑Shcar Valve(s). []%car Vahc(s). [�Divenser Containment Float(%)and Chain(s). ❑Dispenser Containment Float(s)and Chain(s). Dispenser ID; Dispenser ID; ❑Dispenser Containment Seosor(s). Model: ]L)ispenser('ontainment Scnsor(s). Model: Cl Shear valve(%). ❑Shear Valve(s). Ca Dispenser Containment Floats)and Chain(%). ❑Dispenser Containment Float(s)and Chain(%). Dispenser ID: Dispenser ID: ®Dispenser C'ontaitttttetn Sensor(s). Modet; ❑DispunNcr Containment`rnsur(n). Model: ❑Shear Valeiys). ❑Shear Va14e(%) Q Ditpcnscr Containment Float(s)and Chain(t). ®Dismiscr Containment>:loat(s)and C limin(s). *lythe facility contains more tanks or dispensers,copy this form. include inli)rmation lbr every tank and dispenser at the facility. C. Certification-1 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 eqment capable of generating such reports,1 have also attached a copy of the report;(etreck all th4s apply): ut System set-up Alarm history report Technician Name Pete Garcia Signature: Certification No,: A23970 License.No., _220793�� 'Testing Company Gettler-Ryan Inc, Phone Na,: 928 Sal-4777 Tcstinp Company 6747 Sierra Ct., Suite J Dublin CA _ __ Date of Testing/Servicing-6Ilv12048 Page 1 of 3