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A • 0 k A11techPetrZ- Compliance without Compromise MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Hammer 1-5 Arco Date of Testing/Servicing: 5/30/13 Facility Address: 3250 Hammer Lane, Stockton CA 95209 Facility Contact Person: Wes Parkinson Contact Phone No.: 474-9125 Regulatory agency: San Joaquin Health; Inspector: Aris Cacapit; Phone: 468-9847; Fax 468-3433 Make/Model of Monitoring System: Veeder- Root TLS -350 B. Inventory of Equipment Tested/Certified: P.O. Box 4208 Sonora CA 95370 Ca: 623541 A-Haz Phone: 209-532-7320 Fax: 209-533-2650 maiI@aIItechpetro.com www.alltechpetro.com Tank ID: 87A Tank ID: 87B ®In -Tank Gauging Probe. Model: Mag 1 Nln-Tank Gauging Probe. Model: Mag 1 ®Annular Space or Vault Sensor. Model: 794390-409 ®Annular Space or Vault Sensor. Model: 794390-409 ®Piping Sump Sensor(s). Model: 794380-208 ®Piping Sump Sensor(s). Model: 794380-208 ❑Fill Sump Sensor(s). Model: NONE El Fill Sump Sensor(s). Model: NONE ®Mechanical Line Leak Detector. Model: Red Jacket ❑Mechanical Line Leak Detector. Model: Shared ❑Electronic Line Leak Detector. Model: NONE ❑Electronic Line Leak Detector. Model: NONE ®Tank Overfill / High -Level Sensor. Model: Drop Tube NTank Overfill/ High -Level Sensor. Model: Drop Tube N Fillspill buckets tested ❑Pass ❑Fail N Fillspill buckets tested NPass ❑Fail Tank ID: 91 Tank ID: Nln-Tank Gauging Probe. Model: Mag 1 [1 In -Tank Gauging Probe. Model: NAnnular Space or Vault Sensor. Model: 794390-409 ❑Annular Space or Vault Sensor. Model: NPiping Sump Sensor(s). Model: 794380-208 El Piping Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: NONE El Fill Sump Sensor(s). Model: 0Mechanical Line Leak Detector. Model: FE Petro Fl Mechanical Line Leak Detector. Model: El Electronic Line Leak Detector. Model: NONE ❑Electronic Line Leak Detector. Model: NTank Overfill / High -Level Sensor. Model: Drop Tube ❑Tank Overfill / High -Level Sensor. Model: N Fillspill buckets tested NPass ❑Fail ❑ Fillspill buckets tested ❑Pass [-]Fail Vapor Condensate Sump: NDry ❑Water ❑Product Piping Transition Sump: NDry ❑Water ❑Product N Sensor(s). Model: 794380-208 N Sensor(s). Model: 794380-208 N Vapor Pot Sensor(s). Model: 794380-420 Dispenser ID: 1&2 N Sump: NDry ❑Water ❑Product Dispenser ID: 3&4 N Sump: NDry ❑Water❑Product N Dispenser Containment Model: Float and Chain N Dispenser Containment Model: Float and Chain NShear Valve(s) (Functional test) NShear Valve(s) (Functional test) N Dispenser Containment Float(s) and Chain(s). N Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5&6 N Sump: NDry ❑Water ❑Product Dispenser ID: 7&8 N Sump:''NDry []water ❑Product NDispenser Containment Model: Float and Chain NDispenser Containment Model: Float and Chain NShear Valve(s) (Functional test) NShear Valve(s) (Functional test) 11 NDispenser Containment Float(s) and Chain(s). NDispenser 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 a0 that app/y): N System set-up N Alarm history report Signature of Technician: Certification: ICC UST Technician # 8152115 -UT Veeder Root # B36877 Level 4 ISD RED GeEo ivED JUN 0 6 �JiS SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT