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11 <br />MONITORING SYSTEM CERTIFICATION mailoalltechpetro.com <br />www.ailtechpetro.com <br />A. General Information <br />Facility Name: Hammer 1-5 Arco Date of Testing/Servicing: 5/1/12 <br />Facility Address: 3250 Hammer Lane, Stockton CA 95209 <br />Facility Contact Person: Wes Parkinson Contact Phone No.: 474-9125 <br />Regulatory agency: San Joaquin Health; Inspector: Aris Cacapit; Phone: 468-9847; Fax 468-3433 <br />Make/Model of Monitoring System: Veeder- Root TLS -350 <br />D I+wi r%f Gniaimr",mn+ Tnetnri/rarf'ifiar1- <br />Tank ID: 87A <br />Tank ID: 87B <br />®In -Tank Gauging Probe. Model: Mag 1 <br />Nln-Tank Gauging Probe. Model: Mag 1 <br />®Annular Space or Vault Sensor. Model: 794390-409 <br />®Annular Space or Vault Sensor. Model: 794390-409 <br />®Piping Sump Sensor(s). Model: 794380-208 <br />®Piping Sump Sensor(s). Model: 794380-208 <br />F-1 Fill Sump Sensor(s). Model: NONE <br />❑Fill Sump Sensor(s). Model: NONE <br />®Mechanical Line Leak Detector. Model: Red Jacket <br />❑Mechanical Line Leak Detector. Model: Shared <br />❑Electronic Line Leak Detector. Model: NONE <br />❑Electronic Line Leak Detector. Model: NONE <br />®Tank Overfill / High -Level Sensor. Model: Drop Tube <br />®Tank Overfill / High -Level Sensor. Model: Drop Tube <br />N Fillspill buckets tested ❑Pass ❑Fail <br />N Fillspill buckets tested ®Pass ❑Fail <br />Tank ID: 91 <br />Tank ID: <br />N In -Tank Gauging Probe. Model: Mag 1 <br />❑ In -Tank Gauging Probe. Model: <br />❑Annular Space or Vault Sensor. Model: 794390-409 <br />❑Annular Space or Vault Sensor. Model: <br />®Piping Sump Sensor(s). Model: 794380-208 <br />❑Piping Sump Sensor(s). Model: <br />F] Fill Sump Sensor(s). Model: NONE <br />El Fill Sump Sensor(s). Model: <br />❑Mechanical Line Leak Detector. Model: FE Petro <br />❑Mechanical Line Leak Detector. Model: <br />❑Electronic Line Leak Detector. Model: NONE <br />❑Electronic Line Leak Detector. Model: <br />NTank Overfill / High -Level Sensor. Model: Drop Tube <br />❑Tank Overfill/ High -Level Sensor. Model: <br />N Fillspill buckets tested ❑Pass ❑Fail <br />❑ Fillspill buckets tested, ❑Pass ❑Fail <br />Vapor Condensate Sump: NDry ❑Water [-]Product <br />Piping Transition Sump: NDry❑Water ❑Product <br />N Sensor(s). Model: 794380-208 <br />N Sensor(s).'' Model: 794380-208 <br />Dispenser ID: 1&2 N Sump: NDry ❑Water [-]Product <br />Dispenser ID: 3&4 N Sump: NDry ❑Water ❑Product <br />❑Dispenser Containment Model: Float and Chain <br />ED Dispenser Containment Model: Float and Chain <br />NShear Valve(s) (Functional test) <br />❑Shear Valve(s) (Functional test) ' <br />NDispenser Containment Float(s) and Chain(s). <br />NDispenser Containment Float(s) and Chain(s). <br />Dispenser ID: 5&6 N Sump: NDry ❑Water ❑Product <br />Dispenser ID: 7&8 N Sump: NDry ❑Water []Product <br />CE Dispenser Containment Model: Float and Chain <br />❑Dispenser Containment Model: Float and Chain <br />NShear Valves) (Functional test) <br />NShear Valve(s) (Functional test) <br />Dispenser Containment Float(s) and Chain(s). <br />NDispenser Containment Float(s) and Chain(s). <br />C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the <br />manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) ,necessary to verify that this <br />information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such <br />reports, I have also attached a copy of the report; (check a// that app/yr ' N System set-up N Alarm history report <br />Signature of Technician: 4��A� <br />Certification: ICC UST Technician # 8005930 -UT <br />Veeder Root # B36878 Level 4 ISD <br />Date: 5/01/12 <br />