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MONITLRING SYSTEM CERTIFMA <br />CERTIFICATION / TEST DATE: September 11, 2014 <br />Al. FACILITY A2. OWNER <br />Name Teichert Mobile Equipment Name Teichert Constr@WRO ,jMsENNTAL HEALT <br />Address 120 Frank Circle, Stockton, CA 95206 Address P.O. Box 15002, Sacrament� <br />Phone # 916-366-8631 Phone # 916-386-3767 q;A11V1ENT <br />Contact Steve Schamaun Contact Steve Schamaun <br />D. RESULTS OF TESTING/ SERVICING <br />Make / Model of Monitoring System <br />Software Version Installed: <br />Complete the following checklist: <br />Veeder-Root TLS -350 SN# 90962168905001 <br />20.02 <br />■ Yes <br />❑ No * <br />Is the audible alarm operational? <br />■ Yes <br />❑ No * <br />Is the visual alarm operational? <br />■ Yes <br />❑ No * <br />Were all sensors visually inspected, functionally tested, and confi C-2 Gasoline - 87 <br />■ Yes <br />❑ No * <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment <br />will not interfere with their proper operation? <br />❑ Yes <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modems) <br />■ N/A <br />operational? <br />■ Yes <br />❑ No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />❑ N/A <br />monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate <br />positive shutdown? (check all that apply) ■ Sump(Trench sensors; ■ Dispenser Containment Sensors. <br />■ Yes <br />❑ No * <br />Did you confirm positive shut -down due to leaks and sensor fail ure/disconnection? <br />■ Yes <br />❑ No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br />❑ N/A <br />mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br />fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 90% <br />❑ Yes * <br />■ No <br />Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced <br />and list the manufacturer name and model for all replacement parts in Section E, below. <br />❑ Yes * <br />■ No <br />Was any liquid found inside any secondary containment systems designed as dry systems? <br />(Check all that apply) ❑ Product; ❑ Water. If yes, describe causes in Section E, below. <br />■ Yes <br />❑ No * <br />Was monitoring system set-up reviewed to insure proper settings? Attach set-up reports, if applicable. <br />■ Yes <br />❑ No* <br />Is all monitoring equipment operational per manufacturer's specifications? <br />* In Section E below, describe how and when these deficiencies were or will be corrected. <br />E. COMMENTS <br />Diesel is one tank with multiple turbines. <br />Diesel has a flapper, 87 and waste oil do not. <br />Page 2 of 3 <br />