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OCT -27-2008 02:58 PM GETTLER—RYAN INC. 925 551 4770 P.02 y '4 0 0 MONITORING I SYSTEM CERTIFICATION For Use l'iv A11 Jurisdic-lions Within they State e) 'Culifornia Autharity Ciled, Chapter 6-7, Uvalth and Soffit, Code; Chapter 16, Division 3, T (ale ?.i, C'alkfornia Code of ltepulations This form must be used to document testing anti servicing; of monitoring equipment, � � �ttjkistl 3tL�Ot.!�,yt �ie.)7Fe�t �gr�t�2 Ltl�blSt�ripS�y4szcttro(Pancl by the technician who perforins the work. A cope (Willisn m is fiorust be pr�tvided to the trtrtk s_� sWm owncrvoperutor. 'The owncriop rator must submit a copy of thi.4 farm to the Iocal agency regulating ( IST systems within 3() days of test (late. A. General Information Facility Name: �Arco .� Bldg. Nn.: Site Address: 7906 N. El Dorado St. City: Stockton M� Zip: Facility Contact Perron: -Manager � e Contact Phone No,: 209957^2987 MakeiModel of Monitoring System: VIR TLS -350 I)ate of T't :iting/Servicing: 10/15/2008 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicates eciflc 29UI ment_ipapectetllserviced: Tank iD: T1: 87 STP TankID: T2: 87 STP C] In -Tank Gauging probe. Model: ❑ In -Tank (jauging Probe. Model; ® Annular Space or Vault Swwr. Mcatcl: [,J Annular Space or Vault Senaoi. Model: ® Piping Sump: Trench Semorls). Model: VIR 323 Piping Sump ' Trench Sensoria,). Madel: VIR 323 ® Fill Sump Sensor(s). Model: � � Fill Sump Scristlrtsr, Madel; _ © Mechanical Line Leak Detector. Model: ® Mctiltianicul Line Link Detector. Modcl: Electronic Linc Leask Detector, Madel: [] E:kv:tninic Line Leak Detector. Model: [� Tank Overfill i High -Level Scusor, Model: Q Took Overfill High -Level Se swr. Model [� Othcr(spwify equipment type and model in S=tion E on Page 2). C 011ier Islxv:if} equipment type and model in section E on Page 2►. Tank ID: T3: 87 STP Tank 11): ❑ In -Tank gauging probe, Model: ® in -Tank Gauging Pni(w. Model: Annular Space of Vault Sensor. Model:_ _ El Annular Spaix or Vault Sensor. McAel; Piping Sump / Trench Sensuals). Model; VIR 323 I_} Piping Sump . TrLnch Sentunf m), Model: Q fell Sump S orts). Model: [� Fill Sump Seasons). MD&L w.�. .� ® Mechanical Line Leak Detector. Modcl:❑ Muchanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: El t:loonlnic lino Wik Ovimtor M(K1cI; ®'rank OvLrfilli High -Leve) Sensor, Mo(toi: i(31'ank Overfill, Nigh -Level Sensor. Madel: Ej Otha (specify equipment type and model in Section E on Page 2). ❑ Other (specif) etluipment type and model in Section F an Page 2). Dispenser iD: Dispenser ID: Dispenser Containment Sensor(s i Model- [IDispenwrContainment Sensoiie.). McKlel' Shcacr Valvo(v), ❑ Shear Valve(s), �❑ C1 _r Dispenser Containment Floatts) and Chain(s). [] Dispenser Cuntainmcm( Float(sl and Chaitt(s), Dispenser ID: Dispenser IID: DispemwContainment Sensor(s). Model: ®fJicpena:cr Conuainment ScasoliKl. Model: ❑ Shcarvolve(s). [❑ Shear Valve!(%). (� Dispenser Containrflsnt Float(s) and Chain(s). © Dispenser Containment Fkiat(o and Chain(s). Dispenser ID: Dispenser ID; ❑ DispenlscrC'antaininentSimsot(si. Model: ® Dispenser ContainmentScnsor(K), Model: ❑ Shear ValVU(9). f I Sh(rar Vulve18) IL ❑ Dispenser Containment Floats) and Chain(s). [] Dispenser Containment Float(s) and Chains). "If the facility contains more tank. or ditApensers. copy this form. include intiarmation tier uv cry tank and dispenser at the facility. C. Certif eatlon . 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 Piot Plan showing the layout of monitoring eruipment. For any equipment capable of generating such report.% I have also attached a copy of the report; (check aft that appllJ: LJ System set-up Alarm history report Technician Name (print)-. Jose Carrasco _ ® Signature: Certification No.; 835934 _ _ License. No.: 220793.________ Testing Company Name. _q ttler»Ryan Inq..__—_� __--• _._._ Phone No,: (925.531-4777 Testing Company Address: _8747 Sierra Ct., Dublin, Ca _ .� Date of'resting/Servicing; 10/1812008 Page 1 of 3 Rev (2/08)