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MONITORING <br />•R CERTIFICATION 1..• <br />CERTIFICATION /TEST DATE: Auqust 8, 2016 <br />s <br />A1. FACILITY <br />A2. OWNER <br />Name Quik Stop Market # 39 <br />Name Quik Stop Markets, Inc.M <br />Address 2285 E. Fremont Street, Stockton, CA 95205 <br />j Address 4567 Enterprise Street, Fremont; CA'9411 <br />Phone # 510-657-8500 <br />Phone # 510-657-8500 <br />Contact Roger Batra <br />Contact Debbie Markovich <br />D. RESULTS OF TESTING / SERVICING <br />Make / Model of Monitoring System: Vee r- TLS-350TLS-350 SN# 80850112305001 <br />Software Version Installed: 327.04 <br />Complete the following checklist: <br />■ Yes <br />❑ No* <br />Is the audible alarm operational? <br />■ Yes <br />❑ No* <br />Is the visual alarm operational? <br />_ <br />■ Yes <br />❑ No* <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />■ Yes <br />❑ No* <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment <br />; n <br />will not interfere with their proper operation? <br />i <br />❑ Yes <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modems) <br />■ NIA <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 />E <br />s'positive <br />shutdown? (check all that apply) 0 Sump/Trench sensors; 0 Dispenser Containment Sensors. <br />1 ■ Yes <br />❑ No* <br />Did you confirm positive shut -down due to leaks gna sensor failure/disconnection? <br />4 <br />- ❑ Yes <br />❑ No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br />■ NIA <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? _ %® <br />:4 ■ 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 />e, <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 />°' <br />' ■ Yes <br />No* <br />Is all monitoring equipment operational per manufacturer's specifications? <br />.: .,.,1...:: St ,...v... .,s . �n., v.-:,:,. '• ;�3----..—,-,�,ew ca.. .:v. s^e,<. `>.: ,Y .. <e. £.. , c., ., ., - -¢'Ftv 4.°�§L--'-""S ^. °S �� _- <br />* In Section E below, describe how and when these deficiencies were or will be corrected. <br />_ <br />COMMENTS <br />Replaced #112 UDC Stand alone ser <br />Watton Engineering, Inc. <br />Page 2 of 3 <br />