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MONIT NG SYSTEMC RTIFIC TION e By All Jurisdictions Within the State of Califomi Authority Cited.Chapter 6.7, and Safety Code,Chapter 16,Division 3 Title 23, mia Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility,a separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A.General Information Facility Name: CONOCO PHILLIPS#2705447 City: STOCKTON CA Zip:95209 Site Address: 1469 E HAMMER LANE Contact Phone No: 478-1522 Date of Testing/Service: 08/06/2007 Facility Contact Person: MANAGER-TOM Make/Model of Monitoring System:TLS350 Work Order Number: 2250860 B.Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced Tank ID: 91 Tank ID: 89 X In-Tank Gauging Probe. Model: VEEDER ROOT X In-Tank Gauging Probe. Model: VEEDER ROOT X Annular Space or Vault Sensor. Model: 407 Annular Space or Vault Sensor. Model: 407 X Piping Sump/Trench Sensor(s). Model: 208 X1Piping Sumpffrench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: X Mechanical Line Leak Detector. Model: LD2000 X Mechanical Line Leak Detector. Model: FX1V Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: Tank OverfilVHigh-Level Sensor. Model: Other(specify equipment type and model in Section E on page 2). Other(specify equipment type and model in Section E on page 2). TanklD: 87 Tank ID: In-Tank Gauging Probe. Model: VEEDER ROOT In-Tank Gauging Probe. Model: VEEDER ROOT X Annular Space or Vault Sensor. Model: 407 Annular Space or Vault Sensor. Model: 407 X Piping Sump/Trench Sensor(s). Model: 208 X Piping Sump/Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: x1 Mechanical Line Leak Detector. Model: LD2000 X Mechanical Line Leak Detector. Model: FE STP-MLD-D Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: Tank Overfill/High-Level Sensor. Model: Other(specify equipment type and model in Section E on page 2). Other(specify equipment type and model in Section E on page 2). ispenser : 1-2 Dispenser ID: 3-4 X❑Dispenser Containment Sensor(s) Model:BEI 406 X Dispenser Containment Sensor(s) Model: BEI 406 RI Shear Valve(s). X Shear Valve(s) ®Dispenser Containment Float(s)and Chain(s). X Dispenser Containment Float(s)and Chain(s). Dispenser ID: 5-6 Dispenser ID: 7-8 X❑Dispenser Containment Sensor(s) Model:BEI 406 X Dispenser Containment Sensor(s). Model:BEI 406 ® Shear Valve(s). Shear Valve(s). X Dispenser Containment Float(s)and Chain(s). Dispenser Containment Float(s)and Chain(s). Dispenser ID: 9-10 Dispenser ID: X❑ Dispenser Containment Sensor(s) Model: BEI 406 Dispenser Containment Sensor(s). Model: FX-j Valve(s). Shear Valve(s). ❑X Dispenser Containment Float(s)and Chain(s). Dispenser Containment Float(s)and Chain(s). "If the facility contains more tanks or dispensers,copy this form.Include information for every tank and dispenser at the facility. 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 Site Plan showing the layout of monitoring equipment.For any equipment capable of generating such reports,I have also attached a copy of the(Check all that apply): System set-up X❑Alarm history report Technician Name(print): DOUG FALDE Signature: Certification No.: B34906 License.No.: Testing Company Name:Tanknology Phone No.: (800)800-4633 Site Address: 8501 N.MoPac Expressway,suite 400,Austin,TX 78759 Date of Testing/Servicing: 08/06/2007 Monitoring System Certification Page 1 of 3 Based on CA form dated 03/01