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ONIT NG SYSTEM CERTIFIC ION e By All Jurisdictions Within the State of California Authority Cited- Chapter 6.7, He and Safety Code; Chapter 16, Division 3 Title 23, C 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 monitonnq 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 Site Address: 1469 E HAMMER LANE Facility Contact Person: MANAGER -TOM Make/Model of Monitoring System:TLS 350 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced City: STOCKTON CA Zip: 95209 Contact Phone No: 478-1522 Date of Testing/Service: 08/26/2008 Work Order Number: 2259273 Tank ID: 91 Tank ID: 89 R1 In -Tank Gauging Probe. Model: MAG PLUS El In -Tank Gauging Probe. Model: MAG PLUS X Annular Space or Vault Sensor. Model: 402 MX Annular Space or Vault Sensor. Model: 402 X Piping Sump/Trench Sensor(s). Model: 208 Piping Sump/Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: X Mechanical Line Leak Detector. Model: VAPORLESS X Mechanical Line Leak Detector. Model: FXV -1 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). Tank ID: bf Tank ID: 71 In -Tank Gauging Probe. Model: MAG PLUS In -Tank Gauging Probe. Model: MAG PLUS X Annular Space or Vault Sensor. Model: 402 Annular Space or Vault Sensor. Model: 402 X Piping Sump/Trench Sensor(s). Model: 208 X Piping Sumpffrench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: X Mechanical Line Leak Detector. Model: VAPORLESS X Mechanical Line Leak Detector. Model: VAPORLESS 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). Dispenser : 1/2 Dispenser ID: 3/4 3q Dispenser Containment Sensor(s) Model: BEI 406 _X_j Dispenser Containment Sensor(s) Model: BEI 406 X❑ Shear Valve(s). X Shear Valve(s) EX Dispenser Containment Float(s) and Chain(s). X Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5/6 Dispenser ID: 7/8 XO Dispenser Containment Sensor(s) Model: BEI 406 X Dispenser Containment Sensor(s). Model: BEI 406 X❑ 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 Sensors) Model: BEI 406 Dispenser Containment Sensor(s). Model: QX Shear Valve(s). Shear Valve(s). 1!1 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): BRIAN MCPHEELY Certification No.: B36745 Signature: 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 08/26/2008 Monitoring System Certification Page 1 of 3 Based on CA form dated 03/01