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MONITq#ING SYSTEM CERTIWATION CERTIFICATION /TEST DATE: June 18, 2008 Al. FACILITY A2. OWNER Name Quik Stop Market #121 Name Quik Stop Markets, Inc. Address 1196 W. Louise Avenue, Manteca, CA 95336 Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 Phone # 510-657-8500 Contact Michael Karvelot Contact Michael Karvelot F. IN -TANK GAUGING / SIR EQUIPMENT: ■ Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gaugung equipment is used to perform leak detection monitoring. Complete the following checklist: * In Section H below, describe how and when these deficiencies were or will be corrected. IG. LINE LEAK DETECTORS (LLD): ElCheck this box if LLDs are not installed. Complete the following checklist: ■ Yes ElNo* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? El Yes El No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? El Yes El No* Were all tank gauging probes visually inspected for damage and residue buildup? El Yes El No* Was accuracy of system product level readings tested? El Yes El No* Was accuracy of system water level readings tested? El Yes ❑ No* Were all probes reinstalled properly? El Yes El No* Were all items on the equipment manufacturer's maintenance checklist completed? ■ N/A * In Section H below, describe how and when these deficiencies were or will be corrected. IG. LINE LEAK DETECTORS (LLD): ElCheck this box if LLDs are not installed. Complete the following checklist: ■ Yes ElNo* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A (check all that apply) Simulated leak rate: ■ 3 g.p.h.; El0.1 g.p.h.; El0.2 g.p.h. ■ Yes ElNo* Were all LLDs confirmed operational and accurate within regulatory requirements? ■ Yes ElNo* Was the testing apparatus properly calibrated? ■ Yes ElNo* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ElN/A ElYes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ■ N/A ElYes ElNo* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ■ N/A or disconnected? ElYes ElNo * For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ■ N/A or fails a test? ElYes ElNo* For electronic LLDs, have all accessible wiring connections been visually inspected? ■ N/A ■ Yes ElNo* Were all items on the equipment manufacturer's maintenance checklist completed? * In Section H below, describe how and when these deficiencies were or will be corrected. H. COMMENTS Page 3 of 3