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MONIT ING SYSTEM CERTHWATION <br /> CERTIFICATION / TEST DATE: September 21, 2010 <br /> Al. FACILITY A2. OWNER <br /> Name Quik Stop Market#125 Name Quik Stop Markets, Inc. <br /> Address 1580 W. Main Street,Ripon,CA 95366 Address 4567 Enterprise Street,Fremont,CA 94538 <br /> Phone# 510-657-8500 Phone# 510-657-8500 <br /> Contact Michael Karvelot Contact Michael Karvelot <br /> D. RESULTS OF TESTING/SERVICING <br /> Make/ Model of Monitoring System: Gilbarco EMC <br /> Software Version Installed: 327.04 <br /> Complete the following checklist: <br /> ■ Yes ❑ No* Is the audible alarm operational? <br /> ■ Yes ❑ No* Is the visual alarm operational? <br /> ■ Yes ❑ No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> ■ Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment <br /> will not interfere with their proper operation? <br /> ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modems) <br /> ■ N/A operational? <br /> ■ Yes ❑ No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑ N/A monitoring system detects a leak,fails to operate,or is electrically disconnected? If yes:which sensors initiate <br /> positive shutdown? (check all that apply) ■ Sump/Trench sensors; ❑ Dispenser Containment Sensors. <br /> ■ Yes ❑ No* Did you confirm positive shut-down due to leaks and sensor failure/disconnection? <br /> ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no <br /> ■ N/A 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 /> ❑ Yes* ■ No 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 /> ❑ Yes* ■ No 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 ❑ No* Was monitoring system set-up reviewed to insure proper settings? Attach set-up reports,if applicable. <br /> ■ Yes ❑ No* Is all monitoring equipment operational per manufacturer's specifications? <br /> * In Section E below, describe how and when these deficiencies were or will be corrected. <br /> E. COMMENTS <br /> 02010 Walton Engineering,Inc. <br /> Page 2 of 3 <br />