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MONITTRING SYSTEM CETIFICATIQ : - <br />CERTIFICATION / TEST DATE: June 10, 2016 ADD 11 1__2[L <br />`til :.. k u.-F� I U �" <br />.` ...%e�" <br />Al. FACILITY A2. OWNERS , <br />Name Quik Stop Market #125 Name Quik Stop Markets, Inc. <br />Address 1580 W. Main Street, Ripon, CA 95366 1 Address 4567 Enterprise Street, Fremont, CA 94538 <br />Phone # 510-657-8500 Phone # 510-657-8500 <br />PIS <br />Contact Roger Batra Contact Debbie Markovich <br />N-AVVI,,"y�.�4{ �IIILI 1MOTLi07 '' ..., .r�'1Gt�� tN ..i°�ursa.,�.,',�'4 .s�-NZ �.:4;,ze ^._'`,i _?', ',ilr�,:,.t!Vn `. �� „�',`-' ter 0'a�7 au�ni. =_-.7r," ���`a`i .rnz'�l�:vrt,^ ... ;::, ..! ,'iS,.t'", r:N' ., <br />D. RESULTS OF TESTING I SERVICING <br />Make I Model of Monitoring System: Veeder-Root TLS -350 SN# 80850111805001 <br />Software Version Installed: 330.01 <br />Complete the following checklist: <br />mv�" ei, .. rtlC1...." d II U..11F 1 DIY`. <br />Yes <br />❑ No* <br />Is the audible alarm operational? <br />ilk■ <br />n ■ Yes <br />❑ No* <br />Is the visual alarm operational? <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 />r� <br />will not interfere with their proper operation? <br />ElYes <br />ElNo * <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modems) <br />i <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 />Containment Sensors. <br />positive shutdown? (check all that apply) ■ Sump/Trench sensors; ❑ Dispenser <br />$ <br />w ■ Yes <br />❑ No * <br />Did you confirm positive shut -down due to leaks and sensor failure/disconnection? <br />❑ Yes <br />❑ No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br />■ N/A <br />mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br />a <br />fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? _ % <br />❑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 />■ Yes * <br />❑ No <br />Was any liquid found inside any secondary containment systems designed as dry systems? <br />z <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 />■ Yes <br />❑ No* <br />Is all monitoring equipment operational per manufacturer's specifications? <br />�* <br />In Section E below, describe how and when these deficiencies were or will be corrected. <br />w,_ _omw <br />' <br />E. COMMENTS <br />Removed liquid from all fill sumps. <br />i <br />Replaced battery on monitor. <br />41 <br />} <br />�^ <br />01 1-11 <br />©2016 Walton Engineering, Inc. <br />Page 2 of 3 <br />