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MONITORING SYSTEM CERTIFICATION CERTIFICATION /TEST DATE: June 10, 2015 Al. FACILITY Yes A2. OWNER Name Quik Stop Market #125 ❑ Name Quik Stop Markets, Inc. Address 1580 W. Main Street, Ripon, CA 95366 ❑ Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 ❑ Phone # 510-657-8500 Contact Roger Batra ❑ Contact Debbie Markovich No" Were all probes reinstalled property? ❑ Yes ❑ IF. 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: ❑ Yes ❑ No " Has all input wiring been Inspected for proper entry and termination, Including testing for ground faults? ❑ Yes ❑ No • Were all tank gauging probes visually Inspected for damage and residue buildup? ❑ Yes ❑ No* _ Was accuracy of system product level readings tested? ❑ Yes ❑ No' Was accuracy of system water level readings tested? ❑ Yes ❑ No" Were all probes reinstalled property? ❑ Yes ❑ No* _ 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. 1G. LINE LEAK DETECTORS (LLD): ❑ Check this box if LLDs are not installed. ' Complete the following checklist: ■ Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ NIA (check all that apply) Simulated leak rate: ■ 3 g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. ■ Yes ❑ No' Were all LLD* confirmed operational and accurate within regulatory requirements? ■ Yes ❑ No' Was the testing apparatus properly calibrated? For mechanical LLDs, does the LLD restrict product flow If It detects a leak? ■ Yes ❑ No' ❑ NIA ❑ Yea ❑ No' For electronic LLDa, does the turbine automatically shut oft If the LLD detects a leak? ■ NIA ❑ Yes ❑ No' For electronic LLDa, does the turbine automatically shut off If any portion of the monitoring system Is disabled ■ NIA or disconnected? ❑ Yes ❑ No " For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ■ NIA or falls a test? _ ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ■ NIA ■ Yes ❑ No* 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 JUN 14 2016 Page 3 of 3