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PET -TECHZ ENVIRONMENTAL SERVICES MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited.• Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepare for each monitoring, 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 R days of test date. A. General Information Facility Name: UNITED PARCEL SERVICE Date of Certification/Testing Services: 6/12/2008 Site Address: 1532 NORTH BROADWAY City/State: STOCKTON, CA Zip: 95205 Facility Contact Person: HERMAN MEYER- PLANT ENGINEERING Contact Phone No.: (916) 373-4002 Make of Monitoring System: VEEDER-ROOT TLS -350 Model No.: 0847090-022 Serial No.: UNAVAILABLE B. Inventory of Equipment Tested/Certified Check the a ro riate boxes to indicate s cifec ui mint ins ected/serviced: Tank ID: Tl: UNLEADED Annular Space or Vault Sensor. Model: Ll: Veeder-Root # 302 Tank Comments: Piping Sump / Trench Sensor(s). Model: L2: Veeder-Root # 208 Mechanical Line Leak Detector. Model: Red Jacket FX1V ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other (specify ui ment type and model in Section E on Page 2). Dispenser ID: # 1-2 UNLEADED Dispenser Comments: jo Dispenser Containment Sensor(s). Model: Veeder-Root # 001 Shear Valve 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 plot plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have alsc attached a copy of the report; (check all that apply): ffil System set-up�j�l Alarm history report Technician: Dan Zeman Signature Company Name: PETRO-TECHZ Environmental Services Company Address: P.O. Box 29 aradise CA 95967-2941 Company Phone and Fax No.: (530) 680-2905 Fax: (530) 872-8648 SWRCB Tank Tester License No.: # 98-1535 Veeder-Root Certification No.: # 006-05-1363 Exp.: 4/2010 ICC, CA UST Service Technician Certification No.: 5243781 -VI Date/Time of Certification Services:6/12/2008 (a)10:00 am Inspector Present (Name): Ray von Flue- S.J. Co. E.H.D. Page 1 of 5