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'NG SYSTEM CERTIFICA ION se By All Jurisdictions Wrthin the State of California Authority Cited:Chapter 6.7,MON'Tand Safety Code;Chapter 16,Division 3 Title 23,Cal Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility,a separate certfication or rermrt must be prepared 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/ w. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A.General Information Facility Name:ARCO#5450,CC 18022647 City: STOCKTON CA Zip:95205 Site Address: 1617 W.FREMONT Contact Phone No: 462-1617 Date of Testing/Service: 05/31/2006 Facility Contact Person: DEALER/MANAGER Make/Model of MonitoringSystem:TLS-350 Work Order Number: 2242951 `tom B.Inventory of Equipment Tested/Certifiled Check the appropriate boxes to indicate specific equipment inspected/serviced JUN Tank ID: 87 MASTER Tank ID: 87 SLAVE AIPr q- X In-Tank Gauging Probe. Model: MAG 71 In-Tank Gauging Probe. M t X Annular Space or Vault Sensor. Model: 407 -TF mTrIT E Annular Space or Vault Sensor. Model: 40 X Piping Sump/Trench Sensor(s). Model: 208 Piping Sump/Trench Sensor(s). Model: 208 X Fill Sump Sensor(s). Model: 344 344 Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: CPT Electronic Line Leak Detector. Model: Tank Overfill/tiigh-Level Sensor. Model: MAG X Tank Overfill/High-Level Sensor. Model: MAG Other(specify equipment type and model in Section E on page 2). Other(specify equipment type and model in Section E on page 2). TankTank ID: X1 In-Tank Gauging Probe. Model: MAG in-Tank Gauging Prof. Motel: X Annular Space or Vault Sensor. Model: 407 Annular Space or Vault Sensor. Model: X Piping Sump/Trench Sensor(s). Model: 208 Piping Sump/Trench Sensor(s). Model: X Fill Sump Sensor(s). Model: 344 Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector. Model: CPT Electronic Line Leak Detector. Model: X Tank Overfill/High-Level Sensor. Model: MAG Tank Overfill/High-Level Sensor. Model: Other(specify equipment type and model in Section E on page 2). Other(specify equipment type and model in Section E on page 2). Spenser : 1-2 Dispenserl : 3-4 MX Dispenser Containment Sensor(s) Model:208 X Dispenser Containment Sensor(s) Model:208 X Shear Valve(s). —X-1 Shear Valve(s) Dispenser Containment Float(s)and Chain(s). Dispenser Containment Float(s)and Chain(s). Dispenser ID: 5-6 Dispenser ID: 7-8 X Dispenser Containment Sensors) Model:208 Dispenser Containment Sensor(s). Model:208 X Shear Valve(s). 71 Shear Valve(s). Dispenser Containment Float(s)and Chain(s). Dispenser Containment Float(s)and Chain(s). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s)and Chain(s). Dispenser Containment Float(s)and Chain(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 Site Plan showing the layout of monitoring equipment.For any equipment capable of generating such reports,I have also attached a copy of the(Check all that apply): ®System set-upX�Alarm history report Technician Name(print): DENNIS RUE Signature: Certification No.: 006-05-1510 License.No.: Testing Company Name:Tanknology Phone No.: (800)800-4633 Site Address: 8501 N.MoPac Expressway,suite 400,Austin,TX 78759 Date of Testing/Servicing: 05/31/2006 Monitoring System Certification Page 1 of 3 Based on CA form dated 03/01