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MONITING SYSTEM CERTIWATION CERTIFICATION / TEST DATE: August 3, 2012 A1. FACILITY Make / Model of Monitoring System: Gilbarco EMC Software Version Installed: 327.04 A2. OWNER ElNo* Name Quik Stop Market #148 ElNo* Name Quik Stop Markets, Inc. Address 205 W. Lockeford Street, Lodi, CA 95240 Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modems) Phone # 510-657-8500 Contact Michael Karvelot ElNo* Contact Michael Karvelot D. RESULTS OF TESTING / SERVICING Make / Model of Monitoring System: Gilbarco EMC Software Version Installed: 327.04 Complete the following checklist: ElNo* Is the visual alarm operational? ■ Yes ElNo* Were all sensors visually Inspected, functionally tested, and confirmed operational? ■ Yes ElNo* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ❑ Yes ElNo* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modems) ■ N/A operational? ❑ Yes ElNo* _ For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ■ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shutdown? (check all that apply) ElSump/Trench sensors; ❑Dispenser Containment Sensors. ■ Yes ElNo* Did you confirm positive shut -down due to leaks and sensor failure/disconnection? 11Yes [3No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ■ N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? ElYes " ■ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. ■ Yes'" ❑ No Was any liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) El Product; ■Water. If yes, describe causes in Section E, below. ■ Yes ElNo* Was monitoring system set-up reviewed to Insure proper settings? Attach set-up reports, if applicable. ■ Yes ElNo* Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. ■ Yes [INo* Is the audible alarm operational? ■ Yes ElNo* Is the visual alarm operational? ■ Yes ElNo* Were all sensors visually Inspected, functionally tested, and confirmed operational? ■ Yes ElNo* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ❑ Yes ElNo* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modems) ■ N/A operational? ❑ Yes ElNo* _ For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ■ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shutdown? (check all that apply) ElSump/Trench sensors; ❑Dispenser Containment Sensors. ■ Yes ElNo* Did you confirm positive shut -down due to leaks and sensor failure/disconnection? 11Yes [3No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ■ N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? ElYes " ■ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. ■ Yes'" ❑ No Was any liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) El Product; ■Water. If yes, describe causes in Section E, below. ■ Yes ElNo* Was monitoring system set-up reviewed to Insure proper settings? Attach set-up reports, if applicable. ■ Yes ElNo* Is all monitoring equipment operational per manufacturer's specifications? E. COMMENTS Replaced the battery in the EMC monitor. Found large amounts of water in all tree fill sumps. Will return with bigger pump to remove water. Tree, Sums N� �s�( oY - Page 2 of 3