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MONITf&ING SYSTEM CERTIIWATION <br />CERTIFICATION /TEST DATE: August 3. 2010 <br />Al. FACILITY <br />Yes <br />A2. OWNER <br />No * <br />Name <br />Quik Stop Market #148 <br />Yes <br />Name <br />Quik Stop Markets, Inc. <br />Address <br />205 W. Lockeford Street, Lodi, CA 95240 <br />Yes <br />Address <br />4567 Enterprise Street, Fremont, CA 94538 <br />Phone # <br />510-657-8500 <br />Yes <br />Phone # <br />510-657-8500 <br />Contact <br />Michael Karvelot <br />Yes <br />Contact <br />Michael Karvelot <br />F. IN -TANK GAUGING / SIR EQUIPMENT: <br />■ Check this box if tank gauging is used only for inventory control. <br />❑ Check this box if no tank gauging or SIR equipment is installed. <br />This section must be completed if in -tank gaugung equipment is used to perform leak detection monitoring. <br />Complete the following checklist: <br />❑ <br />Yes <br />❑ <br />No * <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ <br />Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ <br />Yes <br />❑ <br />No* <br />Was accuracy of system product level readings tested? <br />❑ <br />Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ <br />Yes <br />❑ <br />No * <br />Were all probes reinstalled properly? <br />❑ <br />Yes <br />❑ <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In Section H below, describe how and when these deficiencies were or will be corrected. <br />Page 3 of 3 <br />