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ZNT <br />Site Location: <br />County: <br />• <br />TAIT Environmental Systems <br />General Contoc!ors CA Lic #588098 <br />U.S.T. & A.S.T. MONITOR CERTIFICATION FORM <br />PACIFIC BELL <br />7717 S. MCKINNLEY <br />Testing Date: <br />Tank ID(s): <br />CLLC Code: <br />STOCKTON Geo Parcel: <br />SAN JOAQUIN Site Contact <br />Make & Model of Monitor Systems <br />8/5/99 <br />807 <br />SKTNCAI4 <br />UE -148 <br />KEN MCDONALD <br />Site Contact Phone #: (209) 943-4128 <br />VEEDER-ROOT TLS350 <br />Tank 1 I Tank 2 1 Tank 3 <br />Tank ID # 807 <br />Type of Tank: (Single Wall or Double Wall) UST or AST DW/UST <br />Contents of Tank: DIESEL <br />Capacity of Tank 2,000 <br />Type of Product Line: (Gravity, Suction, Pressure) SUCTIOI• <br />Type of Piping: (Single Wall or Double Wall) DW <br />INDICATE THE SENSORS TESTED BY PLACING A YES, NO, OR N/A & PASS OR FAIL IN <br />CORRESPONDING BOX: <br />Annular Space Sensor. <br />Fill Sump Sensor. <br />Piping Sump Sensor. <br />Piping Trench Sensor. <br />Dispenser Containment Sensor. <br />Problems System(s) <br />Tank 1 Tank 2 <br />YES PASS <br />YES PASS <br />Tank 3 Tank 4 <br />FOR PRESSURE TYPE SYSTEMS ONLY: <br />Tank 4 <br />Tank 1 Tank 2 Tank 3 Tank 4 <br />Is Mechanical Line Leak Detector Present & Tested?: <br />Does the Turbine Shut -Down if System Detects a Leak?: <br />Does Positive Shut Down Occur if Monitor System is turned off?: <br />Is Tank Level Gauging System Present, Probe Type if Applicable. <br />Type of Irill Leak Detection Test Performed by Monitor. <br />Does the Monitoring System have Audible & Visual Alarms? <br />Electronic Overfill/Level: <br />Is the Monitoring System installed to prevent unauthorized tampering?: <br />Is the Monitoring Devices operable as per manufacture's specifications? <br />.2 GPH DAILY <br />YES <br />90% <br />YES <br />YES <br />Date: 8/5/99 Technician: BRANDON HAM <br />Na lL fW�M1 <br />Certified Tester's ID #: 393 t <br />435 <br />(Signature) <br />701 North Parkcenter Drive • Santa Ana. California 92705 • (714) 560-8222 (714) 560-8237 fax <br />Regional Offices: San Diego • Concord • Sacramento • Phoenix Tucson <br />w .TAIT.com <br />