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MONITORING SYSTEM CERTIFICATION - Page 1 Continuation <br /> MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS-350 <br /> CERTIFICATION /TEST DATE: September 19, 2017 <br /> At. FACILITY A2. OWNER <br /> Name Colonial Energy#40135 Name Colonial Energy, LLC. <br /> Address 192 Lathrop Road, Lathrop,CA 95330 Address 2860 N.Santiago Blvd.2nd Floor,Orange, CA 928E <br /> Phone# 209-8584998 Phone If 714-761-5426 <br /> Contact Station Manager Contact Victor Hassan <br /> B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (check the appropriate boxes to indicate equipment inspected/serviced) <br /> Bt (Continued): TANKS <br /> Tank#5 (Product): Tank#6 (Product): <br /> ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: <br /> ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: <br /> ❑ Piping Sump/Trench Sensors) Model: _ ❑ Piping Sump/Trench Sensor(s) Model: <br /> ❑ Fill Sump Sensoria) Model: ❑ Fill Sump Sensors) Model: <br /> ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: <br /> ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: <br /> ❑ Tank Overfill/High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model: <br /> ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: <br /> Tank#7 (Product): Tank#8 (Product): _ <br /> ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: <br /> ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: <br /> ❑ Piping Sump/Trench Sensoria) Model: _ ❑ Piping Sump/Trench Sensor(s) Model: <br /> ❑ Fill Sump Sensoria) Model: ❑ Fill Sump Sensoria) Model: <br /> ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: <br /> ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: <br /> ❑ Tank Overfill/High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model: <br /> ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: <br /> B2: (Continued) DISPENSERS/UDC's <br /> Dispenser#: 13114 Dispenser#: 15116 <br /> E Dispenser Containment Sensoria) Model: 794390460 0 Dispenser Containment Sensoria) Model: 794390460 <br /> 0 Shear Valves Shear Valves <br /> ❑ Dispenser Containment Float(s)and Chains) ❑ Dispenser Containment Float(s)and Chain(s) <br /> Dispenser#: 17/18 DispenserIf: 19/20 <br /> Dispenser Containment Sensor(s) Model: 794390460 0 Dispenser Containment Sensor(s) Model: 794390.460 <br /> Shear Valves 0 Shear Valves <br /> ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chains) <br /> Dispenser#: 21/22 Dispenser#: 23124 <br /> Dispenser Containment Sensor(s) Model: 794390460 0 Dispenser Containment Sensor(s) Model: 794390460 <br /> Shear Valves Shear Valves <br /> ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s) <br /> Dispenser#: Dispenser# <br /> ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensors) Model: <br /> ❑ Shear Valves ❑ Shear Valves <br /> ❑ Dispenser Containment Float(s)and Chaln(s) ❑ Dispenser Containment Float(s)and Chain(s) <br /> Dispenser#: Dispenser# <br /> ❑ Dispenser Containment Sensors) Model: ❑ Dispenser Containment Sensoria) Model: <br /> ❑ Shear Valves ❑ Shear Valves <br /> ❑ Dispenser Containment Floats)and Chains) ❑ Dispenser Containment Float(s) n s <br /> Dispenser#: Dispenser#: <br /> ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensoria) Modell. <br /> ❑ Shear Valves ❑ Shear Valves <br /> ❑ Dispenser Containment Float(s)and Chains) ❑ Dispenser Containment Float(s)and Chain(s) <br /> DEPARTMENT <br />