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MONITORING SYSTEM CERTIFICATION MAKE/ MODEL OF MONITORING SYSTEM: Veeder-Root TLS-350 CERTIFICATION/ TEST DATE: January4, 2017 A1. FACILITY A2. OWNER Name Colonial Energy#40135 Name ColonialrMr7'\IT�I Address 192 Lathrop Road,Lathrop,CA 95330 Address 2860 N.Santiago BI _Floor,Orange,CA 92867 Phone# 209-858-4998 Phone# 714-761-5426 � - Contact Station Manager Contact Victor Hassan A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering,Inc. Address 1868 E.Hazelton Avenue,Stockton,CA 95202 Address P.O.Box 1025,W.Sacramento,CA 95691 Notified December 21,2016 Lie# 617238 A,B,Haz Inspector Garrett Backus Contact Veronica Freitas Phone# 209-468-3442 Phone# 916-373-1166 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) 61: TANKS Tank#1 (Product): Gsaoline-87-1 Tank#2 (Product): Gasoline-87-2 ❑ In-Tank Gauging Probe Madel: ❑ In-Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 794390-460 ■ Annular Space or Vault Sensor Model: 794390-460 ■ Piping Sump/Trench Sensors) Model: 0794380.208 _ ■ Piping Sump/Trench Sensoria) Model: 0794380.208 ■ Fill Sump Sensors) Model; 0794380.208 ■ FIII Sump Sensor(s) Model: 0794380-208 ❑ Mechanical Line Leak Detector Modal: ❑ Mechanical Line Leak Detector Model: ■ Electronic Line Leak Detector Model: 0848480-001 ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill/High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model: ❑ Other (specify equipment In Section E) Model: ❑ Other (specify equipment in Section E) Model: Tank#3 (Product): Gasoline-91 Tank#4 (Product): Diesel ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 794390-460 ■ Annular Space or Vault Sensor Model: 794390460 ■ Piping Sump/Trench Sensors) Model: 0794380.208 ■ Piping Sump/Trench Sensors) Model: 0794380-208 ■ FIII Sump Sensor(s) Model: 0794380.208 ■ FIII Sump Sensor(s) Model: 0794380-208 ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: ■ Electronic Line Leak Detector Model: 0849480-001 ■ Electronic Line Leak Detector Model: 0848480-001 ❑ Tank Overfill/High-Level Sensor Model: ❑ Tank Overfill/High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: E12: DISPENSERS/UDC's Dispenser#: 1-2 Dispenser#: 3-4 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Shear Valves ■ Shear Valves ❑ Dispenser Containment Floats)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s) Dispenser#: 5-6 Dispenser#: 7-8 ■ Dispenser Containment Sensoria) Model: 0794380.208 ■ Dispenser Containment Sensoria) Model: 0794380-208 ■ Shear Valves ■ Shear Valves ❑ Dispenser Containment Float(s)and Chaln(s) ❑ Dispenser Containment Float(s)and Chain(s) Dispenser#: 9-10 Dispenser#: 11-12 ■ Dispenser Containment Sensor(s) Model: 0794380.208 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Shear Valves ■ Shear Valves ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s) 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 Plot Plan showing th layout of monitoring equipment. For any equipment capable of generating such reports,I have also attached a copy of the report; (check all that apply ■ System set-up ■ Alarm History Report ///� /J WALTON Signature: nn/.a^•. /Z'0- �'— ENGINEERING,INC. Technician I Cert M Anthony Reyes B45115 8293772 Date: January 4, 1017 J2017 Walton Engineering.Inc.