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MONITORING SYSTIM CERTIFICATION -O'age 1 C 'lr le MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 CERTIFICATION /TEST DATE: January A1. FACILITY Name Tower Mart # 104 Address 192 Lathrop Road, Lathrop, CA 95330 Phone# 209-858-4998 Contact Desiz Burns r OWNER e Tower Energy Group, Inc.` NMEqNp i -AL H& ress 1983 West 190th Street, Torrance,/t:r4R�isl4 ne# 916.285-7402 ext 100act Mark Vasev <IWIED (Check the appropriate boaestoindicate equipment inspected/serviced) 131 (Cont-Id TA ❑ Electronic Line Leak Detector Model: - ❑ Electronic Line Leak Detector Motlel: ❑ Tank Overfill / High -Level Sensor Model: _ ❑ Tank Overfill / High -Level Sensor Model: L 1 Other (specify equipment in Section E) Model. ❑ Other (specify equipment In Section E) Model: B2: (Continued) DISPENSERS/UDC's Dispenser # : 13-14 --- Dispenser # nue )- limaTank#5(Product): 0794380.208 ■ Dispenser Containment Sensor(s) Model: ■ Shear Valves ■ Shear Valves _0794380-208 ❑ Dispenser Containment Float($) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) Tank#6 (Product): ❑ In -Tank Gauging Probe Model:- LDsser19-20■ penser ContainmentSensor■ earValves❑ ❑ In -Tank Gauging Probe Model: El Annular Space or Vault Sensor Model: _ El Annular Space or Vault Sensor Motlel: ❑ Piping / Trench Sensors) Model: _0794380.208 ❑ Piping Sump / Trench Sensor(s) Sump Model: [3 Fill Sump Sensoria) Model: Dispenser#: ElDispenser Containment Sensoria) Model: ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: _ ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: -_ -� ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: _ ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) JII ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) - Model: � ❑ Other (specify equipment in Section E) Model: Tank #7 (Product): El Dispenser Containment Floahs) and Chaln(s) _ _ I El Dispenser Containment Float(s) antl Cham(sl Tank #8 (Product): - ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: _ ❑ Annular Space or Vault Sensor Model: El Piping Sump /Trench Sensor(s) Model: _. ❑ Piping Sump / Trench Sensoria) Model: El Fill Sump Sensor(s) Model: ElFill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model ❑ Electronic Line Leak Detector Model: - ❑ Electronic Line Leak Detector Motlel: ❑ Tank Overfill / High -Level Sensor Model: _ ❑ Tank Overfill / High -Level Sensor Model: L 1 Other (specify equipment in Section E) Model. ❑ Other (specify equipment In Section E) Model: B2: (Continued) DISPENSERS/UDC's Dispenser # : 13-14 --- Dispenser # ■ Dispenser Containment Sensor(s) Model: 0794380.208 ■ Dispenser Containment Sensor(s) Model: ■ Shear Valves ■ Shear Valves _0794380-208 ❑ Dispenser Containment Float($) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) Dispenser#: 17-18 Dispenser Containment Sensor(s) Motlel: Shear Valves 0794380.208 LDsser19-20■ penser ContainmentSensor■ earValves❑ Dispenser Containment Float(s) antl Chain(s) penser Containment Float(.) and Chains) Dispenser#: 21-22 Dispenser#: 23-24 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Dispenser Containment Sensor(s) Model: ■ Shear Valves ■ Shear Valves _0794380.208 ❑ -Dispenser Containment Floats) and Chains) ❑ Dispenser Containment Float(s) and Chain(s) Dispenser#: ❑ Dispenser Containment Sensor(s) Motlel:_ Dispenser#: ElDispenser Containment Sensoria) Model: ❑ Shear Valves _ _ ❑ Shear Valves I ❑ Dispenser Containment Float(s) and Chain(s) Dispenser Containment Floats) and Chain(,) Dispenser # : - - - - ❑ Dispenser Containment Sensor($) _- Dispenser —#: - - - -� Motlel:_ ElSeriDispenser Containment SenModel: El Shear Valves ElDispenser Containment Float(s) and Chain(s) ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) JII Dispenser #: Dispenser#: —, LlDispenser Containment Sensoria) Model: � 1:1 Dispenser Containment Sensoria) Model: L1 ShearValves El ShearValves El Dispenser Containment Floahs) and Chaln(s) _ _ I El Dispenser Containment Float(s) antl Cham(sl Page 1a of 3