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MONITC`UNG SYSTEM CERTIFIC ' TION This form must be used to document testing"ld servicing of monitoring equipment. Seyarate'rtifications or reports must be nrenared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator.The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information SET Job#: T7 019238 Facility Name: Yellow Transportation TCY Bldg: Site Address: 1535 E.Pescadero Ave. City/State: Tracy CA Zip: 95376 Facility Contact Person: Richard Smith Contact Phone No.: 209-833-1300 Make/Model of Monitoring System: Veeder Root TIS 250i x 2 Date of Testing/Servicing: 3/18/2004 B. Inventory of Equipment Tested or Certified Check the appropriate boxes to indicate equipment ins ected or serviced: Tank ID: TCY1 Soap Tank ID: TCY2 Waste Oil 1K ❑In-Tank Gauging Probe. Model: None_ ®In-Tank Gauging Probe. Model: Mae 1 ®Annular Space or Vault Sensor. Model: 407 ®Annular Space or Vault Sensor. Model: 302 ®Piping Sump/Trench Sensor(s). Model: . 208., ®Piping Sump/Trench Sensor(s). Model: 208 ❑Fill Sump Sensor(s). 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. M odel: oPW 815 ®Tank Overfill/High-Level Sensor. M odel: OPW 8150 ❑Other(specify equipment type and model in Section E on Page 2). ❑Other(specify equipment t e and model in Section E on Page 2). Tank ID: TCY3 Motor Oil 10K Tank ID: TCY4 Waste Oil 6K ®In-Tank Gauging Probe. Model: Man 1 ®In-Tank Gauging Probe. Model: Mw 1 ®Annular Space or Vault Sensor. Model: 407 ®Annular Space or Vault Sensor. Model: 407 ®Piping Sump/Trench Sensor(s). Model: 208 ®Piping Sump/Trench Sensor(s). Model: _ 208 ❑Fill Sump Sensor(s). Model _— El 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. M odel: OPW 615 ®Tank Overfill/High-Level Sensor. M odel: OPW 6150 ❑Other(specify equipment type and model in Section E on Page 2). Other(specify equipment a and model in Section E on Pae 2). Dispenser ID: Dispenser ID: ❑ Dispenser Containment Sensor(s). Model: 0 Dispenser Containment Sensor(s). Model: 17 Shear Valve(s). 17 Shear Valve(s). ❑ Dispenser Containment Float(s)and Chain(s). 0 Dispenser Containment Float(s)and Chains . Dispenser ID: Dispenser ID: 0 Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s). Shear Valve(s). ❑ Dispenser Containment Floats)and Chain(s). ❑ Dispenser Containment Float(s)and Chants). Dispenser ID: Dispenser ID: 11 Dispenser Containment Sensor(s). Model El Dispenser Containment Sensor(s). Model: 11 Shear Valve(s). E3 Shear Valve(s). 11 Dispenser Containment Floats and Chains . El Dispenser Containment Float(s and Chains . Certification-1 certify that the equipment identified in this document was inspected/serviced in accordance manufacturers'guidelines.Attached to this certification is information(e.g.manufacturers'checklists)to verify this information is correct and a plot plan showing the layout of monitoring equipment. For any equipment capable of generating such reports,1 have also attached a copy of the report(check I that ap�® System `® Alarm history Technician Name(print): Roy walker Signature: i® i Certification No.: 4307 License.No.: 814027 Shirley Environmental Testing 626 Testing Company Name: Phone No.: ( )444-7447 Site Address: 1928 Tyler Avenue Suite South EI Monte, CA Date of Testing/Servicing: 3/18/2004 Monitoring System Certification Page 1 of 3/01 SET Job#: