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-� ;916 9252616 # 2' <br /> 7— 8-05: 9:41 AM;Sec ramenv EMC <br /> T <br /> MONITORING SYSTEM CERTIFICATION <br /> For Use by All Jurisdictisse Wdhin We Slate of Cdifo mie <br /> Authority Cited:Cl ePter 6.7,Health and Safety C-&;Chapter 16,rq i ioa 3,Title 23,California Code ofRegolatiom <br /> 17ds tato[taut be used to document testing and servicing ofmatitoning agaipnatt.A separate certification or report most <br /> be prepared for each monitoring system control <br /> this <br /> panel by the tedstiam svFw performs the work. A copy oftlm form mus[be provided to the tank system owner/operatac. The <br /> ownalaperalor cars[aubnit a ropy ofthis <br /> formto the local agency regulating UST systems wining 30 days oftest date. <br /> gMake/Model <br /> Valley Psetac Cardl.-k Bldg No. <br /> 930 E Victor Road City. ]Aldi Lip <br /> Contact Peron: Pat Rooms @ Tatddec <br /> Comact Phone No.: <br /> Monitoring System: (neon TIS 200 <br /> Date of Testmg/Servicing: 06-28-05 <br /> B. Inventory o[Lrgsdpment'fested/CeNEed <br /> Model Tena ID: (87) Model <br /> Tads ID: (91) <br /> X bi,T.k Gnppg Probe <br /> B TSP LL2-101 X rn-Tank Gaging Pmbe B TSP1J2-01 <br /> X Anular Spaces Vault Sams <br /> A recto 135 X Amialar Spsa or Vault Sens« A Inco.EIS <br /> X Piping Swop/Trench Semor(a) . <br /> P 1 UfS X Pipug Sorry/Trench sew"(s) P In.UIS <br /> Fill Sorry SOW(s) H Fill Smrrysetea(s) H <br /> X Mechanical Lim Leak DetcRs <br /> M Red Jacket 116-056 X Mcchadsi Lim Leak Deuetor M Red Jacket 116056 <br /> i <br /> Electronic Lim LeeklMecis E EftemiicLme Leak Detector E <br /> Tank Ovedill/Iiigti.,avcl sneer T Twin OverfiWHigb-1.1 seats T <br /> Other(apaify vpuNsmdtYR a.dmoddki section Ean Peas 2) Ostia(Veeny egeeVoed type end it d nSatan E ce Paas 2) <br /> Tank to- Madel Teck ID: Mede) 4 <br /> 9 <br /> I Tnkoaugnat,mbs B to-Tank Cmugiag Pro(a B 3 <br /> Amalx Speee s Vault Sesser A j'd�(V <br /> ans s VasMPW2)A @� <br /> PiplsSStmp/Trend[Semm(s) P p/TremrL P <br /> Fill swap Sema(s) I' <br /> sne.(a) fi <br /> h4ml.nal Lux Leak Detaets M Line leakM <br /> Eleasaeie Lvmledc Detects E Lim Luk E <br /> Tank OveRly—q'�level Sauce T anflig6lnT <br /> (xhe tR�y Nd wtiYromd rvodel bis tion E m Pa 2) yMo7m� Em PW2) <br /> Dep.M) 12 Mudd DistwearM3/e odei <br /> DD.-P—couti�^r see—K.) D Dispseercemahmmtsa.oi(s) D M <br /> Shea VeNe(a) shut Nuhn(.) <br /> x no eenser Cadammet Floes(s)and Cheue(s) Bald x Dispenser Centaxm t Floet(s)and Chains(s) Bravo <br /> Di l.lD 516 Model DispeusID 718 Model <br /> I <br /> DispeeccmtemmcMSernar(a) D Dispansa-CaenmmntSeesas(s) D <br /> Shea Vah<(s) Shear Valve(s) <br /> x Disprescwtmem.Floays)aw Cheings) Bravo x Dispmxr Caitaunnad Flost(s)and Cham(s) Bravo <br /> C. CettMcxd.n-I cenify that the equipment identified in this document was insponted/serviced in accordance with the mmufaunum'guidelines. Attached to this <br /> Certificsti®is information(e.g manufacturers'checklists).newt)to verify that this int'oni <br /> mtation is correct and a Plot Plan sbowgthe layout of marmoring <br /> equipment For any equipment capable ofgeneraung such reports,I have also aumbod a copy ofthe(check all that apply) <br /> x sy-semset-upeePet(asselW) I X Alen rePa1(ffiIacLad) <br /> Technician Name(print): Signature: ---r <br /> Certificate: WO 2 Contractors Li NO.: 7 <br /> Testing Company Name: Sacramento Equipment Maintenance Company,Inc. Phone No. 916-925-2716 Work Order#119676 <br /> 03/01 enonw000wsudel-nmmta"We't.wpd Page 144 <br />