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MONITORING SYSTEM CERTIFICATION <br /> Far Use Bl'All Jun'3dictiom Wthin the.Ante of Cal r Pda <br /> Authority Cited:Chapter 6.7, Health and Srtty Code;Chapter 16,Division 3,ntle 23, California Code of Regulations <br /> This farm must be used to document to sting and servicing of monitoring equipment.A separate certiAeation ar rapport m,�st ba areAend <br /> monsto:i.a s�stem c ontrol panel by the technician who performs the work A copy of this form must be provided to the teak <br /> for each system owner/operator. The owner/operator must submit a copy of We form to the local agency rogulntiag UST systems within 30 <br /> days of test data. <br /> A. General Information -- <br /> FuihtyNnme: BP PRODUCTS COMPANY see Station No_:. 9600 <br /> Site Address: 1250 N WILSON WAY Citi I SPOCKTON Zip 195202 <br /> —. <br /> - -- - 5� -a_---- Contact Phone No .^�`SZ5 S6S'7 <br /> :Fac' ContactPersoa S-l�w� - - <br /> MakelModel of Moaitoang_Systam-_., yG�O�Q-��'t T'S �'�� Date ofTestmts/Sarvrce: { ^ �2^o S I <br /> B. Inventory of Equipment Tested/Certified <br /> Ckeek the Acte banes b indicate eific a Ment' ected/serviced: <br /> 7 j2n <br /> nT�kGnu-E�ngP:obs`------;.Mode_L�}` 2 50 • robe:__-._- ,Mo 'to7 <br /> orVaultSensor: ModeL_ �� - utar�nceareu8SensorMadel 7 - 2C}renchSensot(s)--� Model ^Zosi�Sump/TreachSensor e : 1 Model' R 4 '2OSor�_ ___ ModeModel SaLeekDetactor Model "IL- ochenicelLiaeLeakDatector. Model: - <br /> clroaicLineLeekDetector _Model: IecironiclineLenkDetector Model -na <br /> Modal f b9(�-cc t- Ove--- -- ModeL 2 t_ <br /> . .t eandmodelin3actionEonP e2 ther S ec' a ui .t eand modeliaSectionEMUM <br /> 1 <br /> TaakID. _ TanklD: <br /> to a: Model: v-t o rgTenkOau$ngProhe: <br /> AtmtdarSpace arVnultSmsar: Model t7 ' ZD ArmularSpnce arVaultSensar -_ j Model• <br /> Sum reachSen_sor e : Model: rt "�60` �S i ' Sum reach Sensor s : Model: <br /> ---��_..._�.._-._ .fig---�------�-- - <br /> dl3umQSeneo= 2 ;._M_odel• ill L(3gC"^ S Fill SumpBensor s : ----;-Model _ <br /> MecharncalLinelAakDetector. _Model: t,- 0 _ MechenicalLineLeekDetector_ Model: ` <br /> EYeetroaic Line LeakDateetor +Model: , Electronic Line LookDetectar �d <br /> Ovetifittltiipilav+tSseseMode10�(:c�1 enkOve:6lUHig1►lavalSensor. Madel - - <br /> - er,S ec' a ' .t eandmodel inSection Eon Pa e2 Other, ec!&equip.typeand model inSection EonPa e2 <br /> Die anserID: t-Z Dis anew 3' <br /> enserConteiameatSensors: Model: -_ �ZI eneerCordaumuatSens-o s Model: I <br /> ShaerValy c . y..----- hear9al <br /> Dis enserConteinmentFlo s and Chain(s) Dis enserContninmeatFloe s end s <br /> Dioonser ID:_-^ S-(o Dupeasetnon <br /> ewer <br /> heerValve ContainmentSensors: Model _.. �zlDvCC� antFloa c d M6de1:- -3Li <br /> heearPel --- <br /> penser <br /> ontainme <br /> s ericerContnirrrnentFlo s ilidCh ' a <br /> Di enserlD:_,._ _ 4-10 D' enserID: I /!-/Z <br /> Dis enserConteuunentFlo as: Model_ ;ZI ' ewer e(e). ttment3ens s :____j ModeL Zl <br /> hear Valve c . hear 9ah+ s <br /> . <br /> dCh a Dis onserCoatainsUntE s and Ch ' s <br /> `if the facility contains more tanks or dispensers,copy this form. Include information for every tank and dispenser at this facility. <br /> C. Certification-11 certify that the equipment identified in this docnmentwas irupectedherviced in accordance with the nanufiemmW <br /> guidellm. Attached tofhbCertification isinformation(e.g.mnnufactana'checklists)necessary to verify tkatfhbinbreatianb <br /> cornet and a Plet plan showing the layout of Monitoring equipment For any equipment capable of geaenting such repos",I hseale <br /> athched a copy tine ngo:iL�/e{h-sck all tlwt applx):_- _ System set-up_ 6 Al+r�nn ldste <br /> Technician Nome�Pnrrt). r/. ' P.n �, �s� Srgnature <br /> CertificationNo.. ( ^.C,OSoL>-fes_ <br /> License No.: <br /> _. . <br /> TeetingCompenyNeme;, TAITENVIRONMENTALSYSTFMS Phone No.: (/14)MB8222 <br /> page I of 3 OWN <br />