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MONITIGSING SYSTEM CERTIFWATION <br /> CERTIFICATION /TEST DATE: November 20, 2008 <br /> A1. FACILITY A2. OWNER <br /> Name Wine Country 76 Name Jivtesh Gill <br /> Address 1111 East Kettleman Lane, Lodi, CA 95242 Address 4855 South State Hwy 99,Stockton,CA 95215 <br /> Phone# 209-948-2438 Phone# 209-948-2438 <br /> Contact Jivtesh Gill Contact Jivtesh Gill <br /> D. RESULTS OF TESTING I SERVICING <br /> Make / Model of Monitoring System: Gilbarco EMC <br /> Software Version Installed: 123.02 <br /> Complete the following checklist: <br /> ■ Yes ❑ No* Is the audible alar operational? <br /> ■ Yes ❑ No* Is the visual alar operational? <br /> ■ Yes ❑ NO- Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> ■ Yes ❑ No* Were all sensors Installed at lowest point of secondary containment and positioned so that other equipment <br /> will not Interfere with their proper operation? <br /> ❑ Yes ❑ No• If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modems( <br /> ■ NIA operational? <br /> ❑ Yes ❑ No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ■ NIA monitoring system detects a leak,fails to operate,or is electrically disconnected? If yes:which sensors initiate <br /> positive shutdown? (check all that apply) ❑ Sump/Trench sensors; ❑ Dispenser Containment Sensors. <br /> ❑ Yes ❑ No* Did you confirm positive shut-down due to leaks and sensor failureldisconnection? <br /> ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no <br /> ■ NIA mechanical overfill prevention valve is installed(,is the overfill warning alarm visible and audible at the tank <br /> fill polnt(s)and operating properly? If so,at what percent of tank capacity does the alar trigger? _% <br /> ❑ Yes* ■ No Was any monitoring equipment replaced? If yes,Identify specific sensors,probes,or other equipment replaced <br /> and list the manufacturer name and model for all replacement parts in Section E,below. <br /> ❑ Yes* ■ No Was any liquid found inside any secondary containment systems designed as dry systems? <br /> (Check all that apply) ❑ Product; ❑ Water. If yes,describe causes in Section E,below. <br /> ■ Yes ❑ No* Was monitoring system set-up reviewed to insure proper settings? Attach set-up reports,if applicable. <br /> ■ Yes ❑ No Is all monitoring equipment operational per manufacturer's specifications? <br /> In Section E below, describe how and when these deficiencies were or will be corrected. <br /> E. COMMENTS <br /> Tested new 87 annular sensor. <br /> ©2006 Walton Engineering,Inc. <br /> Page 2 of 3 <br />