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1 VEED MONITORING SYSTEM CERTIFICAT APR 13 2017 MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS-350 CERTIFICATION/TEST DATE: April 12, 2017 A1. FACILITY A2. OWNER DEPARTMENT Name Colonial Energy#40138 Name Colonial Energy, LLC. Address 14000 E.Hwy.88,Lockeford,CA 95237 Address 2860 N.Santiago Blvd.2nd Floor,Orange,CA 92867 Phone# 916-285-7402 Phone# 714-761-5426 Contact Station Manager Contact Victor Hassan A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 1868 E.Hazelton Avenue,Stockton,CA 95202 Address P.O.Box 1025,W.Sacramento,CA 95691 Notified March 31,2017 Lic# 617238 A,B,Haz Inspector Cesar Ruvalcaba Contact Veronica Freitas Phone# 209-468-3442 Phone# 916-373-1166 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to Indicate equipment inspected/serviced) B1: TANKS Tank#1 (Product): Gasoline-87 Tank#2 (Product): Gasoline-91 ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: Annular Space or Vault Sensor Model: 0794390-420 Annular Space or Vault Sensor Model: 0794390420 Piping Sump/Trench Sansone) Model: 0794380-208 Piping Sump/Trench Sensoria) Model: 0784380.208 ❑ Fill Sump Sensors) Model: ❑ Fill Sump Sensors) Model: M Mechanical Line Leak Detector Model: FE Petro STP-MLO Mechanical Line Leak Detector Model: FE Petro STP-MLD ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill/High-Level Sensor Model: — ❑ Tank Overfill/High-Level Sensor Madel: ❑ Omer (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Tank#3 (Product): Diesel Tank#4 (Product): _ ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: Annular Space or Vault Sensor Model: 0794390-420 ❑ Annular Space or Vault Sensor Model: Piping Sump/Trench Sensor(s) Model: 0794380-208 ❑ Piping Sump/Trench Sensors) Model: ❑ FIII Sump Sensors) Model: ❑ FIII Sump Sensor(s) Model: 0 Mechanical Line Leak Detector Model: VMI 99L134000 ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill/High-Level Sensor Model: ❑ Tank Overfill High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Omer (specify equipment in Section E) Model: 62: DISPENSERS/UDC's FDispensei4: 1 -2Dispenser#: 3-4 ispenser Containment Sensoria) Modal: 0794380-208 Dispenser Containment Sensors) Model: 0794380-208 hear Valves ShearValves ispenser Containment Float(a)and Chains) M Dispenser Containment Float(6)and Chain(s) Dispenser#: 5-6 Dispenser#: 7-8 0 Dispenser Containment Sensoria) Model: 0794380-208 E Dispenser Containment Sensor(s) Model: 0794380-209 0 Shear Valves E Shear Valves 0 Dispenser Containment Float(s)and Chains) E Dispenser Containment Float(s)and Chaln(s) Dispenser#: Dispenser#: ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensors) Model: _ ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chains) C. CERTIFICATION I certify that the equipment Identified in this document was inspected/serviced in accordance with the manufacturers'guidelines. Attached to this Certification is information(e.g.manufacturers'checklists)necessary to verify that this information is correct and a Plot Plan showing th layout of monitoring equipment. For any equipment capable of generating such reports,I have also attached a copy of the report; (check all that apply ■ System set-up ■ Alarm History Report WALTON Signature: A5 C' 9 ®�"?- C.MgINEERING,INC. Technician/Cert M Thomas Steiger A31060 18156310 Date: April 12, 2017 1,2017 Walton Engineerng.Inc