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Site Certified Monitoring System Certified by <br /> Safeway Service Station Systems <br /> 1804 West 11Th. Street Certification Checklist 680 Quinn Ave. <br /> Tracy, CA 95376- San Jose, CA 95112 <br /> Facility#N-4614-1-2 <br /> Vapor Recovery Tank Fills <br /> Caps Lids ID Vent Drain Caps Lids ID Fill Tube t <br /> Tank/Grade Tank Type Annular Lines OK OK Tags Valve OK OK OK Tags Bucket Bottom <br /> 01-Regu DW Dry DWF FX� X❑ X❑ X❑ 0 X❑ Q Q Phil-tite 85100 4 <br /> 02-Prem DW Dry DWF n Q Fxl X❑ 0 X❑ Q X❑ Phil-tite 85100 4 <br /> 03-Diesel DW Dry DWF F ❑ ❑ ❑ 0 X❑ 0 [X—] Phil-tite 85100 4 <br /> Vapor Recovery Disp.Shutoff <br /> Healy Vac ISD VR to Console <br /> Inspector <br /> Michelle Henry <br /> Sumps Dispensers Monitor <br /> X❑ Sensors at BottomTNozzle <br /> rop 65 Decals FX] set-up Tape ❑ Bolts in Place <br /> X❑ Stenciling Complete Op. Decals X❑ Alarm Tape ❑ Auto-Dial Decal <br /> X❑ Photos Taken ❑ Changed Bulbs ❑ Sump-High Vapor <br /> Printed by ApriIJ at 6/27/11 3:01 pm Page-5- <br />