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FROM :TLM PETRO LABOR FORCE FAX NO. :5629238138 ug. 18 2004 08: 14AM _P2i7 08/17/2004 14: 59 6195899842 F'SI ARCO 9578 PAGE 01 MONITORING SVSTEM CERTWIC.ATION For We By A/1 Jurisdirlia a Within 0,Stg1t of Ca1/fi>r nt� Aurhprlty Citad Cl,Qpter 6 7, lfealrh uad fly Coax;Chupgrr 16,Division S, Title 29,Cal(fornia cordn„f Ra de?/lostm This form trust be used to document testing and servicing of monitorinOf CdAlg equipnxht.A cam by the technician who performs the work. A o0 of this foray must be provided to the tank day test te. star. The ownerlapergtter trust submit a COPY of this form to the lucal ttgWdY regulatingm UST aystts within 3o A. G*nerjk1Information Facility Nettle., Ir4� Site Address 5, �{ 1 $Ida,No.: Clty:�[_QS.iC+ _ _ Zip: Facility Contact Person- ow W; Contact Phone No,:(241 )_ ;kA MekrAMode!of Monitoring Systorn: 0 Q taste of Tesbiag/9+sirvicing: H. inventory of Tquipme"t Tegt&VCertjrWd Chwk the spbmprime r,k*& Tank ID;—�7 �T _ Took tO: 41 In-l'ank Gauging Probe. Model lA In-Tank Gauging Probe, Madel: A447A 0 4 Annular Span or Vault Sensor. Model: • Atmular Spoon or Vault Sensor. Model: ■ piping sump!Ttrnch Sensnr{x). Model: - � Piping Sunip l Trnsch Senwet(a). Model: 0,]n u ■ Fill SSeneor(s). Model kill Su"V scoxt'(s). Model: O Mechanical Line leak Detector. Modal: ❑ Mechanical Line Log Detector. Model; ❑ Fludmulc Line Leak Detector_ ModeL_7 w A Elactronic Line Leak Detectm, Model: 08 O 0 ❑ TM&Ovw ll I High-Level Serum. Model:�_ 0 Tank 0wrfill l High-Lvvcl Sensor. Model: C] iter i o uI t and model i"tt Seetit>n pre p..._.2_ �y O Otho if -Wipwad 11w and mWel in Section E on Page 2). Tank FD; 911 Taak tD•_ ■ In-Tsanic GaMong Probe, Model: ❑ In-Tank Gauging Pmba, Modal• 6 A.nnulm spsaa or Vault Semnor. Model: 07VIJ g- 09 ❑ A mulw Spur prr vnuft 5enmr. Model: # Piping Stomp/Trttnch Sensor($). Model: 0 Ptptng Sump/Trmch Soosor(s)_ Model:--- 9 Fill Stung Sestsor(s). Mandel: b w4YY O Fill Sump Sensor($), Modot: 0 Meehmical Linc Leak D&6Ktor. Model: © Mecharveral Lot Le&k Detector. Model: M Electronic Line Leak Ddedt ,-_ Modcl; d _O ❑ Elenvonic Line Leak I7otvetar. Model; Q Tank Overfill/1—Ugh—Level Sensor. Mode l•_-- ❑ Tsnk Overfill/High-Level Sensor Model: _ _. Other is ci'' 1 t t trtoclol in Section E on P 2). 0 father i and uaodcl is Section F on Pa c 2), Aisp*aNr LD _vim_ Dtspesser ID; IAV ■ DIXI)MMeCvutairuttpntSeWgS). Model: Q_ci a-jp � Dispe3rmrContairvnentSensor(g). .Model: ' 13 Shear Valve($)- ❑ Shear Valve(s)_ + ❑ Die ager Contalruttent Flow(s)and Chiu s. Con * and C Mgwn ter ID; 57I) aDeaser�: DtetperfserContainel'eetlt5e-nsor(s)- M0&l:12`7t9320:�!CA 0DispetuerContainmentSensar(s), Model: 0 Shear Valve(s)_ ❑ Shew Valve(s)- Dib nett Containment Fleas and Cheri s . ❑ Dispen3ar CmWnment F12-3132)and Chat s. Diaperl*r 1w, l Dispsesar ID; U Disipenaean ser Contairut Sensor(s). Model: Q y - 0 * D)ispemsor CnnWntnmt Senw r(q)" Model-_M 1390401b ❑ Shear Valve($). ❑ shear Valve(s). ODI Containmtnt 171 >} aped Chain(s). Duperow Coatainulnnt Madge)and Ch s, 'If the foality eca tnins aeow tts!sks or diapengwe,ropy thio farm. In.lkwami ion for aver'"Ak mW dispm9cr at the&nlity. C. Ce1'tifleation-I ctrtify Ont tDie equipment WkmtlfW In this docnmesit was irspsetedMervkcd In aerordaace wkb the menulfeterers' g"lines. Attabed to this Cert11&*t6n is lnUll"M4oe (e.g. ckeclditb) rwrmarry to verlij• that this leeMrwaatkm Is correct sod a Plot Plan slowing eke layout of ummitorittf equipment. For any etgripranat capable of pnanttirng,$web tegow%I have ahe etttachm■eopy otthe o (Cb a rl6�pty); a systewa set»ap C)A o repon Techniciarn Name(print):� (�J 5eh&2_ -- Signaturc; Certltication No„ Opt-65-115'I�y _ Liconve,No.: Naw- 6 Testing Company Na : J LM 1AJV'o �cty jrte Phone No.'(142 Site Address; 2 o 5, �j` � Date of Testing/Servicing: 8 /: /0Y arN.m3f_114 Prigs 1 Ori am.flay Pel www.aatdamarg