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JUL-12-2010 11 :58 AM GETTLER—RYAN INC. 925 551 4770 P. 02 MONITORING SYSTEM CERTIFICATION Por(./%(!By A11.1urtselictions Within the Stan of Calikrrnin .4whar•Ity Circd: Chriprer A 7. Health rrrrtl Salcit. C'or/c; Chapter-16. Oivixion.f, Titl;-".t, C'nlilornia Code of l?egulurioit.t This form must be used to document testing and servicing of monitoring equipment. A urate calif_ iQgQ1<!r report mush yfged for(r{rrJl tri0lli�ilfdtiA systcrn rxantrolp tq�l by the technician who perforins the work. A copy of this form must be provided to the tank system ownerioperator, The owner/operator must submit a copy cif this fonn to the local agency regulating UST-tvstems within 30 days(if rest date, A, General Information Facility Name: Arco Bld�A. No.: Site Address: 3212 N California Street i -- -- (ily Stnckton ��— Facility Contact Person: UOTI act Phone NO.: 209 947-269b Make,Model oFMonitoring System. Vecdcr(toot TLS-350 -_—_- —_ Darc of Fcsting/Scrvicing7 08/2912010 It. Inventory of Equipment Tested/Certified Chcekthe appropriate,buxom to indicate spectric a ul ment Ins ctcdAervicedc Tank ID: T,t OF_ Tank ID: ®In=1'ank(iauHing t'robc. ivtmilcl: 64731W 101) a In-Tank Oi WRWIv PION: Model: "9390 ❑Annular Spttca or Vault Sensor. Model �. ❑.Annular SJM.X nr\,':ualt ❑Piping Sump/Trench%mwr(s). Model: ❑P(pin4 h,nnp''I retch Scuba) it Madel: ❑1'111 SumpSamorts). Model! ❑F,II Sunyuticnsr-i(n) Nlodcl: Mcchamcal line Leak Dmccwr. Model: []Mr:cl,nmr-;tl Lim:Leak D),chctai. N1oiicL ❑Heetronie Line Ltatk Detmitir. Nfudel: ❑1:1a-ironic Linc Leak Detector. model: �] yank 01,orfull/High-Leval Seroor. Modk+ ❑Wank Utcr(ill Nigh-Iced setisor. Model: [�Oilivy(spvcify equipment type and model in SCetion F.late Page 2). ❑011un(..1kri N t:quilnntnu tyle and model in Scction k un Page 2).- — 1-ank ID: Tank 11) C1 In-Tank(iavging Probe. Model: — _ ❑In-lank(iau f.inc Pnihe. Model: ❑Anmrltar N'pmce or Vault Sencmr Model: ❑Annular 5p;wv or\:cult titnvor. Model! ❑Piping kmtp/I reneh St`nuur(S). Model: -- ❑P,pine.Sump:Trcncli.tip:marl%) Model: ❑Fill Sumrse-M lls). M,410: ❑fill SumpSenw"rtst. Model: ❑Merhnnical Lute Leak Detector. Model: — ❑Meehunical I ane Leak Dekeotor. Nlodel: ❑Flecrronic Line Leak Detector. ,Lt,.+dcl: Li I(kelronie I anc leak Dew%tor. Model ❑'['ank 0%crtlll i Iligh-Level Sensor. Model. ❑ I ank(averlill I ligh-Letel Sensor Nfodrl: El Other(speetfy equipment type alitt modt:l in 5cctinn L on Page_). ❑Otho(stns i N cquiputenl type and mockl in Section F.run P;ige 2). Dispenser ID: -�-W __ Dispenser ID: D DispvmcrC'ontainmentSenwrko 'vl,.Hdcl: n nicpcnsor(.,nlninmcrtl S�Cnnor(`'J. Mudd- U Shear Vahetv). ❑Cht:ar%'Ulw4.c). ❑Oisperim Containment Floatol and C.'haints). Disomic/t laulainmcnt I lval(s)and('hairs(%). Dlspettscr iD: _ __� Dispenser ID: ❑Dist-wrtser Containment Senwrl.) kLnlel t__I nispenwr( wainment lcnstti(>) M-10! ❑Shcar Vah'c(s). r]Sllcar\'ahris) �]nis".,,cr rantalnment Float(s)and('hain(a). ❑DisEnmcr('onli lnment Floats)and('lain(%). Dispenser 1 D: Dispenser I[t:— — ❑Visprnsa Containmiml:cm,ur(y) Mudd. ❑Di,Twnsc,G,titaininent tirnsor(s). Model, []Shinn VaNcIs). []Shcnr Valsr(i). [l DispenserC'ontainmenl Iluu0s)and Chain(s). ❑Dispcn.:r(ontainmcnt Float(s)and l'hain(a). 'If the facility contains mare lank;or dispensers-copy This f)nn. Include infonlialion li+t ecety tank nn(i dispetiser 2t the facility C. Certification-1 certify that the equipment Identified in this document was inspected/serviced,in accordance with the llnanarActurers' guidetlnim Attached to this Certirtcadon is information (e.g. manufacturers' checklists) necessary to verify that thft information is correct and a Plot Plan showing the layout of monitoring c ulpment For any equi rttent capable of generating much report4,t have aim) attached a copy of the report;(check all that appl0: Svstem vet-up lJ Alarm history report Signature: '1'cchmctaa Name(pant): c_san Nicolar. _ _—._... __—.... Certiiicatian No.; n alar Liccn%e No,-- _ — - 92 5 55151 - 7 5 55 Testing Company Namc: tooter-Ayan Inc — _ --. .. - — Phone Nig,:C _ 1'eaftngt ontpany NaaresW y�ro-r%I&ra Cord o„blln.cA Date of TcS/ing/Servicing, p4 —�_ Page 1 of 3 Rev(1,081