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MONIT07ANG SYSTEM CERTIFe"ATION MAKE / MODEL. OF MONITORING SYSTEM: Veeder-moot TLS-350 CERTIFICATION / TEST DATE: July 28, 2006 A1. FACILITY A2. OWNER Name USA Petroleum #3696 Name USA Petroleum Corporation Address 2448 W. Kettleman Ln., Lodi,CA 95242 Address 3034 N.Glacier Way, Hanford, CA 93230 Phone# 559-585-8156 Phone# 559-585-8156 Contact Sandy Edwards Contact Sandy Edwards A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 304 E Weber Avenue, 3rd Floor, Stockton,CA 95202 Address P.O. Box 1025,W.Sacramento,CA 95691 Notified July 26,2006 Lic# 617238 A, B, Haz Inspector Lori Luces Contact Richard Walton Phone# 209-468-9847 Phone# 916-825-3203 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (check the appropriate boxes to indicate equipment inspectedlserviced) 131: TANKS Tank#1 (Product): Tank#2 (Product): Gasoline-89 ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ■ Annular Space or Vault Sensor Model: 0794390.409 ❑ Piping Sump 1 Trench Sensor(s) Model: ❑ Piping Sump I Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ 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: ❑ Other (specify equipment in Section E) Model: Tank#3 (Product): Tank#4 (Product): ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump I Trench Sensor(s) Model: ❑ Piping Sump I Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ 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: ❑ Other (specify equipment in Section E) Model: B2: DISPENSERS/UDC's #: Dispenser# IDispenser :1Dispenser Containment Sensor(s) Model: E) Dispenser Containment Sensor(s) Model: ElShear Valves ElShear Valves ❑ Dispenser Containment Float(s)and Chaln(s) ❑ Dispenser Containment Float(s)and Chains) Dispenser#: Dispenser# ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s) Dispenser#: Dispenser# ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s) 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 the 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: � ENGINEERING,INC. Technician I Cert#: Mauricio Miranda/A27938 Date: .Juin 28, 2006 2006 Walton Engineering,Inc.