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AlItech MAR 0 3 20 AR - ) <br /> 17759 Buttercup Circle, Sonora, CA 95370 ENVIRONMENT �jI Ci i `" `' ` 04 <br /> Phone: 209-532-7320 ; Fax: 209-533-2650 �I rr <br /> California Contractor 623541 A-Haz PERMIT/SER RON t.%z I - ALT' <br /> i <br /> alltecb@getrocketcom R _ _ S <br /> MONITORING SYSTEM CERTIFICATION <br /> A. General Information <br /> Facility Name: Quick-n-Save Date of Testing/Servicing: October 23, 2003 <br /> Facility Address: 1901 S. ElDorado, Stockton CA 95206 <br /> Facility Contact Person: SSEQ Contact Phone No.: 4644333 LFA: San Joaquin; Dina Abate (209) 468-3468 <br /> Make/Model of Monitoring System : Veeder-Root TLS-350 <br /> B. Inventory of Equipment Tested/Certified: <br /> Cheekthca it bora to iddirares cifice u mentis' eclr&3s iced: <br /> Tank ID: Regular compartment , Tank ID: Premium Compartment <br /> ® In•Tank Gauging Probe. <br /> Model: Mag I ® In-Tank Gouging Probe. Model: Mag 1 <br /> ® Annular Space or Vault Sensor. Model: Float switch ® Annular Space or Vault Sensor. Model: (Shared) Float Switch <br /> ® Piping Sump / Trench Sensot(s). Model: Float Switch Piping Sump / Trench Settsor(s). Model: Float Switch <br /> ❑ Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: <br /> ' MM <br /> Mechanical Line Leak Detector, Model: FE Petro ® Mechanical Line Leak Detector. Model: FE Petro <br /> ❑ Electronic Linc Isak Detector. Model: ❑ Electronic Line Leak Dcteam- Model: .� <br /> El Took Overfill / Iliac-level Sensor. Model: Drop Tube ® Tank Overfill / High-Level Sensor. Model: Drop tube <br /> ❑ Other El Other <br /> Dispenser 1D: 1&2 ® Sump: ®Dry ❑Water ❑Product Dispenser ID: 3&4 ® Sump: ZDry []Water ❑Product <br /> ® Dispenser Containment Sensor(s). Model: Float Sw. O D67criser Containment Scnsor(s). Model: Float Sw. <br /> ® Shear Valve(s) (Functional test) ® Shear Valvc(s) (Functional test) <br /> ❑ Dis eraser Containment FImt(s) and Chnin(s). ❑ Dispenser Containment Float(s) and_Chain(s). <br /> Dispeaserm: ❑ Sump: []Dry ❑Water ❑Product Dispenser ID: ❑ Sump: ❑Dry ❑Water ❑Product <br /> ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Screor(s). Model: <br /> ❑ Shear Valve(s) (Functional test) ❑ Shear Valve(s) (Functional test) <br /> ❑ Dis enser Containment Floats and Chain(s). ❑ Dispenser Comaitunent Float(s) and Chain s). <br /> Dispenser ID: ❑ Sump: []Dry ❑water ❑Product Dispenser [D: ❑ Sump: ❑Dry ❑Watcr ❑Product <br /> ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model: <br /> ❑ ShearValve(s) (Functional test) ❑ Shear Valve(s) (Functional test) <br /> ❑ Dis enser Comainmenl Floa[(s and Chain(s). ❑ Dispenser Containment Floats and Chain(s). <br /> Comments: <br /> C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the <br /> manufacturers' guidelines. Attached to this Certification is information (cg. manufacturers' checklists) necessary to verity that this <br /> information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such <br /> reports, I have also attached a cc/o�pyy�o�f the report; (check all that apply): ® System set-up ® Alarm history report <br /> Technician : � 4 A�C7"-- Mike Dotten <br /> Certification : Veeder-Root: 341 -32-6743; Level 3. <br /> Page I of 3 03101 <br />