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Alltech Petro Int.. 17759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320; Fax: 209-533-2650 California Contractor 623541 A-Haz mike@alltechpetro.com MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Village West Marina Date of Testing/Servicing: April 3, 2009 Facility Address: 6649 Embarcadero Drive, Stockton CA 95217 Facility Contact Person: Mike Spence Contact Phone No.: 209-951-1551 Regulatory agency: San Joaquin Health; Inspector: ; Phone: 468-9847; Fax 468-3433. Make/Model of Monitoring System: Veeder-Root TLS 3501 B. Inventory of Equipment Tested/Certified: Tank ID: Premium Tank Tank ID: Diesel Tank ❑ In -Tank Gauging Probe. Model: None ❑ In -Tank Gauging Probe. Model: None ® Annular Space or Vault Sensor. Model: 794380-304 ® Annular Space or Vault Sensor. Model: 794380-304 ® Piping Sump / Trench Sensor(s). Model: 794380-301 ® Piping Sump / Trench Sensor(s). Model: 794380-301 ❑ Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ® Mechanical Line Leak Detector. Model: Red Jacket 116-011. ® Mechanical Line Leak Detector. Model: VMI LD -2000 ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ® Tank Overfill / High -Level Sensor. Model: Drop Tube ® Tank Overfill / High -Level Sensor. Model: Drop Tube ❑ Other ❑ Other Tank ID: Tank ID: ❑ In -Tank Gauging Probe. Model: ❑ In -Tank Gauging Probe. Model: ❑ Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model: ❑ Piping Sump / Trench Sensor(s). Model: ❑ Piping Sump / 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 ❑ Other Dispenser ID: 1 ® Sump: ®Dry ❑Water ❑Product Dispenser ID: 2 E Sump: ®Dry ❑Water ❑Product ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model: ® Shear Valve(s) (Functional test) ® Shear Valve(s) (Functional test) i ® Dispenser Containment Float(s) and Chain(s). ® Dispenser Containment Floats and Chain(s). Dispenser ID: 3 ® Sump: ®Dry ❑Water ❑Product Dispenser ID: ❑ Sump: []Dry ❑Water ❑Product ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model: ® Shear Valve(s) (Functional test) ❑ Shear Valve(s) (Functional test) ® Dispenser Containment Float(s) and Chain(s). ❑ Dispenser Containment Float(s) and Chain(s). Dispenser ID: ❑ Sump: ❑Dry ❑Water ❑Product Dispenser ID: ❑ Sump: ❑Dry ❑Water ❑Product ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s) (Functional test) ❑ Shear Valve(s) (Functional test) ❑ Dispenser Containment Floats 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 Page 1 of 3 Technician: Certification:Veeder-Root B36878, Level 2/3 ICC UST Service Technician # 8005930 -UT Date: 4/2/09 03101