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MClNTORING sysTEM CERTIFICATION For Use By All Jurisdictions Wthin thb Sl=ate cif California Icmo�-zs Authority Cited:Chapter 6.7,Health and Sgfety Code;Chapter 16,Division 3, TVtle 23, California Code of Rei u This form must be used trJ document testing and servicing of monitoring equipment.A stearate certification orreao mustbbe a aced for each enorzitorin�system control oenel by the technician who performs the work A copy of this fom must be providedto the tank system ownefloperator. The ownerfoperntor must submit a copy of this form to the local agency regulating UST systems%avithin 30 days of test date. A. General Information 16020 Facility Name:_; BP WEST COAST PRODUCTS LLC ISS#: _. Site Address:11?11 E YOSEMITE City-. I MANTECA I Zip: 195336 F acilit ContacPerson:^M'• �{i r ah' �- -- - Contact Phone N o.:G��j�-6 6 - 3 7 O�_ I Niake/MadelofMonitoringSystem '7'�S 3�� I DateofTesting/Service: B. Inventory of Equipment TestedlCerti£ed Check the date bu:oes to indicate ecific a naent ectedlank I ed: Tank ID: Tank ID: 'f Tank Gnu Probe: Model "�� 1 a n-Tank Ga Probe: ; Model nnuiarS ace or Vault Sensor: Model veioi-• y 7 nmlar5 ace oz Vault Sensor _ I Model: qr, +�**a' i in Sum Wrench S ens or s : Mo_deL Sump/TrenchSensors : Model- 2a —,�,r y ills Sensor(s): Model v.f✓dw 2v illSumpSensor(s): I Model: echanicelLineLeakDetectoz. Model �r 7 echanicelLine Leek Detector. Model: ctronic Line Leak Detector Model ectronic Line Leak Detector_ I Model• arskOveraffli -level Sensor. Model- t-"Wo• ,or -ail arilcOvetfilVlii -levelSensar. Model: V, .., er Spec' e t e and modal is Section E on Page 2 that S ec' a ui .t e and model in Section E on Page Tank ID: Tank ID: n-TankGau gPzobe: I ModeL e' nTank0a Probe: Model: Anuarspace or Vault Sensor: Model: ;"`� nnularS ace or Vault Sensor Model: ipingSump/TrenchSensor(s : Model eea S /Trench Sensors : Model: il1S Sensor s : Model f F illSurnpSensor(s): Model: echanicalLine Leak Detector. Model ,Q. echanicalLine Leak Detector. Model: actronic Line LeakDetectar Model ectronic Line Leak Detector Model: enkOverFill/High-levelSensor. i Model v.,.d/ r� - ankOverfiMiigh-levelSensor. Model Other S ec' a ui .t e and model in Section E on Pa e 2 that,S ec' a ui .t e and model in Section E on Page 2 Di easerID: Di enser ID: � '. 7 isenserCantninmentSensozs: MadaL v_ ' e is enserContainment Senso s� _i Model: k �v hear Velve(s).� ' Shear Valva�s� -- enserContainmentFloa s and Ch!As s _ is enser Containment Floa s and Ch ' s Dispenser ID: 3 Dis ens at ID: ispenserCont_ainmentSens oro: . Model �� 3- ispens erContainmentSens or(s��- Model: MZoP - ---- he ar V alve(s)__ She ar V aloe s . is eraser Containment Flo s and Ch ' s his enser Containment Flo s and Ch:Mo Dis enser ID: S IIis enser ID: _ I I l !� ispenserContainment Sensors: ; Model _ 20 Fl is2enserContainmentSensor el: o - ---- Shear Valves .^_-_-- hear V nh►eSe�------- is enser Containment Roa s and Ch ' s i enser Containment Floa s and Ch *If the facility contains more tanks or dispensers,copy this form. Include information for every tank and dispenser at this facility. C. Cerffication-I certify that the equipment identified in this documentwas inspectedlsetviced fa accordance with the manufckiiaa' guidelines. Attacloed to this Certification is information(e.&manufacturen'checklists)necessary to verify that this information is correct and a Piot Plan Thawing the layout of monitoring equipment For any equipment capable of generating such reports,I hae alio a#lmched a copy of the report; (check all that)_ ,Alum bistor�resort - Tec2uiicien_Name f�'rint: ! 'So L C. 1 Signature: -------- lam. Y`, - CertificationNo.: 1r4 License No.: Tes�EComQnnyNameT TAIT FNVIRONMENTALSYSTEMS Phone No.:- ; (714)560-8222 Page I of 3 03101