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MONUORING SYSTEM CERIVICAI' ON For Use&All Jurisdictions Wthin tht State of Califlbrnia Authority Cited:Chapter 6.7, Health and Safely Code;Chapter 16,Division 3, Title 13, California Code of Reguldiorus This form must be used to document testing and servicing of monitoring equipment.Ae�tparate certification or report stb jarepared for each monitoring system control 9anel by the technician who performs the work. A copy of this formmustbe providedto the tank system ownerloperator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facih'tyName: BP WEST COAST PRODUCTS. LLC 16020 Site Address: J 711E YOSEMITE _ V I City_ MANTECA - Zip_ 95336 Facilit Cy ontact Person: 1 2,4 ,✓ 5 1 � ---- —- f Contract Phone No.: 7 _-5-YD 7-L-!-_T- Make/Model ofIuionitoringSystem 17-1,5-3So t/��er�e� ��' Date of Testingl5ervice: -7-x,3- B. Inventory of Equipment Tested/Ceitified Check the gpMrizteboxes to indicateecific a xeext lbmwpectedlserviced: Tank ID: 1, TankM: 11makDatector. ugingProbe: I Model: n-TenkG.nugin Pg robe: Model ace or Vault Sensor Model: nnuluS ace orVaultSensor Model- /Trench Sensors : ! Model• I i in S renchSensors : Model: ensors . Model: ill Sum Sensors : Model: lLdne LeakDetector. Model: echanicalline Leek Detector. Model:ine Leak Detector Model: ectronic Line Leak Detector ModeliilJHi - Model: enkOverf ffli level Sensor: Model' e .=e and model in Section E on Pa e 2 or,SgecEX equip.type and model in Section E on Page 2 TankM: ' TanklD: nTankGaugxngProbe: Model: n-Tank Gauging,Probe: LModel: nnular5 race or Vault Sensor Model: mular Sp ace or Vault Sensor Model- ' in SumffrenchSensor(s): Model: , iping Sum /Trench Sensors : I Model.- p Sensors : _Model: ills Sensors : Model: echanical.Line Leek Detector.. Model: echanicalLine Leak Detector. Model: ectronic Line Leek Detector Model: ' 42th tronic Line Leak Detector Model ankOverfilllHi -level Sensor. ; ModellOverfi!Wlii -level Sens or: Modeler S ec' a ui .t e andmodel inSection E on er S ec' a ui .t e and model in Section E on Pa e 2 enserID: l et nserID:enserContainmentSensors: ` Model: Spenser Containment Senso s): Model: ShenrValve1/s . Sheer Valve s`!. isp enser Containment Floa s and Ch ' s is eraser Containment Flo!!W and Ch ' s Dispenser ID: Dis enserID:_ is enserContainmentSensors: ! Model: 2 G Dis enser ContainmentSensor�;__- Modal: S se enserContainmentFloe s an kSheerValve(s). 12en rCContainment _ �) --- -- -- --- - --- d Ch ' s is ensez Containment Flo n s and Ch ' s fSiheuvelve(s)- serID: enserID _ enser_Containment Sensors: Model: s enserContainmentSenso s : I Model: DearValves .aaserContainmentFlon s)and Chj!, s Dis ens erContainmentFloa s end Ch ' s *If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at this facility. C. Certification-I certify that the equipment identified in this document was inspectedherviced in accordance with the manubettam' guidelines. Attacked to this Certification is iT&rmitlon(&g, manufacturers'checklists)necessary to verifiy that this Inh niation is correct and a Plot Plan showing the layout of monitoring equipment For any equipment capable of generating such reports,I Inc also _ --`a - (check all that }: _ ❑item set_ ► _O Alarm hisior�y r ert�- TechnicianName rant: attacked a c of ort; opy r'e�_._._ _ —�__�__ �Y�uu�o i'> '_Signature: Certification No.:_ _ �yG'! ? License No.: Testing,-Company Name: TAIT ENVIRONMENTAL SYSTEMS Phone No.: (714).560-8222 Page 1 of 3 03/01