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P.D.Bax 4209 <br /> Softnia CAV5�73 <br /> Ga b233.41 R-fiaT <br /> A11techPetr"e"'-')"' Dane:ZC9 532-732; <br /> rorrtphitace svitivut ral"Ptom sr Fox z-:9 S33-2-75a <br /> m,,rs?aff =chpQtrr.c+�m <br /> %,:s-;.alh xhfrr4rc cam <br /> MONITORING SYSTEM CERTIFICATION for VPH SYSTEMS <br /> A. Facility General Information <br /> Facility Name: Arco 6080 Date of Testing: Monday, March 12, 2012 <br /> Facility Address: 85 Louise Ave, Lathrop CA 95330 <br /> Facility Contact Person: Terry Manager Facility Phone: 209-983-9144 <br /> LIA: San Joaquin EHD; Inspector: Thuy Tran Email: tttran@sjcehd.com. <br /> Make/Model of Monitoring System: Veeder-Root TLS-350 <br /> B. Inventory of Equipment Tested/Certified: <br /> Tank ID:Regular Tank Tank ID:Premium Tank <br /> ®In-Tank Gauging Probe. Model:Mag 1 Min-Tank Gauging Probe. Model: Mag 1 <br /> ®Tank Annular Space Sensor. Model:794380-302 ®Tank Annular Space Sensor. Model:794380-302(shared) <br /> ®Piping Sump Sensor(s). Model:794380-323 ®Piping Sump Sensor(s). Model:794380-323 <br /> ®Piping Sump Annular: Model:794380-304 ®Piping Sump Annular: Model:794380-304 <br /> ®Fill Sump Sensor(s). Model:794380-323 ®Fill Sump Sensor(s). Model: 794380-323 <br /> ®Fill Sump annular Model:794380-304 ®Fill Sump annular Model:794380-304 <br /> ®Secondary Piping monitor Type:Vacuum ®Secondary Piping monitor Type:Vacuum <br /> ®Electronic Line Leak Detector. Model:VR-PLLD ®Electronic Line Leak Detector. Model:VR-PLLD <br /> ®Tank Overfill/High-Level Sensor.Model:V-R Audible ®Tank Overfill/High-Level Sensor. Model:V-R Audible <br /> ® Fillspill Bucket Tested(In Sump): ®Pass []Fail ®Fillspill Bucket Tested (In Sump): ®Pass ❑Fail <br /> Tank ID:Diesel Tank Tank ID: <br /> ®In-Tank Gauging Probe. Model: Mag 1 ❑In-Tank Gauging Probe. Model: <br /> ®Tank Annular Space Sensor.Model:794380-302(shared) []Tank Annular Space Sensor. Model: <br /> ®Piping Sump Sensor(s). Model:794380-323 ❑Piping Sump Sensor(s). Model: <br /> ®Piping Sump Annular: Model:794380-304 ❑Piping Sump Annular: Model: <br /> ®Fill Sump Sensor(s). Model:794380-323 ❑Fill Sump Sensor(s). Model: <br /> ®Fill Sump annular Model:794380-304 []Fill Sump annular Model: <br /> ®Secondary Piping monitor Type:Vacuum []Secondary Piping monitor Type: <br /> ®Electronic Line Leak Detector. Model:VR-PLLD ❑ Line Leak Detector. Model: <br /> ®Tank Overfill/High-Level Sensor.Model:V-R Audible ❑Tank Overfill/High-Level Sensor. Model: <br /> ® Fillspill BucketTested(In Sump): ®Pass ❑Fail ❑ Fillspill Bucket Tested: ❑Pass ❑Fail <br /> Dispenser ID: 1&2® Sump: ®Dry❑Water❑Product Dispenser ID:3&4® Sump: ®Dry[—]water❑Product <br /> ®Dispenser Containment Sensor(s).Model:794380-323 ®Dispenser Containment Sensor(s).Model:794380-323 <br /> ® UDC Annular sensor. Model:794380-304 ® UDC Annular sensor. Model:794380-304 <br /> ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) <br /> Dispenser ID:5&6® Sump:®Dry❑Water❑Product Dispenser ID:7&8® Sump:®Dry❑Water❑Product <br /> ®Dispenser Containment Sensor(s).Model:794380-323 ®Dispenser Containment Sensor(s).Model:794380-323 <br /> ® UDC Annular sensor. Model:794380-304 ® UDC Annular sensor. Model:794380-304 <br /> ®Shear Valves) (Functional test) ®Shear Valve(s) (Functional test) <br /> Vent Box® Sump:®Dry❑Water❑Product Dispenser ID: ❑ Sump:❑Dry❑Water❑Product <br /> ®Dispenser Containment Sensor(s).Model:794380-323 E]Dispenser Containment Sensor(s). Model: <br /> ® UDC Annular sensor. Model:794380-304 ❑ UDC Annular sensor. Model: <br /> � f <br /> Technician: '-- i Date:3/12/12 <br /> Certification: Veeder-Root 636878, Level 4 <br /> ICC UST Service Technician # 8005930-UT <br />