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P.O.Bcx 4208 A11techPetAbSA 9533 Ca:623541 AMHv Pfira•ie:e:N9-532-732J 2�9-59-53 2-7322J Compliance without Compromise Fax:2,:9-533-2-0 and I%r5)a11-4chpatrr..cnm n^ra�v.all-�chlx+trr..cnm MONITORING SYSTEM CERTIFICATION A. General Information Facility Name:Arco#2133 Date of Testing/Servicing: February 24, 2012 Facility Address:2908 Benjamin Holt Dr., Stockton CA 95207 Facility Contact Person: Juan Facility Phone: 209-478-5552 LIA: San Joaquin Environmental Health;I nspecto r:Garrett Backus;LIA Phone: 209-468-3448; LIA Fax: Make/Model of Monitoring System: Veeder-Root TLS-350 LIA email; gbackus@sjcehd.com B. Inventory of Equipment Tested/Certified: Tank ID:Regular Master Tank Tank ID:Regular Slave Tank Nin-Tank Gauging Probe. Model:Mag 1 Nln-Tank Gauging Probe. Model: Mag 1 ®Annular Space Sensor. Model:794380-420 ®Annular Space Sensor. Model:794380-420 ®Piping Sump Sensor(s). Model:794380-323 NPiping Sump Sensor(s). Model:794380-323 NFill Sump Sensor(s). Model:794380-323 NFill Sump Sensor(s). Model:794380-323 NElectronic Line Leak Detector, Model:V-R PLLD ❑AGT Sump Sensor Model:794380-323 NTank Overfill/High-Level Sensor.Model:V-R Audible ®Tank Overfill/High-Level Sensor.Model:V-R Audible ❑Fillspill Bucket Tested: [-]Pass [-]Fail ❑Fillspill Bucket Tested: ❑Pass []Fail Tank ID:Premium Tank Tank ID: N In-Tank Gauging Probe. Model:Mag 1 ❑In-Tank Gauging Probe. Model: NAnnular Space Sensor. Model:794380-420 [1 Annular Space Sensor. Model: NPiping Sump Sensor(s). Model:794380-323 El Piping Sump Sensor(s). Model: NFill Sump Sensor(s). Model:794380-323 El Fill Sump Sensor(s). Model: NMechanical Line Leak Detector. Model:VMI LD-2000 ❑ Line Leak Detector. Model: ®Tank Overfill/High-Level Sensor.Model:V-R Audible ❑Tank Overfill/High-Level Sensor.Model: ❑Fillspill Bucket Tested: ❑Pass []Fail ❑Fillspill Bucket Tested: ❑Pass ❑Fail Dispenser ID:1&2 N Sump:NDry❑Water❑Product Dispenser ID:3&4 N Sump:NDry❑Water❑Product ®Dispenser Containment Sensor(s).Model:794380-323 ®Dispenser Containment Sensor(s). Model:794380-323 ❑Shear Valve(s) (Functional test) ❑Shear Valves) (Functional test) Dispenser ID:5&6 N Sump:®Dry❑Water❑Product Dispenser ID:7&8®Sump:NDry❑Water❑Product NDispenser Containment Sensor(s).Model:794380-323 ®Dispenser Containment Sensor(s).Model:794380-323 ❑Shear Valves) (Functional test) []Shear Valve(s) (Functional test) Sump ID:N.Vapor Pot N Sump:NDry❑Water❑Product Sump ID:Transition®Sump:NDry E]Water®Product ®Sump Containment Sensor(s).Model:794380-323 NSump Containment Sensor(s).Model:794380-323 NVapor Pot Annular Sensor(s). Model:794380-420 NVapor Pot High Level Sensor(s). Model:794380-420 C. Certification-1 certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is 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; N System set-up N Alarm history report so Technician: AQ01k_ Date: 2/24/12 Certification:;Veeder-Root: B36877 Level 4 ICC Cert: 8005930-UT Facility Name: Arco #2133 (Page 2)