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� f <br /> P.O.Box 4208 <br /> or Sonora CA 95370 <br /> FEB 3 2012 Ca:623541 A-Haz <br /> AlitechPetroo Phone:209-532-7320 <br /> Compliance Without Compromise Fax:209-533-2650 <br /> mail@alltechpetro.com <br /> �. www.alltechpetro.com <br /> MONITORING SYSTEM CERTIFICATION <br /> A. General Information <br /> Facility Name: Arco #2133 Date of Testing/Servicing: January 27, 2012 <br /> Facility Address:2908 Benjamin Holt Dr., Stockton CA 95207 <br /> Facility Contact Person: Juan Facility Phone: 209-478-5552 <br /> LIA: San Joaquin Environmental Health;Inspector:Garrett Backus;LIA Phone: 209-468-3448; LIA Fax: <br /> Make/Model of Monitoring System: Veeder-Root TLS-350 LIA email; gbackus@sjcehd.com <br /> B. Inventory of Equipment Tested/Certified: <br /> Tank ID: Regular Master Tank Tank ID:Regular Slave Tank <br /> Nln-Tank Gauging Probe. Model: Mag 1 ®In-Tank Gauging Probe. Model: Mag 1 <br /> NAnnular Space Sensor. Model: 794380-420 NAnnular Space Sensor. Model:794380-420 <br /> NPiping Sump Sensor(s). Model: 794380-323 NPiping Sump Sensor(s). Model:794380-323 <br /> NFill Sump Sensor(s). Model: 794380-323 NFill Sump Sensor(s). Model:794380-323 <br /> NElectronic Line Leak Detector. Model:V-R PLLD NATG Sump Sensor. Model:794380-323 <br /> NTank Overfill/High-Level Sensor. Model:V-R Audible NTank Overfill/High-Level Sensor. Model:V-R Audible <br /> N Fillspill Bucket Tested: NPass ❑Fail N Fillspill Bucket Tested: NPass ❑Fail <br /> Tank ID: Premium Tank Tank ID: <br /> N In-Tank Gauging Probe. Model: Mag 1 ❑In-Tank Gauging Probe. Model: <br /> NAnnular Space Sensor. Model: 794380-420 ❑Annular Space Sensor. Model: <br /> NPiping Sump Sensor(s). Model: 794380-323 El Piping Sump Sensor(s). Model: <br /> ®Fill Sump Sensor(s). Model:794380-323 El Fill Sump Sensor(s). Model: <br /> NMechanical Line Leak Detector. Model:VMI LD-2000 ❑ Line Leak Detector. Model: <br /> NTank Overfill/High-Level Sensor. Model:V-R Audible ❑Tank Overfill/High-Level Sensor. Model: <br /> N Fillspill Bucket Tested: NPass ❑Fail ❑ Fillspill Bucket Tested: ❑Pass ❑Fail <br /> Dispenser ID: 1&2 N Sump: NDry❑Water❑Product Dispenser ID:3&4 N Sump`.NDry❑Water❑Product <br /> ®Dispenser Containment Sensor(s). Model: 794380-323 N Dispenser Containment Sensor(s). Model: 794380-323 <br /> NShear Valve(s) (Functional test) NShear Valves) (Functional test) <br /> Dispenser ID: 5&6 N Sump: NDry❑Water❑Product Dispenser ID:7&8 N Sump: NDry❑Water❑Product <br /> ED Dispenser Containment Sensor(s). Model:794380-323 NDispenser Containment Sensor(s). Model:794380-323 <br /> NShear Valve(s) (Functional test) NShear Valve(s) (Functional test) <br /> Sump ID:Vapor Pot N Sump: NDry❑Water❑Product Sump ID:Trasition N Sump: NDry❑Water❑Product <br /> NSump Containment Sensor(s). Model: 794380-323 ®Sump Containment Sensor(s). Model:794380-323 <br /> NVapor Pot Annular Sensor(s). Model: 794380-420 <br /> NVapor Pot High Level Sensor(s). Model: 794380-420 <br /> C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' <br /> guidelines. Attached to this Certification is a Plot Plan showing the layout of monitoring equipment. For any equipment capable of <br /> generating such reports,I have also attached a copy of the report; ®System set-up ®Alarm history report <br /> Technician: Date: 1/27/12 <br /> Certification: Veeder-Root: B36877 Level 4 <br /> ICC Cert: 8005930-UT <br />