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Monitoring SYStOm Cert' on <br /> For Use By All Jwbdkgaw WVjft fhe Slale,of CWlkt /a <br /> Clfed:ChapW 0.7, arilCo*,ChBPW IA Dh4wn 3, Tdie 24 CaUbmia Code of <br /> This form Must be Used to d and RegWafforps <br /> morwilo"n s ratem Control nM Y� fam b w Qie hrrotlu A�ppyyn�l A"oerelacwWWOMar must be for each ,The <br /> m s re8ulating t13T sys wEtfhkt 30 of <br /> A.General Inf . <br /> FadW..BP Arco <br /> Addrass:3425 TRACY BLVD Bid No:02093 <br /> E@ft Contact Person:Victoria Gard C .TRACY Zi : 761722 <br /> Make/Model of Monitan S :Ve Root TLS 350 Con Phone No: 35-1605 <br /> Service :01/09 <br /> B.Inventory of Equipment Tested/Cordfled <br /> the speciftsquW"gwIn <br /> Tarda iD:87 'n Tank ID:87 <br /> Sim <br /> ®In-T 8473 0-107 k1-Tartu Prdw <br /> ®mmdw Space or VeUk sensorModeh8473W107 <br /> Model:19090407 ®Annular Space or Vault Sensor Moder 7 <br /> ®Pwro Sump/Trench Sensorm PWQ sump/Trench 8 s) <br /> ®Fig Sump Sena (s) T943 <br /> Moft794380-323 <br /> 13Mechaniw Lane Leak o s s) r <br /> D Mechanical urn Lea Darrow Modek <br /> ®Eledronic Une Leak OeWW ModerPLLD ® LIM Leak Detector ModeLPLLD <br /> Tank Overfill/High Level smw moderMO91401 0 Tank Overlill!H'gth Level Ser= Moft*.790091-M <br /> ❑O#W( bIND and mode!In Section E on 2) ®09w(SPOGUY equOrnerd We and nwM In Section E an Pella 2) <br /> Tank ID:87 ' hon Tank ID:91 <br /> ®bh-Tank Ga>�ireg 107 ®kh-Ta k GwgIng 80-107 <br /> ®Annular 8paos or Vauit Sermw Moft79439UM Annular SPODS or <br /> PlIft Sung/Trench s) 80 32.9 ®PipkV&M! s) <br /> ®FSI Sump s) 7 ®Fi0 Such s) .7 <br /> 04380-323 <br /> ❑Mechanical Lin l D ❑M Lim L Delecta Model: <br /> ❑ Lbe Leak Detector Modet Eleckonlo Lim Lesk Defector <br /> :PLED <br /> ®Tank Overfill/High LeW Sensor l. 1-001 ®Tank GvMl/High LeM Seng Model 1-001 <br /> ❑Other(S GWOTwd type and model In Secdon E on Pap 2) ❑cow(specily aq bps and rnodel in Seclion E an Pap 2) <br /> Dispenser ID:1 &2 Dispenser ID:5&6 <br /> ® s) Modeft 794380-323 H Dispenser Contalrunent S s) Medea:784380.325 <br /> ®Show V s) ®Show V ) <br /> ❑ ' err s)and Chaks) ®Dispenser e)and Chain(s) <br /> Dispenser ID:3&4 QL91mmer ID:7&8 <br /> ®Dispensoor Confsinmod 4s) 0323 ®Dispenses s) <br /> 0 Shear Vehn4s) ®Shear Vah*s) <br /> ❑DIWnser Cwftkmnt s)and s) ❑l3lemnser Con1drunent F s)and Chains) <br /> Dispenser 10, D' ser 10: <br /> ❑ r M s) Modet ❑04enser Coalainment Sansw(s) Model: <br /> ❑ Vaws) ❑Shaw Yaws) <br /> ❑01sponew Contahunert FI *)and ChakXs) ❑Dispenser Conlairwrient Float(a)and Chains) <br /> •If the fatty cwftM more tacks Or dWcnMs.Copy this hush.Include information for every tats and dispenser at the <br /> C.Ce on-I that the egar ent ed In this d ins ervicad In a with the <br /> manufacturers!qui to is tion is I man ren•chsc on(o . )necessary to yeft <br /> that Ws Information Is owed and a Plot Plan showing the t of mon t For any equipment cap"of <br /> rig reports,I also a a copy of the repow,,( all ): <br /> System Alarm history repon <br /> Technician Na (Print.Steve Graham re: �- <br /> Certification No:A24322 Lloe No: <br /> WW98- <br /> Tesfing Company Name:TAIT ENVIRONMENTAL Phone No:(714) 222 <br /> SERVICES <br />