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F.O. Bar.,1208 <br />Sonnra CA 95370 <br />6, <br />Alite Fhane; 2C9 -53 c Petr Ca:ZC9-53 7327 <br />2-732 <br />Compliance without Compromise Fax: 209-533-21550 <br />m,j Kpalt-chr"wc.com <br />n..r,.r:. alf-achlmtrr..c dm <br />MONITORING SYSTEM CERTIFICATION <br />A. General Information <br />Facility Name: Arco #2093 Date of Testing/Servicing: November 28, 2012 <br />Facility Address:3425 Tracy Bvd, Tracy CA 95376 <br />Facility Contact Person: Iqbal Bains Facility Phone: 209-835-1605 <br />LIA: San Joaquin EHD;Inspector:Thuy Tran;LIA Phone: 209-468-3453; LIA Fax: 209-468-3433 <br />Make/Model of Monitoring System: Veeder-Root TLS -350 LIA email; tttran@sjcehd.com <br />B. Inventory of Equipment Tested/Certified: <br />Tank ID: T4 Regular Master Tank <br />Tank ID: T2 Regular aux Tank <br />®In -Tank Gauging Probe. Model: Mag 1 <br />®In -Tank Gauging Probe. Model: Mag 1 <br />®Annular Space Sensor. Model: 794380-409 <br />®Annular Space Sensor. Model: 794380-409 <br />®Piping Sump Sensor(s). Model: 794380-323 <br />®Piping Sump Sensor(s). Model: 794380-323 <br />®Fill Sump Sensor(s). Model: 794380-323 <br />®Fill Sump Sensor(s). Model: 794380-323 <br />®Electronic Line Leak Detector. Model: V -R PLLD <br />❑ Line Leak Detector. Model: <br />®Tank Overfill / High -Level Sensor. Model: V -R Audible <br />®Tank Overfill / High -Level Sensor. Model: V -R Audible <br />® Fillspill Bucket Tested: ®Pass [-]Fail <br />® Fillspill Bucket Tested: ®Pass ❑Fail <br />Tank ID: T3 Regular Syphon Tank <br />Tank ID: T4 Premium Tank <br />® In -Tank Gauging Probe. Model: Mag Plus <br />®In -Tank Gauging Probe. Model: Mag Plus <br />®Annular Space Sensor. Model: 794380-409 <br />®Annular Space Sensor. Model: 794380-409 <br />®Piping Sump Sensor(s). Model: 794380-323 <br />®Piping Sump Sensor(s). Model: 794380-323 <br />®Fill Sump Sensor(s). Model: 794380-323 <br />®Fill Sump Sensor(s). Model: 794380-323 <br />❑ Line Leak Detector. Model: <br />® Electronic Line Leak Detector. Model: V -R PLLD <br />®Tank Overfill / High -Level Sensor. Model: V -R Audible <br />®Tank Overfill / High -Level Sensor. Model: V -R Audible <br />® Fillspill Bucket Tested: ®Pass ❑Fail <br />® Fillspill Bucket Tested: ®Pass ❑Fail <br />Dispenser ID: 1&2 ® Sump: ®Dry ❑Water ❑Product <br />Dispenser ID: 3&4 0 Sump: ®Dry ❑Water ❑Product <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />MDispenser Containment Sensor(s). Model: 794380-323 <br />®Shear Valves Functional test <br />ZShear Valves Functional test <br />Dispenser ID: 5&6 ® Sump: ®Dry ❑Water ❑Product <br />Dispenser ID: 7&8 0 Sump: ®Dry ❑Water ❑Product <br />® Dispenser Containment Sensor(s). Model: 794380-323 <br />® Dispenser Containment Sensor(s). Model: 794380-323 <br />® Shear Valves Functional test <br />® Shear Valves Functional test <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: 9--' f <br />Certification: Veeder-Root: B36878 Level 4 <br />ICC Cert: 8146912 -UT <br />11/28/12 <br />