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MONITCV.ING SYSTEM CERTIF*ATION MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 CERTIFICATION /TEST DATE: March 26, 2009 Al. FACILITY Name Olympian # 487 Address 983 Moffat Blvd., Manteca, CA 95336 Phone # 530-885-0401 Contact Amanda Appelt A2. OWNER Name Nella Oil Company, LLC Address 2360 Lindbergh Street, Auburn, CA 95602 Phone # 530-885-0401 Contact Amanda Appelt A3. C U P A ❑ In -Tank Gauging Probe A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health ■ Piping Sump / Trench Sensor(s) Name Walton Engineering, Inc. Address 600 E. Main Street, Stockton, CA 95202 Model: Address P.O. Box 1025, W. Sacramento, CA 95691 Notified March 23, 2009 ❑ Other (specify equipment in Section E) Lic # 617238 A, B, Haz Inspector Muniappa Naidu Tank Overfill / High -Level Sensor Contact Richard Walton Phone # 209-468-3439 Phone # 916-825-3203 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) 131: TANKS Tank #1 (Product): Gasoline - 87 ❑ In -Tank Gauging Probe ■ Annular Space or Vault Sensor ■ Piping Sump / Trench Sensor(s) ❑ Fill Sump Sensor(s) ❑ Mechanical Line Leak Detector ❑ Electronic Line Leak Detector ❑ Tank Overfill / High -Level Sensor ❑ Other (specify equipment in Section E) Tank #3 (Product): Diesel ❑ In -Tank Gauging Probe ■ Annular Space or Vault Sensor ■ Piping Sump / Trench Sensor(s) ❑ Fill Sump Sensor(s) ❑ Mechanical Line Leak Detector ❑ Electronic Line Leak Detector ❑ Tank Overfill / High -Level Sensor ❑ Other (specify equipment in Section Model: Model: 0794390-420 Model: 0794380-208 Model: Model: Model: Model: Model: Model Model: 0794390-420 Model: 0794380-208 Model: Model: Model: Model: Model: Tank #2 (Product): Gasoline - 91 ❑ In -Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: Tank #4 (Product): _ ❑ In -Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump / Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: 1:01111111 al F.y», F,9 :iyf I I sTsiM C. CERTIFICATION I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and 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; (check all that apply): ■ System set-up ■ Alarm History Report Technician / Cert #: Bruce N. Stewart / A31131 5249892 -UT WALTON ENGINEERING, INC. Date: March 26, 2009 Dispenser # : 1-2 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : 3-4 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : 7-8 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser ■ ❑ ❑ # : 5-6 Dispenser Containment Sensor(s) Model: 0794380-208 Shear Valves Dispenser Containment Float(s) and Chain(s) Dispenser # : ❑ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : 8 Sat ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) C. CERTIFICATION I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and 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; (check all that apply): ■ System set-up ■ Alarm History Report Technician / Cert #: Bruce N. Stewart / A31131 5249892 -UT WALTON ENGINEERING, INC. Date: March 26, 2009