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MONITC#ING SYSTEM CERTIFWATION MAKE / MODEL OF MONITORING SYSTEM: Gilbarco EMC CERTIFICATION 1 TEST DATE: August 10, 2006 A1. FACILITY A2. OWNER Name Quik Stop Market # 76 Name Quik Stop Markets, Inc. Address 1030 S. Olive Avenue, Stockton, CA 95215 Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 Phone # 510-657-8500 Contact Michael Karvelot Contact Michael Karvelot A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 304 E Weber Avenue, 3rd Floor, Stockton, CA 95202 Address P.O. Box 1025, W. Sacramento, CA 95691 Notified July 28, 2006 Lic # 617238 A, B, Haz Inspector Raymond Von Flue Contact Richard Walton Phone # 209-468-9847 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 Tank #2 (Product): Gasoline - 91 ■ In-Tank Gauging Probe Model: 0847390-109 ■ In-Tank Gauging Probe Model: 0847390-109 ■ Annular Space or Vault Sensor Model: 0794380-303 ■ Annular Space or Vault Sensor Model: 0794380-303 ■ Piping Sump / Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: 0794380-208 ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: FE Petro MLD ■ Mechanical Line Leak Detector Model: FE Petro MLD ❑ Electronic Line Leak Detector Model ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Tank Overfill / High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: Tank #3 (Product): Tank #4 (Product): ❑ In-Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ In-Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump / Trench Sensor(s) Model: - - ❑ Piping Sump / Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: - ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model ❑ Tank Overfill / High-Level Sensor Model: ❑ Tank Overfill / High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: — ❑ Other (specify equipment in Section E) Model: 132: DISPENSERS/UDC's Dispenser # : 1-2 1 Dispenser # : 3-4 ❑ Dispenser Containment Sensor(s) Model: _ ❑ Dispenser Containment Sensor(s) Model: ■ Shear Valves ■ Shear Valves ■ Dispenser Containment Float(s) and Chain(s) ■ Dispenser Containment Float(s) and Chain(s) Dispenser # : ❑ Dispenser Containment Sensor(s) Model: Dispenser # ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : I Dispenser # ElDis Dispenser Containment Sensor(s) P (s) Mode ❑ Shear Valves- — ❑ Dispenser Containment Sensor(s) Model: ElShear Valves I ❑ Dispenser Containment Float(s) and Chain(s) �I El Dispenser Containment Float(s) and Chaln(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, 1 have also attached a copy of the report; (check all that apply): ■ System set-up ■ Alarm History Report WALTON Signature: �J�CX ENGINEERING, INC. Technician / Cert M Bruce N. Stewart / A31131 5249892-UT Date: August 10, 2006 c zoos wa¢on engineenng, Inc.