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r MONITORING SYSTEM CERTIFICATIO r MAKE/MODEL OF MONITORING SYSTEM: Gilbarco EMC JAN 0 4 2016 CERTIFICATION/TEST DATE: December 17, 2015 Al. FACILITY A2. OWNER ENVIRONMENTAL Name Flyers#427 Name Flyers Energy LLC. HEALTH DEPARTMENT Address 3300 Waterloo Road,Stockton,CA 95205 Address 2360 Lindbergh Street,Auburn,CA 95602 Phone# 530-885-0401 Phone# 530-885-0401 Contact Amanda Appelt I Contact Amanda Appelt A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering,Inc. Address 1868 E.Hazelton Avenue,Stockton,CA 95202 Address P.O.Box 1025,W.Sacramento,CA 95691 Notif led December 2,2015 Lic# 617238 A,B,Haz Inspector Cindy Contact Veronica Freitas Phone# 209-468-8257 Phone# 916-373-1166 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to Indicate equipment Inspected/serviced) 61: TANKS Tank#1 (Product): Gasoline-87 Tank#2 (Product): Red Diesel ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390-420 ■ Annular Space or Vault Sensor Model: 0794390-420 ■ Piping Sump/Trench Sensor(s) Model: 0794380-208 ■ Piping Sump/Trench Sensor(s) Model: 0794380-205 ❑ Fill Sump Sensor(s) Model: ❑ FIII Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: FE Petro STP-MLD ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ❑ 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: Tank#3 (Product): Diesel Tank#4 (Product): ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390.420 ❑ Annular Space or Vault Sensor Model: ■ Piping Sump/Trench Sensor(s) Model: 0794380-205 ❑ Piping Sump/Trench Sensor(s) Model: ❑ FIII Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ❑ 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: B2: DISPENSERS/UDC's Dispenser#: 1 Dispenser#: 3 ❑ 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#: 3-4 Dispenser#: 5 ❑ 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#: 6 Dispenser#: 7 ❑ 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 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 th 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 WALTON Signature: ENGINEERING.INC. Technician/Cert#: Curtis Carpenter/B37258 8020679 Date: December 17,2015 2015 Walton Engineering,Inc.