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AlItech Petro Inc. <br /> P.O. Box 4208, Sonora, CA 95370 <br /> Phone: 209-532-7320; Fax: 209-533-2650 <br /> California Contractor 623541 A-Haz <br /> alltechmailArnac.com Dallow <br /> MONITORING SYSTEM CERTIFICATI <br /> A. General Information �`� . <br /> Facility Name:Hammer I-5 Arco Date of Testing/Servicing: 8/26/10 <br /> Facility Address:3250 Hammer Lane,Stockton CA 95209 <br /> Facility Contact Person:Wes Parkinson Contact Phone No.:474-9125 AUG 2 2010 <br /> Regulatory agency:San Joaquin Health;Inspector: Garrett Backus;Phone:468-9847;Fax 468-3433 <br /> Make/Model of Monitoring System:Veeder-Root TLS-350 8Ai.I,1CPIQU��11 COUyNT/ <br /> B. Inventory of E ui ment Tested/Certified: A!7,P DE"',`,NTVt:17 <br /> Tank ID:87A Tank ID:87B <br /> ®In-Tank Gauging Probe. Model:Mag 1 ®In-Tank Gauging Probe. Model:Mag 1 <br /> ®Annular Space or Vault Sensor. Model:794390-409 ®Annular Space or Vault Sensor. Model:794390-409 <br /> ®Piping Sump Sensor(s). Model:794380-208 ®Piping Sump Sensor(s). Model:794380-208 <br /> ❑Fill Sump Sensor(s). Model:NONE ❑Fill Sump Sensor(s). Model:NONE <br /> ®Mechanical Line Leak Detector. Model:Red Jacket ❑Mechanical Line Leak Detector. Model:Shared <br /> ❑Electronic Line Leak Detector. Model:NONE ❑Electronic Line Leak Detector. Model:NONE <br /> ®Tank Overfill/High-Level Sensor. Model:Drop Tube ®Tank Overfill/High-Level Sensor. Model:Drop Tube <br /> ®Fills ill buckets tested El Pass ®Fail ®Fills ill buckets tested ®Pass []Fail <br /> Tank ID:91 Tank ID: <br /> ®In-Tank Gauging Probe. Model:Mag I ❑In-Tank Gauging Probe. Model: <br /> ®Annular Space or Vault Sensor. Model:794390-409 ❑Annular Space or Vault Sensor. Model: <br /> ®Piping Sump Sensor(s). Model:794380-208 ❑Piping Sump Sensor(s). Model: <br /> ❑Fill Sump Sensor(s). Model:NONE ❑Fill Sump Sensor(s). Model: <br /> ®Mechanical Line Leak Detector. Model:FE Petro ❑Mechanical Line Leak Detector. Model: <br /> ❑Electronic Line Leak Detector. Model:NONE ❑Electronic Line Leak Detector. Model: <br /> ®Tank Overfill/High-Level Sensor. Model:Drop Tube ❑Tank Overfill/High-Level Sensor. Model: <br /> ®Fills ill buckets tested ®Pass []Fail ❑Fills ill buckets tested ❑Pass ❑Fail <br /> Vapor Condensate Sump:®Dry❑Water❑Product Piping Transition Sump:®Dry❑Water❑Product <br /> ® Sensor(s). Model:794380-208 ® Sensor(s). Model:794380-208 <br /> Dispenser ID: 1&2®Sump:®Dry[]water❑Product Dispenser ID:3&4®Sump:®Dry❑Water❑Product <br /> ®Dispenser Containment Model:Float and Chain ®Dispenser Containment Model:Float and Chain <br /> ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) <br /> ®Dispenser Containment Floats and Chains . ®Dispenser Containment Floats and Chains . <br /> Dispenser ID:5&6®Sump:®Dry[]Water❑Product Dispenser ID:7&8®Sump:®Dry❑Water❑Product <br /> ®Dispenser Containment Model:Float and Chain ®Dispenser Containment Model:Float and Chain <br /> ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) <br /> ®Dis enser Containment Floats and Chain(s). ®Dis enser Containment Floats and Chain(s). <br /> C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the <br /> manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists)necessary to verify that this <br /> information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such <br /> reports,I have also attached a copy of the report;(check all that apply): ❑ System set-up ❑Alarm history report <br /> ® u® <br /> *00 <br /> Signature of Technician: Date:8/26/10 <br /> Certification: ICC UST Technician#8011608-UT <br /> Veeder Root#B36877 Level 4 ISD <br />