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• • <br /> Alliech Petro Inc. <br /> 17759 Buttercup Circle, Sonora, CA 95370 <br /> Phone: 209-532-7320; Fax: 209-533-2650 <br /> California Contractor 623541 A-Haz <br /> alltechmailnd,mac.corn <br /> MONITORING SYSTEM CERTIFICATION <br /> A. General Information <br /> Facility Name: Hammer I-5 Arco Date of Testing/Servicing: August 25,2009 <br /> Facility Address:3250 Hammer Lane,Stockton CA 95209 <br /> Facility Contact Person: Wes Parkinson Contact Phone No.: 474-9125 <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 <br /> B. Invento of Equipment Tested/Certified: <br /> TankID:87A TankID: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 ®Pass ❑Fail ®Fills ill buckets tested ®Pass []Fail <br /> Tank ID:91 Tank ID: <br /> ®In-Tank Gauging Probe. Model:Mag 1 ❑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 /> ® <br /> Dispenser Containment Floats and Chains . ®Dispenser Containment Floats and Chain (s). <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 /> ®Dispenser Containment Floats and Chain(s). ®Dis nser 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 /> 00-0 <br /> e_ <br /> Signature <br /> Signature of Technician: Date: 8/25/09 <br /> Certification: ICC UST Technician#8011608-UT <br /> Veeder Root#B36877 Level 2/3 ISD <br />