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e j Alltech Petro Inc. - 17759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320; Fax: 209-533-2650 California Contractor 623541 A-Haz Mike@AlltechPetro.com I d MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Hammer I-5 Arco Date of Testing/Servicing: August 9,2007 Facility Address:3250 Hammer Lane,Stockton CA 95209 Facility Contact Person: Wes Parkinson Contact Phone No.: 474-9125 Regulatory agency: San Joaquin Health;Inspector: Michelle Henry; Phone: 468-9847;Fax 468-3433 Make/Model of Monitoring System: Veeder-Root TLS-350 This test report is a:®Final Report(Facility was observed to be in Compliance)or a❑Preliminary Report(Unresolved Issues Exist) B. Inventoa of E ui ment Tested/Certified: Tank ID:Regular Master Tank ID: Regular Skave ®In-Tank Gauging Probe. Model:Mag I ®In-Tank Gauging Probe. Model: Mag 1 ®Annular Space or Vault Sensor. Model:794390-409 ®Annular Space or Vault Sensor. Model:794390-409 ®Piping Sump Sensor(s). Model:794380-208 ®Piping Sump Sensor(s). Model:794380-208 ❑Fill Sump Sensor(s). Model:NONE ❑Fill Sump Sensor(s). Model:NONE ®Mechanical Line Leak Detector. Model:Red Jacket ❑Mechanical Line Leak Detector. Model: Shared ❑Electronic Line Leak Detector. Model:NONE ❑Electronic Line Leak Detector. Model:NONE ®Tank Overfill/High-Level Sensor. Model:Drop Tube ®Tank Overfill/High-Level Sensor. Model:Drop Tube ®Fills ill buckets tested ®Pass ❑Fail ®Fills ill buckets tested ®Pass ❑Fail Tank ID:Premium Tank ID: ®In-Tank Gauging Probe. Model:Mag I ❑In-Tank Gauging Probe. Model: ®Annular Space or Vault Sensor. Model: 794390-409 ❑Annular Space or Vault Sensor. Model: ®Piping Sump Sensor(s). Model: 794380-208 ❑Piping Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model:NONE ❑Fill Sump Sensor(s). Model: ®Mechanical Line Leak Detector. Model:FE Petro ❑Mechanical Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model:NONE ❑Electronic Line Leak Detector. Model: ®Tank Overfill/High-Level Sensor. Model:Drop Tube ❑Tank Overfill/High-Level Sensor. Model: ®Fills ill buckets tested ®Pass []Fail ❑Fills ill buckets tested ❑Pass ❑Fail Vapor Condensate Sump: 1&2 ®Dry❑Water❑Product Piping Transition Sump:3&4 ®Dry❑Water❑Product ® Sensor(s). Model:794380-208 ® Sensor(s). Model:794380-208 Dispenser ID: 1&2® Sump:®Dry ❑Water❑Product Dispenser ID:3&4®Sump: ®Dry❑Water❑Product ❑Dispenser Containment Sensor(s). Model:Bravo Box ❑Dispenser Containment Sensor(s). Model:Bravo Box ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) ® Dispenser Containment Floats and Chains. ®Disenser Containment Float(s)and Chains . Dispenser ID:5&6❑Sump:❑Dry❑Water❑Product Dispenser ID:7&8❑Sump:❑Dry❑Water❑Product ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) ❑Dispenser Containment Floats and Chain(s). ❑Dispenser Containment Floats 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: Mike Dotten,California Contractor License.No.: 623541 Certification: Veeder-Root:341-32-6743; Level 4. ICC UST Technician#5259412-UT