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P.O.Box 4208 Sonora CA 95370 • Atec or 11 03 2017 Ca:623541 A-Haz hPetr -5 Phone:209-532-7320 Compliance without Compromise E V i R,C)N"IM.E N TA L HEAL TH Fax:209-533-2650 MONITORING SYSTEM maii@alltechpetro.com www.alitechpetro.com A. General Information Facility Name: Hammer 1-5 Arco Date of Testing/Servicing: 5/25/17 J Facility Address: 3250 Hammer Lane, Stockton CA 95209 Facility Contact Person: Wes Parkinson Contact Phone No.: 474-9125 Regulatory agency: San Joaquin Health; Inspector: Vicki McCartney; Phone: 468-9847; Fax 468-3433 Make/Model of Monitoring System: Veeder- Root TLS-350 B. Inventory of Equipment Tested/Certified: dz Tank ID: 87A Tank ID:87B N In-Tank Gauging Probe. Model: Mag 1 N In-Tank Gauging Probe. Model: Mag 1 NAnnular Space or Vault Sensor. Model: 794390-409 ®Annular Space or Vault Sensor. Model: 794390-409 [E Piping Sump Sensor(s). Model: 794380-208 NPiping Sump Sensor(s). Model: 794380-208 ❑Fill Sump Sensor(s). Model: NONE D Fill Sump Sensor(s). Model: NONE Z Mechanical Line Leak Detector. Model. Red Jacket FX1V ❑Mechanical Line Leak Detector. Model: Shared ❑Electronic Line Leak Detector. Model: NONE El Electronic Line Leak Detector. Model: NONE NTank Overfill/High-Level Sen r. Model: Drop Tube ZTank Overfill/High-Level Sensor. Model: Drop Tube N fills ill buckets tested [EPass ❑Fail Z Fills ill buckets tested ®Pass ❑Fail Tank ID: 91 Tank ID: Z In-Tank Gauging Probe. Model: Mag 1 El In-Tank Gauging Probe. Model: NAnnular Space or Vault Sensor. Model: 794390-409 ❑Annular Space or Vault Sensor. Model: N Piping Sump Sensor(s). Model: 794380-208 ❑Piping Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: NONE El Fill Sump Sensor(s). Model: MMechanical Line Leak Detector. Model: FE Petro STP-MLD E]Mechanical Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: NONE 0 Electronic Line Leak Detector. Model: ZTank Overfill/High-Level Sensor. Model: Drop Tube ❑Tank Overfill/High-Level Sensor. Model: Z Fillspill buckets tested ZPass ❑Fail ❑ ❑Pass ❑Fail Vapor Condensate Sump: NDry❑Water❑Product Piping Transition Sump: NDry❑Water❑Product M Sensor(s). Model: 794380-208 Z Sensor(s). Model: 794380-208 Z Vapor Pot Sensor(s). Model: 794380-420 Dispenser ID: 1&2 Z Sump: NDry❑Water❑Product Dispenser ID: 3&4 N Sump: NDry❑Water❑Product Z Dispenser Containment Model: Float and Chain X Dispenser Containment Model: Float and Chain NShear Valve(s) (Functional test) Z Shear Valve(s) (Functional test) M Dispenser Containment Float(s)and Chain(s). E Dispenser Containment Float(s)and Chain(s). Dispenser ID: 5&6 Z Sump: NDry❑Water❑Product Dispenser ID: 7&8 Z Sump: NDry❑Water❑Product Z Dispenser Containment Model: Float and Chain Z Dispenser Containment Model: Float and Chain Shear Valve(s) (Functional test) MShearValve(s) (Functional test) Dispenser Containment Float(s)and Chain(s). Z Dispenser Containment Float(s)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 app/yr Z System set-up N Alarm history report Signature of Technician: "0 Date: 5/25/17 Certification: ICC LIST Technician #8152115-UT Veeder Root# B36877 Level 4 ISD