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A11teChPetr'B- or Compliance without Compromise A. General Information P.O. Box 4208 Sonora CA 95370 Ca: 623541 A-Haz Phone: 209-532-7320 Fax: 209-533-2650 mail @a I (tech pet ro. co m www.alitechpetro.com Facility Name: Hammer 1-5 Arco Date of Testing/Servicing: 05/26/16 Facility Address: 3250 Hammer Lane, Stockton CA 95209 Facility Contact Person: Wes Parkinson Contact Phone No.: 209-474-9125 Regulatory agency: San Joaquin Health; Inspector: Stacy Rivera; Phone: 209-468-9847; Fax 209-468-3433 Make/Model of Monitoring System: Veeder- Root TLS -350 B. Inventory of Equipment Tested/Certified: Tank ID: 87A Tank ID: 87B ®In -Tank Gauging Probe. Model: Mag 1 ®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 El 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: 91 Tank ID: ®In -Tank Gauging Probe. Model: Mag 1 El 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 F1 Mechanical Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: NONE El Electronic Line Leak Detector. Model: ®Tank Overfill / High -Level Sensor. Model: Drop Tube ❑Tank Overfill / High -Level Sensor. Model: ® Fillspill buckets tested ®Pass [-]Fail ❑ ❑Pass ❑Fail Vapor Condensate Sump: ®Dry ❑Water ❑Product Piping Transition Sump: ®Dry ❑Water ❑Product ® Sensor(s). Model: 794380-208 ® Sensor(s). Model: 794380-208 ® Vapor Pot Sensor(s). Model: 794380-420 Dispenser ID: 1&2 ® Sump: ®Dry ❑Water ❑Product Dispenser ID: 3&4 ❑ Sump: ❑Dry [-]water ❑Product ®Dispenser Containment Model: Float and Chain Dispenser Containment Model: Float and Chain ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) ®Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5&6 ® Sump: ®Dry ❑Water ❑Product Dispenser ID: 7&8 ® Sump: ®Dry ❑Water ❑Product ®Dispenser Containment Model: Float and Chain ®Dispenser Containment Model: Float and Chain ®Shear Valves) (Functional test) ®Shear Valve(s) (Functional test) ®Dispenser Containment Float(s) and Chain(s). ®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 a// that app/yt ®System set-up ® Alarm history report Signature of Technician: Date: 05/26/16 Certification: ICC UST Technician # 8146912 -UT Veeder Root # 836878 Level 4 ISD