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ox 4208 RECEIVES P.O. A95370 ' Sonora CA 95370 AlitechPetr - Ca:623541 -7320 JUL��"L V z 2U�U Phone:209-532-7320 Compliance without Compromise ��Tqq Fax:209-533-2650 LHEALTH mail@alltechpetro.com MONITORING SYSTEM CERTM �h V!CES www.alltechpetro.com A. General Information Facility Name: Hammer 1-5 Arco Date of Testing/Servicing: 05/07/15 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 F-1 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 F-1 Electronic Line Leak Detector. Model: NONE F1 Electronic Line Leak Detector. Model: NONE ®Tank Overfill/High-Level Sensor. Model: Drop Tube ®Tank Overfill/High-Level Sensor. Model: Drop Tube ® Fillspill buckets tested ®Pass ❑Fail ® Fillspill buckets tested ®Pass ❑Fail Tank ID: 91 Tank ID: ®In-Tank Gauging Probe. Model: Mag 1 ❑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: ® 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 Valve(s) (Functional test) ®Shear Valve(s) (Functional test) 01 ®Dispenser Containment Floats and Chain(s). ®Dis enser 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 a//that app/y}. ® System set-up ®Alarm history report Signature of Technician: Date: 05/07/15 Certification: ICC UST Technician # 8146912-UT Veeder Root # B36878 Level 4 ISD