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AlItech ENO 17759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320; Fax: 209-533-2650 r ;,a California Contractor 623541 A-Haz Mike@MtechPetro.com Ef'dVI�Qfia�,9f�Nfi HEALTH I'E( ^ !7/;ERV10ES MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: California Stop Date of Testing/Servicing: February 25,2005 Facility Address: 2224 Manthey Road,Stockton CA 95205 Facility Contact Person:Nancy Le Contact Phone No.:462-7621 Regulatory agency: San Joaquin Health;Inspector: Steven Shih;Phone:468-9850;Fax 468-3433 Make/Model of Monitoring System:Veeder-Root TLS-350 b*:0FUA In Compliance)or a❑Preumbsry Report(Uwv n kw laws Exist) B. Invento of Equipment Tested/Certified: Tank M.Regular Tank Tank ID:Premium Tank N In-Tank Gauging Probe. Model:Mag 1 ®In-Tank Gauging Probe. Model:Mag 1 N Annular Space or Vault Sensor. Model:Wrap-Around N Annular Space or Vault Sensor. Model:Wrap-Around N Piping Sump Sensor(s). Model:Non-Discriminating N Piping Sump Sensor(s), Model:Non-Discriminating ❑Fill Sump Sensor(s). Model:NONE ❑Fill Sump Sensor(s). Model:NONE N Mechanical Line Leak Detector. Model:Vaporless LD-2000 N Mechanical Line Leak Detector. Model:Vaporless LD-2000 ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: N Tank Overfill/High-Level Sensor. Model:Drop Tube N Tank Overfill/High-Level Sensor. Model:Drop Tube N Fillill buckets tested NPass ❑Fail N Fills ill buckets tested ®Pass ❑Fail Tank ID:Diesel Tank Tank ID: N In-Tank Gauging Probe. Model:Mag 1 ❑In-Tank Gauging Probe. Model: N Annular Space or Vault Sensor. Model:Wrap-Around ❑Annular Space or Vault Sensor. Model: N Piping Sump Sensor(s). Model:Non-Discriminating ❑Piping Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model:NONE ❑Fill Sump Sensor(s). Model: N Mechanical Line Leak Detector. Model:Vaporless LD-2000 ❑Mechanical Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ®Tank Overfill/High-Level Sensor. Model:Drop Tube ❑Tank Overfill/High-Level Sensor. Model: ® FiEMill buckets tested NPass ❑Fail ❑Fills ill buckets tested ❑Pass ❑Fail Dispenser ID: 1&2 N Sump:❑Dry NWater❑Product Dispenser ID:3&4 N Sump:NDry❑Water❑Product N Dispenser Containment Sensor(s). Model:Non-Discriminating N Dispenser Containment Sensor(s). Model:Non-Discriminating N Shear Valve(s) (Functional test) N Shear Valve(s) (Functional test) ❑Dispenser Containment Floa s and Chain s). ❑Dispenser Containment Floats and Chains . Dispenser ID:5&6 N Sump:®Dry❑Water❑Product Dispenser ID: 7&8 N Sump:NDry❑Water❑Product N Dispenser Containment Sensor(s). Model:Non-Discriminating ®Dispenser Containment Sensor(s). Model:Non-Discriminating ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) ❑Di ser Containment F122s and Chains). ❑Di ser Containment Floa s and Chains . Dispenser ID: ❑Sump:❑Dry❑Water❑Product Dispenser ID: ❑Sump:❑Dry❑Water❑Product ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) ❑DiTqjser Containment Floa s and Chains . ❑Dis r Containment Floats and Chains . 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): N System set-up N Alarm history report Technician: 7y 4e A Mike Dotten,California Contractor License.No.:623541 Certification:Veeder-Root:341-32-6743;Level 4. Page 1 of 3 03101