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OC'T-20-2008 03 :03 PM GETTLER—RYAN INC. 925 551 4770 P. 03 <br /> 0 0B <br /> MONITORING SYSTEM CERTIFICATION <br /> f"ui-U.ve 8v All Jurisdit tions 97thin tet,.Scutt of'C'ttlifornia <br /> aurlrorttY Cited: Chapter 6.7, Heec/th and Sglctt-C'vc/r; Chapter 16. Divikiun�, 7Yt1r 2.4, C'algf)rnia Code ufReplatiuns <br /> This fomn mutat IN used to document testing and servicing of monitoring ugwipincttt. ,�,seporgr�_S;SCl'.I)J�LL4U?-�r��t?�JltlJzl-1�.R . .6"1qh <br /> mon'efiUAY51;M&onnx> by the technicia 1 who pertbrins the work. A copy of titin form must be Provided to the tank system ownerioperator. <br /> The ownur'nperator tnust submit a copy of this;form to the local agency regidwing t iS'Isyslents within 30 days of test date. <br /> A. General Information <br /> Facility Name: ..A.Telehert&Son ®� Bldg. No.: <br /> Site Address: 120 Frankwest Cir. _ City' Stockton Zip: 952016 <br /> Facility Contact Person: Steve Contact Phone No.; 918 366-3716 <br /> Make,'Model of Monitoring System: Veeder Root TLS-350 L)atr of Testing/Servicing: 9125/2006 <br /> B. Inventory of Equipment Tested/Certified -.-,,....'-•,-.... <br /> Check the,air ro mate butes to indicate s►eciric c of mens tui ected/cervteed: <br /> Tank ID: Diesel ___ _ -rank ID: Unleaded <br /> ®In-Tank Gauging Probc, Model: 847390-1099 In-'funk Gauging Pmbc. .,.._.. Model' i14'P380-100 - <br /> ®Annular Space or Vault Sensor. Model: 79390.409 — ®Annular Space or Vault Sensor, Model: 794.990.409 <br /> ®Piping Sump/Trench Sensorls) Model: 7943M208 Z, Piping Sump Trench Sensons). Model: 794380-200 <br /> 0 Fill Sump Scruwr(s). Model: 794380.208 0 Fill Sump`unsorW. Modell: 794300-208 <br /> 0 Mechanical Lane Usk Detector. Model; � 0 Mechanie;cl Linc:Leak,Detector. Model: <br /> C1 Electronic line Leak L%ttwte>r. Model: ®Electronic I ine Lcalc Detector. Model: _ <br /> Tank Ovc�ll/High-revel Sensor. Model' TOOOVI.001 Lank Charfiil High t cv4l Su.»sot. Modcl: 790091-01 <br /> ® <br /> Other(specify equipment type and model in Sectinn Eon Page 2). []Other I specify Lcluipment type and model in 50CtiMt F,ire Page 2). <br /> Man+A <br /> Tank ID: Used tail _ _ Tank u): <br /> In-Tank Gauging Prube. Mvclul, 847300104 ❑In-'Tank Ciuuging Pmt+c, Mndcl:..__ �_ <br /> ®Annular Space or Vault Sensor. Model: 79090.404 [-,]Annular Space or Vault Sensor. Model: <br /> ®Piping Sump/Tronch Sensotis) Model: - O Piping Sump french Sensor]%). Model: ..-�.�..-��-........-... <br /> Fill sump Swism(s). Model: 794380.208 — 1.1 bill Stoup Seasons) Model: <br /> [�Mechanical Lino Leak Detector. Modcl; -- FJ Mechanical Linc leak Detector. Mtldel: � <br /> 0 Eluctrunic Line Leak Detector, McAul: []Electronic. Line Leak Detector. Model: <br /> ®'rank Overfill/High-Levu]Sensor. Model; 790091-001 O Tank Overfill iligh-Level Sensor. Model: _ <br /> ((her(specify cquipment type and mudrl in Suction E on Page 2)2). � F.J Othct-(specify equipment type and model in Section E on Page'). <br /> Dispenser ID: 1/2 — Dispenser 1D: 3/4 <br /> 0 Dispenser Containment Sensorts1. Mndtl: 794380-208 �Diapenso Containment Sens.ms), Modcl: 794880-aQ8 <br /> ( Sher Valyls). � _ .. - `+hear Vak oi,,,i, _... .., .... <br /> ©Dispenser Containment FI»at(s)and C'hamM ®Dispc^ttser Containment Float(s)and C'hairt(s). <br /> Dispenser ID: Dispenser 1D: __ _ <br /> [MsN-nsc:rC»ntninmottt Sonsoos). Mmlel: --� � ®Dispenses C.'untainment St^rt:�nts) Mndct ----- <br /> Shur Valve(s). Shear Val voisi. ­.­ <br /> ®D1.."iscr Containment Floats)and Citam(.o. ❑Dispenser Containment Float(s)and C'hain(ts). <br /> Dispenser ID; Dispenser 1D: <br /> ©DispenserContaituncnt Smsotfs). Model: (]DispenscrC'ontainment Scnsntts). Modcl! <br /> a Shear Val V(96). Shear Valv61si. <br /> ®D igpcnscrContainment Float(s)and Cham(s), ❑11spenscr(71111talnincnt Float(s)and Chain(s). <br /> "!f the facility contains more tanks or dispense srs,copy this t1onn. Include information for every tank and dispcaser at the facility. <br /> C. Certification -I certify that the equipment Identified in this document was inspected/serviced in accordance with the manufacturers' <br /> guidelines, Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is <br /> correct and it Plot Plan showing the layout of monitoring equipment, For any equipment capable of generating such reports,l have also <br /> attached a copy of the report-,(check all that apply): Z System set-tip Alarm history report <br /> '1"echtiician Name(print): Mike Pratt Signature! <br /> Certification No.: A29265 I-ic-ense. No.; 220793 <br /> l'ectittf Company Name: Gettler•R-Iran Inc, _____......... Phone No.:ta92514-777 ,__.....__..._._....____-_ <br /> 1'esting Company Address: 6747 Sierra Ct., Dublin, Ca Date of Testinb/Servicing: 912512008- <br /> Page 1 of 3 <br />