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MONITORING SYSTEM CERTIFICATION MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 CERTIFICATION /TEST DATE: September 17, 2018 Al. FACILITY A2. OWNER Name Teichert Mobile Equipment Name Teichert Construction Address 120 Frank Circle , Stockton, CA 95206 Address P.O. Box 15002, Sacramento, CA 95851 Phone # 916-366-8631 Phone # 916-386-3767 Contact Steve Schamaun Contact Steve Schamaun A3. C U P A A4, TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 1868 E. Hazelton Avenue, Stockton, CA 95202 Address P.O. Box 1025, W. Sacramento, CA 95691 Notified September 05, 2018 Lic # 617238 A, B, Haz Inspector Stacey Contact Veronica Freitas Phone # 209-468-3442 Phone # 916-373-1166 B. 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 INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) 131: TANKS Tank #1 (Product): C1 -Diesel Tank #2 (Product): C1 -Gasoline - 87 ❑ In -Tank Gauging Probe Model: ■ In -Tank Gauging Probe Model: 0847390-109 ■ Annular Space or Vault Sensor Model: 0794390409 ■ Annular Space or Vault Sensor Model: 0794390-409 ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: ■ Electronic Line Leak Detector Model: 0848480-001 ■ Electronic Line Leak Detector Model: 0848480-001 ❑ Tank Overfill / High -Level Sensor Model: ■ Tank Overfill / High -Level Sensor Model: 0847390-109 ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Tank #3 (Product): WO -7 Used Waste Oil Tank #4 (Product): Lube 30=30 ■ In -Tank Gauging Probe Model: 0847390-109 ❑ In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390409 ■ Annular Space or Vault Sensor Model: 0794390=420 ❑ Piping Sump / Trench Sensor(s) Model: ❑ Piping Sump / Trench Sensor(s) Model: ■ Fill Sump Sensor(s) Model: 0794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: 0 Tank Overfill / High -Level Sensor Model: 0847390-109 ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: E12: DISPENSERS/UDC's Dispenser # : 1-2 ■ Dispenser Containment Sensor(s) Model: 0794380-208 Dispenser # : 34 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Shear Valves ■ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : ❑ Dispenser Containment Sensor(s) Model: Dispenser # : ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : Dispenser # : ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) to verify that this information is correct and a Plot Plan showing th 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 ■ System set-up ■ Alarm History Report _ wAETGH�. Signature: ENGINEERING, IP1C. Technician / Cert #: Curtis Carpenter I B37258 8020679 Date: Septelnbet' 17, 218 ng,