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MONIT(#ING SYSTEM CERTIFWATION MAKE / MODEL OF MONITORING SYSTEM: Gilbarco EMC CERTIFICATION /TEST DATE: August 23, 2006 Al. FACILITY A2. OWNER Name Quik Stop Market # 39 Name Quik Stop Markets, Inc. Address 2289 E. Fremont Street, Stockton, CA 95205 Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 Phone # 510-657-8500 Contact Michael Karvelot Contact Michael Karvelot A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 304 E Weber Avenue, 3rd Floor, Stockton, CA 95202 Address P.O. Box 1025, W. Sacramento, CA 95691 Notified August 8, 2006 Lic # 617238 A, B, Haz Inspector Toua Yang Contact Richard Walton Phone # 209-468-9847 Phone # 916-825-3203 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (check the appropriate boxes to indicate equipment inspected/serviced) 131: TANKS Tank #1 (Product): Gasoline - 87 #2 (Product): Gasoline - 91 [T�ank ■ In -Tank Gauging Probe Model: 0847390-109 In -Tank Gauging Probe Model: 0847390-109 ■ Annular Space or Vault Sensor Model: 0794380-303 ■ Annular Space or Vault Sensor Model: 0794380-303 ■ 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: Vaporless LD -2000 ■ Mechanical Line Leak Detector Model: Vaporless LD -2000 ❑ Electronic Line Leak Detector Model: ❑ Electronic Line Leak Detector Model: El Tank Overfill /High -Level Sensor Model: ❑ Tank Overfill /High -Level Sensor Model: _ � 1-1 Other (specify equipment in Section E) Model:- El Other (specify equipment in Section E) Model: _- _ Tank #3 (Product): Tank #4 (Product): ❑ In -Tank Gauging Probe Model: ❑ In -Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump I Trench Sensor(s) Model: ❑ Piping Sump I Trench Sensor(s) Model: ❑ 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: ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model. ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: 132: DISPENSERSIUDC's Dispenser # : 1-2 Dispenser # : 3-4 ■ Dispenser Containment Sensor(s) Model: 0847990-0.01 ■ Dispenser Containment Sensor(s) Model: 0847990-001 ■ Shear Valves El Dispenser Containment Float(s) and Chain(s) ■ Shear Valves ❑ 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 Chains) Dispenser # : Dispenser # ❑ Dispenser Containment Sensor(s) Model: ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chains) ❑ Dispenser Containment Float(s) and Chaln(s) C. CERTIFICATION 1 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): ■ System set-up ■ Alarm History Report WALTON Signature: ENGINEERING, INC. Technician / Cert #: Bruce N. Stewart / A31131 5249892 -UT Date: August 23, 2006 u zum wanon engmeenng, Inc.