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MONITC+ ING SYSTEM CERTIP A MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root CERTIFICATION /TEST DATE: July 28. 2014 A7. FACILITY Name Pacific Pride Address 351 N. Beckman Road, Lodi, CA 95240 Phone # Contact A2. OWNER Name California Gas IMM OMENTAL HEALTH Address 1399 E. Yosemite Avenue[ [aOMEW Phone # Contact Ted Guzman A3. C U P A INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) B1: TANKS A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 1868 E. Hazelton Avenue, Stockton, CA 95202 Tank #1 (Product): Red Diesel ❑ In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390420 ❑ Piping Sump / Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: Address P.O. Box 1025, W. Sacramento, CA 95691 Notified July 18, 2014 Lic # 617238 A, B, Haz Inspector Aris Veloso Model: Model: Model: Model: Model: Red Jacket FX Model: Model: Model: Contact Dulcinea Covan Phone # 209-468-8257 Phone # 916-373-1166 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) B1: TANKS Tank #1 (Product): Red Diesel ❑ In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390420 ❑ Piping Sump / Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: Tank #2 (Product): Gasoline - 91 ❑ In -Tank Gauging Probe ❑ Annular Space or Vault Sensor ❑ Piping Sump / Trench Sensor(s) ❑ Fill Sump Sensor(s) ■ Mechanical Line Leak Detector ❑ Electronic Line Leak Detector ❑ Tank Overfill / High -Level Sensor ❑ Other (specify equipment in Section E) Model: Model: Model: Model: Model: VMI 99LD-2000 Model: Model: Model: Tank #3 (Product): Gasoline - 87 ❑ In -Tank Gauging Probe Model: ❑ Annular Space or Vault Sensor Model: ❑ Piping Sump / Trench Sensor(s) Model: ❑ Fill Sump Sensor(s) Model: ■ Mechanical Line Leak Detector Model: VMI 99LD-2000 ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Other (specify equipment in Section E) Model: Tank #4 (Product): Diesel ❑ In -Tank Gauging Probe ❑ Annular Space or Vault Sensor ❑ Piping Sump / Trench Sensor(s) ❑ Fill Sump Sensor(s) ■ Mechanical Line Leak Detector ❑ Electronic Line Leak Detector ❑ Tank Overfill / High -Level Sensor ❑ Other (specify equipment in Section E) Model: Model: Model: Model: Model: Red Jacket FX Model: Model: Model: 62: DISPENSERS/UDC's Dispenser # : 1-2 ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : 3-4 ❑ Dispenser Containment Sensor(s) ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Model: Dispenser # : 5-6 ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : 7-8 ❑ Dispenser Containment Sensor(s) ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Model: Dispenser # : 9-10 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : 11-12 ❑ Dispenser Containment Sensor(s) Model: ❑ Shear Valves ❑ Dispenser Containment Float(s) 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 all that apply): ■ System set-up ■ Alarm History Report Signature: Lac WALTON ENGINEERING, INC. Technician / Cert M Curtis Carpenter / B37258 8020679 Date: July 28, 2014