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MONIT4WING SYSTEM CERTIFWATION MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS -350 CERTIFICATION /TEST DATE: December 15. 2006 Al. FACILITY INVENTORY OF EQUIPMENT TESTED/CERTIFIED A4. TESTING CONTRACTOR A2. OWNER San Joaquin County Environmental Health Name Bonfare Market # 35 Address Name Bonfare Markets, Inc. Address 15 W. Grant Line Road, Tracy, CA 95376 November 30, 2006 Address 25064 Viking Street, Hayward, CA 94545 Phone # 209-833-9619 Contact Phone # 510-732-5700 Contact Sean Kapoor 916-825-3203 Contact Sean Kapoor A3. C U P A INVENTORY OF EQUIPMENT TESTED/CERTIFIED 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 November 30, 2006 Lic # 617238 A, B, Haz Inspector Willy Ng 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 - 91 Tank #2 (Product): Gasoline - 87-1 Syphon ■ In -Tank Gauging Probe Model: 0847390-109 ■ In -Tank Gauging Probe Model: 084739_0-109 ■ Annular Space or Vault Sensor Model: 0794390-420 ■ Annular Space or Vault Sensor Model: 0794390-420 ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ■ Piping Sump I Trench Sensor(s) Model: 0794380-208 ■ Fill Sump Sensor(s) Model: 0794380-208 ■ Fill Sump Sensor(s) Model: 0794380-208 ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector Model: ■ Electronic Line Leak Detector Model: 084_8480-001 ❑ Electronic Line Leak Detector Model: ❑ Tank Overfill / High -Level Sensor Model: ❑ Tank Overfill / High -Level Sensor Model: ~i ! ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Tank #3 (Product): Gasoline - 87-2 Master Tank #4 (Product): ■ In -Tank Gauging Probe Model: 0847390-109 - ❑ In -Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794390-020 ❑ Annular Space or Vault Sensor Model: ■ Piping Sump / Trench Sensor(s) Model: 0794380-208 ❑ Piping Sump / Trench Sensor(s) Model: ' ■ Fill Sump Sensor(s) Model: 0794380-208 El Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Model: ❑ Mechanical Line Leak Detector I Model: ■ Electronic Line Leak Detector Model: 0848480-001 ❑ 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: B2: DISPENSERS/UDC's Dispenser # : 1-2 Dispenser # : 3-4 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ■ Shear Valves ■ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) I ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : 5-6 Dispenser # ■ Dispenser Containment Sensor(s) Model: 0794380-208 ❑ Dispenser Containment Sensor(s) Model: ■ Shear Valves ❑ Shear Valves L ❑ 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 Chains) -- — J ❑ 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 WALTON Signature: +WilXu ENGINEERING, INC. Technician / Cert M Bruce N. Stewart / A31131 5249892 -UT Date: December 1 S, 2006