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MONIT(WING SYSTEM CERTIf`ATION CERTIFICATION /TEST DATE: July 13. 2011 Al. FACILITY ❑ No* Is the audible alarm operational? A2. OWNER ❑ No * Name BW # 98 H & M Market ❑ No* Name Boyett Petroleum Address 2501 E. Jackson Avenue, Escalon, CA 95320 Address 601 McHenry Avenue, Modesto, CA 95350 Phone # 209-838-3971 If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modems) Phone # 209-577-6000 Contact Rohda Henry ❑ No* Contact Rohda Henry D. RESULTS OF TESTING / SERVICING Make / Model of Monitoring System: Veeder-Root TLS -350 Software Version Installed: 330.01 Complete the following checklist: ■ Yes ❑ No* Is the audible alarm operational? ■ Yes ❑ No * Is the visual alarm operational? ■ Yes ❑ No* Were all sensors visually inspected, functionally tested, and confirmed operational? ■ Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ■ Yes ❑ No * If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modems) ❑ N/A operational? ■ Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ❑ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shutdown? (check all that apply) ■ Sump/Trench sensors; ❑ Dispenser Containment Sensors. ■ Yes ❑ No * Did you confirm positive shut -down due to leaks and sensor failure/disconnection? ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ■ N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? _ % ❑ Yes * ■ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. ■ Yes * ❑ No Was any liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑ Product; ■ Water. If yes, describe causes in Section E, below. ■ Yes ❑ No* Was monitoring system set-up reviewed to insure proper settings? Attach set-up reports, if applicable. ■ Yes ❑ No* Is all monitoring equipment operational per manufacturer's specifications? x In Section E below, describe how and when these deficiencies were or will be corrected. E. COMMENTS Removed a small amount of water from the 91 and diesel STP sumps. 91 and diesel are a split tank with a single annular. Page 2 of 3