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PETRO- CHZ ENVIRONMENTAAERVICES MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code;Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment.A separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: UNITED PARCEL SERVICE Date of Certification/Testing Services:6/15/2010 Site Address: 1532 NORTH BROADWAY City/State: STOCKTON,CA Zip: 95205 Facility Contact Person:HERMAN MEYER-PLANT ENGINEERING Contact Phone No.:(916)373-4002 Make of Monitoring System:VEEDER-ROOT TLS-350 Model No.:0847090-022 Serial No.:UNAVAILABLE B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicatespecific equipment ins ected/serviced: Tank ID: Tl:DIESEL Annular Space or Vault Sensor. Model: Ll:Veeder-Root#302 Tank Comments: Piping Sump/Trench Sensor(s). Model: L2:Veeder-Root#208 Mechanical Line Leak Detector. Model: Voorless 99LD2000 ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill/High-Level Sensor. Model: ❑ Other(specify equipment a and model in Section E on P e 2). Dispenser ID: #1-2 DIESEL Dispenser Comments: 0 Dispenser Containment Sensor(s). Model:Veeder-Root#001 [7� Shear Valve(s). *If the facility contains more tanks or dispensers,copy this form. Include information for every tank and dispenser at the facility. 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 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): [I System set-up 1 Alarm history report Technician: Dan Zeman Signature Company Name: PETRO-TECHZ Environmental Services Company Address: P.O.Box 29 aradise CA 95967-2941 Company Phone and Fax No.: (530)680-2905 Fax: (530)872-8648 SWRCB Tank ester License No.:#98-1535 Veeder-Root Certification No.:#006-05-1363 Exp.: 4/2012 ICC,CA UST Service Technician Certification No.: 5243781-UT Date/Time of Certification Services:6/15/2010 Cid 9:00 am Inspector Present(Name):Jeff Wong-S.J.Co.E.H.D. Page 1 of 5