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MONI*MNG SYSTEM CERTIF*kTION 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 7 9 77r.,.7 7 , j, 7 7 17771 A � 1: IF; 1 f " FT771 7.17, �-. � F-41 1777 1'- 7 7 1 7 = 7 1 7W -, T•77 7 _7 7 7 , E - 7 7 11 -7 7 -, T 7 , 777 17 7 r, 7 - 7A 7 777 17 1 - 7 r T 7 7, , T 1w, "P 1P, RR P. I 7 T1 x-; 01 Facility Name: —AT&T Corp. GEOPAR# CAK482 CLLC Code: LODICA02 Site Address: 110 W. Turner Road City: Lodi Zip: 95240 Facility Contact Person: Connie Mitchell Contact Phone No.: 20474-4022 Make/Model of Monitoring System: VEEDER ROOT TLS 350 PLUS Date of Testing/Service: 1/28/08 B. Inventory of Equornent TestedCor~ Check the appropriate boxes to indicate sM!fic ui ment ins l iected/serviced: Tank ID: 605 Tank ID: ®In -Tank Gauging Probe: Model: 846390-109 Elln-Tank Gauging Probe: Model: ®Annular Space or Vault Sensor: Model: 794390-420 E]Annular Space or Vault Sensor Model: ®Piping Sump/Trench Sensor (s): Model: 794380-208 E]Piping Sump/Trench Sensor (s): Model: []Fill Sump Sensor (s): Model: OFill Sump Sensor (s): Model: ElMechanical Line Leak Detector. Model: DMechanical Line Leak Detector. Model: DElectronic Line Leak Detector Model: 013lectronic Line Leak Detector Model: []Tank Overfill High-level Sensor: Model: []Tank Overfill/High-level Sensor: Model: ®Other, Specify equ!p. !)Te and model in Section E on Pa e 2 00ther, Specia ega. !Me and model in Section E on Pa e 2 Tank ID: Tank ID: []In -Tank Gauging Probe: Model: []In -Tank Gauging Probe: Model: E]Annular Space or Vault Sensor: Model: E]Annular Space or Vault Sensor Model: OPiping Sump/Trench Sensor (s): Model: []Piping Sump/Trench Sensor (s): Model: E]Fill Sump Sensor (s): Model: 0Fill Sump Sensor (s): Model: []Mechanical Line Leak Detector. Model: []Mechanical Line Leak Detector. Model: ElElectronic Line Leak Detector Model: rlElectronic Line Leak Detector Model: []Tank Overfill/High-level Sensor: Model: E]Tank Overfill/High-level Sensor: Model: 00ther, §pScify equ!p. e and model in Section E on Page 2 00ther, SpecLeqHip. e and model in Section E on Pae 2 Dispenser ID: Dispenser ID: ODispenser Containment Sensor(s): Model: ElDispenser Containment Sensor(s): Model: [I Shear Valve(s). [I Shear Valve(s). DDispenser Containment Float(s) and Chain(s) EIDispenser Containment Float(s) and Chas) Dispenser ID: Dispenser ID: ElDispenser Containment Sensor(s): Model: ElDispenser Containment Sensor(s): Model: 0 Shear Valve(s).[I Shear Valve(s). ODigenser Containment Float(L) and Chain(s) ODispenser Containment Float s) and Chain(s) Dispenser ID: Dispenser ID: 013ispenser Containment Sensor(s): Model: []Dispenser Containment Sensor(s): Model: [I Shear Valve(s). [I Shear Valve(s). ODiTenser Containment Float(s),and Chas) p ElDispenser Containment Float(s) and Chain(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 ins 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): 0 System set-up 0 All" history report Technician Name (Print): John Cascio Signature: - Certification No.: B35337 License No.: _$098 Testing Company Name: TAIT ENVIRONMENTAL SERVICES — Phone No.: (714) 560-8222