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MONn ORING SYSTEM CERTILF1 ATION <br />fibr Use & At Jurisdictions Wthin the S?We qf California <br />Authority Cited: Chz2,v;ter 67, Jkalth and S*V Code; Chapter 16, Division 3, 7Vtle 23, Califorwa Code qf ReRulations <br />This form must,be used to do cement testing and servicing of monitoring equipment,& 91agg cedffiggt <br />ioLorlegd n I b e <br />a -.I %, L_tr A "e <br />for each MQ3342das s by the technician who performs the work A copy of this form must be provided to the tank <br />system ownedopetetor, The Ownedoperdtor must submit a copy of this form to the local agency regtda*UST s3rotems within 30 <br />days of test date. <br />A. General Informatiolm <br />------ ------ <br />FPRODUCTS- ------- <br />�cilityName: ' ARCO - <br />, COMPANY ServiceStationNo.: <br />1 <br />Sate Address : 46oWfiiEd 1 Csty L STOCKTON 95203 <br />MakafModef-ofmDate of Teo <br />B. Inventory of Equipment Tested/Certified <br />Check dw asorooriate bones to inlUcate sPecilfic equbment inswtaftervicaLl <br />Tank ID: l <br />TonkID: <br />;1 -Tank0a <br />Model: <br />Model <br />.gProbe: <br />------ <br />ace VaultSensor <br />Model:--�ixigSurnplTranch- <br />�s; or (a): <br />Model: --7,q4 <br />S renchSensor(s): <br />Moiaj- <br />ill Su�np S or <br />Model: <br />Model: <br />. <br />echanical line Leek Detector <br />ModeL <br />e chenical Line Leek Detector. <br />Model <br />ctronicLine LeakDetectar <br />Modal <br />actronic Line Leak Detector <br />Model: <br />or: <br />W*0vovert_tflumigh-leve <br />Model <br />or. S ocify eauip, type and model in Section E on P e 2 <br />SpecfZ a ie. t and model inSectionE onPage 2 <br />Tankp-. <br />TankID: 'I <br />ank Gauging Probe: <br />M-1-- <br />odef <br />ank!2!a p§e: <br />I Model <br />arS ace orvoultsendor: <br />Modal <br />S ace orvoultsensor <br />Model: <br />SU <br />Model: <br />g!�frrenchoj !! <br />Model <br />iu SuxapSensor(s): <br />M- <br />Model: <br />a eal <br />chanical Line Le!4DeteC!�0!:----,I <br />Model: <br />al Line Leek Detector. <br />1 Model <br />e Zane Leak Detector <br />Model: <br />c Line Leak Detector <br />Model: <br />61*0'redamish-levelsemor: <br />Model -i <br />level Sensor: <br />-e —cim <br />Model 1 <br />--d - -E- <br />ecfX eft e and model in Section E 2af!ge 2 <br />n-- -o­ni-Paige 2 <br />ac' a 92i 2. tM- e o o-lia-S e-c-t-io-n- <br />onset ID: <br />enser Containment Sensors: <br />Model* <br />onser Containment Se&oi<s): <br />Model: <br />Shear <br />j wsarContainmentFIOLUs andCL62us <br />ewer ContainmentFloW <br />and akAsl <br />LheyoussrID: <br />DonserID: <br />' <br />enherco !qSen!L)r!.. <br />Model-, <br />enserContainmontSMsox(o,-, Model: <br />Sheer <br />S hear V!!ncq). <br />. *I and <br />eensarContsinma� LIF16 �W <br />enser <br />angCmin(s) <br />I CQ" <br />'; Model: <br />Dis onser ID: <br />onset Containment Sens <br />Slaealve�slw-----Sheet <br />Valve(si). <br />*If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at this facility. <br />C. Certification -I certify thm the equipment identified is this docw.nentvas hupciedfarviced in a"ordave with the nmufftwl <br />gaidelines, Attaclod to Oh Ce tion is inn teen (e.& man ufacturen'checate) necessaly to verily that this inbrauaieR is <br />cornet and a Fbt Pians dile layout of monitexing eqi4meRt For any equipment capable of genuafinsuh xvports, I haean <br />altar a of (,-:W au that kUte ori <br />Technician Nameffl��- <br />Certification No Ucense No <br />. 1�� <br />�-..---.--..-...-.-----�---- (- X <br />Testing Company Name: TAIT ENVIRONMENTAL SYSTEMS Phone No.: C714) 560-8M <br />Pap 1 of 3gl <br />