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MONITORING SYSTEM CERT ATION <br />CERTIFICATION /TEST DATE: July 29, 2013 <br />Al. FACILITY A2. OWNER <br />Name Quik Stop Market #148 Name Quik Stop Markets, Inc. <br />Address 205 W. Lockeford Street, Lodi, CA 95240 Address 4567 Enterprise Street, Fremont, CA 94538 <br />Phone # 510-657-8500 Phone # 510-657-8500 <br />Contact Michael Karvelot Contact Michael Karvelot <br />D. RESULTS OF TESTING / SERVICING <br />Make / Model of Monitoring System: Gilbarco EMC SN# <br />Software Version Installed: 327.04 <br />Complete the following checklist: <br />■ Yes <br />❑ No* <br />Is the audible alarm operation. <br />■ Yes <br />❑ No * <br />Is the visual alarm operational <br />■ Yes <br />❑ No * <br />Were all sensors visually inspi <br />■ Yes <br />❑ No* <br />Were all sensors installed at Ic <br />will not interfere with their pro, <br />❑ Yes <br />❑ No* <br />If alarms are relayed to a remo <br />■ N/A <br />operational? <br />■ Yes <br />❑ No* <br />For pressurized piping system <br />❑ N/A <br />monitoring system detects a le <br />positive shutdown? (check all <br />■ Yes <br />❑ No* <br />Did you confirm positive shut -i <br />❑ Yes <br />❑ No* <br />For tank systems that utilize th <br />■ N/A <br />mechanical overfill prevention <br />fill point(s) and operating props <br />❑ Yes * <br />■ No <br />Was any monitoring equipmen <br />and list the manufacturer name <br />■ Yes * <br />❑ No <br />Was any liquid found inside an <br />(Check all that apply) ❑ Prod <br />■ Yes <br />❑ No* <br />Was monitoring system set-up <br />■ Yes 1 <br />El No * <br />Is all monitoring equipment opo <br />* in Section E below, describe how and when these deficiencies were or will be corrected. <br />80850113305001 <br />E. COMMENTS <br />Replaced the backup battery in the EMC console. <br />Removed liquid from the 87, 89, and 91 STP sumg <br />Page 2 of 3 <br />