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MONITORING SYSTEM CERTIFI MAKE / MODEL OF MONITORING SYSTEM : Veeder- Root TLS -350 CERTIFICATION / TEST DATE : September 17 , 2018 I . FACILITY Al OWNER Name Teichert Mobile Equipment Name Teichert Construction Address 120 Frank Circle , Stockton, CA 95206 Address P.O . Box 15002, Sacramento, CA 95851 Phone # 916-366-8631 Phone # 9164864767 Contact Steve Schamaun contact Steve Schamaun A3 . C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering , Inc . Address 1868 E . Hazelton Avenue, Stockton , CA 95202 Address P. O. Box 1025, W. Sacramento, CA 95691 Notified September 05, 2018 Lic # 617238 A, B, Haz Inspector Stacey Contact Veronica Freitas Phone # 209m468=3442 Phone # 916-3734166 Be INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) _ B1 : TANKS Tank #1 ( Product) : C1 -Diesel Tank #2 ( Product) : C1 -Gasoline - 87 ❑ InJank Gauging Probe Model : _ N In-Tank Gauging Probe Model : 0847390409 Annular Space or Vault Sensor Model : 0794390=309 0 Annular Space or Vault Sensor Model : 0794390409 Piping Sump / Trench Sensor(s) Model : 0794380408 0 Piping Sump I Trench Sensor(s) Model : 0794380408 ❑ Fill Sump Sensor(s) Model : _ ❑ Fill Sump Sensor(s) Model : ❑ Mechanical Line Leak Detector Model : ❑ Mechanical Line Leak Detector Model : Electronic Line Leak Detector Model : 0848480-001 _ Electronic Line Leak Detector Model : 0848480-001 ❑ Tank Overfill / High-Level Sensor Model : Tank Overfill / High -Level Sensor Model : 0847390.109 _❑ Other (specify equipment in Section E) Model : I ❑ Other (specify equipment in Section E) Model: F Tank #3 ( Product) : WO-7 Used Waste Oil Tank #4 ( Product) : Lube 30-30 10 In •Tank Gauging Probe Model : 0847390-109 _ _ ❑ In•Tank Gauging Probe Model : Annular Space ' or Vault Sensor Model : 0794390=409 _ Annular Space or Vault Sensor Model : 0794390420 ❑ Piping Sump / Trench Sensor(s) Model : ❑ Piping Sump / Trench Sensor(s) Model : Fill Sump Sensor(s) Model : 0794380408 _ _ ❑ Fill Sump Sensor(s) Model : ❑ Mechanical Line Leak Detector Model : _ ❑ Mechanical Line Leak Detector Model: ❑ Electronic Line Leak Detector Model : _ ❑ Electronic Line Leak Detector Model : _ Tank Overfill / High -Level Sensor Model : 0847390-109 _ _ ❑ Tank Overfill / High •Levei Sensor Model : ❑ Other (specify equipment in Section E) Model : ❑ Other (specify equipment In Section E) Model : 132 : DISPENSERS/UDC's Dispenser # : 1 -2 spenser # : 34 Dispenser Containment Sensor(s) Model : 0794380.208 Dispenser Containment Sensor(s) Model : 0794380408 . Shear Valves Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : Dispenser # ❑ Dispenser Containment Sensor(s) Model : ❑ Dispenser Containment Sensor(s) Model : ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain(s) ❑ Dispenser Containment Float(s) and Chain(s) Dispenser # : Dispenser # ❑ Dispenser Containment Sensor(s) Model : ❑ Dispenser Containment Sensor(s) Model : ❑ Shear Valves ❑ Shear Valves ❑ Dispenser Containment Float(s) and Chain (s) ❑ Dispenser Containment Float(s) and Chains) 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 a Piot 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) : System N Alarm Histog Report IN ALTOPd Signature : Technician / Cert M Curtis Carpenter / B37258 8020679 Date : September I Z 2018 2078 Walton Engineering, Inc.