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A//tech lip Compliance without Compromise A. Facility General Inf__ ormation Facility Name: Costco # 1031 Manteca Facility Address: 2440 Daniel St., Manteca CA Facility Contact Person: Dave Zizzo (Ser. Sta. Supervisor); LIA: San Joaquin Health Make/Model of Monitoring System: Veeder-Root TLS -350 Tank ID: Unleaded 87A Tank t ®In -Tank Gauging Probe. oTank Annular Space Sensor. Model: Mag plus ®Piping Sump Sensor(s). Model: 794380.301) ®Piping Sump Annular: Model: 857080-112 ®Fill Sump Senspr(s). Model: 794380-304 Zc Fill Sump annular Model: 794380.323 Secondary Piping monitor Model: 794380.304 ]Electronic Line Leak Detector. DTank Overfill/ High -Level Sensor. Type: Vacuum Model: V -R PLLD Rl Filisnill Ru.6... t...._a. Model: V -R Audible _ Tank ID: Unleaded 91 Tank 3 min -Tank Gauging Probe. Model: Mag Plus BTank Annular Space Sensor. Mode,: 794380-301 ®Piping Sump Sensor(,). Model: 857080-112 ®Piping Sump Annular: Model: 794380-304 ®Fill Sump Sensor(s). Model: 794380.323 ®Fill Sump annular Model: 794380.304 SSecondary Piping monitor Type: Vacuum ®Electronic Line Leak Detector. Model: PLLD ®Tank Overfill/ High -Level Sensor. Model: V -R Audible © Fillspol Bucket Tested: ®Pass ❑F: Dispenser ID: 1&2 ® Sump: ®Dry❑Water ❑Product ®Dispenser Containment Sensor(s). Model: 794380.323 m UDC Annular sensor. Model: 794380-304 ®Shear Valves) (Functional test) Dispenser ID: 5&6 ©Sump: ®Dry ❑Water ❑Product (21nispenser Containment Sensor(s). Model: 794380-323 OUDC Annular sensor. Model: 794380-304 m Shear Valves) (Functional test) Dispenser ID: 9&10 ® Sump: ®Dry ❑Water ❑Product �]t Dispenser Containment Sensor(s). Model: 794380.323 21 UDC Annular sensor. Model: 794380-304 penser to: 13&14 DQ Sump: ®Dry ❑Water ❑rrodu Dispenser Containment Sensor(s). Model: 794380-323 UDC Annular sensor. Model: 794380.304 Dispenser ID: Vent Stack Transition Sump ® Sump: ®Dry ❑Water ❑Product ® UDC Sump Containment Sensor(s). Model: 794380-323 Sensor Installed but not Technician: ii� Certification UVeeder-Root 836878, Level 4 ICC UST Service Technician # 8146912 -UT 0 P.O. Bax 4708 Sonars CA 95370 Lr. 623541 A -Naz Phone 209.532-7320 Fax: 209-533.2650 Date of Testing: Thursday, August 18, 2016 Facility Phone: 209-824_2860 Inspector: Stacy Rivera. Tank ID: Unleaded 87B Tank 2 ®In -Tank Gauging Probe. Model: Mag Plus ®Tank Annular Space Sensor. Model: Mag Plus ®Piping Sump Sensor(s), Model: 794380.301 ®Piping Sump Annular: Model: 857080.112 Fill Sump Sensor(,). Model: 794380.304 BFill Sump annular Model: 794380.323 0a5econdary Piping monitor Model: 794380-304 pt Electronic Line Leak Detector. Type: Vacuum X]Tank Overfill/ High Model: V -R PLLD Z3r.tl-_.,. _ . _ -Level Sensor. Model: V -R Anrrlhh. Tank ID: Fuel Additive Tank ®In -Tank Gauging Probe. ®Tank Annular Space Sensor. Model: Mag Plus ®Piping/Fiil Sump Sensor(s). Model: 794380.301 ®Piping/Fill Sump Annular: ®Secondary Piping monitor Model: 794380.323 Model: 794380-304 ®Mechanical Line Leak Detector. ®Tank Overfill/ High -Level Sensor. Type: Vacuum Model: FE Petro ® Fillspill Bucket Tested: Model: V -R Audible ®Pass ❑Fail Dispenser ID: 3&4 ®Sump: ®Dry ❑ Water ❑product ®Dispenser Containment Sensor(s). Model: 794380.323 ®' UDC Annular sensor. Model: 794380-3D4 2IShear Valve(s) (Functional test) Dispenser ID: 7&8 ®Sump: ®Ory ❑Water ❑Product SIDispenser Containment Sensor(s). Model: 794380.323 0 UDC Annular sensor. Model: 794380-304 ZlShear Valve(s) (Functional test) ))Spenser 1D: 11&12 ® Sump: ®Dry ❑Water ❑Produc 90ispenser Containment Sensor(s). Model: 794380.323 UDC Annular sensor. Model: 794380-304 ]Shear Valve(s) (Functional test) lispenser ID: 1 S&16 ® Sump: ®D ry D Dispenser Containment Sensor(s). Model: 7943Water 380.323 c UDC Annular sensor. Model: 794380.304 _ Dispenser ID: Additive Tank Vent Sump ® Sump: ®Dry ❑ Water ❑Product ® UDC Sump Containment Sensor(s). Model: 794380.323 Stl Iln, [._ ._.. . Date: 08/18/16