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Al/tech <br />Fu <br />Compliance without compromise <br />A Facility General Information <br />Facility Name: Costco # 1031 Manteca <br />Facility Address: 2440 Daniel St., Manteca CA <br />Facility Contact Person: Dave Zizzo (Ser. Sta. Supervisor); <br />LIA: San Joaquin Health <br />Make/Model of Monitoring System: Veeder-Root TLS -350 <br />B. Inventnry of <br />u <br />P.O. Box 4108 <br />Sonora CA 95370 <br />Ca: 623541 A -H,, <br />Phone: 209-532-7320 <br />Fax: 209-533-2650 <br />Date of Testing: Thursday, August 18, 2016 <br />Facility Phone: 209-824-2860 <br />Inspector: Stacy Rivera. <br />Tank ID: Unleaded 87A Tank 1 <br />ED In -Tank Gauging Probe. Model: Mag Plus <br />®Tank Annular Space Sensor. <br />Tank ID: Unleaded 878 Tank 2 <br />Gauging Probe. Model: <br />Model: 794380-301 <br />®Piping Sump Sensor(s). <br />() Model: 857080.112 <br />®Piping Sump Annular: <br />Mag Plus <br />STank A <br />®Tank Annular Space Sensor. Model: 794380-301 <br />®Piping Sump Sensor(s). <br />Model: 794380-304 <br />®Fill Sump Sensor(s). Model: 794380-323 <br />®Fill Sump annular <br />Model: 857080.112 <br />®Piping Sump Annular: Model: 794380-304 <br />®Fill Sump Sensor(s). <br />Model: 794380-304 <br />®Secondary Piping monitor Type: Vacuum <br />®Electronic Line Leak Detector. <br />Model: 794380-323 <br />®Fill Sump annular Model: 794380-304 <br />®Secondary Piping monitor T <br />Type: <br />Model: V -R PLLD <br />®Tank Overfill / High -Level Sensor. Model: V -R Audible <br />N Fills ill Bucket Tested: <br />Vacuum <br />OTankrOve Line Leak Detector. Model: V -R LLD <br />®Tank Overfill/ High -Level Sensor. <br />NPdSS ❑Fail <br />Tank to: Unleaded 91 Tank 3 <br />Model: V -R Audible <br />Audible <br />N Fills ill Bucket Tested: ®Pass ❑Fail <br />Nln-Tank Gauging Probe. Model: Ma Plus <br />9 <br />NTank Annular Space Sensor. <br />Tank ID: Fuel Additive Tank <br />Nln-Tank Gauging Probe. Model; <br />Model: 794380-301 <br />NPiping Sump Sensor(s). Model: 857080.112 <br />NPiping Sump Annular: <br />Mag Plus <br />NTank Annular Space Sensor. Model: 794380-301 <br />NPiping/Fill Sump Sensor(s). <br />F. Model: 794380-304 <br />[@Fill Sump Sensor(s). Model: 794380-323 <br />NFill Sump annular <br />Model: 794380-323 <br />Pi m <br />® p g/Fill Sump Annular: Model: 794380-304 <br />NSecondary Piping monitor <br />NSeconda Piping monitor Model: 794380-304 <br />rY P 9 Type: Vacuum <br />NElectronic Line Leak Detector. <br />Type: Vacuum <br />NMechanical Line Leak Detector. Model: FE Petro <br />NTank Overfill / High -Level Sensor. Model; <br />Model: PLLD <br />[RTank Overfill / High -Level Sensor. Model: V -R Audible <br />V -R Audible <br />N Fillspill Bucket Tested: NPass ❑Fail <br />[@ Fillspill Bucket Tested: NPass []Fail <br />Dispenser ID: 1&2 N Sump: [@Dry ❑Water []Product <br />NDispenser Containment Sensor(s). Model: 794380-323 <br />Dispenser ID: 3&4 Sum <br />® P: [@Dry' ❑Water ❑Product <br />NUDC Annular sensor. Mode[: 794380-304 <br />Dispenser <br />0. UDC <br />05hear Valve(s) (Functional test) <br />odel:(79Model:794380-323 <br />Annular sensor. Model: 794380-304 <br />1z Shear Valve(s) (Functional test) <br />Dispenser ID: 5&6 N Sump: NDry ❑Water ❑Product <br />NDispenser Containment Sensor(s). Model: 794380-323 <br />Dispenser ID: 7&8 N Sum p' ®Dry ❑Water ❑product <br />NUDC Annular sensor. Model: 794380-304 <br />N5hear Valve(s) (Functional test) <br />NDispenser Containment Sensor(s). Model: 794380-323 <br />N UDC Annular sensor. Model: 794380-304 <br />ID: 9&10 N Sump: NDry []Water ❑Product <br />®Shear Valves) (Functional test) <br />NDispenser <br />Dispenser Containment Sensor(s). Model: 794380.323 <br />N UDC Annular <br />Dispenser ID: 11&12 N Sump: NDry ❑Water ❑product <br />NDispenser Containment Sensor(s). Model: <br />sensor. Model: 79438ol: <br />N5hear Valve(s) (Functional test) <br />794380-323 <br />N UDC Annular sensor. Model: 794380-304 <br />05hear Valves) (Functional test) <br />Dispenser ID: 13&14 N Sump: NDry ❑Water []Product <br />NDispenser Containment Sensor(s). Model: 794380-3230 <br />N UDC Annular <br />Dispenser to: 15&16 Sump: NDry ❑Water ❑product <br />NDispenser Containment Sensor(s). <br />sensor. Model: 794380-304 <br />NShear Valve(s) (Functional test) <br />Model: 794380-323 <br />N UDC Annular sensor. Model: 794380.304 <br />Dispenser ID: Vent Stack Transition Sump <br />NShear Valve(s) (Functional test) <br />Sum D <br />P: N ry ❑Water ❑product <br />Dispenser ID: Additive Tank Vent Sump <br />N UDC Sump containment Sensor(s). Model: 794380-323 <br />N Sump: ND rY ❑Water []Product <br />UDC Sum Annular sensor. Model: 794380-304 <br />" Sensor <br />®UDC Sump Containment Sensor(s). Model: 794380-323 <br />NUDC Sump Annular <br />Installed but not operating properly. . <br />I P Y <br />I <br />sensor. Model: 794380-304 <br />Technician: <br />Certification: Veeder-Root 836878, Level 4 <br />Date: 08/18/16 <br />ICC UST Service Technician # 8146912 -UT <br />