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P.O. Box 4208 <br />Sonora CA 95370 <br />tech,N ca: 623541 A-Haz <br />AliPhone: 209-532-7320 <br />Compliance without Compromise Fax: 209-533-2650 <br />MONITORING SYSTEM CERTIFICATION for VPH SYSTEMSnail@alltechpetro.com <br />A. Facility General Information <br />Facility Name: Costco # 1031 Manteca Date of Testing: Thursday, August 18, 2011 <br />Facility Address: 2440 Daniel St., Manteca CA <br />Facility Contact Person: Julian Ochoa (Ser. Sta. Supervisor); Facility Phone: <br />LIA: San Jaoquin Health; Inspector: Thuy Tran. <br />Make/Model of Monitoring System: Veeder-Root TLS -350 <br />Tank ID: Regular 1 Tank <br />Tank ID: Regular 2 Tank <br />Model: <br />❑In -Tank Gauging Probe. <br />Model: Mag Plus <br />®In -Yank Gauging Probe. <br />Model: Mag Plus <br />®Tank Annular Space Sensor. <br />Model: 794380-301 <br />®Tank Annular Space Sensor. <br />Model: 794380-301 <br />®Piping Sump Sensor(s). <br />Model 857080-112 <br />®Piping Sump Sensor(s). <br />Model: 857080-112 <br />❑Piping Sump Annular: <br />Model: 794380-304 <br />❑Piping Sump Annular: <br />Model: 794380-304 <br />®Fill Sump Sensor(s), <br />Model: 857080-112 <br />®Fill Sump Sensor(s). <br />Model: 857080-112 <br />®Fill Sump annular <br />Model: 794380-304 <br />EFill Sump annular <br />Model: 794380-304 <br />®Secondary Piping monitor <br />Type: Vacuum <br />®Secondary Piping monitor <br />Type: Vacuum <br />❑Elecrtonic Line Leak Detector. <br />Model: PLLD <br />®Electronic Line Leak Detector. <br />Model: PTLD <br />ZTank Overfill / High -Level Sensor. Model: V -R Audible <br />®Tank Overfill / High -Level Sensor. Model: V -R Audible <br />F� Fillspill Bucket Tested: (Vapor Bucket Failed) ®Pass ❑Fail <br />® Fillspill Bucket Tested: <br />®Pass ❑Fail <br />Tank ID: Premium Tank <br />® In -Tank Gauging Probe. Model: Mag Plus <br />®Tank Annular Space Sensor. Model: 794380-301 <br />®Piping Sump Sensor(s). Model: 857080-112 <br />®Piping Sump Annular: Model: 794380-304 <br />®Fill Sump Sensor(s). Model: 857080-112 <br />®Fill Sump annular Model: 794380-304 <br />®Secondary Piping monitor Type: Vacuum <br />❑Electronic Line Leak Detector. Model: PLLD <br />❑Tank Overfill / High -Level Sensor. Model: V -R Audible <br />® Fillspill Bucket Tested: ®Pass ❑Fail <br />Dispenser ID: 1&2 ❑ Sump: ®Dry ❑Water ❑Product <br />® Dispenser Containment Sensor(s). Model: 794380-323 <br />® UDC Annular sensor. Model: 794380-304 <br />®Shear Valve(s) (Functional test) <br />Dispenser ID: 5&6 ® Sump: ®Dry ❑Water ❑Product <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />UDC Annular sensor. Model: 794380-304 <br />�Shear Valve(s) (Functional test) <br />Dispenser ID: 9&10 ® Sump: ®Dry ❑Water ❑Product <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />® UDC Annular sensor. Model: 794380-304 <br />®ShearValve(s) (Functional test) <br />Dispenser ID: 13&14 ® Sump: ®Dry []water ❑Product <br />(Dispenser Containment Sensor(s). Model: 794380-323 <br />0 UDC Annular sensor. Model: 794380-304 <br />® Shear Valve(s) (Functional test) <br />Dispenser ID: Vent Stack Transition Sump <br />® Sump: ®Dry ❑Water ❑Product <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />® UDC Annular sensor. Model: 794380-304 <br />Sensor installed but not operating pro <br />Technician: 4�� <br />Certification: Veeder-Root B36878, Level 4 <br />ICC UST Service Technician # 8005930 -UT <br />Tank ID: <br />Din -Tank Gauging Probe. <br />Model: <br />❑Tank Annular Space Sensor. <br />Model: <br />❑Piping Sump Sensor(s). <br />Model: <br />❑Piping Sump Annular: <br />Model: <br />❑ Fill Sump Sensor(s). <br />Model: <br />❑Fill Sump annular <br />Model: <br />❑Secondary Piping monitor <br />Type: <br />❑ Line Leak Detector. <br />Model: <br />❑Tank Overfill / High -Level Sensor. Model: <br />❑ Fillspill Bucket Tested: <br />❑Pass ❑Fail <br />Dispenser ID: 3&4 M Sump: MDry ❑Water ❑Product <br />❑Dispenser Containment Sensor(s). Model: 794380-323 <br />®* UDC Annular sensor. Model: 794380-304 <br />®Shear Valve(s) (Functional test) <br />Dispenser ID: 7&8 ❑ Sump: ZDry ❑Water ❑Product <br />® Dispenser Containment Sensor(s). Model: 794380-323 <br />Z UDC Annular sensor. Model: 794380-304 <br />®Shear Valve(s) (Functional test) <br />Dispenser ID: 11&12 0 Sump: [ADry ❑Water ❑Product <br />® Dispenser Containment Sensor(s). Model: 794380-323 <br />UDC Annular sensor. Model: 794380-304 <br />®Shear Valve(s) (Functional test) <br />Dispenser ID: 15&16 E Sump: [ADry ❑Water ❑Product <br />❑ Dispenser Containment Sensor(s). Model: 794384-323 <br />® UDC Annular sensor. Model: 794380-304 <br />®Shear Valve(s) (Functional test) <br />Dispenser ID: ❑ Sump: ❑Dry ❑Water ❑Product <br />[:]Dispenser Containment Sensor(s). Model: <br />❑ UDC Annular sensor, Model: <br />Date: 8/18/11 <br />