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Sep 0904 02: 23p Mik= rotten (20" 1 533-2650 p. l AlItech II. 17759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320; Fate: 209-533-2650 1 '' California Contractor 623541 A-IIaz Mike@AlltechPetro.com ; MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Costco# 658 Tracy bate of Testing/Servicing: September 1, 2004 Facility Address-3250 W. Grant Line Rd,, Tracy CA 95304 Facility Contact Person: Leo Facility Phone: 209-834-1247 LIA: San Joaquin Health; Inspector: Steven Shih; LIA Phone: (209) 468-9850; LIA Fax: (209) 468-3433 Make/Model of Monitoring System: Veeder-Root TLS-350 B. Inventory of Equipment Tested/Certified: Tank ID:Regular 1 Tank Tani:TD:Regular 2 Tank ®In-Tank Gauging Probe. Model:Mag 1 ®In-`Tank Gauging Probe. Modcl:Mag 1 0 Annular Space or Vault Semsor. Model:Single-Float Brine ®Annular Space or Vault Sensor. Model:Single-Float Brine ®Piping Sump Sensor(s). Model:Discriminating Sensor ®Piping Sump Sensor(s). Model:Discriminating Sensor 0 Fill Sump Sensor(s). Model:Discriminating Sensor 0 Fill Sump Sensor(s). Model:Discriminating Sensor ®Mechanical Lute Leak Detector. Model:Vaproless Mechanical Line Leak Detector. Model:Vaporless ❑Electronic Line Leak Detector. Model: []Electronic Line Leak Detector. Model: N Tank Overfill/High-Level Sensor. Model: Tank Overfill/High-Level Sensor. Model:Veeder-Root Audible Fillspill Bucket Tested: NPass ❑Fail 21 Fillspill Bucket Tested: EQPass ❑Fail ®Other Fire LxtinEshers checked and ed N Other Fire exam 'shesr checked and ed Tank ID:Premium Tank;Capacity: Tank ID:Nolte N In-Tank Gauging Probe. Model:Mag 1 ❑In-Tank Gauging Probe. Model: 0 Annular Space or Vault Sensor. Model:Single-Float Brine ❑Annular Space or Vault Sensor. Model: 0 Piping Sump Sensor(s). Model:Discriminating Sensor ❑Piping Sump Sensor(s). Model: ®Fill Stamp Sensor(s). Model:Discr4ninating Sensor ❑Fill Sump Sensor(s). Model: N Mechanical Line Leak Detector. Model:Vaporless ❑Mechanical Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: O'Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model:Veeder-Root Audible ❑Tauk Overfill/High-Level Sensor. Model: ®Fillspill Bucket Tested. ®Pass ❑Fail ❑Fillspill Bucket Tested: ❑Pass []Fail f Other Fire extinguishers checked and to gt, d ❑Other Fire extin 'shcrs checked and tagged Dispenser ID: 1&2 0 Sump:RDry❑Water❑Product Dispenser[D: 3&4®Sump:Srhy❑Water©Product ®Dispenser Containment Sensor(s). Model:Non-Discriminating 0 Dispenser Containment Sensor(s), Model:Non-Discriminating N Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) ®Fire isher checked and tagged ❑Fire extinguisher checked sand to ed Dispenser ID:5&6 N Sump: ®Dry❑Water[]Product Dispenser ID: 7&8 ®Sump:EDry❑Water[]Product ®Dispenser Containment Sensor(s). Model:Non-Discriminating 0 Dispenser Containment Sensor(s). Model:Non-Discriminating ®Shear Valve(s) (Functional test) N Shear Valve(s) (Functional test) N Fire extinguisher checked and to ed N Fire exon isher checked and tagmed Dispenser lU: 9&10®Sump:( Dry❑Water[]Product Dispenser ID: 11&12[K Sump:®Dry❑Water❑Product ®Dispenser Containment Sensor(s). Model:Non-Discriminating N Dispenser Containment Sensor(s). Model:Non-Discriminating ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) N Fire extin isher checked and taQaed N Fire exon 'sher checked and to ed Dispenser ID: 13&a 14® Sump: NDry❑Water❑Product Dispenser ID: 15&16 M Sump:EDry❑Water❑Product N Dispenser Containment Sensor(s). Model:Non-Discriminating ®Dispenser Containment Sensor(s). Model:Non-Discriminating 1 ®Shear Valve(s) (Functional test) N Shear Valve(s) (Functional test) ❑Fire extinguisher checked and to ed p ❑Fire extinguisher checked and!aged C_ Certification-I certify that the equipment identified In this docorment%us inspected/serviced in accordance with the manufacturers'guldeline%. Attached to this Certification is a Plot flan shoving the layout ofmonitoring equipment. For any equipment capable of generating such reports,I have also attached a copy of the report, M System set-up 0 Alarm history report x- MikeDotter,California Contractor 623541 A-Flat Technician: Vfdy. Certification:Veeder-Root:006-05-0789;Level 4.