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P.O.Box 4208 AlitechPetrrra= Sonora 370 Ca:623541 A-Haz Phone:209-5353 2-7-7320 Compliance without Compromise Fax:209-533-2650 mail(_@alltechpetro.com MONITORING SYSTEM CERTIFICATION www.alltechpetro.com A. General Information E�EIVE Facility Name: Costco # 038 Stockton Date of Testing/Servicing: March 5, 2015 Facility Address:1616 W. Hammer Lane, Stockton CA MAR 17 2015 Facility Contact Person: Raj Mohan (Ser. Sta. Supervisor); Facility Phone: (209) 478-2040 LIA: San Make/Model oflMonitoringnspector: Fatinah Syst m: Veeder-Root TLS-350; 5IA hone: (209) 468-3448; LIA Fax: ENVIRONMENTAL B. Inventory of Equipment Tested/Certified: HEALTH�vvAlxrte�nlT Tank ID: Unleaded 87A Tank 1 Tank ID: Unleaded 87B Tank 2 •In-Tank Gauging Probe. Model: Mag 1 Min-Tank Gauging Probe. Model: Mag 1 ®Tank Annular Space Sensor. Model: 794380-301 ®Tank Annular Space Sensor. Model: 794380-301 ®Piping Sump Sensor(s). Model: 857080-112 ®Piping Sump Sensor(s). Model: 857080-112 ®Fill Sump Sensor(s). Model: 794380-323 ®Fill Sump Sensor(s). Model: 794380-323 ®Fill Sump Annular Sensor. Model: 794380-304 ®Fill Sump Annular Sensor. Model: 794380-304 ®Electronic Line Leak Detector. Model: PLLD ®Electronic Line Leak Detector. Model: PLLD ®Tank Overfill/High-Level Sensor. Model:V-R Audible ®Tank Overfill/High-Level Sensor. Model:V-R Audible • Fillspill Bucket Tested: ®Pass ❑Fail E Fillspill Bucket Tested: ®Pass ❑Fail • Fire extinguishers inspected and tagged: ECK ❑Not OK • Fire extinguishers inspected and tagged: EOK❑Not OK Tank ID: Unleaded 91 Tank 3 Tank ID: Fuel Additive Tank 4 • In-Tank Gauging Probe. Model: Mag 1 •In-Tank Gauging Probe. Model: Mag 1 NAnnular Space Sensor. Model: 794380-301 ETank Annular Space Sensor. Model: 794380-303 •Piping Sump Sensor(s). Model: 857080-112 •Piping/Fill Sump Sensor(s). Model: 794380-323 •Fill Sump Sensor(s). Model: 794380-323 •Piping/Fill Sump Annular Sensor. Model: 794380-304 •Fill Sump Annular Sensor. Model: 794380-304 NMechanical Line Leak Detector. Model: Fe Petro EElectronic Line Leak Detector. Model: PLLD •Tank Overfill/High-Level Sensor. Model: V-R Audible ETank Overfill/High-Level Sensor. Model:V-R Audible N Fillspill Bucket Tested: •Pass ❑Fail • Fillspill Bucket Tested: •Pass ❑Fail E Fire extinguishers inspected and tagged: •OK ❑Not OK • Fire extinguishers inspected and to ed: EOK ❑Not OK Dispenser ID: 1&2 E Sump: EDry❑Water❑Product Dispenser ID: 3&4 E Sump: EDry❑Water❑Product NDispenser Containment Sensor(s). Model: 794380-208 •Dispenser Containment Sensor(s). Model: 794380-208 •Shear Valve(s) (Functional test) •Shear Valve(s) (Functional test) • Fire extinguisher inspected and to ed: NOK ❑Not OK E Fire extinguisher inspected and tagged: NOK ❑Not OK Dispenser ID: 5&6 N Sump: NDry❑Water❑Product Dispenser ID: 78,8 E Sump: •Dry[]Water❑Product •Dispenser Containment Sensor(s). Model: 794380-208 •Dispenser Containment Sensor(s). Model: 794380-208 •Shear Valve(s) (Functional test) EShear Valve(s) (Functional test) N Fire extinguisher inspected and to ed: NOK ❑Not OK N Fire extinguisher inspected and tagged: EOK []NotOK Dispenser ID: 98,10 N Sump: EDry❑Water[]Product Dispenser ID: 11&12 N Sump: NDry❑Water E]Product E Dispenser Containment Sensor(s). Model: 794380-208 •Dispenser Containment Sensor(s). Model: 794380-208 EShear Valve(s) (Functional test) •Shear Valve(s) (Functional test) E Fire extinguisher inspected and tagged: EOK ❑Not OK E Fire extinguisher inspected and tagged: EOK ❑Not OK Dispenser ID:Vent Stack N Sump:NDry❑Water❑Product Dispenser ID:Adtiv Vent N Sump:NDry❑Water[]Product •Sump Containment Sensor(s). Model: 794380-323 •Sump Containment Sensor(s). Model: 794380-323 •Sump Annular Sensor(s). Model: 794380-304N Sump Annular Sensor(s). Model: 794380-304 • Fire extinguisher inspected and tagged: NOK ❑Not OK • Fire extinguisher inspected and to ed: •OK ❑Not OK 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 a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports,I have also attached a copy of the report; ®System set-up ®Alarm history report Technician: Date: 3/5/15 Certification: Veeder-Root 636878, Level 4 ICC UST Service Technician # 8146912-UT