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Alltech Petro Inc. 17759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320; Fax: 209-533-2650 California Contractor 623541 A-Haz Mike@AlltechPetro.com MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Costco# Costco 658 Tracy Date of Testing/Servicing: September 20, 2007 Facility Address: 3250 W Grant Line Rd.,Tracy CA 95304 Service Station Supervisor: Robert Mendoza Hut Phone: 834-1247 Warehouse Phone: 830-5343 LIA: San Joaquin Health; Inspector: Willy Ng; LIA Phone: 468-3448; LIA Fax: 468-3433 Make/Model of Monitoring System: Veeder-Root TLS-350 B. Inventory of Equipment Tested/Certified: Tank ID: Regular 1 Tank Tank ID:Regular 2 Tank N In-Tank Gauging Probe. Model:Mag 1 N In-Tank Gauging Probe. Model:Mag l N Annular Space Sensor. Model:794380-201 N Annular Space Sensor. Model:794380-201 N Piping Sump Sensor(s). Model:793380-352 N Piping Sump Sensor(s). Model:793380-352 N Fill Sump Sensor(s). Model:794380-352 N Fill Sump Sensor(s). Model:793380-352 N Mechanical Line Leak Detector. Model:Vaporless LD-2000 N Mechanical Line Leak Detector. Model:Vaporless LD-2000 N Tank Overfill/High-Level Season Model:V-R Audible N Tank Overfill/High-Level Sensor. Model:V-R Audible N Fillspill Bucket Tested: ®Pass ❑Fail N Fillspill Bucket Tested: ®Pass ❑Fail N Fire extinguishers inspected and tagged: NOK []NotOK N Fire extinguishers inspected and tagged: ROK ❑Not OK Tank ID:Premium Tank: Tank to:None N In-Tank Gauging Probe. Model:Mag 1 ❑In-Tank Gauging Probe. Model: ®Annular Space Sensor. Model:794380-201 ❑Annular Space Sensor. Model: ®Piping Sump Sensor(s). Model:793380-352 ❑Piping Sump Sensor(s). Model: N Fill Sump Sensor(s). Model:793380-352 ❑Fill Sump Sensor(s). Model: N Mechanical Line Leak Detector. Model:Vaporless LD-2000 ❑ Line Leak Detector. Model: N Tank Overfill/High-Level Sensor. Model:V-R Audible ❑Tank Overfill/High-Level Sensor. Model: N Fillspill Bucket Tested: ®Pass []Fail ❑Fillspill Bucket Tested: ❑Pass ❑Fail N Fire extinguishers inspected and tagged: ®OK [:]NotOK ❑ Fire extinguishers inspected and tagged: ❑OK []NotOK Dispenser ID: 1&2 N Sump:®Dry❑Water❑Product Dispenser ID:3&4 N Sump:®Dry❑Water❑Product N Dispenser Containment Sensor(s). Model:794380-208 N Dispenser Containment Sensor(s). Model:794380-208 N Shear Valve(s) (Functional test) N Shear Valve(s) (Functional test) N Fire extinguisher inspected and tagged: NOK []Not OK N Fire extinguisher inspected and tagged: NOK []Not OK Dispenser to:5&6 N Sump:®Dry❑Water[]Product Dispenser ID:7&8 N Sump:®Dry❑Water❑Product N Dispenser Containment Sensor(s). Model:794380-208 N Dispenser Containment Sensor(s). Model:794380-208 N Shear Valve(s) (Functional test) N Shear Valve(s) (Functional test) N Fire extinguisher inspected and tagged: NOK []Not OK N Fire extinguisher inspected and tagged: NOK ❑Not OK Dispenser ID:9&10 N Sump:®Dry❑Water[:]Product Dispenser to: 11&12 N Sump:®Dry[]Water❑Product N Dispenser Containment Sensor(s). Model:794380-208 N Dispenser Containment Sensor(s). Model:794380-208 N Shear Valve(s) (Functional test) N Shear Valve(s) (Functional test) N Fire extinguisher inspected and tagged: NOK ❑Nat OK N Fireextin isher ins ted and to ed: NOK Not OK Dispenser ID:NONE❑Sump:❑Dry❑Water❑Product Dispenser ID:NONE❑Sump:[]Dry❑Water❑Product ❑Dispenser Containment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) ❑ Fire extinguisher inspected and tagged: OK []Not OK ❑ Fire extinguisher inspected and tagged: ❑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,1 have also attached accoyoppy�y of the report; N System set-up ®Alarm history report Technician: lI��y e4 z2d'Ae`/t Mike Dotten,California Contractor 623541 A-Haz Certification: Veeder-Root: A23046;Level 4.;ICC UST Service Technician#5259412-UT.