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Sep 25 06 01:22p Mike Dotten 209-533-2650 p.1 1-we 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 �FMA A. General Information Facility Name: Costco# Costco 658 Tracy Date of Testing/Servicing: September 12, 2006 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/Certifred: Tank to:Regular I Tank Tank m:Regular 2 Tank ®in-Tank Gauging Probe. Model:Mag I S In-Tank Gauging Probe_ Model:Mag 1 ®Annular Space Sensor, Model:Single-Float Brine S Annular Space Sensor. Model Single-Float Brine ®Piping Sump Seasor(s). Model:Discriminating Sensor ®Piping Sump Sensor(s). Model:Discriminating Sensor Fill Sump Sensor(s). Model:Discriminating Sensor ®Fill Sump Sensor(s). Model:Discriminating Sensor ®Mechanical Line Leak Detector. Model:Vaporless ®Mechanical Line Leak Detector. Model:Vaporless ®Tank Overfill/High-Level Sensor. Model:V-R Audible ®Tack Overfill/High-Level Sensor. Model:V-R Audible ® Fillspill Bucket Tested: ®Pass ❑Fail M Fillspill Bucket Tmhed: ®Pass []Fail ® Fire extinguishers inspected and ed: MOK ❑Not OK S Fire extinguishers inspected and ed: ROK ❑Not OK Tank m:Premium Tank: Tank ID:None ®In-Tank Gauging Probe. Model:Mag 1 ❑In-Tank Gauging Probe. Model: ®Annular Space Sensor. Model:Single-Float Brine ❑Annular Space Sensor. Model: ®Piping Sump Sensor(s). Model:Discriminating Sensor ❑Piping Sump Sensor(s). Model: ®Fill Sump Sensor(s). Model:Discriminating Sensor ❑Fill Sump Sensor(s). Model: S Mechanical Line Leak Detector, Model:Vaporless ❑ Line Leak Detector. Model: S Tank Overfill/High-Level Sensor. Model:V-R Audible ❑Tank Overfill/High-Level Sensor. Model: ® Fillspill Bucket Tested: []Pass ®Fail ❑Fillspill Bucket Tested: ❑Pass []Fail ® Fire extin 'stets in ected and[a ed: MOK ❑Not OK ❑ Fire extinguishers inspected and ed; ❑OK []Not OK Dispenser ID: 1&2 19 Sump:®Dry[]Water❑Product Dispenser m:3&4 M Sump:MDry❑Water❑Product S Dispenser Containment Sensor(s). Model:Non-Discriminating S Dispenser Containment Sensor(s). Model:Non-Diseriminating S Shear Valve(s) (Functional test) S Shear Valves) (Functional test) S Fire extinguisher inspected and : MOK ❑Not OK S Fire extinguisher inspected and to d: SOK ❑Not OK Dispenser M:5&6 M Sump:®Dry❑Water❑Produot Dispenser ID:7&8®Sump:MDry❑Water❑Product S Dispenser Containment Sensor(s). Model:Non-Discriminating S Dispenser Containment Sensor(s). Model:Non-Discriminating S Shear Valve(s) (Functional test) S Shear Valve(s) (Functional test) S Fire extinguisher inspected and to OK ❑Not OK S Fire extinguisher iected and : MOK ❑Not OK Dispenser ID:9&10 M Sump:®Dry❑Water❑Product Dispenser ID:11&12 M Sump:MDry[]Water❑Product S Dispenser Containment Senser(s). Model:Non-Discriminating ®Dispenser Containment Sensor(s). Model:Non-Discriminating ®Shear Valve(s) (Functional test) S Shear Valve(s) (Functional test) S Fire eXtiagaishcr inspected and tagged: ®OK ❑Not OK S Fire extinguisher inspected and : MOK ❑Not OK Dispenser ID: ❑Sump: []Dry❑Water❑Product Dispenser ID. ❑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 ed: ❑OK ❑Not OK I ❑ Fire extinguisher inspected and ed: ❑OK []Not OK C. Certification - I eery that the equipment identified in this document was irepected/serviced in accordance with the manufacturers' guidelines. Attached to this Certirkaattiioonn�is Plot Plan showing the tayout of monitoring equipment For any equipment cepahk orgeneratiag such reports,I hav also attached a copy Of the Syste et-u ®Alarm history report e Technician: Mike Dotteo,California Contractor 623541 A-Flaz Certification: Veeder-Root:006-05-0789;Level 4. ;ICC UST Service Teehniciar 0 5259412-OT.