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"* 1Itech Petro Inbs ls- 17759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320; Fax: 209-533-2650 California Contractor 623541 A-Haz Mike@AlltechPetro.com FIL I MONITORING SYSTEM CERTIFICATION 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. Invento of Equipment Tested/Certified: Tank ID:Regular 1 Tank Tank ID:Regular 2 Tank ®In-Tank Gauging Probe. Model:Mag 1 ®In-Tank Gauging Probe. Model:Mag 1 ®Annular Space Sensor. Model:Single-Float Brine ®Annular Space Sensor. Model:Single-Float Brine ®Piping Sump Sensor(s). Model:Discriminating Sensor ®Piping Sump Sensor(s). Model:Discriminating Sensor ®Fill Sump Sensor(s). Model:Discriminating Sensor M Fill Sump Sensor(s). Model:Discriminating Sensor ®Mechanical Line Leak Detector. Model:Vaporless M Mechanical Line Leak Detector. Model:Vaporless ®Tank Overfill/High-Level Sensor. Model:V-R Audible M Tank Overfill/High-Level Sensor. Model:V-R Audible M Fillspill Bucket Tested: ®Pass ❑Fail N Fillspill Bucket Tested: MPass ❑Fail ® Fire extinguishers inspected and tagged: NOK ❑Not OK ® Fire extinguishers ins ected and tagged: NOK [-]NotOK Tank ID:Premium Tank: Tank ID:None N 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 Sensoria). Model:Discriminating Sensor ❑Fill Sump Sensor(s). Model: ®Mechanical Line Leak Detector. Model:Vaporless ❑ Line Leak Detector. Model: M Tank Overfill/High-Level Sensor. Model:V-R Audible ❑Tank Overfill/High-Level Sensor. Model: M Fillspill Bucket Tested: ❑Pass MFail ❑Fillspill Bucket Tested: ❑Pass []Fail ® Fire extin uishers in ected and tagged: MOK ❑Not OK I ❑ Fire extinguishers inspected and tagged: ❑OK ❑Not OK Dispenser ID: 1&2 M Sump: NDry❑Water❑Product Dispenser ID:3&4 M Sump: MDry❑Water❑Product ®Dispenser Containment Sensor(s). Model:Non-Discriminating ®Dispenser Containment Sensoria). Model:Non-Discriminating N Shear Valve(s) (Functional test) N Shear Valve(s) (Functional test) N Fire extinguisher inspected and tagged: NOK ❑Not OK ® Fire extinguisher inspected and to ed: MOK []Not OK Dispenser ID:5&6 M Sump: NDry❑Water❑Product Dispenser ID:7&8 M Sump: NDry❑Water❑Product N Dispenser Containment Sensor(s). Model:Non-Discriminating ®Dispenser Containment Sensor(s). Model:Non-Discriminating ®Shear Valve(s) (Functional test) M Shear Valve(s) (Functional test) ® Fire extinguisher inspected and to ed: MOK ❑Not OK M Fire extinguisher inspected and tagged: MOK ❑Not OK Dispenser ID:9&10 M Sump: MDry❑Water❑Product Dispenser ID: 11&12 M Sump: MDry❑Water❑Product ®Dispenser Containment Sensor(s). Model:Non-Discriminating ®Dispenser Containment Sensor(s). Model:Non-Discriminating ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) ® Fire extin isher ins ected and to ed: MOK ❑Not OK ® Fire extinguisher inspected and tagged: 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 tagged: ❑OK [-]Not OK ❑ Fire extinguisher inspected and tagged: ❑OK ❑Not OK C. Certification - 1 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 a copy of the report; ®System set-up ®Alarm history report Technician: Mike Dotten Mike Dotten, California Contractor 623541 A- Haz Certification:Veeder-Root: 006-05-0789;Level 4.;ICC UST Service Technician#5259412-UT.