Laserfiche WebLink
■-1%I P.O.Box 4208 <br /> Alt techPetr Sonora CA 370 <br /> Ca:623541 A-Haz <br /> Phone:209-532-7-7320 <br /> Compliance without Compromise Fax:209-533-2650 <br /> mail@alltechpetro.com <br /> www.alltechpetro.com <br /> MONITORING SYSTEM CERTIFICATION <br /> A. General Information <br /> Facility Name: Costco#658 Tracy Date of Testing/Servicing: May 22, 2013 <br /> Facility Address: 3250 W Grant Line Rd.,Tracy CA 95304 <br /> Service Station Supervisor: Troy Dominici Hut Phone: 209-834-1247 Warehouse Phone: 830-5343 <br /> LIA: San Joaquin Health; Inspector: Thuy Tran; LIA Phone: 209-468-3440; LIA Fax: 209-468-8392 <br /> Make/Model of Monitoring System: Veeder-Root TLS-350 <br /> B. Inventory of Equipment Tested/Certified: <br /> Tank ID:87 A Tank Tank ID:87 B Tank <br /> []In-Tank Gauging Probe. Model: Mag 1 []In-Tank Gauging Probe. Model: Mag 1 <br /> ®Annular Space Sensor. Model:794380-301 ®Annular Space Sensor. Model: 794380-301 <br /> ®Piping Sump Sensor(s). Model: 793380-352 ®Piping Sump Sensor(s). Model: 793380-352 <br /> NFill Sump Sensor(s). Model: 794380-352 NFill Sump Sensor(s). Model: 793380-352 <br /> []Electronic Line Leak Detector. Model:VR PLLD []Electronic Line Leak Detector. Model:VR PLLD <br /> []Tank Overfill/High-Level Sensor. Model:V-R Audible NTank Overfill/High-Level Sensor. Model:V-R Audible <br /> [] Fillspill Bucket Tested: NPass ❑Fail [] Fillspill Bucket Tested: NPass ❑Fail <br /> N Fire extinguishers inspected and tagged: NOK ❑Not OK N Fire extinguishers inspected and tagged: NOK ❑Not OK <br /> Tank ID: 91 Tank Tank ID:Additive Tank <br /> [] In-Tank Gauging Probe. Model: Mag 1 Nin-Tank Gauging Probe. Model: Mag Plus <br /> NAnnular Space Sensor. Model:794380-301 []Annular Space Sensor. Model:794380-302 <br /> []Piping Sump Sensor(s). Model:793380-352 0Piping/Fill Sump Sensor(s). Model: 793380-323 <br /> []Fill Sump Sensor(s). Model: 793380-208 []Fill Sump annular. Model: 794380-304 <br /> N Electronic Line Leak Detector. Model:VR PLLD []Mechanical Line Leak Detector. Model:V-R Audible <br /> NTank Overfill/High-Level Sensor. Model:V-R Audible []Tank Overfill/High-Level Sensor. Model: <br /> N Fillspill Bucket Tested: []Pass ❑Fail N Fillspill Bucket Tested: []Pass ❑Fail <br /> N Fire extinguishers inspected and tagged: NOK []NotOK N Fire extinguishers inspected and tagged: NOK ❑Not OK <br /> Dispenser ID: 18,2 N Sump: []Dry[]Water E]Product Dispenser ID: 3&4[] Sump: NDry❑Water❑Product <br /> N Dispenser Containment Sensor(s). Model: 794380-208 []Dispenser Containment Sensor(s). Model: 794380-208 <br /> []Shear Valve(s) (Functional test) []Shear Valve(s) (Functional test) <br /> [] Fire extinguisher inspected and tagged: NOK ❑Not OK [] Fire extinguisher inspected and tagged: NOK []NotOK <br /> Dispenser ID: 5&6 N Sump:NDry❑Water❑Product Dispenser ID: 7&8[] Sump: NDry[]Water❑Product <br /> []Dispenser Containment Sensor(s).Model:794380-208 []Dispenser Containment Sensor(s). Model:794380-208 <br /> []Shear Valve(s) (Functional test) []Shear Valve(s) (Functional test) <br /> [] Fire extinguisher inspected and tagged: []OK ❑Not OK [] Fire extinguisher inspected and tagged: NOK ❑Not OK <br /> Dispenser ID:9&10 [] Sump: NDry[]Water[]Product Dispenser ID: 11&12 N Sump: []Dry❑Water[]Product <br /> N Dispenser Containment Sensor(s).Model: 794380-208 N Dispenser Containment Sensor(s). Model: 794380-208 <br /> []Shear Valves) (Functional test) NShear Valve(s) (Functional test) <br /> N Fire extinguisher ins acted and tagged: NOK ❑Not OK N Fire extinguisher inspected and tagged: NOK —]Not OK <br /> Vent Box: NONE [] Sump: NDry❑Water❑Product Dispenser ID: E ❑ Sump: ❑Dry❑Water❑Product <br /> N Dispenser Containment Sensor(s). Model: 793380-323 ❑Dispenser Containment Sensor(s). Model: <br /> N UDC Annular Space Sensor. Model:794380-304 ❑Shear Va lve(s) (Functional test) <br /> N Fire extinguisher inspected and tagged: NOK ❑Not OK ❑ Fire extinguisher inspected and tagged: ❑OK ❑Nat OK <br /> C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' <br /> guidelines. Attached to this Certification is a Plot Plan showing the layout of monitoring equipment. For any equipment capable of <br /> generating such reports,I have also attached a copy of the report; ®System set-up ®Alarm history report <br /> Technician: .0004 <br /> Date: 5/22/13 <br /> Certification: <br /> Veeder-Root 836877, Level 4 ISD; <br /> ICC UST Service Technician # 8152115-UT. <br />