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Facility Name: Costco#658 Tracy (Page 4) <br /> I. Results of Vacuum/Pressure Monitoring Equipment Testing <br /> F <br /> facturer: Veeder-Root Model : 331117 System Type: ❑ Pressure ®Vacuum <br /> r <br /> Component(s) Monitored by this Sensor: Additive Product Line <br /> Sensor Functionality Test Results: ® Pass; ❑ Fail Interstitial Communication Test Result: ® Pass: El Fail <br /> sio Component(s) Monitored by this Sensor: Additive Vent Line <br /> Sensor Functionality Test Results: ® Pass; ❑ Fail Interstitial Communication Test Result ® Pass: ❑ Fail <br /> Sensor Functionality Test Results: Pass; Ll Fail Interstitial Communication Test Result: ® Pass: Ll Fail <br /> How was interstitial communication verified? <br /> ® Leak Introduced at Far End of Interstitial Space; ❑ Gauge; ❑ Visual Inspection; Other (Describe in J be/ow) <br /> Vacuum was restored tooperating levels in all interstitials aces: ® Yes ❑ No (if no, describe in l be/ow) <br /> J. Comments: <br />