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RECEIWED <br /> P.O.Box 4208 <br /> Sonora CA 95370 <br /> AiltechFetrJUN Ca:623541 A-Haz <br /> Jv 2 Phone:209-532-7320 <br /> Compliance without Compromise ENVIRONMENTAL Fax:209-533-2650 <br /> HEAUNDEPARTMEW mail@alltechpetro.com <br /> www.alitechpetro.com <br /> MONITORING SYSTEM CERTIFICATION for VPH SYSTEM <br /> A. Facility General Information <br /> Facility Name:Costco#1091 Lodi Date of Testing:05/28/14 <br /> Facility Address:2680 Reynolds Ranch Rd., Lodi CA <br /> Facility Contact Person: Rick Medeiros Facility Phone: 209-366-7332 <br /> LIA: San Joaquin County EHD; Inspector:Aris Cacapit. Email:Aris Cacapit <acacapit@sjcehd.com> <br /> Make/Model of Monitoring System:Veeder-Root TLS-350 <br /> B. Invento of E ui ment Tested Certified: <br /> Tank 87A Tank ID:878 <br /> ®In-Tank Gauging Probe. Model: Mag Plus ®In-Tank Gauging Probe. Model: Mag Plus <br /> ®Tank Annular Space Sensor. Model:794380-301 ®Tank Annular Space Sensor. Model: 794380-301 <br /> ®Piping Sump Sensor(s). Model:857080-112 ®Piping Sump Sensor(s). Model: 857080-112 <br /> ®Piping Sump Annular: Model: 794380-304 ®Piping Sump Annular: Model: 794380-304 <br /> ®Fill Sump Sensor(s). Model:794380-323 ®Fill Sump Sensor(s). Model: 794380-323 <br /> ®Fill Sump annular Model:794380-304 ®Fill Sump annular Model: 794380-304 <br /> ®Secondary Piping monitor Type:Vacuum ®Secondary Piping monitor Type:Vacuum <br /> ®Electronic Line Leak Detector. Model:VR-PLLD ®Electronic Line Leak Detector. Model:VR-PLLD <br /> ®Tank Overfill/High-Level Sensor. Model:VR Audible ®Tank Overfill/High-Level Sensor. Model:VR Audible <br /> ® Fills ill Bucket Tested: ®Pass ❑Fail ® Fills ill Bucket Tested: ®Pass [—]Fail <br /> Tank ID: 91 Tank ID:Additive Tank <br /> ®In-Tank Gauging Probe. Model: Mag Plus ®In-Tank Gauging Probe. Model: Mag Plus <br /> ®Tank Annular Space Sensor. Model:794380-301 ®Tank Annular Space Sensor. Model: 794380-303 <br /> ®Piping Sump Sensor(s). Model:857080-112 ®Piping/Fill Sump Sensor(s). Model:794380-323 <br /> ®Piping Sump Annular: Model:794380-304 ®Piping/Fill Sump annular sensor Model: 794380-304 <br /> ®Fill Sump Sensor(s). Model: 794380-323 ®Secondary Piping monitor Type:Vacuum <br /> ®Fill Sump annular Model: 794380-304 ®Mechanical Line Leak Detector. Model: FE Petro <br /> ®Secondary Piping monitor Type:Vacuum ®Tank Overfill/High-Level Sensor. Model:VR-Audible <br /> ®Electronic Line Leak Detector. Model:VR-PLLD ED Fillspill Bucket Tested: ®Pass ❑Fail <br /> ®Tank Overfill/High-Level Sensor. Model:VR Audible, <br /> ® Fills ill Bucket Tested: ®Pass ❑Fail <br /> Dispenser ID: 1&2 ® Sump: ®Dry❑Water[]Product Dispenser ID 3&4 Z Sump:ZDry❑Water❑Product <br /> ®Dispenser Containment Sensor(s). Model: 794380-323 ®Dispenser Containment Sensor(s). Model:794380-323 <br /> ® UDC Annular sensor. Model: 794380-304 ® UDC Annular sensor. 'Model: 794380-304 <br /> ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) <br /> Dispenser ID: 5&6® Sump: ®Dry❑Water❑Product Dispenser ID: 7&8® Sump:ZDry❑Water❑Product <br /> ®Dispenser Containment Sensor(s). Model: 794380-323 ®Dispenser Containment Sensor(s). Model:794380-323 <br /> ® UDC Annular sensor. Model: 794380-304 ® UDC Annular sensor. Model 794380-304 <br /> ®Shear Valves) (Functional test) ®Shear Valve(s) (Functional test) <br /> Dispenser ID: 9&10® Sump: ®Dry❑Water❑Product Dispenser ID: 11&12 ® Sump: ®Dry❑Water El Product <br /> ®Dispenser Containment Sensor(s). Model: 794380-323 ®Dispenser Containment Sensor(s). Model:794380-323 <br /> ® UDC Annular sensor. Model:794380-304 ® UDC Annular sensor. Model:794380-304 <br /> ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) <br /> Dispenser ID: 13&14® Sump: ®Dry❑Water[]Product Dispenser ID:'15&16® Sump: ®Dry❑Water❑Product <br /> ®Dispenser Containment Sensor(s). Model: 794380-323 ®Dispenser Containment Sensor(s).Model:794380-323 <br /> ® UDC Annular sensor. Model: 794380-304 ® UDC Annular sensor. Model: 794380-304 <br /> ®ShearValve(s) (Functional test) M Shear Valve(s) (Functional,test) <br /> Tank Vent Box® Sump: ®Dry❑Water❑Product Adtve Vent Box® Sump; ®Dry❑Water[]Product <br /> ® Sump Containment Sensor(s). Model: 794380-323 ® Sump Containment Sensor(s).Model:794380-323' <br /> ® Sump Annular sensor. Model: 794380-304 ® Sump Annular sensor. Model:794380-304 <br /> ® Shear Valve(s) (Functional test) ® Shear Valve(s) (Functional test) <br /> Technician: �P� <br /> Veeder-Root: B36878 Level 4 ICC UST Technician #8146912-UT. Date:05/28/14 <br />