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0 0 <br />P.O. Box 4208 <br />Senora CA 95376 <br />Ca: 523541 A-Haz <br />jV1tech-- <br />c.. <br />Phone- 2p4-532-7326 <br />Compliance without Compromise Fax: 209-533-2650 <br />MONITORING SYSTEM CERTIFICATION for VPH SYSTEtIIIV11W `itechpep c <br />A. Fa lit Eigneral Information <br />Facility Marne: Costco # 1031 Manteca <br />Facility !address: 2440 Daniel St., Manteca CA <br />Facility Contact Persow. Dave Zizzo (Ser. Sta- Supervisor); <br />LIA: San Joaquin Health <br />Make/Model of Monitoring System: Veeder-Root TLS -350 <br />B. Inventory of Eauioment Tested/Certified: <br />.ft.W <br />Date of Testing: Tuesday, August 19, 2015 <br />Facility Phone: 209-824-2860 <br />Inspector: Jeff Wong, <br />Tank ID: Unleaded 87A Tank 1 <br />Tank ID: Unleaded 878 Tank 2 <br />21 in -Tank Gauging Probe. Model: Mag Plus <br />ER In -Ta nk Gauging Probe. Model: Mag Plus <br />®Tank Annular Space Sensor. Model: 794380-301 <br />®Tank Annular Spare Sensor. Model: 794380-301 <br />OPiping Sump Sensor(s). Model: 857080-112 <br />SPiping Sump Sensor(s). Madel: 857080-112 <br />Piping Sump Annular: Model: 794380-304 <br />Piping Sump Annular. Model: 794380304 <br />OFill Sump Sensor(s). Model: 794380-323 <br />ZFill Sump Sensor(s). Model: 794380-323 <br />Will Sump annular Model: 794380-304 <br />SFill Sump annular Model: 794380-304 <br />OSeconclary Piping monitor Type- Vacuum <br />ZSecondary Piping monitor Type: Vacuum <br />®Electronic Line Leak Detector. Model: V -R PLLD <br />NElectranic line leak Detector. Model: V -R PLLi7 <br />ZTank Overfill! Hlgh-Level Sensor. Model: V -R Audible <br />®Tank Overfill { High -Level Sensor. Model: V -R Audible <br />Fills ill Bucket Tested: RPass dFail <br />® Fills pill Bucket Tested: nPass ❑Fail <br />Tank ID: unleaded 91 Tank 3 <br />Tank ID: Fuel Addittve Tank <br />®1n -Tank Gauging Probe. Model: Mag Plus <br />®In -Tank Gauging Probe. Model: Mag Plus <br />XTank Annular Space Sensor. Model: 794380-301 <br />®Tank Annular Space Sensor. Model: 794380-301 <br />{Piping Sump Sensor(s). Model. 857080.112 <br />ZPiping/Fiil Surnp Sensor(s). Model: 794384.323 <br />oPiping Sump Annular: Model: 194380-304 <br />®Pipinoifl Sump Annular. Model: 794384-304 <br />®Fill Sump sensor(s). Model: 794380-323 <br />®Secondary Piping monitor TypR. Vacuum <br />Will Sump annular Moc40: 794380.304 <br />1AMechamcal Line Leak Detector. Model: FE Petro <br />®Secondary Piping monitor Type: Vacuum <br />STank Overfill I High -Level Sensor. Model: V -R Audible <br />®Electronic Line Leak Detector. Model: PLLD <br />Fillspill Bucket Tested: JZPass []Fail <br />STank Overfill/ High -Level Sensor. Model. V -R Audible <br />Fills ill Bucket Tested: Pass QFail <br />Dispenser ID: 1&2 M sump: ZDry ❑Water ❑Product <br />Dispenser ID: 3&4 23 Sump: ODryF ❑Water ❑Product <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />Z Dispenser Containment Sensor(s). Model. 794390-323 <br />0 UDC Annular sensor_ Model: 79+3380-3174 <br />iZ` llvC Annular sensor. Model: 794380-304 <br />Shear Va s Functional test <br />195hear Valves J-unctlonai test <br />Dispenser ID: 5&6 21 Sump: WDry [!Water ❑Product <br />Dispenser ICJ: 7&8 0 Sump: ®Dry []Water ❑Product <br />ElVispenser Containment Sensor(s). Model: 794380.323 <br />SDispenser Containment Sensor(s). Model: 794380-323 <br />JZUDC Annular sensor. Model: 794380-304 <br />[RUDC Annular sensor. Model: 794390-304 <br />Shear Va s Functional test <br />Shear Valves Functional test <br />Dispenser ID: 9&10 0 Sump: Wry OWater ❑Product <br />Dispenser ID: 11&12 Z Sump: ZDry ❑Water ❑Product. <br />®Dispenser Containment Semor(s). Model: 794380-323 <br />j$Dispenser Containment Sensor(s). Model: 794380-323 <br />UDC Annular sensor. Model: 79e4380-304 <br />[Q UDC Annular sensor. M6del: 79438Q-304 <br />Shear Va S Functional test <br />Shear Vaiv s Functional test <br />Dispenser II]: 13&14 9 Sump: [&Dry [}Water []Product <br />Dispenser ID: 15&16 2 Sump: ¢ Dry ❑Water ElProduct <br />MDispenser Containment 5ensor(s), Model: 794380-323 <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />N UDC Annular sensor. Model: 794380-304 <br />21 UDC Annular sensor. Model: 794380-304 <br />Shear Va s Functional test <br />Shear Valve(s)( Functional test <br />Dispenser ID: Vent Stack Transition Sump <br />Dispenser Iia: Additive Tank Vent Sump <br />0 Sump: WDry ❑Water []Product <br />Z Sump: (&Dry ❑Water ❑Product <br />�$ UDC Sump Containment Sensor(s). Model: 794380-323 <br />® UDC Sump Containment Sensor(s). Model: 794384323 <br />UDC.Sume Annular sensor. Model: 794380-304 <br />0 UDC Sump Annular sensor. Model: 7 9 43 8 0-3 114 <br />Senior Installed but not operating properly. <br />Technician: IT6� <br />Certification: Veeder-Root 836878, Level 4 <br />ICC UST Service Technician ,If 8146912 -UT <br />Date: 8119!15 <br />