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P.O. Box 4208 <br />Sonora C4 95370 <br />echPe <br />Allttrw Ca: 623541 A-Haz <br />Phone: 209-532-7324 <br />Compliance without Compromise Fax: 209-533-2654 <br />MONITORING SYSTEM CERTIFICATION for VPH SYSTEMST'ail@alltechpetro.com <br />--- ---—www.ailtechpetro.com <br />A. Facilitv General Information <br />Facility Name: Costco # 1031 Manteca Date of Testing: Wednesday, August 21, <br />2013 <br />Facility Address: 2440 Daniel St., Manteca CA <br />Facility Contact Person: Julian Ochoa (Ser. Sta. Supervisor); Facility Phone: <br />LIA: San Jaoquin Health Inspector: Thuy Tran. <br />Make/Model of Monitoring System: Veeder-Root TLS -350 <br />B. Inventory of Equipment Tested/Certified: <br />Tank ID: Unleaded 87A Tank 1 <br />Tank ID: Unleaded 87B Tank 2 <br />Nln-Tank Gauging Probe. Model: Mag Plus <br />[qIn-TankGauging Probe. Model: Mag Plus <br />❑Tank Annular Space Sensor. Model: 794380-301 <br />®Tank Annular Space Sensor. Model: 794380-301 <br />❑Piping Sump Sensor(s). Model: 857080-112 <br />®Piping Sump Sensor(s). Model: 857080-112 <br />®Piping Sump Annular: Model: 794380-304 <br />®Piping Sump Annular: Model: 794380-304 <br />Fill Sump Sensor(s). Model: 794380-323 <br />®Fill Sump Sensor(s). Model: 794380-323 <br />®Fill Sump annular Model: 794380-304 <br />NFill Sump annular Model: 794380-304 <br />❑Secondary Piping monitor Type: Vacuum <br />❑Secondary Piping monitor Type: Vacuum <br />Electronic Line Leak Detector. Model: V -R PLLD <br />® Electronic Line Leak Detector. Model: V -R PLLD <br />®Tank Overfill / High -Level Sensor. Model: V -R Audible <br />NTank Overfill/ High -Level Sensor. Model: V -R Audible <br />N Fillspill Bucket Tested: NPass ❑Fail <br />N Fillspill Bucket Tested: ®Pass ❑Fail <br />Tank ID: Unleaded 91 Tank 3 <br />Tank ID: Fuel Additive Tank <br />®In -Tank Gauging Probe. Model: Mag Plus <br />NIn-Tank Gauging Probe. Model: Mag Plus <br />NTank Annular Space Sensor. Model: 794380-301 <br />NTank Annular Space Sensor. Model: 794380-301 <br />❑Piping Sump Sensor(s). Model: 857080-112 <br />❑Piping/Fill Sump Sensor(s). Model: 794380-323 <br />❑Piping Sump Annular. Model: 794380-304 <br />❑Piping/Fill Sump Annular: Model: 794380-304 <br />NFill Sump Sensor(s). Model: 794380-323 <br />❑Secondary Piping monitor Type: Vacuum <br />NFill Sump annular Model: 794380-304 <br />❑Mechanical Line Leak Detector. Model: FE Petro <br />❑Secondary Piping monitor Type: Vacuum <br />NTank Overfill / High -Level Sensor. Model: V -R Audible <br />® Electronic Line Leak Detector. Model: PLLD <br />N Fillspill Bucket Tested: NPass ❑Fail <br />NTank Overfill / High -Level Sensor. Model: V -R Audible <br />® Fillspill Bucket Tested: NPass ❑Fail <br />Dispenser ID: 1&2 N Sump: ❑Dry ❑Water ❑Product <br />Dispenser ID: 3&4 N Sump: ❑Dry []water ❑Product <br />N Dispenser Containment Sensor(s). Model: 794380-323 <br />N Dispenser Containment Sensor(s). Model: 794380-323 <br />N UDC Annular sensor. Model: 794380-304 <br />N* UDC Annular sensor. Model: 794380-304 <br />❑Shear Valve(s) (Functional test) <br />®Shear Valve(s) (Functional test) <br />Dispenser ID: 5&6 N Sump: NDry ❑Water ❑Product <br />Dispenser ID: 7&8 N Sump: ❑Dry ❑Water ❑Product <br />N Dispenser Containment Sensor(s). Model: 794380-323 <br />N Dispenser Containment Sensor(s). Model: 794380-323 <br />N UDC Annular sensor. Model: 794380-304 <br />N UDC Annular sensor. Model: 794380-304 <br />❑Shear Valve(s) (Functional test) <br />❑Shear Valve(s) (Functional test) <br />Dispenser ID: 9&10 N Sump: ®Dry ❑Water ❑Product <br />Dispenser ID: 11&12 N Sump: NDry ❑Water ❑Product <br />N Dispenser Containment Sensor(s). Model: 794380-323 <br />N Dispenser Containment Sensor(s). Model: 794380-323 <br />N UDC Annular sensor. Model: 794380-304 <br />® UDC Annular sensor. Model: 794380-304 <br />®Shear Valve(s) (Functional test) <br />❑Shear Valve(s) (Functional test) <br />Dispenser ID: 13&14 N Sump: NDry ❑Water ❑Product <br />Dispenser ID: 15&16 N Sump: NDry ❑Water ❑Product <br />N Dispenser Containment Sensor(s). Model: 794380-323 <br />N Dispenser Containment 5ensor(s), Model: 794380-323 <br />N UDC Annular sensor. Model: 794380-304 <br />® UDC Annular sensor. Model: 794380-304 <br />NShear Valves) (Functional test) <br />®Shear Valve(s) (Functional test) <br />Dispenser ID: Vent Stack Transition Sump <br />Dispenser ID: Additive Tank Vent Sump <br />N Sump: NDry ❑Water ❑Product <br />N Sump: NDry [–]water ❑Product <br />N UDC Sump Containment Sensor(s). Model: 794380-323 <br />N UDC Sump Containment Sensor(s). Model: 794380-323 <br />N UDC Sump Annular sensor. Model: 794380-304 <br />® UDC Sump Annular sensor. Model: 794380-304 <br />* Sensor installed but not operating properly. <br />Technician: <br />4POk— <br />Certification: Veeder-Root 1336878, Level 4 <br />Date: 8/21/13 <br />