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Alltech Petro Inc. P.O. Box 4208, Sonora, CA 95370 Phone: 209-532-7320; Fax: 209-533-2650 California Contractor 623541 A-Haz In alltechma' me.com MONITORING SYSTEM CERTIFICATION for VPH SYSTEMS A. Facility General Information Facility Name: Costco # 1031 Manteca Date of Testing: Thursday, August 19, 2010 Facility Address: 2440 Daniel St., Manteca CA Facility Contact Person. Julian Ochoa (Ser. Sta. Supervisor); Facility Phone: LIA: San Jaoquin Health; Inspector: Michelle Henry. Make/Model of Monitoring System: Veeder-Root TLS -350 rank ID: Regular 1 Fank In -Tank Gauging Probe, Tank Annular Space Sensor, Model: Mag Plus Piping Sump Sensor(s), Model: 794380-301 Model: 857080-112 ®Piping Sump Annular: ® Fill Sump Sensor(s). Model: 794380-304 ®Fill Sump annular Model: 857080-112 Model: 794380-304 OSecondary Piping monitor Type: Vacuum ED Elecrtonic Line Leak Detector, Model: PLLD (� Tank Overfill / High -Level Sensor. Model: V -R Audible Fillspill Bucket Tested: (Vanor Mirle-pt F.ii, n Mn--. r Tank ID: Premium Tank 0 In -Tank Gauging Probe. Model: Mag Plus 0 Tank Annular Space Sensor. ®Piping Sump Sensor(s). Model: 794380-301 ®Piping Sump Annular: Model: 857080-112 Model: 794380-304 ED Fill Sump Sensor(s). ®Fill Sump annular Model: 857080-112 ZSccondary Piping monitor Model: 794380-304 Type: Vacuum 0 Electronic Line Leak Detector. Model: PLLD ® Tank Overfill / High -Level Sensor. 0 Fillspill Bucket Tested: Model: V -R Audible Mu_: Dispenser ID: 1&2 ED Sump: MDry❑Water❑Product ® Dispenser Containment Sensor(s). Model: 794380-323 0 UDC Annular sensor. Model: 794380-304 ® Shear Valves Functional test Dispenser ID: 5&6 ® Sump: RDry ❑Water ❑Product ® Dispenser Containment Sensor(s). Model: 794380-323 ® UDC Annular sensor. Model: 794380-304 Shcar Valves Functional test Dispenser ID: 9&10 ® Sump: ®Dry ❑Water ❑Product ® Dispenser Containment Sensor(s). Modcl: 794380-323 ® UDC Annular sensor. Model: 794380-304 ( Shear Valve(s)( Functional test Dispenser ID: 13&14 0 Sump: ®Dry []Water ❑Product ® Dispenser Containment Sensor(s). Model: 794380-323 UDC Annular sensor. Model: 794380-304 Dispenser ID: Vent Stack Transition Sump ❑ Sump: ElDry ❑Water ❑Product ® Dispenser Containment Sensor(s). Model: 794380-323 ❑ UDC Annular sensor. Model: 794380-304 * Sensor Installed but not operating properly. Technician: Certification: Veeder-Root 1336878, Level 2/3 ICC UST Service Technician # 8005930 -UT Tank ID: Regular 2 Tank 10 In -Tank Gauging Probe. Model: Mag Plus ® Tank Annular Space Sensor. Model: 794380-301 0 Piping Sump Sensor(s). Piping Sump Annular: Model: 857080-112 ® Fill Sump Sensor(s). Model: 794380-304 Model: 857080-112 (Fill Sump annular ®Secondary Piping monitor Model: 794380-304 ® Electronic Linc Leak Detector. Type: Vacuum Model: PLLD ® Tank Overfill / High -Level Sensor. Fills ill Bucket Tested: Model: V -R Audible SPass ❑Fail Tank ID: ❑ In -Tank Gauging Probe. Model: ❑ Tank Annular Space Sensor. Model: ❑ Piping Sump Sensor(s). Model: ❑Piping Sump Annular. Model: ❑ Fill Sump Sensor(s). Model: ❑Fill Sump annular Model: ❑Secondary Piping monitor Type: ❑ Line Leak Detector. ❑ Tank Overfill / High -Level Sensor. Mil: Model: ❑ Fills ill Bucket Tested: ❑Pass ❑Fail Dispenser ID: 3&4 0 Sump: ®Dry ❑Water ❑Product ® Dispenser Containment Sensor(s). Model: 794380-323 �* UDC Annular sensor. Model: 794380-304 ® Shear Valves) (Functional test) Dispenser ID: 7&8 ® Sump: ®Dry ❑Water ❑Product . 0 Dispenser Containment Sensor(s), Modcl: 794380-323 ® UDC Annular sensor. Model: 794380-304 Shear Valves) (Functional test) Dispenser ID: 11&12 ® Sump: ZDry ❑ Water ❑Product 0 Dispenser Containment Scnsor(s). Model: 794380-323 ® UDC Annular sensor. Model. 794380-304 Shear Valve(s) Functional test Dispenser ID: 15&16 ED Sump: 1ZDry ❑ Water ❑Product Dispenser Containment Sensor(s). Model: 794380-323 UDC Annular sensor. Model: 794380-304 Dispenser ID: ❑ Sump: ❑Dry ❑Water []Product ❑ Dispenser Containment Sensor(s). Model. ❑ UDC Annular sensor. Model: Date: 8/19/10