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Jun 05 06 04:25p Mike Dotten 249-533-2650 p.1 <br /> Alltech Petro Inc. <br /> 17759 Buttercup Circle, Sonora, CA 95370 <br /> Phone: 209-532-7320; Fax: 209-533-2650 <br /> California Contractor 623541 A-Haz <br /> Mike@AlltechPetro.com <br /> MONITORING SYSTEM CERTIFICATIONMonalft Ij <br /> A. General Information <br /> Facility Name: Costco # 038 Stockton Date of Testing/Servicing: May 24,2006 <br /> Facility Address:1616 W.Hammer Lane, Stockton CA <br /> Facility Contact Person:Rick Medeiros (Ser. Sta. Supervisor); Facility Phone: (209)478-2040 <br /> LIA: San Joaquon Health;Inspector: Willy Ng; LIA Phone: (209)468-3448; LIA Fax: (209) 468-3433 <br /> Make/Model of Monitoring System: Veeder-Root TLS-350 <br /> B. Invento of E ui meat Tested/Certified: <br /> Tank ID:Regular 1 Tank Tank ID:Regular 2 Tank <br /> E In-Tank Gauging Probe. Model:Mag 1 E In-Tank Gauging Probe. Model:Mag 1 <br /> E Annular Space Sensor. Model:Single-Float Brine ®Annular Space Sensor. Model:Single-Float Brine <br /> ®Piping Sump Sensor(s). Model:Discriminating Sensor E Piping Sump Sensor(s). Model:Discriminating Sensor <br /> ®Fill Sump Sensor(s). Model:Discriminating Sensor E Fill Sump Sensor(s). Model:Discriminating Sensor <br /> E Electronic Line Leak Detector. Model:PLLD E Elecuvnic Line Leak Detector. Model:PLLD <br /> E Tank Overfill/High-Level Sensor, Model:V-R Audible E Tank Overfill/High-Level Sensor. Model:V-R Audible <br /> ®Fillspill Bucket Tested: ®Pass []Fail N Fillspill Bucket Tested: ®pass []Fail <br /> ® Fire extinguishers inspected and ed: ®OK ❑Not OK E Fire extinguishers inspected and tae ed: MOK []NotOK <br /> Tank ID:Premium Tank: Tank ID:None <br /> M In-Tank Gauging Probe. Model:Mag I ❑In-Tank Gauging Probe. Model: <br /> ®Annular Space Sensor. Model:Single-Float Brine ❑Annular Space Sensor. Model: <br /> ®Piping Sump Sensor(s). Model:Discriminating Sensor ❑Piping Sump Sensor(s). Model: <br /> ®Fill Sump Sensor(s). Model:Discriminating Sensor ❑Fill Sump Scnsm(s). Model: <br /> Electronic Line Leak Detector. Model:PLLD ❑ Line Leak Detector. Model: <br /> ®Tank Overfill I High-Level Sensor. Model:V-R Audible ❑Tank Overfill/High-Level Sensor. Model: <br /> ®Fillspill Bucket Tested: MPass []Fail ❑Fillspill Bucket Tested: ❑Pass ❑Fail <br /> ® Fire exon uishersin• ected and to ed: ROK ❑Not OK ❑ Fire extinguishers inspected and tagged: ❑OK []Not OK <br /> Dispenser ID: U2 M Sump:RDry❑Water❑Product Dispenser ID:3&4 MSump:MDry❑Water❑Product <br /> E Dispenser Containment Sensor(s). Model:Non-Discriminating E Dispenser Containment Sensor(s). Model:Non-Discriminating <br /> E Shear Valve(s) (Functional test) E Shear Valve(s) (Functional test) <br /> M Fire extinguisher inspected and ed: ROK ❑Not OK E Fire extinguisher inspected and ed: NOK ❑Not OK <br /> Dispenser ID:5&6 M Sump:NDry❑Water❑Product Dispenser ID:7&8 N Sump:NDry❑Water❑Product <br /> E Dispenser Containment Sensor(s). Model:Non-Discriminating N Dispenser Containment Sensor(s). Model:Non-Discriminating <br /> E Shear Valve(s) (Functional test) E Shear Valve(s) (Functional test) <br /> E Firecxti2Mishcr inspected and tagged: MOK ❑Not OK ® Fire extinguisher inspected and : NOK ❑Not OK <br /> Dispenser ID:9&10 N Sump:®Dry❑WaterProduct Dispenser ID: I I&1Z <br /> ❑ pe R Sump:NDry❑Water❑Product <br /> E Dispenser Containment Sensor(s). Model;Non-Discriminating ®Dispenser Containment Sensor(s). Model:Non-Discriminating <br /> ®Shear Valves) (Functional test) E Shear Valve(s) (Functional test) <br /> N Fire extinguisher inspected and tagged: ROK []Not OK E Fire extinguisher inspected and to ed; ROK ❑Not OK <br /> Dispenser ID: ❑Sump:❑Dry❑Water❑Product Dispenser ID: ❑Sump:[]Dry❑W'ater❑Product <br /> []Dispenser ContainmentSensor(s). Model: ❑Dispenser Containment Sensot(s). Model: <br /> ❑Shear Valve(s) (Functional test) ❑Shear Valve(s) (Functional test) <br /> ❑ Fire extinguisher inspected and to ed: []OK ❑Not OK ❑ Fire extinguisher inspected and to ed: ❑OK ❑Not OK <br /> C. Certification - 1 certify that the equipment identified in this document was inspected/serviced in accordance with the manolacturcrs' guidelines. <br /> Attached to this Certification is a Plot Plan showing the layout of monitoring equipment For any equipment capable of generating such reports.I have <br /> also attached a copy of the report; ®System set-up ®Alarm history report <br /> \ <br /> Technician: ly1Vn,U,W(UtAlJsb t,'��,� <br /> U^ Mike Dotten,California Contractor 623541 A-Raz <br /> Certification:Veeder-Root: 006-05-0789; Level 4. <br /> ICC Cert: 5259412-UT <br />