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\ t ■■y■p■py M■ l a ✓ R � P.O.Box 4208 Afltechft tri- Sonora 53 -7370 MAR 0 7 2016 Ca:623541 A-Haz p p ENVIRONMENTAL Phone:209-532-7320 Compliance without Compromise Fax:209-533-2650 HEALTH'DFp4RTYMNIT mail@alltechpetro.com MONITORING SYSTEM CERTIFICATION www.alltechpetro.com A. General Information Facility Name: Costco # 038 Stockton Date of Testing/Servicing: March 3, 2016 Facility Address:1616 W. Hammer Lane, Stockton CA Facility Contact Person: Raj Mohan (Ser. Sta. Supervisor); Facility Phone: (209) 478-2040 LIA: San Joaquin Health; Inspector: Fatinah Zareef; LIA Phone: (209) 468-3448; LIA Fax: Make/Model of Monitoring System: Veeder-Root TLS-350 B. Invento of Equipment Tested/Certified: Tank ID: Unleaded 87A Tank 1 Tank ID: Unleaded 87B Tank 2 EIn-Tank Gauging Probe. Model: Mag 1 Zln-Tank Gauging Probe. Model: Mag 1 ®Tank Annular Space Sensor. Model: 794380-301 ®Tank Annular Space Sensor. Model:794380-301 ®Piping Sump Sensor(s). Model: 857080-112 ❑Piping Sump Sensor(s). Model: 857080-112 ®Fill Sump Sensor(s). Model: 794380-323 ®Fill Sump Sensor(s). Model: 794380-323 ®Fill Sump Annular Sensor. Model: 794380-304 ®Fill Sump Annular Sensor. Model: 794380-304 ®Electronic Line Leak Detector. Model: PLLD ®Electronic Line Leak Detector. Model: PLLD ®Tank Overfill/High-Level Sensor. Model:V-R Audible ®Tank Overfill/High-Level Sensor. Model:V-R Audible N Fillspill Bucket Tested: ®Pass ❑Fail E Fillspill Bucket Tested: ®Pass ❑Fail E Fire extinguishers inspected and tagged: ECK ❑Not OK E Fire extinguishers inspected and tagged: NOK[]Not OK Tank ID: Unleaded 91 Tank 3 Tank ID: Fuel Additive Tank 4 E In-Tank Gauging Probe. Model: Mag 1 Rln-Tank Gauging Probe. Model: Mag 1 ❑Annular Space Sensor. Model: 794380-301 ❑Tank Annular Space Sensor. Model: 794380-303 ❑Piping Sump Sensor(s). Model:857080-112 EPiping/Fill Sump Sensor(s). Model: 794380-323 ❑Fill Sump Sensor(s). Model: 794380-323 ®Piping/Fill Sump Annular Sensor. Model: 794380-304 E Fill Sump Annular Sensor. Model: 794380-304 ❑Mechanical Line Leak Detector. Model: Fe Petro ❑Electronic Line Leak Detector. Model: PLLD ETank Overfill/High-Level Sensor. Model: V-R Audible ETank Overfill/High-Level Sensor. Model:V-R Audible E Fillspill Bucket Tested: RPass ❑Fail Z Fillspill Bucket Tested: ❑Pass ❑Fail N Fire extinguishers inspected and tagged: NOK ❑Not OK Z Fire extin uishers inspected and tagged: EOK ❑Not OK Dispenser ID: 1&2 E Sump: EDry❑Water❑Product Dispenser ID: 3&4 E Sump: EDry❑Water[-]Product E Dispenser Containment Sensor(s). Model: 794380-208 ❑Dispenser Containment Sensor(s). Model: 794380-208 NShear Valves) (Functional test) NShear Valve(s) (Functional test) N Fire extinguisher inspected and tagged: NOK ❑Not OK E Fire extinguisher ins ected and to ed: EOK ❑Not OK Dispenser ID: 5&6 Z Sump: EDry❑Water❑Product Dispenser ID: 78,8 Z Sump: ZDry❑Water❑Product Z Dispenser Containment Sensor(s).Model:794380-208 E Dispenser Containment Sensor(s). Model: 794380-208 NShear Valves) (Functional test) NShear Valve(s) (Functional test) R Fire exon uisher inspected and tagged: EOK ❑Not OK Z Fire extinguisher inspected and to ed: ROK ❑Not OK Dispenser ID: 9&10 Z Sump: EDry❑Water❑Product Dispenser ID: 118,12 R Sump: EDry❑Water[]Product ZDispenser Containment Sensor(s). Model: 794380-208 NDispenser Containment Sensor(s). Model:794380-208 NShear Valve(s) (Functional test) NShear Valve(s) (Functional test) R Fire extin uisher inspected and tagged: ZOK ❑Not OK E Fire extinguisher inspected and tagged: ECK ❑Not OK Dispenser ID:Vent Stack E Sump:EDry❑Water❑Product Dispenser ID:Adtiv Vent E Sump:ZDry❑Water❑Product ZSump Containment Sensor(s). Model: 794380-323 ❑Sump Containment Sensor(s). Model: 794380-323 ZSump Annular Sensor(s). Model: 794380-304 NSump Annular Sensor(s). Model: 794380-304 E Fire extinguisher inspected and tagged: NOK ❑Not OK N Fire exon uisher ins ected and tag ed: EOK ❑Not OK C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports,I have also attached a copy of the report; ® System set-up ®Alarm history report Technician: oiiDate: 3/3/16 Certification: Veeder-Root 836877, Level 4 ICC UST Service Technician # 8152115-UT