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Alltech Petro Inc. an"annal 17759 Buttercup Circle, Sonora, CA 95370 Phone: 209-532-7320; Rax: 209-533-2650 California Contractor 623541 A-Haz Mike@,AlltechPetro.com MONITORING SYSTEM CERTIFICATION A. General Information Facility Name: Costco#658 Tracy Date of Testing/Servicing: September 29,2009 Facility Address: 3250 W Grant Line Rd.,Tracy CA 95304 Service Station Supervisor: Christine Hernandez Hut Phone: 209-834-1247 Warehouse Phone: 830-5343 LIA: San Joaquin Health; Inspector: Michelle Henry; LIA Phone: 468-3448; LIA Fax: 468-3433 Make/Model of Monitoring System: Veeder-Root TLS-350 B. Inventory of Equipment Tested/Certified: Tank ID: Regular 1 Tank Tank ID Regular 2 Tank ®In-Tank Gauging Probe Model:Mag 1 ®In-Tank Gauging Probe Model:Mag I ®Annular Space Sensor. Model:794380-301 ®Annular Space Sensor. Model 794380-301 ®Piping Sump Sensons) Model:793380-352 ®Piping Sump Sensors) Model: 793380-352 El Fill Sump Sensor(sl. Model:794380-352 ®Fill Sump Sensor(s). Model: 793380-352 ®Mechanical Line Leak Detector. Model:Red Jacket ®Mechanical Line Leak Detector. Model:Red Jacket ®Tank Overfill/High-Level Sensor. Model. V-R Audible ®Tank Overfill/High-Level Sensor. Model:V-R Audible ®Fillspill Bucket Tested: ®Pass ❑Fail ®Fillspill Bucket Tested. ®Pass ❑Fail ® Fire extinguishers inspected and tagged. ®OK ❑Not OK 0 Fire extinguishers inspected and tagged ®OK ❑Not OK Tank In Premium Tank: Tank ID:None 51 In-Tank Gauging Probe. Model.Mag 1 ❑In-Tank Gauging Probe. Model: ®Annular Space Sensor. Model: 794380-301 ❑Annular Space Sensor Model ®Piping Sump Sensors) Model 793380-352 ❑Piping Sump Sensors). Model: El Fill Sump Sensor(s). Model: 793380-352 ❑Fill Sump Sensor(s). Model. ®Mechanical Line Leak Detector. Model:Vaporless LD-2000 ❑ Line Leak Detector Model ®Tank Overfill/High-Level Sensor Model V-R Audible ❑Tank Overfill/High-Level Sensor Model ®Fillspill Bucket Tested: ®Pass ❑Fail ❑Fillspill Bucket Tested ❑Pass ❑Fail ® Fire extinguishers inspected and tagged: ®OK []Not OK ❑ Fire extinguishers inspected and tagged. ❑OK ❑Nol OK Dispenser ID: 1&2®Sump:®Dry []Water[]Product Dispenser to:3&4®Sump. ®Dry❑Water❑Product ®Dispenser Containment Sensor(s). Model: 794380-208 ®Dispenser Containment Sensor(s). Model. 794380-208 ElShearValvels) (Functional test) ®Shear Valve(s) (Functional test) ® Fire extinguisher inspected and tagged: ®OK ❑Not OK 0 Fire extinguisher inspected and tagged ®OK ❑Nol OK Dispenser ID:5&6®Sump. ®Dry❑Water❑Product Dispenser ID:7&8®Sump. ®Dry❑Water❑Product ®Dispenser Containment Sensor(s) Model 794380-208 ®Dispenser Containment Sensons). Model: 794380-208 ®Shear Valve(s) (Functional test) ®Shear Valve(s) (Functional test) ® Fire extinguisher inspected and tagged: ®OK ❑Nol OK ® Fire extinguisher inspected and tagged ®OK ❑Not OK Dispenser ID:9&10®Sump. ®Dry❑Water❑Product Dispenser ID: 11&12®Sump. ®Dry❑Water❑Product ®Dispenser Containment Sensors) Model:794380-208 ®Dispenser Containment Senors) Model 794380-208 ®Shear Valve(s) (Functional test) O Shear Valve(s) (Functional test) ® Fire extinguisher inspected and tagged ®OK ❑Not OK ® Fire extinguisher inspected and tagged ®OK ❑Not OK Dispenser ID: NONE❑Sump: ❑Dry❑Water❑Product Dispenser to: NONE❑Sump. ❑Dry❑Water❑Product ❑Dispenser Containment Sensor(s). Model. ❑Dispenser Containment Sensor(s). Model: ❑ShearValve(s) (Functional test) []ShearValve(s) (Functional test) ❑ Fire extinguisher inspected and tagged ❑OK ❑Not OK ❑ Fire extinguisher inspected and tagged ❑OK ❑Not OK C. Certification - 1 certify that the equipment identified in this document was inspecled/serviced in accordance with the manufaclumn' guidelines. .Attached to this Ucitif canon k a Plot Plan showing the lavonl of moniloriug equipment. For any equipment capable of generating such reports.I have itis.attached a copy or the report: [3 Syvtem set-up 0 Alarm hulory retort Technician: Date:9/29/09 Certification: Veeder-Root 636878,Level 2/3 ISD; Expires 08-13-2010 ICC UST Service Technician 9 8W5930-UT. Expires 06-14-2010