DERR-2024-010842

Testing and Inspection Certificate
Tanknology Inc.
11000 North MoPac Expressway, Suite 500, Austin, TX 78759
800-800-4633 www.tanknology.com Page 1 of 1

Test Date 6/5/2024 Tanknology WO#NW1-2368535
Test Purpose COMPLIANCE Customer PO#

Customer Location

U.S. FOODS
9399 HIGGINS ROAD
SUITE 500
ROSEMONT, IL 60018

U. S. FOODS 4H
835 W SAN JOSE ST
OGDEN, UT 84401

Attn: JILL TUBBS Attn:
[phone]
[phone]

Test / Inspection Description Item Tested Date
Tested Result
Precision Tank Tightness Tank TNK1 Low Sulfur Diesel 6/5/2024 Pass

Precision Line Tightness (.1 GPH) Tank TNK1 Line 1 Low Sulfur Diesel 6/5/2024 Pass
Precision Line Tightness (.1 GPH) Satellite Line 1 6/5/2024 Tested w/ Primary
Precision Line Tightness (.1 GPH) Satellite Line 2 6/5/2024 Tested w/ Primary
Precision Line Tightness (.1 GPH) Satellite Line 3 6/5/2024 Tested w/ Primary
Precision Line Tightness (.1 GPH) Satellite Line 4 6/5/2024 Tested w/ Primary

PEI RP 1200 Leak Detector See test report for details 6/5/2024 Pass

Impact Valve Inspection See test report for details 6/5/2024 Pass

RP 1200 ATG See test report for details 6/5/2024 Pass

RP 1200 Sensors See test report for details 6/5/2024 Pass

Sump Inspection See test report for details 6/5/2024 Pass

Tanknology Representative: David Edens Technician: David Mathie
Telephone: ()Technician Certification: (See forms)

VacuTect
Tank Tightness Test
page 1 of 1
Work Order:2368535 Date:6/5/2024
Site Name/ID:U. S. FOODS 4H 4H
Address:835 W SAN JOSE ST
City:OGDEN State:UT Zip:84401
Tank Information
Customer Tank ID
Regulatory Tank ID
Product Category
Product Name
Gallons Capacity
Tank Type
Tank Walls
Compartmentalized
Siphon Tank
Vents included with test
Test Start Time
Test End Time
Water ingress (Y/N)
Bubble ingress (Y/N)
Ullage ingress (Y/N)
Test Result (P/F/I)
TNK1 Low Sulfur
Diesel
TNK1

Diesel
Low Sulfur Diesel
19951
Fiberglass
Doublewall (factory)
No
No
with this tank
11:24:00
12:41:00
No
No
No
Pass

Yes - Test was performed per 3rd party certifications as specified in 40 CFR parts 280 and 281. No - diagnostic only

Technician Comments : UT151
Technician Name David Mathie Certification #41448 exp: 10/20/2025
Technician Signature

Environmental Compliance for Petroleum Systems
©2024 Tanknology Inc., Austin,TX. All rights reserved. tanknology.com
Product Line Tightness Test Page 1 of 1
Work Order: 2368535 Date: 6/5/2024
Site Name/ID: U. S. FOODS 4H / 4H
Address: 835 W SAN JOSE ST
City: OGDEN State: UT Zip: 84401
Tank Information
Test Method
Customer Tank ID
Product Name
Delivery Type
Test Pressure (psi)
Test Start Time
Test End Time
Final Leak Rate (gph)
Test Result(P/F/I)
Test was performed per
3rd party certifications as
specified in 40 CFR parts
280 and 281
Tank # 1
Line # 1
TLD-1
TNK1
Low Sulfur
Diesel
Pressure
60
11:36
12:36
0.00
Pass
Yes
Tank #
Line #

Tank #
Line #

Tank #
Line #

Tank #
Line #

Tank #
Line #

Technician Comments: UT151
Technician Name:David Mathie Certification #:41442 exp:
10/20/2025
Technician Signature:

Environmental Compliance for Petroleum Systems
©2024 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com

Product Line Tightness Test
Satellite Line Tightness Test Page 1 of 1
Work Order: 2368535 Date: 6/5/2024
Site Name/ID: U. S. FOODS 4H / 4H
Address: 835 W SAN JOSE ST
City: OGDEN State: UT Zip: 84401
Satellite Line #
Fueling From - To
Product Name
Delivery Type
Test Pressure (psi)
Test Start Time
Test End Time
Final Leak Rate (gph)
Test Result(P/F/I)
Test was performed per
3rd party certifications as
specified in 40 CFR parts
280 and 281
Sat # 1
1 - 1S
Low Sulfur
Diesel
Pressure

Included with
primary line test
Sat # 2
2 - 2S
Low Sulfur
Diesel
Pressure

Included with
primary line test
Sat # 3
3 - 3S
Low Sulfur
Diesel
Pressure

Included with
primary line test
Sat # 4
4 - 4S
Low Sulfur
Diesel
Pressure

Included with
primary line test
Sat #

Sat #

Technician Comments: UT151
Technician Name:David Mathie Certification #:41442 exp:
10/20/2025
Technician Signature:

Environmental Compliance for Petroleum Systems
©2024 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com
U. S. FOODS 4H
835 W SAN JOSE ST
OGDEN UT 84401
4H
Tanknology, Inc.
U.S. FOODS
9399 HIGGINS ROAD SUITE 500
ROSEMONT IL 60018
847-720-1712
06/05/2024
Low Sulfur Diesel
Veeder Root
FX1DV
40
20
250
2
10
3
UT151
David Mathie
NW1-2368535
TTNK1:1
Impact Valve
Inspection
Impact Valve Operational
Inspection
Work Order:2368535 Date:6/5/2024
Site Name/ID:U. S. FOODS 4H
Address:835 W SAN JOSE ST
City:OGDEN State:UT Zip:84401
How Inspected: Line Test NFPA 30A PEI RP1200 Other
Dispenser
Number Grade
Secure
Mount?
Valve
Lock?Pass/ Fail Comments
1/2 40 Pass Fail Not Tested
1S/ 40 Pass Fail Not Tested
3/4 40 Pass Fail Not Tested
3S/ 40 Pass Fail Not Tested
5/2S 40 Pass Fail Not Tested
6/4S 40 Pass Fail Not Tested

Technician Comments:
Technician Name:David Mathie
Signature:
Environmental Compliance for Petroleum Systems
©2024 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com
U. S. FOODS 4H U.S. FOODS
835 W SAN JOSE ST
OGDEN UT 84401
4H
Tanknology, Inc.
9399 HIGGINS ROAD SUITE 500
ROSEMONT IL 60018
847-720-1712
800-964-1250 06/05/2024
1
DSL
VR350
19951
119.5
UT151
David Mathie
835 W SAN JOSE ST
U. S. FOODS 4H
835 W SAN JOSE ST , OGDEN, UT 84401
4H
Tanknology, Inc.
U.S. FOODS
9399 HIGGINS ROAD SUITE 500
ROSEMONT, IL 60018
847-720-1712
06/05/2024
ANNULAR WET STP UDC UDC UDC UDC UDC
DSL DSL 1 S 3 S 1/2 3/4 2S/5
UT151
David Mathie
835 W SAN JOSE ST
U. S. FOODS 4H
835 W SAN JOSE ST , OGDEN, UT 84401
4H
Tanknology, Inc.
U.S. FOODS
9399 HIGGINS ROAD SUITE 500
ROSEMONT, IL 60018
847-720-1712
06/05/2024
UDC
4S/6
UT151
David Mathie
ANNUAL CONTAINMENT SUMP INSPECTION
This form may be utilized to document the inspection of containment sumps.
Date of Inspection
6/5/2024
UST Facility Person Conducting Test
Facility Name
U. S. FOODS 4H
Facility ID #
OGDEN
Tester's Name
DMATHIE
Physical Address
835 W SAN JOSE ST
Company
Tanknology Inc.
City
OGDEN
County
WEBER
State
UT
Certification #
41442
Expiration Date
10/20/2025
UST Owner
U.S. FOODS
Tester's Signature Date
6/5/2024
Containment Sump Inspection
Sump Material
of Construction Fiberglass Reinforced Plastic Thermoplastic Steel Composite
Containment Sump Inspection Procedure
1. Clean-out and properly dispose of all debris, soil and/or fluids from the containment sump.
2. Visually examine the containment sump to ensure there are no cracks, holes, deteriorated seals, deformation or other
indications that the sump is not liquid tight.
3. If the sump appears to be liquid tight and no water was in the sump, the inspection result is "pass" and no further
action is required.
4. If the sump appears to be liquid tight but water was present within the sump, the inspection result is "fail".
5. If there is visual evidence that the sump is not liquid tight, then repair or replacement (see note below) of the sump is
required.
Inspection Results for the Year 2024
Sump ID
(product stored for STP or
dispenser number)
Sump lid/gasket in good
condition (yes/no)
Sump is dry (yes/no)
All penetration fittings in
good condition (yes/no)
Sump walls/bottom in
good condition (yes/no)
Are there any leaks from
pipe components (yes/no)
Inspection Result
(Pass/Fail)
STP:TNK1 Low Sulfur
Diesel - 1
N
Y
Y
Y
N
Pass

Comments:

WO: 2368535
Site Diagram
(This site diagram is for reference only and is not drawn to scale)

Work Order:2368535
Site ID / Name:4H / U. S. FOODS 4H
Address:835 W SAN JOSE ST
City:OGDEN State:UT Zip:84401
W.O.# NW1-2368535
OVF
W.O.# NW1-2368535
+AAE-
I10100
JUN 5, 2024 12:56 PM
U.S. FOOD SERVICE
835 SAN JOSE
OGDEN, UTAH

84401
SYSTEM STATUS REPORT
ALL FUNCTIONS NORMAL
+AAMAAQ-
I90200
JUN 5, 2024 12:56 PM
SOFTWARE REVISION LEVEL
VERSION 128.03
SOFTWARE+ACM-
346128-100-D
CREATED - 08.06.06.17.51
S-MODULE+ACM- 330160-002-A
SYSTEM FEATURES:

PERIODIC IN-TANK TESTS
ANNUAL IN-TANK TESTS
CSLD
+AAMAAQ-
I20100
JUN 5, 2024 12:56
PM
U.S. FOOD SERVICE
835 SAN JOSE
OGDEN, UTAH
84401
IN-TANK INVENTORY
TANK PRODUCT VOLUME TC VOLUME ULLAGE HEIGHT
WATER TEMP
1 DIESEL 7413 7371 12538 48.09 0.00
72.52
+AAMAAQ-
I30100
JUN 5, 2024 12:56 PM
U.S. FOOD SERVICE
835 SAN JOSE
OGDEN, UTAH
84401
LIQUID STATUS REPORT
SENSOR LOCATION
STATUS
1 ANNULAR303 SENSOR NORMAL
2 STP SUMP SENSOR
NORMAL
3 S1 NO SAT SENSOR NORMAL
4 S3 SO SAT SENSOR
NORMAL
5 1-2 DUAL MASTER SENSOR NORMAL
6 3-4 DUAL MASTER SENSOR
NORMAL
7 5NO COMBO SENSOR NORMAL
8 6SO COMBO SENSOR
NORMAL
+AAMAAQ-
I30200
JUN 5, 2024 12:56 PM
U.S. FOOD SERVICE
835 SAN JOSE
OGDEN, UTAH
84401
LIQUID ALARM HISTORY REPORT
SENSOR LOCATION

1 ANNULAR303
JUN 5, 2024 10:40 AM LOW LIQUID ALARM
MAR 14,
2024 8:43 AM LOW LIQUID ALARM
MAR 14, 2024 8:42 AM LOW LIQUID ALARM

2 STP SUMP
JUN 5, 2024 11:26 AM FUEL ALARM
SEP 5, 2023
8:30 AM FUEL ALARM
SEP 4, 2023 4:17 AM FUEL ALARM
3 S1 NO SAT

JUN 5, 2024 11:33 AM FUEL ALARM
JUN 6, 2023 9:19 AM
FUEL ALARM
JUN 6, 2023 9:19 AM SENSOR OUT ALARM
4 S3 SO SAT
JUN 5, 2024 11:27 AM FUEL ALARM
JUN 6, 2023 9:19 AM FUEL ALARM
JUN 22, 2022 9:41 AM FUEL ALARM
5 1-2 DUAL MASTER
JUN 5,
2024 11:28 AM FUEL ALARM
JUN 6, 2023 9:18 AM FUEL ALARM
JUN 22,
2022 9:41 AM FUEL ALARM
6 3-4 DUAL MASTER
JUN 5, 2024 11:28 AM
FUEL ALARM
JUN 6, 2023 9:18 AM FUEL ALARM
JUN 22, 2022 9:41 AM
FUEL ALARM
7 5NO COMBO
JUN 5, 2024 11:28 AM FUEL ALARM

JUN 6, 2023 9:19 AM FUEL ALARM
JUN 6, 2023 9:07 AM FUEL ALARM

8 6SO COMBO
JUN 5, 2024 11:29 AM FUEL ALARM
JUN 6, 2023
9:19 AM FUEL ALARM
JUN 22, 2022 9:42 AM FUEL
ALARM
+AAMAAQ-
I20600
JUN 5, 2024 12:56 PM
U.S. FOOD SERVICE
835 SAN JOSE
OGDEN, UTAH
84401
TANK ALARM HISTORY
TANK 1 DIESEL
HIGH WATER ALARM JUN 5, 2024 10:50 AM
JUN 6, 2023
8:18 AM
SEP 8, 2022 10:56 PM
OVERFILL ALARM JUN
5, 2024 11:25 AM
JUN 6, 2023 9:03 AM

SEP 9, 2022 7:38 AM
LOW PRODUCT ALARM JUN 5, 2024 11:26 AM

JUN 5, 2024 10:46 AM
APR 5, 2024 1:38 PM
HIGH
PRODUCT ALARM JUN 5, 2024 11:25 AM
MAY 1, 2024 3:28 PM

FEB 14, 2024 10:54 AM
INVALID FUEL LEVEL SEP 9, 2022 6:09
AM
SEP 9, 2022 6:03 AM
SEP 9, 2022
5:09 AM
PROBE OUT JUN 5, 2024 12:31 PM
JUN
5, 2024 10:46 AM
APR 5, 2024 9:06 AM
HIGH WATER WARNING
JUN 5, 2024 10:50 AM
JUN 6, 2023 8:18 AM

SEP 8, 2022 10:56 PM
DELIVERY NEEDED JUN 5, 2024 11:26 AM

JUN 5, 2024 10:46 AM
MAY 29, 2024 6:19 PM

MAX PRODUCT ALARM JUN 6, 2023 9:04 AM
SEP 7, 2022 8:52
PM
SEP 7, 2022 8:52 PM
LOW TEMP WARNING JUN 6,
2023 10:38 AM
SEP 9, 2022 4:11 AM

SEP 9, 2022 2:27 AM
+AAMAAQ-
I20700
JUN 5, 2024 12:56 PM
U.S. FOOD SERVICE
835 SAN
JOSE
OGDEN, UTAH
84401
TANK LEAK TEST HISTORY
T 1:DIESEL

LAST GROSS TEST PASSED:
NO TEST PASSED
LAST ANNUAL TEST PASSED:
NO TEST
PASSED
FULLEST ANNUAL TEST PASS
NO TEST PASSED
LAST PERIODIC TEST PASS:
TEST START TIME
HOURS VOLUME +ACU- VOLUME TEST TYPE
JUN 5, 2024 9:31 AM 33 11667
58.5 CSLD
FULLEST PERIODIC TEST
PASSED EACH MONTH:
TEST START TIME HOURS
VOLUME +ACU- VOLUME TEST TYPE
JAN 28, 2024 1:18 PM 45 14553 72.9
CSLD
FEB 2, 2024 8:47 PM 38 14583 73.1 CSLD
MAR 29, 2024 5:49 PM
32 16201 81.2 CSLD
APR 19, 2024 4:14 PM 29 13960 70.0
CSLD
MAY 18, 2024 1:21 AM 31 16305 81.7 CSLD
JUN 1, 2024 11:48 AM
31 11944 59.9 CSLD
JUL 2, 2023 9:49 AM 42 15248 76.4
CSLD
AUG 20, 2023 1:43 PM 37 15118 75.8 CSLD
SEP 19, 2023 2:35 PM
35 16618 83.3 CSLD
OCT 18, 2023 7:11 AM 36 13757 69.0
CSLD
NOV 20, 2023 8:41 AM 35 15097 75.7 CSLD
DEC 16, 2023 9:10 AM
34 14466 72.5 CSLD
+AAMAAQ-
IA0100
JUN 5, 2024 12:56 PM

TYPE CODE LENGTH SERIAL NO. D/CODE
TANK 1 DIESEL MAG
D004 120.00 561520 4904
+AAMAAQ-
931
TANK 1 SETUP CONDITIONS
PRODUCT:
DIESEL
PRODUCT CODE 1
HIGH WATER LIMIT 2.5
OVERFILL LIMIT:
18953
HIGH PRODUCT LIMIT: 17956
LOW PRODUCT: 4000
SUDDEN LOSS LIMIT:
99
LEAK LIMIT: 8
THERMAL COEFF: 0.000450
DELIVERY DELAY: 5
TANK
FULL CAPACITY: 19951 0 0 0 0
3/4 HEIGHT CAPACITY: 16124 0
0 0 0
1/2 HEIGHT CAPACITY: 9935 0 0 0 0
1/4 HEIGHT
CAPACITY: 3758 0 0 0 0
TANK DIAMETER: 119.50
TANK TILT ADDER:
0.00
MANIFOLDED TANKS: NONE
TANK CONFIGURED: NO
+AAMAAQ-
I61100
JUN 5, 2024
12:57 PM
LEAK TEST METHOD
- - - - - - - - - - - -
TEST CSLD : ALL TANK
Pd +AD0-
95+ACU-
CLIMATE FACTOR:MODERATE
REPORT ONLY:
DISABLED
TST EARLY
STOP:DISABLED
+AAMAAQ-
I70300
JUN 5, 2024 12:57 PM
LIQUID TYPE
SENSOR LOCATION
TYPE
1 ANNULAR303 DUAL POINT HYDROSTATIC
2 STP SUMP
TRI-STATE (SINGLE FLOAT)
3 S1 NO SAT TRI-STATE (SINGLE FLOAT)
4 S3 SO
SAT TRI-STATE (SINGLE FLOAT)
5 1-2 DUAL MASTER TRI-STATE (SINGLE
FLOAT)
6 3-4 DUAL MASTER TRI-STATE (SINGLE FLOAT)
7 5NO COMBO
TRI-STATE (SINGLE FLOAT)
8 6SO COMBO TRI-STATE (SINGLE
FLOAT)
+AAMAAQ-
I80800
JUN 5, 2024 12:57 PM
+AAMAAQ-
I10200
JUN 5, 2024 12:57
PM
U.S. FOOD SERVICE
835 SAN JOSE
OGDEN, UTAH
84401
SYSTEM CONFIGURATION
SLOT BOARD TYPE POWER ON RESET CURRENT
1 4
PROBE / G.T. 162725 162917
2 INTERSTITIAL BD
199912 200110
3 UNUSED 15000000 15000000
4
UNUSED 15000000 15000000
5 UNUSED
15000000 15000000
6 UNUSED 15000000 15000000
7
UNUSED 15000000 15000000
8 UNUSED
15000000 15000000
9 UNUSED 15000000 15000000
10
UNUSED 15000000 15000000
11 UNUSED
15000000 15000000
12 UNUSED 15000000 15000000
13
UNUSED 15000000 15000000
14 UNUSED
15000000 15000000
15 UNUSED 15000000 15000000
16
UNUSED 15000000 15000000
COMM 1 UNUSED
15000000 15000000
COMM 2 SERIAL SAT BD 478011 478708

COMM 3 SERIAL SAT BD 484692 478310
COMM 4 UNUSED
15000000 15000000
COMM 5 UNUSED 15000000 15000000

COMM 6 UNUSED 15000000 15000000
+AAM-