DERR-2025-005495

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 6/4/2025 Tanknology WO#NW1-2381231
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 Line Tightness (.1 GPH) Tank TNK1 Line 1 Low Sulfur Diesel 6/4/2025 Pass
Precision Line Tightness (.1 GPH) Satellite Line 1 6/4/2025 Tested w/ Primary
Precision Line Tightness (.1 GPH) Satellite Line 2 6/4/2025 Tested w/ Primary
Precision Line Tightness (.1 GPH) Satellite Line 3 6/4/2025 Tested w/ Primary
Precision Line Tightness (.1 GPH) Satellite Line 4 6/4/2025 Tested w/ Primary

PEI RP 1200 Leak Detector See test report for details 6/4/2025 Pass

Impact Valve Inspection See test report for details 6/4/2025 Pass

RP 1200 ATG See test report for details 6/4/2025 Pass

RP 1200 Sensors See test report for details 6/4/2025 Pass

Sump Inspection See test report for details 6/4/2025 Pass

Tanknology Representative: David Edens Technician: David Mathie
Telephone: ()Technician Certification: (See forms)
Product Line Tightness Test Page 1 of 1
Work Order: 2381231 Date: 6/4/2025
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
08:55
09:55
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
©2025 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com

Product Line Tightness Test
Satellite Line Tightness Test Page 1 of 1
Work Order: 2381231 Date: 6/4/2025
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
©2025 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
06/04/2025
Low Sulfur Diesel
Veeder Root
FX1DV
40
20
250
2
10
3
UT151
David Mathie
NW1-2381231
TTNK1:1
Impact Valve
Inspection
Impact Valve Operational
Inspection
Work Order:2381231 Date:6/4/2025
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
©2025 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 06/04/2025
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
06/04/2025
ANNULAR STP UDC UDC UDC UDC UDC
DSL WET DSL 1S 1/2 3S 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
06/04/2025
UDC
4S/6
David Mathie
ANNUAL CONTAINMENT SUMP INSPECTION
This form may be utilized to document the inspection of containment sumps.
Date of Inspection
6/4/2025
UST Facility Person Conducting Test
Facility Name
U. S. FOODS 4H
Facility ID #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
6/4/2025
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 2025
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
Y
Y
Y
Y
N
Pass

Comments:

WO: 2381231
Site Diagram
(This site diagram is for reference only and is not drawn to scale)

Work Order:2381231
Site ID / Name:4H / U. S. FOODS 4H
Address:835 W SAN JOSE ST
City:OGDEN State:UT Zip:84401
W.O.# NW1-2381231
OVF
W.O.# NW1-2381231
+AAE-
I10100
JUN 4, 2025 9:38 AM
U.S. FOOD SERVICE
835 SAN JOSE
OGDEN, UTAH

84401
SYSTEM STATUS REPORT
ALL FUNCTIONS NORMAL
+AAMAAQ-
I90200
JUN 4, 2025 9:38 AM
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 4, 2025 9:38
AM
U.S. FOOD SERVICE
835 SAN JOSE
OGDEN, UTAH
84401
IN-TANK INVENTORY
TANK PRODUCT VOLUME TC VOLUME ULLAGE HEIGHT
WATER TEMP
1 DIESEL 6859 6809 13092 45.47 0.00
76.05
+AAMAAQ-
I30100
JUN 4, 2025 9:38 AM
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 4, 2025 9:38 AM
U.S. FOOD SERVICE
835 SAN JOSE
OGDEN, UTAH
84401
LIQUID ALARM HISTORY REPORT
SENSOR LOCATION

1 ANNULAR303
JUN 4, 2025 8:32 AM LOW LIQUID ALARM
MAR 4,
2025 7:47 AM SENSOR OUT ALARM
JUN 5, 2024 10:40 AM LOW LIQUID ALARM

2 STP SUMP
JUN 4, 2025 8:50 AM FUEL ALARM
MAR 4, 2025
8:05 AM SENSOR OUT ALARM
JAN 18, 2025 5:45 AM FUEL ALARM
3 S1 NO
SAT
JUN 4, 2025 9:18 AM FUEL ALARM
JUN 4, 2025 9:15 AM
SENSOR OUT ALARM
JUN 4, 2025 9:15 AM SENSOR OUT ALARM
4 S3 SO SAT

JUN 4, 2025 8:54 AM FUEL ALARM
FEB 28, 2025 6:40 AM
SENSOR OUT ALARM
FEB 28, 2025 5:02 AM SENSOR OUT ALARM
5 1-2 DUAL MASTER

JUN 4, 2025 8:54 AM FUEL ALARM
JUN 5, 2024 11:28 AM FUEL
ALARM
JUN 6, 2023 9:18 AM FUEL ALARM
6 3-4 DUAL MASTER
JUN
4, 2025 8:54 AM FUEL ALARM
JUN 5, 2024 11:28 AM FUEL ALARM
JUN
6, 2023 9:18 AM FUEL ALARM
7 5NO COMBO
JUN 4, 2025 8:55 AM
FUEL ALARM
JUN 5, 2024 11:28 AM FUEL ALARM
JUN 6, 2023 9:19 AM
FUEL ALARM
8 6SO COMBO
JUN 4, 2025 8:55 AM FUEL
ALARM
JUN 5, 2024 11:29 AM FUEL ALARM
JUN 6, 2023 9:19 AM FUEL
ALARM
+AAMAAQ-
IA0100
JUN 4, 2025 9:38 AM
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 4, 2025 9:39 AM
LEAK TEST METHOD
- -
- - - - - - - - - -
TEST CSLD : ALL TANK
Pd +AD0- 95+ACU-
CLIMATE FACTOR:MODERATE
REPORT
ONLY:
DISABLED
TST EARLY STOP:DISABLED
+AAMAAQ-
I70300
JUN 4, 2025 9:39 AM
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 4, 2025 9:39 AM
+AAMAAQ-
I10200
JUN 4,
2025 9:39 AM
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 163188
2 INTERSTITIAL BD
199912 200285
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 479463

COMM 3 SERIAL SAT BD 484692 478805
COMM 4 UNUSED
15000000 15000000
COMM 5 UNUSED 15000000 15000000

COMM 6 UNUSED 15000000 15000000
+AAM-