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HomeMy WebLinkAbout2011 RESULTSLk 31S MONITORING SYSTEM CERTIFICATION. For Use By All Jurisdictions Within the State of Cgli ,brnid Authority Cited Chapter 6 7, Health and Safety Code; Chapter .16, lair ision 3;. Title 23, California Code of Rekulaticns Thais form must be used to document testing and servicing of monitoring equipment. A separate certification or report must beoreoared :or gac11 monitoring tstem control Hanel by the technician who performs the work. A copy of this"'fortn mustbe.provided to the tank system ownerfopetator. The owner /operator must submit a copy of this form to the local agency regulating USl systems Within, 30 days of test. date. A. General Information Facility Name: MOBIL STATION Site Address: 13001 STOCKDALE AVENUE Facility Contact Person: _ Make/Model of Monitoring System: TLS -350 B. Inventory of Equipment'. Tested /Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: Bldg. No.: City: BAKERSFIELD Zip: 93312 Contact,Phone -No.: ( ) Date of Testing/Servicing: 10/412011 Tank iD: 87 SYPHON Tank iD: 87 MASTER' ®'In-Tank Gauging Probe. Model: MAG -1 ® In -Tank Gauging, Probe. Model: MAG -1 ®.Annular Space or Vault Sensor. Model: 409 0 Annular-Space or Vault Sensor, Model: 409 0 Piping Sump / Trench Sensor(s). 'Model: 208 ® Piping Sump /Trench Sensor(s): Model: 208 ❑ Fill.Sump Sensor(s). Model: [] Fill Sump Sensor(s). Modei. ® Mechanical Line Leah Detector. Model RED JACKET ® Mechanical Linc.Leak Detector.. Model` RED JACKET [Q Electronic Line Leak Detector, Model: ❑ Electronic Line Leak Detector: Model: Tank .Overfill / High -Level Sensor. Model: BALL FLOAT. ❑ yank Overfill-/ Nigh -Level Sensor: Model: ❑ Other (Specify equipment n-pe and model in Section E on Page 2). ❑ Other (specify equipment type and model in Section E on 6ge 2). ,Tank..im DIESEL Tank ED: 97. Z'in =Tank Gauging Probe. Model: MAG -1 M In -Tank Gauging Probe. Model: MAG -1 S Annular Space or Vault Sensor. Model: 409 ® Annular Space or Vault Scnsor. Model: 409. 2 Piping Sump / Trench Sensor(s). Model: 208 ® Piping Sumi5l 1 rench`Sensor(s). Model: 208 ❑ Fill Sump Sensor(s), Model: ❑ Fill Sump Sen. s): Model: ® Mechanical Line Leak Detector. Model: RED JACKET Mechanical Lim,LeA Detector: Model: RED JACKET ❑ electronic Line ILA Detector. Model: ❑ Electronic Line Le k- Detector. Model: ® Tank Overfill i Fligh -Level Sensor, Model: BALL FLOAT ® Tank'Overfill. /'High -Level Sensor; Model: BALL:FLOAT ❑ Other (specify equipment type and model in Section E on Page 2). ❑ Other f specifyequi equipment p t}pe :and "maxleLin Section E on rage 2). Dispenser ID: 132 Dispenser ID 314 9 Dispenser Containment Sensor(s). Model: 01 ®Dispenser Containment. Sensor(s)... Model: 01 ® Shear Valve(s). ® Shear Valvefs). tD'Uispenser Containment Float(s) a nd.Chain(s). El Dispenser Containment ;Float(s) :and Dispenser ID: -718 Chain(s)., Dispenser ID: _516 ® Dispenser Containment Scnsor(s). Model: 01 ® Dispenser Containment Sensor(s). Model: 01 ® Sheai Valve(s). ® Shear Valve(s). ❑ Dispenser Containment Fkmt(s) and Chain(s). ❑ Dispenser Containment Float,(s) and Chain(s). Dispemer ID: Dispenser ID: Q 1)'aspenser Containment Sensor(s). Model: ❑ Dispenser Containmeni.Sensor(s). Model: Shear Valvets). ❑ Shear Valve(s). ❑ Dispenser Containment Float(s) and Chain(s). ❑ Dispenser (outaidiTient Floats) and Chain(s)_ *If.the facility contains more tanks or dispensers, copy this form. Include information for evdiy tank and dispenser at the facility. C. Certification - i certify that the equipment identified in this document was inspectedlserviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the: layout of monitoring a uipment. For any equipmenfcapable generating such reports, I have also attached a copy of the report; (check all that apply): System set -up Alarm h' " rv' report Technician Name (print): RICH PHILLIPS Signature: Certification No.: A2908411036169-UT License. No. 11 D40. 809850- Testing Company Name: RICH ENVIRONMENTAL `Phone No.c (661),392 -8687 Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date of Testing Servicing: 10/412011 Page 1 of 5 CN -036— t/t www.unidoes.org. Rev. 01, /17M • Monitoring System Certification j D. ,Results of Testing /Servicing Software Version Installed: 330.01 Complete the followine checklist: 46-151-, / ® Yes ❑ No',' Is the audible alarm operational? ®; Yes ❑ No* Is the visual alarm operational? 0 Yes ❑ No* Were all sensors visually inspected, functionally tested, and confirmed operational? Yes ❑ No* Were all sensors installed..at lowest point of secondary containment:and positioned so that.other equipment will not interfere'with''their proper operation? ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) 0 N/A operational? 23 Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ❑ N/A monitoring system detects a leak, fails to operate, or is eiectncally:disconnected? If'yes: which sensors initiate positive shut - down? (Check all that apply) ® Sumpi french. Sensors, ❑ Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure /disconnection? ® Yes: 0 No. li ® Yes ❑ No's I For tank systems that utilize the monitoring system as the primary tank overfill warning device (Le., no ❑ N/A ( mechanical overfill 'prevention valve.is installed), is the overfill warning aiat7tl visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does` the alarm trigger? % ❑ Yes* ®No T�ist any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced the manufacturer name and model for:ail replaceme3it parts:in Section E, below. 0 Yes* ® No Was liquid found inside any secondary containment systems designed. as dry systems? (Check all that.apply) ❑ Product; ❑ Water. If yes, describe causes in Section.E; below. (� Yes ❑ No* Was monitoring system set -up reviewed,to ensure proper settings ? - Attach set-up,reports inapplicable ® Yes ❑ No* is all monitoring equipment operational per manufacturer's specifications? } In Section E_below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of $ LTM1i4136 — 2/4 www.unidoes.org Rey. 01 /17/08 Monitoring System Certification F. In -Tank Garaging / SIR Equipment: lV3't5Z— / ❑ Check this box 1f tank gauging is used`only for inventory control, ❑ Checicthis box'ifnoaank'gauging of SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to .perform leak. detection monitoring. Complete the - following checklist- 0 Yes ❑ No* Has all input wiring been inspected for proper entry and termination; including testing for D ound faults? s? Yes 0 No* Were all tank gauging probes visually inspected for damage acid residue buildup? Yes ❑ No* Was accuracy of system product level readings.tested? 0 Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No" I Were all items on the equipment manufacturer's maintenance checklist completed? " In Section % below, describe how and when these deficiencies were or will be corrected. G. Line Leak (Detectors (LLD): Complete the following checklist: ❑ Check ibis box if LLDs are not installed: Z Yes ❑ No* ' For equipment start -up or annual equipment certification, was a leak simulated to: verify LL,D perforr ance? i ❑ 'N /A (Check ail that apph) Cumulated leak rate: ®.3 g.p.h.; O.Q. I g.p.h ; 0.02 g.p.h. Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ❑ No* Was the testing apparatus properly calibrated? [3 Yes ❑ No* For mechanical LLDs, does the -LLD restrict product flow if it detects a leak?: ❑ N/A [] Yes- ❑ No* For electronic LLDs, does. the turbine automatically shut off if the LLD detects a leak;' ® N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ® N/A or disconnected? ❑ Yes ❑ NO For electronic LLDs, does the turbine automatically shut off if.any portion of the manitonng system malfunctions 0 N/A or fails a test? � 0 Yes ❑ No's For electronic LUDs, have all accessible wiring connections been visually inspected ?` ,RI N/A 9 Yes ❑ No* Were all items on the equipment manufacturer's maintenance.checklist completed? * In Section H; below, describe how and when these deficiencies were or will -be corrected. 110. Comments: Page 3 of 5 UN-036 — 3/4 www.unidomorg Rev. 01 /17108. Monitoring System Certification Form: Addendum for Vacudm/iPressure Interstitial. Sensors I. Results of Vacuum /Pressure Monitoring Equipment 'Testing W 3ZSZ.. ei� r This page should be used to document testing and servicing of vacuum and pressure interstitial, sensors. A copy of this form, must be included with the Monitoring System Certification Form, which must be provided to the tank system owner /operator. The owner /operator must submit a copy of the Monitoring. System `Certification Form to the local agency regulating UST systems within 30 days of test date. Manufacturer: NONE Model: System Type: ❑ Pressure; ® Vacuum Sensor ID Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial'Communication°Test :Result: ❑ Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result; ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fair Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial �Communication Test Result: ❑ Pass; ❑ .Fail. Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial'Comniunication Test Result: ❑ Pass; Ej Fail . Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ . Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result ❑ Pass; ❑ Fail Interstitial'Communication Test Result:' ❑ Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication 'Test Result: ❑ Pass-, ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail Components) Monitored by this Sensor: Sensor Functionality Test Result: ❑ Pass; ❑ Fair Interstitial Communication Test Result;, ❑Pass;, ❑; Fail, How was interstitial communication verified? ❑ Leak Introduced at Far End of Interstitial Space;' El Gauge; [] Visual Inspection; ❑ Other'(Describe in Sec., J, below) Was vacuum /pressure restored to operating levels in all interstitial spaces? ❑ Yes ❑ No (If no, describe in Sec. J, below) J. Comments: NONE OF THESE SENSORS ARE PRESENT AT THIS SITE. Page 4 of 5 ` If the sensor successfully detects a simulated vacuum /pressure leak' introduced in the interstitial space at the finthest point from the sensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice. LIN -036A - 1/1 www.unidocs org Rev. 01/26/06 Monitoring System Certification UST Monitoring Site Plan Site Address: % 3 VO i r7-4(- N3'tSZ Date map was drawn: 10 Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your" Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spares,. sumps, dispenser pans, spill. containers, or other secondary containment areas; mechanical or. electronic 'line..leak. detectors; and in -tank- liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. UN -036 = 4/4 Page 5 of 5 www:anidomorg Rev. 01/17/09 1 SWRCB; January 2006 Spill Bucket Testing Report, Form This form is intended for use by conrractors performing annual testing of UST spill containment structures. -The. completed form and. printouts from, tests (if applicable), should be provided to the facility ownerloperator fur submittpl to the local reguluiofy. agency. 1. FACILITY INFORMATION Facility Name: MOBIL STATION Date of T'esting`. 10/4/11 Facility, Address: 13001 STOCKDALE HWY, BAKERSFIELD Facility Contact: Phone: 4 bate Local Agency Was Notified of Testing: 8/18/,11 Name of Local. Agency Inspector (j present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RICH PHILLIPS Credentials': :'i CSLB Contractor X 1CC Service Tech, Q SWRCB Tank Tester 0 Other-(Specify _ License Number(s): 1035169 -UT 3. SPILL BUCKET TESTING.INFORMAATION Test .Method Used: X Hydrostatic [I Vacuum ::i Other Test Equipment Used: VISUAL Equipment Resolution: 0. Identify Spill Bucket (Av Tank Number, Stored Product, .491 I WESEL 287-S 3'87 -M Bucket Instal iation Type: Direct Bury X Contained in Sump ❑ Direct Bury X Contained in Sam p_. 0 Direct.Bury X:Contained in Sump ❑Direct Bury X Contained in Sump `Bucket Diameter: 12" 12" 12" 12" Bucket Depth 14" 14" 14" 14" 'Wait time between applying vacuum/water and start of test: 30 MIN 30 MIN 30 MIN 30'M1N Test =Start Time (T,): 9 :00 9:00 9:00 9 :00 Initial Reading (Rj): 14" 14" 14" 14" Test End Time (Tr): 10:00 10:00 10:00 10:00 Final Reading (RF): 14" 14" 14" 14' Test, Duration (TF — T;): 1 -HOUR 1 -HOUR 1 -HOUR 1 -HOUR Change in Reading (R: - Ri): .000 .000 000 .000 PassiFail Threshold or Criteria: a,.k,•,e.;...�,..•,,_.rr. /-0.00 +/-0.00 •) +/- 0:00 , y:. _ +/- 0.00 f ."° ?t'::;,i�lf. Comments — (include information on repairs made-prior to- testing and recommended follow -up for failed'tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING T141S TESTING I herehv certify that ali the information contaipof in this report is true, accurate,: and infull compliance with legal requirenteitts. Technician's Signature:_ ^_ Date: _10,14/I'l } State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. (Alb'iSZ/ RICH ENVIRONMENTAL 5643 BROODS CT. BAKFRSFIELD, CA. 93308 OFFICE (661)392 -8687 FAX {661)397 -0621 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET FACILITY NAME: MOBIL STATION FACILITY ADDRESS: 13001 STOCKDALE HWY, BAKERSFIELD PRODUCT LINE TYPE: PRESSURE PRODUCT � LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.M. OR SERIAL NUMBER 3 G.P.H. FAIL DIESEL L/D TYPE: RED JACKET I YES 11 PASS I ^ i SERIAL #_ I i i LID TYPE: RED JACKET YES 11 PASS i i SERIAL # _ 0 91 L/D TYPE. RED JACKET I YES 10 PASS f i SERIAL # - L/D TYPE.- YES PASS SERIAL # - T n O FA%L � 1. CERTIFY THE ABOVE TESTS WERE CONDUCTED ON THIS DATE ACCORDING TO RED JACKET PI -IMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMITATIONS. THE MECHANICAL LEAK DETECTOR TEST PASS / FAIL. IS DETERMINED BY USING A LOW FLOW THRESHOLD TRIP RATE OF 3 GALLONS PER HOUR-OR LESS AT 10 P.S'L I ACKNOWLEDGE THAT ALL DATA COLLECTED IS TRUE AYD'CORRECT TO THE BEST OF MY KNOWLEDGE. TECHNICIAN: RICH PHILLIP SIC NATURE: DATE: 10 /4 /11 SOFTWARE REVISION LEVEL VERSION 330.01 SOFTWARE# 346330 -100 -B CREATED - 10.07.23.17.25 S- MODULE# 330160 -004 -a SYSTEM FEATURES: PERIODIC IN -TANK TESTS ANNUAL IN -TANK. TESTS ISD f SYSTEM ^SETUP - - - - - OCT 4. 2011 13:25 AM SYSTEM UNITS U.S.. SYSTEM LANGUAGE ENGLISH SYSTEM DATE /TIME FORMA'r MON DD YYYY HH : fIM1: SS xM MOBIL 1300,1 STOCKDALE HWY BAKERSFIELD CA SHIFT T I 1'1E 1 DISABLED SHIFT TIME 2 DISABLED SHIFT. TIME 3 DISABLED SHIFT TIME 4 DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE RE- ENABLE METHOD PASS LINE TEST LINE PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEC F ): 60.0 STICK HEIGHT OFFSET DISABLED ULLAGE: 90% H- PROTOCOL DATA FORMAT HEIGHT DAYLIGHT SAVING TIME DISABLED RE- DIRECT LOCAL PRINTOUT DISABLED EURO.PROTOCOL PREFIX S 031., 1-1'I NGv UJ'il 1 3 "' SIPHON MANIFOLDED TANKS *,b4�� CODE : 000000 RS�2.32; SEC UR:ITY LINE MANIFOLDED TANKS MAINTENANCE HISTORY T#: NOME i DISABLED AUTO TRANSMIT SETTINGS: LEAK MIN PERIODIC: 0� i RS-232 END OF MESSAGE TANK CHART SECURITY D'ISABLED bISABI;ED DISABLED AUTO HIGH WATER LIMIT i 0 CUSTOM ALARMS AUTO OVERFILL LIMIT DISABLED DISABLED PERIODIC TEST TYPE SERVICE NOTICE STANDARD DISABLED DISABLED AUTO THEFT LIMIT ANNUAL TEST FAIL ISO 3166 COUNTRY- I`N -TANK SETUP AUTO DELIVERY START CODE: - - - - - _ - - - - - AUTO DELIVERY END T 1:.87 SIPHON DISABLED MASS:DENSITY PROD C•ODE 1 DISABLED .UCT' THERMAL COEFF :.400740 AUTO EXTERNAL INPUT OFF TANK DIAMETER 96,00 AUTO SENSOR.FIJEL ALARM TANK PROFILE I PT FULL.VOL 10000 DISABLED FLOAT SIZE: 4.0 IN. AUTO SENSOR OUT ALARM WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX' ;OR' LABEL VOL: 10000 OVERFILL 1.'IMIT COMMUNICATIONS SETUP 9.000 - - - - - - - - - - - - HIGH PRODUCT 5% 99 DELIVERY LIMIT f PORT SETTINGS: . 1000 COMM BOARD : 1 (EDIM ) LOW PRODUCT 1000 RS-232 SECURITY LEAK ALARM LIMIT: 99 CODE : DISABLED SUDDEN LOSS LIMIT: 99 TANK TILT 0,00 COMM BOARD 2 (RS -232) PROBE OFFSET 0.00 BAUD RATE : 1200 PARITY ODD STOP BIT : 1 STOP SIPHON MANIFOLDED TANKS DATA LENGTH, DATA Tit: , 02 RS�2.32; SEC UR:ITY LINE MANIFOLDED TANKS CODE-: DISABLED T#: NOME i AUTO TRANSMIT SETTINGS: LEAK MIN PERIODIC: 0� 0 bISABI;ED LEAK MIN ANNUAL AUTO HIGH WATER LIMIT i 0 DISABLED AUTO OVERFILL LIMIT DISABLED PERIODIC TEST TYPE AUTO LOW PRODUCT STANDARD DISABLED AUTO THEFT LIMIT ANNUAL TEST FAIL DISABLED ALARM DISABLED AUTO DELIVERY START DISABLED PERIODIC TEST FAIL . AUTO DELIVERY END ALARM DISABLED DISABLED AUTO EXTERNAL INPUT ON GROSS: TEST FAIL DISABLED ALARM DISABLED AUTO EXTERNAL INPUT OFF DISABLED ANN TEST AVERAGING: OFF AUTO SENSOR.FIJEL ALARM PER TEST AVERAGING: OFF DISABLED AUTO SENSOR WATER ALARM TANK TEST NOTIFY: OFF DISABLED AUTO SENSOR OUT ALARM TNK TST SIPHON 8REAK:OFF DISABLED DELIVERY DELAY 5 MIN PUMP THRESHOLD. 10,00'- 43152_ T 4­:1SUPEIR PRODUCT CODE 4 T 3: D I EBEL THERMAL COEFF :.o obo ' 0 T 2:87 REC� PRODUCT CODE 3 TANK D.IAHETtR 96.60 PRODUCT CODE THERMAL COEFF :.000450 TANK PROFILE' F 'I PT 2 THERMAL COEFF 000700 TANK DIAMETER 96-00 FULL VOL : 1.0000 TANK-DIAMETER 96.00 TANK PROFILE I PT TANY.PROFILE FULL VOL 10000 I PT FULL VOL 10000 FLOAT 8111I.£* 4.0 IN. FLOAT SIZE: 4.0 IN• WATER WARNING 2.0 FLOAT S 1 4.0 IN. HIGH WATER LIMIT: 3.0 WATER WARNING 2.0 ,WATER WARNING 2.0 HIGH WATER LIMIT: 3,0 MAX OR LABEL VOL: 1,0000 -" HIGH WATER LIMIT: 3.0 OVERFILL LIMIT 95% MAX OR LABEL VOL: 10000 9500 MAX OR LABEL VOL: loono OVERFILL LIMIT 95%, HIGH. PRODUCT 901 OVERFILL LIMIT 90% 9500 HIGH P 0% PRODUCT 9 'DELIVERY LIMIT 9000 15% HIGH PRODUCT 9000 9000 1500 95% DELIVERY L 1111T 9500 DELIVERY LIMIT 15%. 15011 LOW PRODUCT., 1000 10% LEAK ALARM ,LIMIT;: 59 1000 LOW PRODUCT 1000 SUDDEN LOSS LIMIT. 99 LOW PRODUCT I li- 0 o LEAK ALARM LIMIT: 99 TANK TILT 0.00 LEAK ALAR11 LIMIT: 99 SUDDEN LOSS LIMIT: 99 PROBE OFFSET, 0.00 SUDDEN, LOSS LIMIT 99 TANK TILT 0.00 -TANK TILT 0.00 PROBE OFFSET PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS 0.00 TO' NONE SIPHON IIAP41FOLDED TANX-S LINE:MAN,IFOLDED TANKS SIPHON MANIFOLDED TANKS TO: NONE TO: NONE TO: 01 LINE MANIFOLDED TANKS LINE MANIFOLDED TANKS TO: NONE T#: NONE EAM I N PER I OD I C' 0% LEAK MIN PERIODIC: 0% EAK MIN PER I OD I C: 0 LEAK MIN ANNUAL 01% 0% 0 0 LEAK MIN ANNUAL 0*/* XAX 111 N ANNUAL : 0% 0 PERIODIC TEST TYPE 0 STANDARD PERIODIC TEST TYPE 'ERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL. ALARM DISABLED STANDARD ANNUAL TEST FAIL ,wNUAL TEST FAIL ALARM DISABLED. PERIODIC TEST FAIL ALARM DISABLED ALARM DISABLED PERIODIC TEST FAIL ERIODIC TEST FAIL ALARM D I 3ABLED GROSS 'TEST , FA I I, ALARM DISABLED ALARM DISABLED I GROSS TEST FAIL I ROSS TEST FAIL ALARM DISABLED ANN TEST AVERAG I'W-:: OFF ALARI-1 DISABLED PER TEST AVERAGING: OFF'.. ANN TEST AVERAGING: OFF IN TEST AVERAGING: PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF OFF R TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK,TST SIPHON BREAK:OFF . 4NK TEST NOTIFY' OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 5 MIN TST SIPHON BREAK:OFF PUMP THRESHOLD 10.00% DELIVERY, DELAx' 5 MIN ,LIVERY RELAY 5 M IN PUMP THRESHOLD 10.00% IMP THRESHOLD lfj.[)O% LEAK TEST METHOD .TEST ON DATE ALL TANK JAN 29. 2009 START TIME : DISABLED TEST RATE :0.20 GAL /HR DURATION 2 HOURS TST EARLY STOP, D I lsi)BLED LEAK TEST REPORT FORMAT NORMAL i LIQUID SENSOR SETUP L 167 STP SIPHON TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP H 2:87 ANNULAR TRI -STATE (SINGLE FLOAT) ,ATEGORY ANNULAR SPACE 3:87 STP ,RI-STATE '( SINGLE FLOAT) TEGORY STP SUMP k 4:87 ANNULAR SIPHON ' I- STATE (SINGLE FLOAT) 'ATEGORY : ANNULAR SPACE 5:DIESEL STP RI--STATE (SINGLE FLOAT) 4;TRGORY : STP SUMP '6:DikSEL ANfVULAR RI -STATE (SINGLE FLOAT) ~TEGORY ANNULAR SPACE 7:91 STP �I -STATE (SINGLE FLOAT) TEGORY : STP SUMP 4 T 91 ANNULAR -STATE (SINGLE FLOAT) EGORY ANNULAR SPACE OUTPUT RELAY SETUP: R 1:87 SHUTDOWN' TYPE,) STANDARD NORMALLY CLOSED TANK #: 2 LIQUID SENSOR ALMS L 1 :FUEL ALARM L 3:FUEL ALARM L I:SENSOR OUT ALARM L 3 :SENSOR OUT ALARM ISD SITE ALARMS ISD GROSS PRES FAIL ISD DEGRD PRES FAIL ISD VAPOR LEAK FAIL ISD . VP, PRES FAIL ISD HOSE ALARMS ALL:GROSS COLLECT FAIL ALL :DEGRD COLLECT FAIL ALL :FLOW COLLECT FAIL R 2 :91 SHUTDOWN TYPE: STANDARD NORMALLY CLOSED TANK #: 4 LIQUID SENSOR ALMS L ?:FUEL ALARM L 7:SENSOR OUT ALARM ISD SITE ALARMS ISD GROSS PRES FAIL ISD DEGRD PRES FAIL ISD VAPOR LEAK FAIL .ISD VP PRES FAIL ISD VP STATUS FAIL ISD HOSE ALARMS ALL:GROSS COLLECT FAIL ALL:DEGRD COLLECT FAIL ALL:FLOW COLLECT.FA1L R 3 :DIESEL SHUTDOWN TYPE: STANDARD NORMALLY CLOSED TANK #: NONE LIQUID SENSOR ALMS L 5:FUEL ALARM L 5:SENSOR OUT ALARM SMARTSENSOR SETUP g I':'VAPOR PRESSURE CATEGORY VAPOR PRESSURE 2::GARBON CAfVISTOR CATEGORY VAPOR VALVE s 3:DIS. 5 -6 CATEGORY AIR FLOW METER CATEGORY AIR.FLOW.METER 7 -8 CATEGORY AIR FLOW METER g 6 :DI5,. 1-2 CATEGORY AIR FLOW METER s 8: :ATM CATEGORY ATM P SENSOR EVR /ISD SIrTUP EVR TYPE:: BALANCE BALANCE NOZZLE TYPE V8T VEEDER ROOTSPOLISHER ANALYS_12 TIMES TIME! 10:•bOI AM. ACGEPT..HIGH ORVR: ;DISABLED w' I SD HOSE TABLE ID' FP FL HL AA RR 01 01 01 02 04 02 -02 02 02 02 04 02 X03 03 03 02 02 02 04 04 04 02 02 02 05 05 05 02 01 02 `06 06 06 02 01 02 -07 07 07 02 03 02 08 09 08 02 03 0•? �Y 'ISD AIRFLOW METER MAP `*ID SERIAL NUM LABEL 1 3897fi� - - - -- DIS. -5 -6 -- 2 36596 DIS.3 -4 3 389.82 DIS. 7 -8 4 38266 DIS. 1 -2 ISD FUEL GRADE HOSE MAP 1 2 3 4 FP MHH MHH 11HH MHH AA r----------------------- U1 101 901 201 U U 4 <02 102 902 202 U U 4 ;03. 1.03 903 203 U U 2 X04 10:4 904 204 U U 2 05.105 905 205 3 U 1 06 .106 906 206 3 U 1 07 107 907 207 3 U 3 ;08 208 908 108 3 U 3 LABEL TABLE .�I UNASSIGNED j2:. HLEND3 'x3: REGULAR 4: MID GRADE `5: .PREMIUM ° 6 GOLD 7: BRONZE 8: SILVER r -,9: BLEND2 1,O: HLEND4 t WL SETUP 410 VERSION: 01.03 1APOR PROCESSOR TYPE fEDER -ROOT POLISHER ALARM HISTORY REPORT ----- SENSOR ALARM - -_ L 1 :87 STP SIPHON STP SUMP SENSOR OUT ALARM OCT 4, 2011 9:38 AM FUEL ALARM OCT 4, 2011 1 9:15 All FUEL AL14RPI MAR 21.. 2011 6:36 PP9 ALARM HISTORY REPORT SENSOR ALARM L 2:87 ANNULAR ANNULAR SPACE SENSOR OUT ALARM OCT 4, 2011 9:38 AM FUEL ALARM OCT 4, 2011 9:27 AM ALARM HISTORY REPORT - - - -- SENSOR ALARM - - - -- L 3:87 STP STP SUMP SENSOR OUT ALARM OCT 4. 2011 9 :36 AM FUEL ALARM OCT 4, 2011 9:15 AM FUEL ALARM MAR 3, 2011 2:38 PM ALARM HISTORY REPORT SENSOR ALARM L 4 :87 ANNULAR SIPHON ANNULAR SPACE SENSOR OUT ALARM OCT 4. 2011 9:36 AM FUEL ALARM OCT 4, 2011 9:24 AM ALARM HISTORY REPORT - - - -- SENSOR ALARM 4 5 :DJESEL STP STP SUMP SENSOR O1JT ALARM 00T 4, 2011. 9:38 AM FUEL. ALARM - ° , 4, 2011 9:1-5 AM ALARM HISTORY REPORT - - - -- ,SENSOR ALARM -. - = -� L 6.:DIESEL ANNULAR ANNULAR -SPACE SENSOR OUT ALARM OCT- 4., 2011 9 :38 AM FUEL ALARM OCT 4. 2011 9:22 W .ALARM HISTORY REPORT �k3isz �, - - - -- SENSOR. ALAR11 - - - -- L 7:91.OTP STP :SUMP SENSOR OUT ALARM OCT' 4 , 2011 9': 38 AM FUEL ALARM OCT 4, 20111 9::16 AM FUEL ALARM, DEG '18, 2010 5 :07 PM ALARM H I STOR'!. RET''ORT ------ SENSOR'ALARM L B -::91 ANNULAR ANNULAR SPACE. SENSOR OUT .ALARM OCT 4, 2011 9:38 AM !:ILL AL' IS1 -1 OCT 4, 2011 9 :18 AM MONITOR CERT. FAILURE REPORT SITE NAME: /y11> X31 L DATE: fl, --'� ADDRESS: / 3 oo t rroc,k —p bt' Il wy TECHNICIAN: CITY: IJA 66-a� i L SIGNATURE: REPAIRS: NONE PARTS INSTALLED: NONE THE ABOVE NAMED PERSON TAKES ]FULL RESPONSIBILITY. OF NOTHrYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTH YING RICH ENVIRONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASE&RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURiNG FROM NON- COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON-SITE FOR -YOUR CONVIENENCE.