HomeMy WebLinkAbout2011 RESULTS{25.5
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of California
Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prreoared for each
monitoring system control panel by the technician who performs the work A copy of this form must be provided to the tank system owner /operator.
The owner /operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date_
A. General Information
Facility Name: LUCKY 7 FOOD STORE
Site Address: 2501 WHITE LN.
City: BAKERSFIELD
Bldg. No.:
_ Zip: 93304
Facility Contact Person: MANJIT SINGH Contact Phone No.: ( )
Make/Model of Monitoring System: TLS -350 INSP. - ERNIE MADINA Date of Testing/Servicing: 1111412011
B. Inventory of Equipment Teste&Certified
Check the aourotirlate boxes to indicate specific eauiriment insaected/serviced:
Tank ID: REGULAR 87
Tank ID: MID GRADE 89
Z In -Tank Gauging Probe.
Model: MAG
® In -Tank Gauging Probe.
Model: MACS
® Annular Space or Vault Sensor.
Model: 409
® Annular Space or Vault Sensor.
Model: 409
Z Piping Sump / Trench Sensor(s).
Model: 208
® Piping Sump / Trench Sensor(s).
Model: 208
❑ Fill Sump Sensor(s).
Model:
❑ Fill Sump Sensor(s).
Model:
® Mechanical Line Leak Detector.
Model: FX1V
Z Mechanical Line Leak Detector,
Model: FE -PETRO
❑ Electronic Line Leak Detector.
Model:
❑ Electronic Line Leak Detector.
Model:
❑ Tank Overfill / High -Level Sensor.
Model:
❑ Tank Overfill / High -Level Sensor.
Model:
❑ Other (specify equipment type and model in Section E on Page 2).
❑ Other (specify equipment type and model in Section E on Page 2).
Tank ID: PREMIUM 91
Tank ID:
® In -Tank Gauging Probe.
Model: MACS
❑ In -Tank Gauging Probe.
Model:
® Annular Space or Vault Sensor.
Model: 409
❑ Annular Space or Vault Sensor.
Model:
Z Piping Sump /Trench Sensor(s),
Model: 208
❑ Piping Sump / Trench Sensor(s).
Model:
❑ Fill Sump Sensor(s).
Model:
❑ Fill Sump Sensor(s).
Model:
® Mechanical Line Leak Detector.
Model: FX1V
❑ Mechanical Line Leak Detector.
Model:
❑ Electronic Line Leak Detector.
Model:
❑ Electronic Line Leak Detector.
Model:
❑ Tank Overfill / High - Level Sensor.
Model:
❑ Tank Overfill / High -Level Sensor.
Model:
❑ Other (specify equipment type and model in Section E on Page 2).
❑ Other (specify equipment type and model in Section E on Page 2).
Dispenser ID: 112
Dispenser ID: 314
Z Dispenser Containment Sensor(s).
Model: 406
® Dispenser Containment Sensor(s).
Model: 406
® Shear Valve(s).
Z Shear Valve(s).
❑ Dispenser Containment Float(s) and Chain(s).
❑ Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
Dispenser ID:
❑ Dispenser Containment Sensor(s).
Model:
❑ Dispenser Containment Sensor(s).
Model:
❑ Shear Valve(s).
❑ Shear Valve(s).
❑ Dispenser Containment Float(s) and Chain(s).
❑ Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
Dispenser ID:
❑ Dispenser Containment Sensor(s).
Model:
❑ Dispenser Containment Sensor(s).
Model:
❑ Shear Valve(s).
❑ Shear Valve(s).
❑ Dispenser Containment Float(s) and Chain(s).
❑ Dispenser Containment Float(s) and Chain(s).
*If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility.
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 information (e g. manufacturers' checklists) necessary to verify that this information is
correct and 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; (check all that apply): ® System set -ap Alarm history report
Technician Name (print): RYAN MASON Signature:
Certification No.: A273671 ICC# 8029371 -UT License. No.: 611 809850
Testing Company Name: RICH ENVIRONMENTAL Phone o.: (661) 326 -8402
Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date of Testing/Servicing: 11/14/2011
Page 1 of 5
UN -036 — U4 www.unidocs.org Rev. 01/17/08
, Monitoring System Certification
A Results of Testing/Servicing
Software Version Installed: 323.03
Complete the following checklist:
® Yes
❑ No*
Is the audible alarm operational?
® Yes
❑ No*
Is the visual alarm operational?
® 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)
® N/A
operational?
® 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 electrically disconnected? If yes: which sensors initiate
positive shut -down? (Check all that apply) ® Sump/Trench Sensors; ❑ Dispenser Containment Sensors.
Did you confirm positive shut -down due to leaks and sensor failure/disconnection? ® Yes; ❑ No.
❑ Yes
❑ No*
For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no
® N/A
mechanical overfill prevention valve is installed), is the overfill warning alarm 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
Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced
and list the manufacturer name and model for all replacement parts in Section E, below.
❑ 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, if applicable
® Yes
❑ No*
1 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 5
UN -036 —2/4 www.unidocs org Rev. 01/17/08
Monitoring System Certification
F. In -Tank Gauging / SIR Equipment:
® Check this box if tank gauging is used only for inventory control.
❑ Check this box if no tank gauging or 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:
• Yes
❑ No*
Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
• Yes
❑ No*
Were all tank gauging probes visually inspected for damage and residue buildup?
• Yes
❑ No*
Was accuracy of system product level readings tested?
• Yes
❑ No*
Was accuracy of system water level readings tested?
• Yes
❑ No*
Were all probes reinstalled properly?
• 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.
G. Line Leak Detectors (LLD):
Cmmnlete the fallnwino checkiistr
❑ Check this box if LLDs are not installed.
® Yes
❑ No*
For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
❑ N/A
(Check all that apply) Simulated leak rate: ® 3 g.p.h.; [10.1 g.p.h ; ❑ 0.2 g.p.h.
• Yes
❑ No*
Were all LLDs confirmed operational and accurate within regulatory requirements?
• Yes
❑ No*
Was the testing apparatus properly calibrated?
• 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 monitoring system malfunctions
® N/A
or fails a test?
• Yes
❑ No*
For electronic LLDs, have all accessible wiring connections been visually inspected?
® N
• 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.
H. Comments:
UN -036 — 3/4
Page 3 of 5
www.unidocs.org
Rev. 01/17/08
Monitoring System Certification
UST Monitoring Site Plan
Site Address: 2501 WHITE LN. BAKERSFIELD, CA. 93304
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Date map was drawn: 11/2512009.
Instruetions
)f you already Crave a Wagrram that shows all required infarmation, you may include it, rather than this page, with your Monitoring
System Costificatiom On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following
equipment, if installtxL moniloring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill
containers, or other secondary corrtaiumeirt areas; mechanical or electronic line leak detectors; and in -tack liquid level probes (if used
for leak detection). In the space provided, note the Jade Lhi9 Site Plan was prepared.
UN4% -as
Page 5 of 5
www.anidomorg
Rev. 01/17/08-
4QU9
SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and
printouts from tests (if applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: LUCKY 7 FOOD STORE
I Date of Testing: 11/14/11
Facility Address: 2501 WHITE LN, BAKERSFIELD, CA. 93304
Facility Contact: MANJIT SINGH
Phone:
Date Local Agency Was Notified of Testing:
Name of Local Agency Inspector (if present during testing): ERNE MADINA
2. TESTING CONTRACTOR INFORMATION
Company Name: RICH ENVIRONMENTAL
Technician Conducting Test: RYAN MASON
Credentials: ❑ CSLB Contractor X ]CC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Spec)
License Number(s): 8029371 -UT
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: X Hydrostatic ❑ Vacuum ❑ Other
Test Equipment Used: VISUAL
Equipment Resolution: 0
Identify Spill Bucket (By Tank
Number, Stored Product, eta 2
1
REGULAR 87 -FILL
2 PREMHUM 91-
FILL
3
MID-89 FILL
4
Bucket Installation Type:
X Direct Bury
❑ Contained in Sump
X Direct Bury
❑ Contained in Sump
X Direct Bury
❑ Contained in Sump
❑ Direct Bury
❑ Contained in Sum
Bucket Diameter:
12"
12"
12"
Bucket Depth:
14"
14"
14"
Wait time between applying
vacuum/water and start of test:
30 MIN
30 MIN
30 MIN
Test Start Time (TO:
09:30
09:30
09:30
Initial Reading (Rj):
12"
12"
12"
Test End Time (TF):
10:30
10:30
10:30
Final Reading (RF):
12"
12"
12"
Test Duration (Ty— TO:
1 -HOUR
1 -HOUR
1 -HOUR
Change in Reading (RF - R,):
0
0
0
Pass/Fad Threshold or
Criteria:
+/-0.00
+/-0.00
+/-0.00
Test Result:
X Pass ❑ Fail
X Pass ❑ Fail
X Pass ❑ Fail
❑ Pass ❑ Fail
Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all lite information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician's
Date: 11/14/11
State laws and regulations do noycurrently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
RICH ENVIRONMENTAL
3305 BRITTAN ST. BAKERSFIELD, CA. 93308
OFFICE (661)326 -8402 FAX (661)326 -8934
PRODUCT LINE LEAK DETECTOR TEST
WORK SHEET
WIN:
FACILITY NAME: LUCKY 7 FOOD STORE
FACILITY ADDRESS: 2501 WHITE LANE, BAKERSFIELD
PRODUCT LINE TYPE: PRESSURE
q4Z19 Aj
V
PRODUCT
LEAK DETECTOR TYPE
TEST
TRIP
PASS
BELOW
P.S.I.
OR
SERIAL NUMBER
3 G.P.H.
FAIL
UNL -87
L/D TYPE: FX1V
YES
11 P.S.I.
PASS
SERIAL # 6251
NE9"9
L/D TYPE: FE -PETRO
YES
10 P.S.I.
PASS
SERIAL # UNREADABLE
PREM -91
L/D TYPE : FX1 V
YES
10 P.S.I.
PASS
SERIAL # 9787
LID TYPE:
PASS
YES
SERIAL #
FAIL
i CERTIFY THE ABOVE TESTS WERE CONDUCTED ON THIS DATE ACCORDING TO RED
JACKET PUMPS 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.I. I
ACKNOWLEDGE THAT ALL DATA COLLECTED IS TRUE AND CORRECT TO THE BEST
OF MY KNOWLEDGE.
TECHNICIAN: RYAN MASON
SIGNATURE: DATE: 11/14/11
'9--o
SYSTEM SETUP
DEC 14. 2011 4 :17 PM
SYSTEM UNITS
U.S.
SYSTEM LANGUAGE
ENGLISH
MMOONTDD YYYTYY'HH:�MM:SS )d,
LUCKY 7
2501 WHITE N
BAAKERSFIELDLCA 93304
661 - 397 -3722
SHIFT TIME 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
PASS RE-ENABLE EST' METHOD
LINE PER TST NEEDED WRN
DISABLED
LINE ANN TST NEEDED WRN
DISABLED
PRINT TC VOLUMES
ENABLED
TEMP COMPENSATION
VALUE (DEG F ): 60.0
STICK HEIGHT OFFSET
DISABLED
DAYLIGHT SAVING TIME
DISABLED
SYSTEM SECURITY
CODE : 000000
CUSTOM ALARM LABELS
DISABLED
IN -TANK SETUP
T I:UNLEADED 87
PRODUCT CODE
COMMUNICATIONS SETUP
SOFTWARE REVISION LEVEL
- - - - - _ - - - - - -
VERSION 323.03
: 96.00
TANK PROFILE
1 PT
CREATED - 03.08306.06.10
PORT SETTINGS:
NO SOFTWARE MODULE
NONE FOUND
SYSTEM FEATURES:
PERIODIC IN -TANK TESTS
ANNUAL IN -TANK TESTS
RS -232 END OF MESSAGE
DISABLED
SYSTEM SETUP
DEC 14. 2011 4 :17 PM
SYSTEM UNITS
U.S.
SYSTEM LANGUAGE
ENGLISH
MMOONTDD YYYTYY'HH:�MM:SS )d,
LUCKY 7
2501 WHITE N
BAAKERSFIELDLCA 93304
661 - 397 -3722
SHIFT TIME 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
PASS RE-ENABLE EST' METHOD
LINE PER TST NEEDED WRN
DISABLED
LINE ANN TST NEEDED WRN
DISABLED
PRINT TC VOLUMES
ENABLED
TEMP COMPENSATION
VALUE (DEG F ): 60.0
STICK HEIGHT OFFSET
DISABLED
DAYLIGHT SAVING TIME
DISABLED
SYSTEM SECURITY
CODE : 000000
CUSTOM ALARM LABELS
DISABLED
IN -TANK SETUP
T I:UNLEADED 87
PRODUCT CODE
I 1
THERMAL COEFF
:.000070
TANK DIAMETER
: 96.00
TANK PROFILE
1 PT
FULL VOL
10000
FLOAT SIZE: 4.0 IN.
WATER WARNING 2.0
HIGH WATER LIMIT: 3.0
MAX OR LABEL VOL: 10000
OVERFILL LIMIT 909
9000
HIGH PRODUCT 95°r.
DELIVERY LIMIT 95�
1000
LOW PRODUCT 500
LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 99
TANK TILT 4.00
PROBE OFFSET -1.00
SIPHON MANIFOLDED TANKS
T #: NONE
LINE MANIFOLDED TANKS
T#: NONE
LEAK MIN PERIODIC: 0%
• D
LEAK MIN ANNUAL 0%
Q
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
T 2 :SUPER 91
PRODUCT CODE 2
THERMAL COEFF :.000070
TANK DIAMETER 96.00
TANK PROFILE 1 PT
FULL VOL 10000
FLOAT SIZE:
WATER WARNING
HIGH WATER LIMIT:
MAX OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
4.0 IN.
2.0
3.0
LOW PRODUCT
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT
PROBE OFFSET
10000
9000
95%
9500
100/0
1000
500
99
99
3.10
0.00
SIPHON MANIFOLDED TANKS
T#t NONE
LINE MANIFOLDED TANKS
T#: NONE
LEAK MIN PERIODIC: cm
0
LEAK MIN ANNUAL 0/1,
0
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLE[
PERIODIC TEST FAIL
ALARM DISABLEI
GROSS TEST FAIL
ALARM DISABLE,
ANN TEST AVERAGING: OF
PER TEST AVERAGING: OF
TANK TEST NOTIFY: OF
TNK TST SIPHON BREAK:OF
DELIVERY DELAY 15 MI
PUMP THRESHOLD 10.0(
SIPHON MANIFOLDED TANKS ALARM HISTORY REPORT
T#: NONE L 6:89- ANNULAR
LINE MANIFOLDED TANKS TRI -STATE (SINGLE FLOAT) - -- -- SYSTEM ALARM
TO: NONE CATEGORY : ANNULAR SPACE PAPER OUT
OCT 30. 201I 6:34 PM
PRINTER ERROR
LEAK MIN PERIODIC: 00% OCT 30. 2011 6:34 PM
0 BATTERY IS OFF
LEAK MIN ANNUAL 0 JAN 1. 1996 8:00 0% JAN
0
PERIODIC TEST TYPE
STANDARD
LIQUID SENSOR SETUP
qLt24 `
T3:SPECIAL89
OUTPUT RELAY SETUP
- - - - - - - - - - - -
* * * END
R 1:87 SHUTOFF
PRODUCT CODE 3
L
RECONCILIATION SETUF
THERMAL COEFF :.000070
ALARM DISABLED
1:87 STP
- - _ - _ _
TANK DIAMETER
96.00
LE
_ _ _
TANK PROFILE
I PT
CATEGORY :(SIN FLOAT)
FULL VOL
10000
AUTOMATIC DAILY CLOS
R 2:91 SHUTOFF
DELIVERY DELAY 15 MIN
L 2:89 -STP
TIME: 2:00 AM
FLOAT SIZE: 4.0
IN.
TRI -STATE (SINGLE FLOAT)
PERIODIC RECONCILIAT
CATEGORY : STP SUMP
MODE:
WATER WARNING
2.0
MON'
HIGH WATER LIMIT:
3.0
COMPENSATION
L 3'91 -STP
STANDARD.
MAX OR LABEL VOL:
10000
TRI -STATE (SINGLE FLOAT)
OVERFILL LIMIT .:
901/0
CATEGORY : STP SUMP
BUS SLOT FUEL
9000
METER
HIGH PRODUCT
959
TANK MAP EMPTY -
9500
L 4:87- ANNULAR
DELIVERY LIMIT
loo
TRI -STATE (SINGLE FLOAT)
1000
CATEGORY : ANNULAR SPACE
LOW PRODUCT
500
LEAK ALARM LIMIT:
99
SUDDEN LOSS LIMIT:
99
L 5:91 - ANNULAR
TANK TILT
4.00
TRI-STATE (SINGLE FLOAT)
PROBE OFFSET
0.00
CATEGORY : ANNULAR SPACE
SIPHON MANIFOLDED TANKS ALARM HISTORY REPORT
T#: NONE L 6:89- ANNULAR
LINE MANIFOLDED TANKS TRI -STATE (SINGLE FLOAT) - -- -- SYSTEM ALARM
TO: NONE CATEGORY : ANNULAR SPACE PAPER OUT
OCT 30. 201I 6:34 PM
PRINTER ERROR
LEAK MIN PERIODIC: 00% OCT 30. 2011 6:34 PM
0 BATTERY IS OFF
LEAK MIN ANNUAL 0 JAN 1. 1996 8:00 0% JAN
0
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
OUTPUT RELAY SETUP
PERIODIC TEST FAIL
ALARM DISABLED
* * * END
R 1:87 SHUTOFF
TYPE:
GROSS TEST FAIL
STANDARD
ALARM DISABLED
NORMALLY CLOSED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
LIQUID SE _ SOR ALMS
TANK TEST NOTIFY: OFF
�:SHONSOROUTT ALARM
TNK TST SIPHON BREAK:OFF
R 2:91 SHUTOFF
DELIVERY DELAY 15 MIN
TYPE:
PUMP THRESHOLD 10.00%
STANDARD
NORMALLY CLOSED
LEAK TEST METHOD
TEST ON DATE : ALL TANK
JAN 1. 1996
START TIME : DISABLED
TEST RATE :0.20 GAL/HR
DURATION : 2 HOURS
•.•n... r•nrn �. n•rnn • n r annr ti>
LIQUID SENSOR ALMS
ALL :FUEL ALARM
ALL:SENSOR OUT ALARM
ALL:SHORT ALARM
R 3:89 SHUTOFF
TYPE:
STANDARD
NORMALLY CLOSED
LIQUID SENSOR ALMS
ALL:FUEL ALARM
ALL:SENSOR OUT ALARM
ALL:SHORT ALARM
DELIVERY NEEDED
SEP 2, 2011 5:43 PM
AUG 4, 2011 10:18 AM
MAY 25, 2011 4:20 PM
xXXxX END X*xxs
%-" L-L-t
ALARM HISTORY REPORT
ALARM HISTORY REPORT
ALARM HISTORY REPORT
- - -- IN-TAW ALARM - - - --
-- SENSOR ALARM -
- - -- IN -TANK ALARM - - - --
L 2:89 -STP
T 1:UNLEADED 87
STP SUMP
T 3:SPECIAL 69
ENSO4,OUT ALARM
ALARM
ALARM HISTORY REPORT
30 AM
OCT 29, 2011 9:13 PM
OCT 11. 2011 9:28 AM
INVALID FUEL LEVEL
NOV 6. 2011 8:42 AM
FUEL ALARM
MAY 26. 2011 7:19 PM
OCT 17, 2011 8:27 AM
NOV 14. 2011 9:22 AM
SEP 7, 2011 9:39 AM
SENSOR OUT ALARM
HIGH PRODUCT ALARM
STP SUMP
SETUP DATA WARNING
OCT 29. 2011 9:14 PM
PROBE OUT
MAR 31. 2011 2:20 PM
DEC 6. 2008 5:39 AM
NOV 25. 2009 10:19 AM
MAR 2. 2008 4:14 AM
FUEL ALARM
INVALID FUEL LEVEL
DELIVERY NEEDED
SEP 2. 2011 10 :20 PM
DEC 13, 2011 7:14 AM
AUG 4, 2011 4:51 PM
DEC 3. 2011 5:14 PM
MAY 19. 2011 4:08 PM
NOV 4, 2011 3:07 PM
PROBE OUT
* * * END
NOV 25, 2009 10:19 AM
END
DELIVERY NEEDED
SEP 2, 2011 5:43 PM
AUG 4, 2011 10:18 AM
MAY 25, 2011 4:20 PM
xXXxX END X*xxs
ALARM HISTORY REPORT
- - - -- SENSOR ALARM - - - --
L 3:91 -STP
STP SUMP
* END *
SENSOR OUT ALARM
NOV 14, 2011 9:30 AM
ALARM HISTORY REPORT
FUEL ALARM
NOV 14, 2011 9:21 AM
-- - -- SENSOR ALARM - - - --
L 1:87 STP
SENSOR OUT ALARM
STP SUMP
NOV 23. 2010 9 :41 AM
SENSOR OUT ALARM
NOV 14. 2011 9:30 AM
FUEL ALARM
ALARM HISTORY REPORT
NOV 14, 2011 9:21 AM
- - -- IN -TANK ALARM - - - --
SENSOR OUT ALARM
NOV 23. 2010 9:41 AM
T 2:SUPER 91
INVALID FUEL LEVEL
* * * END
NOV 28, 2011 7:02 PM
OCT 19, 2011 3:21 PM
JUL 14. 2011 8:31 PM
PROBE OUT
NOV 25, 2009 10:19 AM
* * END
DELIVERY NEEDED
DEC 12. 2011 3:46 PM
NOV 24, 2011 8:22 AM
OCT 13, 2011 6:33 AM
ALARM HISTORY REPORT
- - - -- SENSOR ALARM - - --
L 4:87- ANNULAR
ANNULAR SPACE
SENSOR OUT ALARM
NOV 14. 2011 9:30 AM
FUEL ALARM
NOV 14. 2011 9:24 AM
SENSOR OUT ALARM
;� * * X END X x x
NOV 23. 2010 9:41 AM
qL W
ALARM HISTORY REPORT
----- SENSOR ALARM - -�_
L 5:91-ANNULAR
ANNULAR SPACE
SENSOR OUT ALARM
NOV 14. 2011 9:30 AM
FUEL. ALARM
NOV 14, 2011 9:23 AM
SENSOR-OUT ALARM
NOV 23. 2010 9:41 AM
x w x N X END A x X K x
ALARM HISTORY REPORT
----- SENSOR ALARM
L 6169 - ANNULAR
ANNULAR SPACE
SENSOR OUT ALARM
NOV 14. 2011 9:30 AM
FUEL ALARM
NOV 14. 2011 9:22 AM
SENSOR OUT ALARI
NOV 23. 2019 9:41 AM
X*0( *X END xxxwx
L-mlq ?
MONITOR CERT. FAILURE REPORT
SITE NAME : LUCKY 7 FOOD STORE DATE: 11/14/11
THE FOLLOWING COMPONENTS WERE REPLACED/R.EPAARED r COMPLETE
TESTING. (f
REPAIRS: NONE
LABOR: NONE
PARTS INTALLED : NONE
NAME : TITLE:
SIGNATURE:
THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING
THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR
THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR
ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF
ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE.
A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR
CONVIENENCE.