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Home My WebLink About2012 RESULTSHOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH oOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. 6)a7go- File Number: Address: _ Bakersfiel Date Received: (9 - 5 -' i3 Business Name: C�! r (e-c- , CA 933 Comments: 1 2. 3. 4, INSPECTION LOG Date Time Signature SYSTEM: r BUILDING SQUARE FEET: New Mod. ❑ ❑ Commercial Hood System Building Sq. Feet: ❑ ❑ Fire Alarm System Calculation Bldg. Sq. Ft: ❑ ❑ Fire Sprinkler System ❑ ❑ SpPa'y finish System ❑ ❑ Aboveground Storage Tank ❑ ❑ Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank r ❑ Other. r— (Z-- Comments: 1 2. 3. 4, INSPECTION LOG Date Time Signature BILLING & PERMIT STATEMENT PERMIT NO.: ' BAKERSFIELD FIRE DEPT. • g s P r D Prevention Services FIR ##FA // 1600 Truxtun Ave Ste 401 F f f Bakersfield CA 93301 Tel.: (661) 326 -3979 • Fax: (661) 852 -2171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. ■ • ■ • FA ❑ PERM IT TYPE Alarms - New & Modifications - (Minimum Charge) SITE INFORMATION TOTAI TREASURY DUE ACCT ■ • ■ 98 LOCATION OF PROJECT PROPERTY OWNER Sq. Ft. x.028 = Permit fee ■ ■ STARTING DATE OMPLETI NAME/'+ PROJECT NAME $280.00 / (1 ` � 1- ` ` ADDRE O (2 PHONE NO. PROJECT ADDRESS � \ U CITY STATE ZIP CODE CONTRACTOR INFORMATION 98 CONTRACTOR NAME CA LICENSE NO. J Pm1�-:S TYPE OF LICENSE. EXPIRATION DATE PHONE NO. SO SO 1 �4c�gNA 30 20l g 2 —$ CONTRACTOR COMPANY NAME FAX NO. i c Div v - 80 ADDRESS CITY ZIP wue Additional Hoods c_ ■ ■ All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. ■ • ■ • FA ❑ PERM IT TYPE Alarms - New & Modifications - (Minimum Charge) FEE CALCULATION $280.00 TOTAI TREASURY DUE ACCT ■ • ■ 98 ❑ Over 10,000 Sq. Ft. Sq. Ft. x.028 = Permit fee ■ ■ 84 98 ❑ Sprinklers - New & Modifications - (Minimum Charge) $280.00 ■ ■ 84 98 ❑ Over 10,000 Sq. Ft. Sq. Ft x.028 = Permit fee 84 98 ❑ Minor Sprinkler Modifications (< 10 heads) $ 96.00 [Inspection Only] ' ■ 84 98 ❑ Commercial Hoods — New & Modifications $ 470.00 ■ 84 98 ❑ Additional Hoods $ 58.00 ■ ■ 84 98 ❑ Spray Booths - New & Modifications $470.00 ■ • 84 98 ❑ Aboveground Storage Tanks (Instal /afibrdinsp. -1g Time) $180.00 ' 82 ❑ Additional Tanks $ 96.00 ; 82 ❑ Aboveground Storage Tanks (RemovaYinspection) $109.00 : 82 ❑ Underground Storage Tanks (Installation✓Inspection) $878.00 (per tank) ■ 82 ❑ Underground Storage Tanks (Modification) $878.00 (per site) ■ 82 ❑ Underground Storage Tanks (Minor Modification) $167.00 ■ 82 ❑ Underground Storage Tanks (Removal) $573.00 (per tank) ' 84 ❑ Oilwell (Installation) $ 96.00 ; 84 6 Mandated Leak Detection (Testin / Fuel Mon CerUSB989. Note: $96.00 for each type of test 1 fte (eve ' scheduled at the same time) $9869-(persite,� f n ■ ■ ■ 82 ❑ Tents $ 96.00 (per tend ' 84 ❑ Pyrotechnic - (Per event, Plus Insp. Fee re? $96 per hour) $ 96.00 + (5 hrs. min. standby fee Anspedon)= $576..00 ; 64 ❑ After hours inspection fee $121.00 M 84 • RE- INSPECTIONS) /FOLL OW-UP /NSPECTION(S) $ 96.00 (per hour) ■ B4 • Portable LPG (Propane): NO. OF CAGES? _ $ 96.00 ■ 84 • Explosive Storage $266.00 ' B4 • Copying & File Research (File Research Fee $50.00 per hr) 250 per page ; 84 • Miscellaneous 84 FD 2021 (Rev. 06/07) 1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1-1PINK (to customer) P -, BILLING & PERMIT STATEMENT PERMIT NO.: f� BAKERSFIELD FIRE DEPT. B F Prevention Services *jeep FIRE 1600 TnuctLm Ave Ste 401 �R r r s Bakersfield CA 93301 Tel.: 661 326 -3979 • Fax: 661) 852 -2171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. ❑ 1 Alarms - New & Modffications - (Minimum Charge) 1$280.00 Ft. x.028 = Permit fee 98 = RICH ENVIRONMENTAL'. SITE INFORMATION LOCATION OF PROJECT e &t-� a�a� Dam PROPERTY OWNEA STARTING DATE -�, OMPLETI NAME UD�A� PROJECT NAME W6�Ao(- N ADORE h PHONE NO. PROJECTADDRESS r �„\ �.� �"�(�✓n U CITY STATE ZIPCODE • • CONTRACTOR NAME CA LICENSE NO. J As't'1'1�c.S R �C INFORMATION TYPE OF LICENSE EXPIRATION DATE PHONE NO. CONTRACTOR COMPANY NAME tV FAX NQ - O� ADDRESS �� p - CITY ZlPwut 9 ?3 c) All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. ❑ 1 Alarms - New & Modffications - (Minimum Charge) 1$280.00 Ft. x.028 = Permit fee 98 FD 2021 (Rev. 06/07) 1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer) = RICH ENVIRONMENTAL'. . SERVICE STATION SERVICES 90- 7162/3222 ' 4'224 LIC. #809850 .: 5643 BROOKS CT - y BAKERSFIELD, ,CA. 93308. -3708 ' Z DATE I (661) 392 -8687 PA1' TO THE ORDER OF -7—r. 7. �xX a. w la :DOLLARS 8 d� r'� CHASE w.0 JP Morgan Chase Barik, N A��3� Bakersfield, CA 93308 9f y FOR C /1 .AUTHORIZED SIGNATURE 1100 4 22 i,Ih 'i; 3 2 2 2 7 L.6 2 7�: 308 3 50 400 ?II' $167.00 y In 11 Underground Storage Tanks (Minor Modification) • Underground Storage Tanks (Removal) $573.00 (per tank) ' 84 • Oilwell (Installation) $ 96.00 : 84 Mandated Leak Detection (Tesdn /Fuel Mon Cert/SB989. 9 ,� n ■ ■ 62 Note: $96.00 for each type of test / Ite eve scheduled at the same time) ■ ❑ Tents $ 96.00 (per tens ' 84 ❑ Pyrotechnic - (Per event, Plus Insp. Fee 0 $96 per hour) $ 96.00 + (5 hrs. min. standby fee Anspection)4576..00 � 84 ❑ After hours inspection fee $121.00 : 84 ❑ RE4NSPECTION(S) / FOLLOW-UP /NSPECTION(S) $ 96.00 (per hour) ■ 84 ❑ Portable LPG (Propane): NO. OF CAGES? — $ 96.00 ■ 84 ❑ Explosive Storage $266.00 ' 84 ❑ Copying &File Research (File Research Fee $50.00 per hr) 25o per page ; 84 ❑ Miscellaneous 84 FD 2021 (Rev. 06/07) 1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer) i i r UNDERGROUND STORAGE TANKS v.�iACf4d;: APPLICATION :r TO PERFORM END /LINE TESTING /: S8989 SECONDARY CONTAINMENT I ES I NG/TANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION (Plawn note that these are separate Mcilvkk al tests and will be charved per separate type test accordingly.) PERMIT PINE At! BAKERSFIELD FIRE DEPARTMENT Prevention Services a101 tt s-mF_F_T Bakerstleld, CA 93301 Phone: 661-326-3979 • Fax: 661 -852 -2171 Page 1 Of 1 ❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ Ss-989 SECONDARY CONTAINMENT ❑ TANK TIGHTNESS EL MONITORING FICATION SITED. 0WMATI FACIlI7Y NAME 8z PHONE 3 OF CONTACT PERSON ADDRESS L l O L4 C) OWNER NAME sS 1 -<�ry t OPERATOR MANE PERMIT TO OPERATE t 0 OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO TANK VOLUME CONTENTS TANK TMTZ" COMPANY TESTING COMPANY tJV ��DN i NAME & PHONE a OF CONTACT PERSON MAILING ADDRESS LA -3 16C{,o0\K_% CT. — F3AcKEIE2SFlE� -D.C%E 9330 NAME & PHONE OF TESTER OR SPECIAL INSPECTOR r.. CERTIFICATION 8 �+` 8O Q 9 Vsv i DATE & TIME TEST VO K CONOUCTEO ICC A TEST METHOD APPLICANT SI RE DATE I THIS APPLICATION BECOMES A PERMIT WHEN APPROVED DATE FD2095 (Rev 03/08) BAKERSFIELD CITY FIRE DEPARTMENT - INSPECTION RECORD Post this Card at the Job Site and DO NOT Remove for Duration of Work Inspection Request Phone No. (661) 326 -3979 UST NEW INSTALL DESCRIPTION DATE SIGNATURE BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF tr, *TANK`TESTING"...:�....�.,.._, UST REMOVAL DESCRIPTION DATE SIGNATURE AST NEW INSTALL DESCRIPTION DATE SIGNATURE MODIFICATIONS MINOR / MAJOR I AST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE PRIOR 'T0-OPERATION OF ANY SYSTEM, ALL -UST AND/OR AST SYSTEMS SHALL BE ' INSTALL, COMPLETE AND ACCEPTED BY MISC. ACTIVITY THE BAKERSFIELD CITY FIRE DEPARTMENT. FIRE DEPARTMENT (FINAL) REMARKS: BUILDING ADDRESS: �- JOQ DESCRIPTION: OCCUPANCY TYPE: OWNER: T PERMIT NO. 1-3`4 -? %Z. CONTRACTOR: c c PHONE # 3�2- R69 FD 1743 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 prepared for each monitorine 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: ORANGE BELT STAGES Bldg. No.: Site Address: 3640 SILLECT AVE City: BAKERSFIELD Zip: 93308 Facility Contact Person: MATT Contact Phone No.: ) Make/Model of Monitoring System: Date of Testing/Servicing: 6/25/2012 B. Inventory of Equipment Tested/Certified Check the anorooriate boxes to indicate soecific equipment insnected/serviced: Tank ID: DIESEL. Tank ID: ® In -Tank Gauging Probe. Model: MAGI ❑ In -Tank Gauging Probe. Model: ® Annular Space or Vault Sensor. Model: TRANSDUCER ❑ Annular Space or Vault Sensor_ Model: ® Piping Sump / Trench Sensor(s). Model: 208 ❑ Piping Sump / Trench Sensor(s). Model: El Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ® Mechanical Line Leak Detector. Model: FX1 DV ❑ 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). Tank ID: Tank ID: ❑ In -Tank Gauging Probe. Model: ❑ In -Tank Gauging Probe. Model: ❑ Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model: ❑ Piping Sump /Trench Sensor(s). Model: ❑ Piping Sump / Trench Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ❑ Mechanical Line Leak Detector. Model: ❑ 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: 1 Dispenser ID: ® Dispenser Containment Sensor(s). Model: 001- STAND ALONE ❑ 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 Floats) 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 ail that apply): ® System set -up ® AlarM history report Technician Name (print): JAMES RICH Signature: V Certification No.: A2963611064166 -UT License. No C611 D40 09850 Testing Company Name: RICH ENVIRONMENTAL Phone No.: (661) 392 -8687 Testing Company Address: 6643 BROOKS CT. BAKERSFIELD, CA 93308 Date of Testing/Servicing: 6/25/2012 Page 1 of 5 UN -036 —1/4 www.unidocs.org Rev. 01/17/08 Monitoring System Certification I D. Results of Testing/Servicing Software Version Installed: 6.01 Complete the following checklist: 46`W 1 ® 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 fist 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* 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.unidomorg 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? [[01 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): Complete the following checklist: ❑ 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.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. ® Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? 19 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/A ® 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. FL Comments: UN -036 — 3/4 Page 3 of 5 www.unidoca.org Rev. 01/17/08 Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors I. Results of Vacuum/Pressure Monitoring Equipment Testing 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: MORRISON BROS Model: TRANSDUCER System Type: ❑ Pressure; ® Vacuum Sensor ID Component(s) Monitored by this Sensor: DIESEL ANNULAR L ;2 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 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 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 How was interstitial communication verified? ❑ Leak Introduced at Far End of Interstitial Space;' ❑ 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: Page 4 of 5 If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice. UN-MA -1/1 www.unidoes.org Rev. 01/26/06 ring $ystem Certification UST Monitoring Site Plan site Address; ..3.640 SILLECT AVE BAKERSFIELD, CA 93308 0 Date map was drawn! 6/2812010. Instructions P'' you already have a diagram that shows all required information, you may include iL rather -than this page. with your !vloniuni!.1- System Certification. On your site plan. show the general layout of tanks and piping. Clearly identify lucations o!' the Following cquip+tnent- if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps. dispcnser pees. spii: containers. or other secondary containment areas, mechanical or electronic line leak detectors; and in -tank liquid level probes (il'uae:i liar leak detection). In the space provided. note the. date this Site Alan was prepared. Page S of 5 t:\- Rib -V4 »� + ».uniducaur� tnAI t O, RICH ENVIRONMENTAL 3305 BRITTAN ST. BAKERSFIELD, CA. 93308 OFFICE (661)326 -8402 FAX (661)326 -8934 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET W /0#: FACILITY NAME: ORANGE BELT STAGES FACILITY ADDRESS: 3640 SILLECT AVENUE, BAKERSFIELD PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL DIESEL L/D TYPE: RED JACKET YES 10 PASS SERIAL # 6857 LID TYPE: - PASS YES SERIAL # FAIL L/D TYPE: i PASS YES SERIAL # FAIL L/D 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 1S 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: JAMES J RICH SIGNATURE: DATE: 6125/12 g0L.M 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 (f applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency. Facility Name: ORANGE BELT STAGES Date of Testing: 6/25/12 Facility Address: 3640 SILLECT AVE, BAKERSFIELD Facility Contact: MATT Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (fpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: JAMES J RICH Credentials': D CSLB Contractor X ICC Service Tech. ❑ SWRCB Tank Tester 0 Other (Specs ) License Number(s): 1064166 -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, etc 1 DIESEL 2 3 4 Bucket Installation Type: X Direct Bury ❑ Contained in Sump ❑ Direct Bury ❑ Contained in Sump ❑ Direct Bury ❑ Contained in Sump ❑ Direct Bury ❑ Contained in Sum Bucket Diameter: 12" Bucket Depth: 14" Wait time between applying vacuum/water and start of test: 30 MIN Test Start Time (T,): 11:33 11:49 Initial Reading (R,): 2298 2.298 Test End Time (TF): 11:48 12:04 Final Reading (RF): 2.298 2.298 Test Duration (TF — TO: 60MIN 60MIN Change in Reading (RF - Ri): -.000 -.000 Pass/Fail Threshold or Criteria: -.002 -.002 Test Results X Pass ❑ Fail ❑ Pass ❑ Fail D Pass ❑ Fail ❑ Pass ❑ Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Date: 6/25/12 State laws and regulations'do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. ALARM HISTORY REPORT LEAK TEST METHOD COMMUNICATIONS SETUP - - - -- SENSOR ALARM - - - -- - - _ _ - _ L 1:DIESEL STP SUMP TEST ON DATE ALL TANK STP SUMP MAR 30, 2006 PORT SETTINGS: FUEL ALARM START TIME : DISABLED JUN 25. 2012 9:09 AM TEST RATE :0.20 GAL/HR NONE FQUIVD DURATION : 2 HOURS JUN 27,0201ALA9M15 AM RS -232 SECURITY CODE : 000000 FUEL ALARM JUN 27, 2011 9:05 AM RS -232 END OF MESSAGE ALARM HISTORY REPORT - - - -- SENSOR ALARM - - -- L 3: - OTHER SENSORS DISABLED OUTPUT RELAY SETUP R 1:POSITIVE SHUTDOWN ALARM HISTORY REPORT LIQUID SENSOR SETUP TYPE: STANDARD - - - -- SENSOR ALARM - - - -- - _ _ - - - NORMALLY CLOSED L 2:DIESEL ANNULAR ANNULAR SPACE L I'DIESEL STP SUMP FUEL ALARM TRI-STATE LIQUID SENSOR ALMS JUN 27, 2011 9:15 AM CATEGORY : STP SUMP L 1:FUEL ALARM FUEL ALARM L 2:FUEL ALARM JUN 27. 2011 9:08 AM L 2:DIESEL ANNULAR ALL:SENSOR OUT ALARIh NORMALLY CLOSED FUEL ALARM CATEGORY : ANNULAR SPACE JUN 28. 2010 8:52 AM - - - -- SENSOR ALARM - - - -- L I:DIESEL STP SUMP STP SUMP FUEL ALARM JUN 25. 2012 9:09 AM ALARM HISTORY REPORT - - - -- SENSOR ALARM - - -- L 3: - OTHER SENSORS r SYSTEM SETUP JUN 25, 2012 9:08 AM SYSTEM UNITS Ahm LANGUAGE ENGLISH. ORANGE BELT STAGES 3640 SILLECT AVE BAKERSFIELD. CA SHIFT TIME I DISABLED SHIFT TIME 2 SHIFT TIME 3 DISABLED PERIODIC TEST WARNINGSS DISABLED ANNUAL TEST WARNINGS DISABLED CODEE 000000TY IN -TANK SETUP T 1:DIEBEL PRODUCT CODE 1 THERMAL COEFF :.000450• TANK DIAMETER 95.00 TANK PROFILE 1 PT FULL VOL : 11783 FLOAT SIZE: 4.0 INCHES WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MASS OR. .LABEL VOL: 11783 OVERFILL LIMIT 90% -HIGH PRODU(:"P- 10604 ..: - 11193 DELIVERY LA MIT. 5% . 589 LOW PRODUCT 1000 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 MANIFOLDED TANKS TO: NONE PERIODIC TEST TYPE STANDARD PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL . ALARM DISABLED PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY . 1 MIN r MONITOR CERT. FAILURE REPORT SITE NAME: ORANGE BELT STAGES DATE : 6125/12 THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS • NONE LABOR: NONE PARTS INSTALLED: 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 ENVIRONMENTAL 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.