HomeMy WebLinkAboutFMC 7-30-13HOODS ALARMS SPRINKLER SYSTEMS SPRAY H AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
/.3 - /0c(fD 370
File Number: 30 ( Address: 4'. r-/ 0 ( � ( -P L ')
Bakersfield, CA 933
Date Received: 7-30-13
Business Name: 4::;N'
SYSTEM: BUILDING SQUARE FEET:
New Mod.
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
minor
modification
Commercial Hood System
Fire Alarm System
Fire Sprinkler System
qv?y F'Wsh
Aboveground Storage Tank
Underground Storage Tank
Underground Storage Tank
removal Underground Storage Tank
❑ Ml- Other. C-
Building Sq. Feet:
Calculation Bldg. Sq. Ft:
:
0 1.
q
3.
4.
9NSPEC8M d0�a
Date Time
Signature
Signature
Comments: 7L-c4: R;x apAre zaows
iGc �W 32LY1i6(- 'cX .O. 2 &/jE
yR Ir I33yo& ex. a- 52z V/ I e"
Vr. i 1w 2538' 6 )r? 2 /S'% 3
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions li ithin the State of California
AuthoritY Cited: Chapter 6.7, Health and Safety Cade; Chapter 16, Division 3, Title 23, California Code of R<vtlaliote
This form must be used to document testing and servicing of monitoring equipment. A Separate ccrOfication or report must beprcuarcd for each
monitoring system control panel by the technician who performs the work. A copy of this form must K, provided to the tank system
owner /operator. The owner /operator must submit a copy of this firm to the local agency regulating UST systems within 30 days of test date.
A. General Information
Facility Name: #13360 Farrell's Fastri
Site Address: 6401 White Lane
Facility Contact Person: Omero Garcia
Make/Model of Monitoring System: Veeder -Root TLS 350
B. Inventory of Equipment Tested /Certified
Check the nooroorinte boxes to Indleate snecine eouloment insoected/servieed:
Bldg. No.:
City: Bakersfield, CA Zip: 93309
_ Contact Phone No.: (661) 393 -7000
Date of Testing /Servicing: 811412013
Tank 1D: 12,000 gal. Regular
'Tank ID: 12,000 gal. Super
® Ire Tank Gauging Probe.
Mokl: 847390.107
® 111-Tank Gauging Prohc.
Mmid: 847390.107
® Annular Spacc or Vault Sensor.
Mocki: 794380 -303
® Annular Space or Vault Sensor.
%xlel: 794380.303
® Piping Sump /'I'rtt ch Scts(x(s).
M(xld: 794380.208
0 Piping Sump / 1 'narcln Scnsals).
Model: 794380.208
® bill Sump Scns(x(s).
Model: 794380.208
® Fill Sunup Sensor(s).
Model: 794380 -208
19 Mechanical Line Leak I)etecurr.
Mtxlel: FX -1V
® Mechanical Line Lode Detector.
Model: FX -1V
❑ lilectmnic Line Lcak Detector.
Model:
❑ Fkctmnic Line Lurk Detector.
M(KM:
® Tank Overtill / Iligln -Level Setw(r.
Maid: 847390 -107
® 'Tank (')vcrlill / Iligh- I.ewel Semwr.
M(xkl: 847390 -107
❑ Other (,pecify cyuipmcnt type anti model in S(x lkwi F on Page 2).
❑ Other (spccity ctluipmLn( type and nuwlel in Section Ii on Page 21.
Tank ID: 12,000 gal. Diesel
Tank ID:
® In I•ank Gouging Probe.
Mahal: 847390 -107
❑ In-Tank Gauging Probe.
Model:
® Annular Space or Vault Soat,Sm•.
Model: 794380 -303
❑ Annular Space or Vault Sensor.
Model:
IR Piping Sunup / 1'rewh Sermuls).
M(xte1: 794380 -208
❑ Piping Sump /'I'nanch Sensut(s).
Model:
® Fill Sump Sensot1s).
Mmkl: 794380 -208
❑ Fill tiump SCUSCU(s).
Model:
® Mechanical Line Lurk Detco(w-.
Model: FX -10V
❑ Mechanical Lieu Leak Detector.
MWe1:
❑ Hee mmie Line Leak Detetilor.
Model:
❑ lilectnmic Line leak Detccl(r.
Model:
® 1'ank Overliil / Iligh -Love) Sensor.
M(xki: 847390 -107
❑ 'Tank Overlill / I ligh -Level Seism.
Model:
❑ Other (r pCti* cquipiriml type and moll in Section G nn Page 2).
❑ Other (specify aluipnneat type aml nuxicl in Section F. on Page'_ ).
Dispenser ID: _1 & 2
Dispenser ID: 3 & 4
0 Dn:penut-OwAaimnent Scnn(n(s).
Motel: 794380 -208
®DispcnSer('rnnulimrnrnt Sc7tww(s).
MtW- : 794380 -208
® Shutr Valvels).
® Shear Valveys).
❑ Dispett serConlainimniFlnat (s) and Chain(s).
❑ Dispeww— r(.' ontainnutuFhrit(s) and (:hain(s).
Dispenser ID: 5 & 6
Dispenser ID: 7 & 8
0 Dispenser Containment Sctcsoris).
Model: 794380.208
® Disposer Containment Sensor(s).
Model: 794380 -208
® Sh(9r Velve(s).
® Shwr Valve {s).
❑ DispenwrContaimnmtFl (anls) and Chain(s).
❑ NsM rtserC (mtaintimitFkuitls) and 0taints),
Dispenser ID:
Dispenser ID:
❑ Dispenser Containment Settun(s).
Model:
❑ Distxnxr ('ontainmcnt Serosot(s1.
Model:
❑ Shear Vaivds).
❑ Shear Valve(s).
❑ Dispetnsur C(mtairnnent Floatl s) mxl Chain(s).
❑ Dispenser Contaimneml Float(:;) and Chain(.).
•I1-the lacility ccmtains more tanks or dispensers. copy this form. Include intbrination feu every tank and dispenser at the litcility.
C. Certification - I certify that the equipment identified In this document was inspected /serviced in accordance with the
manufucturers' 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 -up ® Alarm history report
Technician Name Kristopher Karns Signature:(,�,��1,.
Certification No.: B34106 License. No.: 804904
Testing Company Name: Confidence UST Services Phone No.: (800) 339.9930
Site Address: 6401 White Lane, Bakersfield, CA 93309 Date of Tcsting /Servicing: 8/14/2013
Page 1 of 3
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed: 331.01
ComDlete the followine 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 conlinmed 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*
11' 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 appl) ® Sump/Trench Sensors: ® Dispenser Containment Sensors.
Did you confirm positive shut -down due to leaks and sensor Iailure /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'? 90%
® 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 apphv)
❑ Product, ® Water. If yes, dmcrihe causes in Section f helow.
® 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: I removed 1/4 Gallon of water from the Regular Fill Sump, and also removed small amounts of water
from all three STP Sump.
Page 2 of 3
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 the Section II, 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 LLUs are not installed.
® Yes
❑ No*
For equipment start -up or annual equipment certification, was a leak simulated to verity LLD performance!
❑ N/A
(Cheek all that apphv) 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!
® 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 I.LDs, does the turbine automatically shut off if any portion of the monitoring system
® N/A
malfunctions 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 the Section II, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 3
L','*F'fWAkI- RL.V1;;Is,N L.I.VIA
qM'l j *'w
17:vFlv,ifo
Fri ::4C• -l%lI -Jul) -8.
-401 W111TE LAM•*
!-;Y-i3TI-1-1 :'IETUP
STFiRT DHTF
MAR WEVE 2
zTi4wr TI ME
%': cl 0 Al
END r'-r-§Tf '
NOW WED: i
END TIME
00 HII
87STEM boll' 'I-jiiF, F-L.qj•k-,j
EUkQ PK)Tv,-'0L kRUT:
640I WHITE Li4l]:
Puki7
I T.'
SHIF-T TIPIE I
1E 7
HE I A 11 1 N, 'HES
TIME J pi-shiiiii.
1•P7 Lk W(A. "4
::;HIF*f
44-1 rEF. I
T H It
TAPW PER TST NELAILP WRPI
TI;N): ::;U'IJAT;
TIANY ANN TCST NEEIIEl'i WF:Jj
L iijAwn,
T
'Luf IF
L1 NF RL
LINE MI-
Tl-
HL I t,i 1'[, •.1", 1 pi"m
LINE PER T;-4T MAJ,EL, 1,Wo
I'virFlo 0 13HU13
1) 1 Z-:mJ;LELp
SF.*Y%I%i 111 I'#c;'I I
14011�! n C;. CIO I N, 'I IF.;,:
LINE tMll
83 . y LE!; F
1.11.9tirtEli
I'FJ 14T *ri:
120 Ill I' F.*'.'
F14t tULr.r1
(44
90% 1; ';iiU..*.
HS
�T)E(; F ': I-. fj . Il
VfiV•OR IT-AITOF-111,; I-,Tk.'
.
1:
"APE 1.1311
.14. 1 Nil U
VOL = n '-40-S
4,y-,
tAw-It';
fi. UU I I IL'I iL'-'
6 1 i.4-iwixrl
Lc6.1 K '; F
L','*F'fWAkI- RL.V1;;Is,N L.I.VIA
qM'l j *'w
17:vFlv,ifo
Fri ::4C• -l%lI -Jul) -8.
1AWDIS 1 2
LEN, TEST mt.
T 1 '0141.
T#.;tl.)
MHR
t1:0LA) w'? 110
TIME I IN X1,
?t,, UI I
'T P
'fill-IV. Y-korill I pi,
EIALIL, Ri iTF
III
WiPIF
U."'T
I S1'+:•1' :A'01' 1JIT
:i UATH
PEST
rr,
111W WtillR 1111I7:
:tiAltl Bti:I ;N1 ek
WtATLP LCI I
JiAUL, ti't iTI- ' `. 11111
t•)NE
T AF.11`., :
S,ror- BIT l SNP
9cx
con;
.1no
DELIVER.' 1-1111T
LFW" il1.-IM•1 LIMIT:
LIMIT: �I Q
L I
i4lfro T1+.ki•11-4111'
: I (J. (J((
0. (j 1.1
h1j,ptl tjj�jlj'
11-11T
t.
ti1.)T•5 (NEXT"A.L. UNIT
LINE MANIVoll'11,
D I sfil-l. 1:1
TIP : MAW
eat ITi) 66J I,.vouIfi_.v
fliElq, 1.1111 r
I.Fou: 11IN
L -I: UNL )=ILL
0
TRI h7,%TE Zt4n".I.L.,
Al."TO, 1,164 j ouF ..,. sa.? wl
H,:4411 R.
LEQ: 1,11(1 eA,111AW. P.
mUI'C,. DEL I L", IV
pe ISU r..
L 4 PIC
Li I SAbLE
t,3jt4,;Lj; pt.,yq.>
o1UTO
EABI. El
Au'ro SEWA.' ?"
AIARM I'Wiibllb
9:k'14L FILL
WTEF OLONI
UPI -STki'rE
r' 1:3abLEl+
PEPIONC' Ti:.-'.l F(ill-
L G:Pm. riMIV
D04L POINT
imm "j I t� ;: ol
r 1*.,p `F
iiVr-.P;v'AI*'.;: DI'F
L 7-PIE
ov
THY. �:IPHON L�,
TkI Sl'mTr 01JI43L
HIN
L 8 - t+11: F) LL
TR I , J'E >
C,,ATt7.GC)F?-' • O'DIER, :_;LI4s-',R4j
1AWDIS 1 2
M
Ll I APIS, --4
L; I I O."Ll
fill
TL(c -l:v I'AN
TU
H
1.16:DIE ANN
LP144. PCHNT
l'ATE'.;C19v :
- ol4l.
r I I svj-'! Lif: 11-.11 +F.:
A
P I : tjNL
T';PE:
TriNI: 0:
LIO:FUEL ttl.;iRi
L I I : IIJEL ALMET1
1. 12: 1 t IEL til-ARI I
1,13' FUEL- AliRl"l
L I :.A-A OP OLrf
{:l-I• i %Lmld-1
ouT ,AL.o sP i
`)1jT &AT1
L I I o-sl.oRT'l
L I-): I ' wop'r ml-ilPl I
1.I I : ;1IOR T ill.mPT1
r. 12 1 IORT ril.Af I
t.I 14OFT HLrIFfI
Irl, tiiTL rill, }; Pk
I�:U VAPOR LF*N): Fm I L
ISD VP Fili.
ist, kip ro.ti-
1`31 HOSL HLA-3t;
1"zA.LE1A' r,wlL
HLI.*E-.';Prs col.Lb'l* Foll
e4l-L:FLOW
R. 2:l lil.
T%'-F•E:
2TtnNDt%R[s
�Kll' (If 'ikt!
611T i4l i<j
L I I : ?..Eli; %�f: OOT PsUiVis
p!-i:srvjqoK our Aid,y.'pi
L 12: £i}OPT ml.r,RH
L l Cs ::.;HOOT
I U :� IT V i
I Sr- i WG'2 - PPES I'ol I L
1';I I VO'41-",R UiiK Fii 11.
sp kii, 6dE:",, Ftiii. •
1:';I:k VP
181" H'.IhE
tiLL:1A,086
HLI-JIDA1, ,'OLLP"T hill.
r%].I-:FI,OW -'A.LF(":T F;01-
TAM'. 11: 'J
1. 7: FOU 'I AD431
Ll 1y;-
H P I' t-ILORPI
L1 i1
%WEN
ti: I
AIR
A:Em r,L!' 5-b
Fk)U HO'CO
j•TF)juyr-,, Hip
. m . * - DIL, - - ' ' '
EVP I T
VA, '(7111-1L. 1dri"Llull rv,61,lyl
-HEot.V
T1'I-1
Ali
C','1-'E
VoiC
WIT
I,+.Ioff� OUT
'A.E
p-RoA,!i;.swR
7. �-"(Ito
(NA W1.1itA,
i4ONF.
MAX. I . 15 1`1114, 0.
'146R
NOIlE
Tlhh.;
1,ED-%',- HINUTI ':7;: 1
fiOTT"r HI"
-
1-341:
GI: IMA Fi
I 51a
If'- FV H HL rtM P.P.
F-RftE OUT
HUC; 7. 2013 1 :.V4 1,11
I LII 01 1.1::: 111 (12
W? IK F1:: CO" 01 02
C? U3 n3 1. 11*,- 11:1
Cl I a-W 11.1 f! ' X., U
CPS' U!i I'J 1,1:1 n"
Ub I'II'. :11% X" 0�3 Ij,.,
n7 U� 01 U-, 1,14 62
PEVOWI
flu
0". Otl Q (14 kl'.!
114 -'roUIC 011,1MI
I EAU, W'RFLOPA HFI'Ell llli}'
N141 I r%W-1.
•'Jill 0, n
Fm ills 5-6
111 rill.. 7-8
r.
VP MHH NHH HIM 11116 on
LAU
01 �u 1 31;1 401 U 1
202 ou-2. -:4U:- r, I) I
th; !kj:3 U 11
'.IU4
04 "U4 ',J04 11 U
r Soz;
131E. 21.16 -Qt, 141 1r. U
1.1, M7 :JIO? 907 H 11
:
Oil' rj::% WIC. -:4 Lid U I., I
AARN
F.
'1: 111v C;FwjI-,
T
5: F, RD! I
9. vI Xtjrl^
LO: DI-FNE-4
. m . * - DIL, - - ' ' '
L I
FUEL o4l-j#,,j I
'FIC' IR OOT mbtPlti
"Lk., A, 'ib,hil
1. :':1M2 Hllli
LA-1
- , U1,;
i ou i r) Au,F.tt
J I , •14 11
U-41 1,1t:&lijfi tAIAPI-1
10:1; 71. 1 :.1.1 w
- ♦ - • - ENTt w - - , .
OTHER, NTLSQK�
11 WL i,LArdl
2131:5 1
!)U'J- Aj.r41111
• 0. * • - LOD -i - '. - -
- ;;LW44.,
2110 1 ::'J(l V I I
0(11 W.oW
...6 11.1
ALA" I
FUEL ftfiR1,,
,41 Jr., Y. - ;,! o I -,j I , 711,
�,,EusoFl 'OT mi.tARM
iji.h.; 7. ..,ul:j I :,Ilk F I1
rALAK1 HlJ:;I'OWT kl-MKI
. ..- .
L 1•'I141. mNN
L«l 1.11--jillL, HU&PI
W.K. ., . :'U1:. I : 44 1.1.1
HIGH 1-11klUl-tiLARJ1
AW 7. 2015 1 : d•1 I'll
LOW L1C41.1111 WAN-1
f-AC. 'I. 5*.-A•4 4.k,1
- * ;t - ♦ El-lb ft - . I -
kk . 4' 4. ,51
0 IM-1
L I �N. U-5 7
1. 7:011:
i•,?
pfif•
FUEL
'20
FIEL MMM
7.
too 7. VIO.'i
'201a 1:19 P11
OLrr 114ARM
STW".* (:,$.(T LI
t�Lk-X*., Oil' N,Q1
go! 7. 2011 1" FYI
wil 1:16 F"
MLK? 7. 2w 3 1 06 Pi I
i.
. Ad
ENO
0 IM-1
L I �N. U-5 7
L W(PIF 1:11-i.
3-1
Fl IL'. I g L) t gLPFM
I
FitEL Hij+ti
HO,
MI I Ws I"
AD! only I :jS 1+1
c AIT 14-APH
Boom tjUT vAij-A"
WT *C(AW
mLK;
7 2(11:j 1 PtI
tALA; 7 20 1 '1 1 :^6 F 1
i.
. Ad
ENO
I
I r
C401 I'M I I L I rAfIL
EI(P. ISW, :;L:*l TIV•
WIN
LoO 1.1"Jull) r►f,wilom
It
E 'I, PE: %iN",Ijljtl ro.SIL,r
7• 201
V,v:*L1I1I'1 iv.%ilbl' 1I.Tr
RCHLY uric
II II:cH 1.IV111r)
Atli]; ?. ITI
PH "il:11
L
LOW 1,101111%
ol a,
r'vl I . I C3 m 114: 0. qI"
41K. 15 P I i
NONE
TIME: ICk:f)fl k'I
HIIAl
D
VMIT*F!t-3 I LLI - -.';A 9: 1 11YI
-'L F
ISO K), Ti%BI.
Irl FP R IlL Ni
AW 14 1101:3 1 '. UL. 11,11
1 cl Ij:.
ri 17.11 — I II:-. III LKLI
Cl: ri 2 (Ii:.-
04 W: (Jd
IA,
8T W�
(I,,, wiI 05 n;.,
I'll. ae. Up, U'., 03 U2'
T OUT
U7 V/ 07 02 04 n*-:
I-RuElF, our
I ti11 ii I kl 1 9 4 f lFrEF., KkT,
E:4 y1: fill'.; I
-72
A6111 R. 1 1118 15-6
�1 .1 Fft LI L 14
1,-Al FIJEI. i.;PAIII: li'!t:!E PIHP
UT MIH I"IHI i 111411 1 IHI I PiH
Will; 14.
fil :'1.11 :401 ';01 LI I
orl 2 G" JX: q41"! 1.1 1 j
134 20 :304 :11-14 U I I
05 '-'U`-) A15 41715 If- U
CJG W, :1ij6 9U. 5 II
07 20? 307 U U
OH 201:1 :-10i? %tOE- U U •1
i 411: dAF.11
1 A SL FmFil.F.
T I 1-:1'IEL
1-04, 1 H lk' l,"F'N i t II.
I -- I -.0-ilLA,
,'ill i 1 :111) j'Pj
BLE141 - -,.
RF'31 'L.
I'MaIll iim
13OL11
BP( -10E
8 S I I-VEF
1 Li: N.Efc14
fAIJ•; 14.
I
ffii I
"1
I- 1 102 "
L 4 ; 1 -141. STF'
SEW-141 OIJT til..Hhli :
:;Emi,A: 01IT HLARI'l
1110-3, 14', 201:3 1 Uq PH 1
14 . 'U I J I :I I 1-1 1
14 201:3 1 1'+•I
d 11F9
T I LIM,
L 1.j:VNL FILL
OTHU ;1AVYin: ; i
iqr-'Af"F
OUT iiLmOl 1
1 21,04.11,
14 • 2(+I "i I It) I
I.). :r1-4 H-I "
"n
AUG L -1 13 1 PI I
7
VoL ' Of 7214
HF I rlF1T 114A11;:
'HES
Tl J If, LAI,3
I 141.*YEK��F,
it 1
1 1 F tVIll 7
7'1 A
tit i
1%F: I
I 111P t
t:.8
'.01,
? OOT Alt•litl w
w, iTEP 1111 1 N."I IN,;
?
s
. 3.rli - -�.+: -,L,,Kl I
L 4 :1 HL. `-T
vO !'1. zu I
It :
STP
FUEL
,iUG 14. "`61:1 1 : I S V•I•t
I ELI
: A: - 'I&:i;P A r-Hi
L
UV fAvilici ii!.rikil
110'.' 1 -1 - _151 1 1 : 17 1'•11
L FILL
FUEL i-ti--iRil
,iik'i 14. '.1A ., I :IV 1,11
. - w
L. T f4L i INN
'ilMul.rik Iff-pi''r
1-011 LIGUh.
AUG 14, *,.,01.1 1.17 111
A.04:11
L, I L iiNN
MNI-011.fkk '.:WoV:F
L(A-1 l.I-'vUlE1 hLiiRtl
601; 14. 2101`t I , I v. I Ii
:A':[r,;:,•- iiiilk"'I
1. J141. i MH
ANpluijkp: ,,,I ;''f
HK;H 1.11JU111 t,L,k•'
14. 1 : I q
44:,11 W111TE 1 -141:
L 2:H11,*? I—ro011, W+ikfl
-
I t..'HI"Al I,IuUlI1
Llw.1.641 1.161411-
111!41
IW.31v:Ip
64ijI wHOT
I ELI, -
AUG
3 1
I .-A -W`;F``�
lLHWI
1-1- `0)'j
..)L. ill "Ell
L
POEL III.HFrI Y Hi
L
•iJ ',U-4: M
F TF I T,
k „Lo4:1 I
iliji[Al
L I I 11:-,. Y -u
LI .._Wtfv 17
I.;AJ ]J,.)IIID oLohll
WK; 14. 1
FIIF. okokll
I cl - I I I I N
201a I I -I I
WIG 14,
I
L ?:LOW 1.11•Aill)
L Z'LCKf 1, 1 kill I f*- o it iPri
L 6:HVIII 1.1kol-Ilf, •I-M-1
-.AUI WHIII: DINE
LIo:HII*;H LI vOIJI IiLmkll
1. ::11NL IAIA
L I W 1.11 1 —2
I (IFT
14.
0 1 j 1 29 111
I,IX; 14, W,
L 'Z LQW L IoUl I.-
L U:1111'-Ii LIVRO r,L Ak1I
Uill;
I.IU:lIII;II LikjUilf t• liWil
L t:1,14L i_iNN
A1,11,10I.Ptle
v1HEP :,EN: -" Ok�,
Is.41
F IFI. HI-mPI
H-
fAIJ1_; 1-4. 2('�i:" I :Y4 PH
k „Lo4:1 I
iliji[Al
L I I 11:-,. Y -u
LI .._Wtfv 17
FIIF. okokll
201a I I -I I
HW 14. 1 H I
L Z'LCKf 1, 1 kill I f*- o it iPri
L I W 1.11 1 —2
FUEL hbihil
I,IX; 14, W,
r I I
:I INI.
N
k.401 WHITE I.PkHE
I IVENTc-P: I F+ TJ E
T {:I1117 U L
I '3^:'C!`+
illcal
ir
1144' . FFK_;F L31`10ft
HUG 14. 20)j I �i5 }vl
! ' 14. 1 PI
oil-.,
L[ 1 4 - 1 0 7
' 71.1t
HE I IAIT 7-1 .70
WATEE' I'l . C10 114, A th'.-3
TEMP I 11 .13 1`1171; r
eil.l_ FUNS TIOM;
14 1 ; jj PH
I *_":1-11f.
HEIGHT 7 1
';'h,trr
P-I
PD.; I
•'41T 7"..44 INq`HF1'
I N]
C. ET I 14g 'PJ"'
T :f L$r, - I:0 i
W
TEI*' I I C1.5 IIEC'
F14j;
t4W I I j I I'M
IE kA 11* - Il I . 40 1 rSA
I.ImTEF.' . 1).00 1 rPHES
TRIP I I I I. -I f Lt.; F
Ih Too)): I•i.ilkil
Cj 1:1
T I uNL
rc. nF.T I
1-1•:01-A. vOT
6401 WHI'il: 1.,Alih
111111.).Zi Ir.).ft."'IA '-jjjU'1
4. �33 PH
T I :LW 1.410411h'.:
IN TWO.,
T I tail.
fN-'rtv.I)' '41.:Wql
LC-W M-11 14i9j-1111c;
T 3:111R11,
Hill;
RO-1 ilk, i IA
:'.:PIG
T 2
I, MUL OUT
4 '2U I
PROK. OUT
ALK" 14. 21010 1 -it. PM
T
fiW 14 .!0 13
DAJ TVIP 1JAM-Mil';
Ali,,, 14 ;1 1 : 37 F-11
F, 64 v I P
i�401 IM11'E Lt4NF: e.,j((j LJHI1'F I.-J,1F
14- 2013 1 4'- PI I
ALL 1-*I)N,-'r1 ()ff7- NOF11MI.
V61- ?al.
1111"PD-6E 8714WT
.-'s i,•( I
TEMP A 1 I. l DE(� F
VOLUNI: I10,U 14AIt7,
I.IATEF., 0. On 114. 1 a- " ,
-19 F 1,4AL—i
I'Ll.; F F
i 11A.,i* Ill 'i Ub-1 4.n L'x;
rlf)L,.. F-4 .-ALS
Tt'� 'AU41,
END
HE 11.4,141 .11 .29 1114:�iE%;
WH,1711: cl GHT.S
U. ub 11. q I'., I 11::
HE 1,:i rr
th-sTF.P. . 11-1, WS
T 3: 111 hSEI.
nin,
;. 4) 1, * j, 1 -,868 :;mU�
lfo"PEA l:- 49t
174 H L. -S
tf- Wr 4
-t.t�
M 113 KT �'1.411 IINKIHE''
0.00 114CHL."
SWRCB. January 2006
Spill Bucket Testing Report Form
This form is intended fa• use h1' contractors perfurrring annual testirrt; of UST spill containment stnectures. 77re completed form and
printouts from tests (if applicable), should be provided to the, fociliti, owner/operaten- fur submittal to the local rrgrdatury age.ncv.
1. FACIIATV INFORMATION
Facility Name: 113360 Farrell's Fastrip Date of Testing: 8/14/2013
Facility Address: 6401 White We. Bakersfield, CA 93309
Facility Contact: Omero Garcia
I Phone: 661- 393 -7000
Date Local Agency Was Notified of Testing: Ernie Medina
Name of Local Agency Inspector /if present during tasting): 7/24/2013
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials: X CSLB Contractor X ICC Service Tcch. X SWRCB Tank Tester 0 Other (Speclfy)
License Number(s): CSLB 11804904 ICC It5264406 -UT SWRCB1i 09 -1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: z Hydrostatic 0 Vacuum Cl Other
"Pest Equipment Used: Lake Test
Equipment Resolution: 0.0625"
Identify Spill Bucket (41, Tank
Numlxr, Stored Product, etc.)
1 Regular
2 Super
3 Diesel
4
Bucket Installation Type:
0 Direct Bury
® Contained in Sump
0 Direct Bury
® Contained in Sump
0 Direct Bury
® Comtained in Sump
0 Direct Bury
0 Contained in Sum
Bucket Diameter:
14.00"
14.00"
14.00"
Bucket Depth:
12.00"
12.00"
12.00"
Wait time between applying
vacuum /water and start of test:
5 min.
5 min.
5 min.
Test Stan Time (Tj):
1:15 PM
1: 15 PM
1:15 I'M
Initial Reading (Ri):
10.75"
10.50"
10.75"
Pest End Time (TF ):
2:15 PM
2:15 I'M
2:15 PM
Final Reading (12:):
10.75"
10.50"
10.75"
'rest Duration (TF — Ti):
1 hour
1 hour
1 hour
Change in Reading (RF- Rr):
0.00"
0.00"
0.00"
Pass/Fail 'Ihreshold or
Criteria:
0.0625"
0.0625"
0.0625"
Test Result:
® Pass 0 Fail
® Pass 0 Fall
® Pass 0 Fall
0 Pass 0 Fail
Comments — (include igformatiorr on repaint made: prior to testing, and recnnunended follow -up f rr failed tests)
CERTIFICATION OF I- ECHNICIAN 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 Signature: Date: 8/15/2013
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
Li
- - - - - -i r-- - - - - -I
•
I I
I I
1
I I
�- -- - -J
L-- - - - - -J 1
ANNITLARe
3.12,000
I
USTS
I 1
•
I j j
I I I
•
I
1 I
I•
I I I I t 1 I I t I I I I
1 I 1 I I 1 i 1 i I I I I
I I I 1 1 I I I I I I I I
�
T4
FUEL
ISLAND
7
e
L3
slwroFa+a81Ea eAKK
BREAKER
PREVL�1
SYSTEM
1
r- -- - -i
I I
I I
1
I I
�- -- - -J
L-- - - - - -J 1
ANNITLARe
3.12,000
GALLON"
USTS
I I I I t 1 I I t I I I I
1 I 1 I I 1 i 1 i I I I I
I I I 1 1 I I I I I I I I
�
T4
FUEL
ISLAND
7
e
L3
slwroFa+a81Ea eAKK
BREAKER
PREVL�1
SYSTEM
ANNITLARe
-o
P
LEGEND
ae�
!: r—
L1 07 STP
WS WATER SHUT-OFF ® STREET
SITE PLOT PLAN far:
L2 87 ANNULAR
W0 WATER SHUT-OFF ® BLDG
z
L3 87 FILL
F FILL
0300 FARRELL'S FASTRIP
6
L4 91 STP
V VAPOR
6401 VVhife Lane
Y
LS 91ANNULAR
PIV PRESSUREIVACUUM VENTS
Bakersfield, CA 53308
g
L7 DSL 8TP
H HEALY CAB
(661) 397 -0271
L8 DSL FILL
TL8 VEEOER ROOT MONITOR
L10 UDC 1 •2
ESO EMERGENCY SHUT-OFF
•
L71 UDC 3.4
L12 UDC S•8
L13 UDC 7.8
L18 D8l ANNULAR
1
BAKERSFIELD CITY FIRE DEPARTMENT -- INSPECTION RECORD
Post this Card at the Job Site dhd DO NOT Rbrhove 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
UST REMOVAL
DESCRIPTION DATE SIGNATURE
AST NEW INSTALL
DESCRIPTION DATE SIGNATURE
MODIFICATIONS MINOR / MAJOR
AST REMOVAL
DESCRIPTION DATE SIGNATURE
EVRUPGRADE
PRIOR TO.OPERATION OF ANY — SYSTEM;
ALL UST,AND /OR AST SYSTEMS'SHALL BE a
' IN STALL;. COMPLETE AND ACCEPTED BY\
MISC. ACTIVITY tTHE "_BAKERSFIELD CITY FIRE - DEPARTMENT.,
EFIRE- DEPARTMENT — (FINAL) —2 _ i3 +
REMARKS:
BUILDING ADDRESS: 6C/C / i 7 2_�
JOB DESCRIPTION: '-LkA Q__
I OCCUPANCY TYPE:
OWNER: _ 2 �c� � I- —
1 PERMIT NO. <3 —/eOe v
CONTRACTOR: PHONE # G3,/-3-2j-,?C3
FD 1743
BILLING & PERMIT STATEMENT
PERMIT #
�
Ry,�! H_R B P 1, 8\L_D
(\ F%RB
OCPARym"r
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phnno• AA1- 27F, -'4Q7Q a Fay- AA1 -RS7 -7171
All
0
❑
permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
PERMIT TYPE FEE CALCULATION TOTAL
DUE
Alarm - New & Modification (minimum charge) $280
SITE INFORMATION
LOCATION OF PROJECT
PROPERTY OWNER
Farrell's Fastrip
Jaco Hill
STARTING DATE Ee
NAME
8/14/13 1:00 PM
Omero Garcia Maintenance Manager
PROJECT NAME
ADDRESS
PHONE #
Farrell's Fastrip
PO Box 82515
661 - 393 -7000
PROJECT ADDRESS
CITY gA K,E�R.SF I E Lp STATE CA
ZIP CODE
6401 White Ln Bakersfield CA 93308
93380 -2515
CONTRACTOR INFORMATION
❑
Sprinkler - Minor Modification (<10 heads)
CONTRACTOR NAME
CA LICENSE #
TYPE OF LICENSE EXPIRATION DATE
PHONE #
Bradley Se kora
804904
IC61, D40 I 3 31 14
661 -631 -3870
CONTRACTOR COMPANY NAME
FAX #
Confidence UST Services Inc.
661 - 587 -9758
ADDRESS
CITY
ZIP CODE
16250 Meacham Road
13akersfield
93314
All
0
❑
permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
PERMIT TYPE FEE CALCULATION TOTAL
DUE
Alarm - New & Modification (minimum charge) $280
nNLY
TREASURY
ACCT NO
❑
Over 10,000 sq ft
$0 .028 x sq ft
❑
Sprinkler - New & Modification (minimum charge)
$280
❑
Over 10,000 sq ft
$0 .028 x sq ft
❑
Sprinkler - Minor Modification (<10 heads)
$ 96 (inspection only)
84
❑
Commercial Hood (New & UL 300 Upgrade Modification)
Additional Hood
$470
58 hood
•
Commercial Hood - Minor Modification (add /move nozzle)
$ 96 (inspection only)
84
•
Spray Booth (New & Modification)
$470
98
•
Aboveground Storage Tank (1 inspection per installation) AST
$180 /tank
82
❑
Additional Tank ATI
$ 96 /tank
82
•
Aboveground Storage Tank (Removal, Mod,or Inspect'n) ATR
$109 /tank
82
•
Underground Storage Tank (Installation /Inspection) NI
$878 /tank
82
•
Underground Storage Tank (Modification) MOD
$878 /site
82
•
Underground Storage Tank (Minor Modification) MTM
$167 /site
82
•
Underground Storage Tank (Removal) TR
$573 /tank
84
Mandated UST Testing: Fuel Mont Cert/SB989 /Cath. Prot.
NOTE: $96 /hr for each type of test/per site /per UST system
ven if scheduled at the same time
$ 96 /hr (2 hrs minimum) _ $192
82
❑
Oil well (Installation, Inspection, or re- inspection) X
$ 96 /hr
82
•
Tent #
$ 96 /tent
84
•
After -hours inspection fee
$121 /hr (2 hrs minimum) = $242
•
Pyrotechnic (1 permit per event, plus an inspection fee of
$96 /hr during business hours) PY
NOTE: After hours Pyrotechnic event inspection is @ $121 /hr
$ 96 /hr + (5 hrs min standby fee /insp) _ $576
5 hrs min standby fee /ins = $605
84
•
Re-inspection /Follow -up Inspection
$ 96 /hr
84
•
Portable LPG (Propane): # of Cages? _
$ 96 /hr
84
•
Explosive Storage
$266
84
•
Copying & File Research (File Research fee $50 /hr)
$0.25 /page
84
❑
Miscellaneous
84
_I7
T
FD2021 (Rey 05/11
�:.. � ,,
..- _';y
�, �.�,_
-£ - ;r;
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING /TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
AR1N f
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171
Page 1 of 1
❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
® FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Farrell's Fa strip
NAME &PHONE # OF CONTACT PERSON
Omero Garcia (661) 393 -7000
ADDRESS
6401 White Ln Bakersfield CA 93309
OWNER NAME
Jaco Hill
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
Confidence UST Services Inc.
NAME & PHONE # OF CONTACT PERSON
Karli Karns (661) 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Bradley Seykc)ra (661) 487-9'ISS
CERTIFICATION #
B40738
DATE & TIME TEST TO BE CONDUCTED
8/14/13 at
ICc #
8111231 -UT
TEST METHOD
APPLICANT SIGNATURE
n
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPfQVED BY
DATE
FD2095 (Rev 03/08)