HomeMy WebLinkAboutFMC 2014MONITORING 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
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: _S.=..:..::h-=.e.:..:ll ____________________________ Bldg. No.: ____ _
Site Address: 8803 Camino Media Blvd. City: Bakersfield Zip: 93311 .:....:....:.....:....:..._ __ _
Facility Contact Person: _M_att_J_;e_ff_r_ie:....:s'---------------Contact Phone No.: (661) 758-3077
Make/Model of Monitoring System: --'V--=e--=e-'-d-"e-'-r--'-R.:..;o:....:o:....:t'-T_L=-S-'----=3--=5--=0---------Date of Testing/Servicing: 1/6/2014
B. Inventory of Equipment Tested/Certified
c heck the appropriate boxes to indicate specific equipment inspected/serviced:
Tank 10: 20,000 gal. Regular Tank 10: 12,000 gal. Su~er
181 In-Tank Gauging Probe. Model: 847390-107 181 In-Tank Gauging Probe. Model: 847390-107
181 Annular Space or Vault Sensor. Model: 794390-420 ~ Annular Space or Vault Sen~or. Model: 794390-420
181 Piping Sump I Trench Sensor(s). Model: 794380-208 181 Piping Sump I Trench Sensor(s). Model: 794380-208
181 I' ill Sump Sensor(s). Model: 794380-208 181 Fill Sump Sensor(s). Model: 794380-208
181 Mechanical Line Leak Detector. Model: FX1V 181 Mechanical Line Leak Detector. Model: FX1V
D l lectronic Line Leak Detector. Model: D Electronic Line Leak Detector. Model:
181 fank Overfill /lligh-Level Sensor. Model: 847390-107 ~Tank Overfill / High-Level Sensor. Model: 847390-107 D Other (specif'y equipment type and model in Section Eon Page 2). D Other (specify equipment type and model in Section 1: on Page 2).
Tank 10: 8,000 gal. Diesel Tank 10:
181In-Tank Gauging Probe. Model: 847390-107 D In-Tank Gauging Probe. Model:
181 Annular Space or Vault Sensor. Model: sent w/91 D Annular Space or Vault Senwr. Model:
181 Piping Sump I Trench Sensor(s). Model: 794380-208 D Piping Sump I Trench Sensor(s). Model:
181 Fill Sump Sensor(s). Model: 794380-208 D !'ill Sump Sensor(s). Model:
181 Mechanical Line Leak Detector. Model: FX1DV D Mechanical Line Leak Detector. Model:
0 Hectronic Line Leak Detector. Model: D Ucctronic Line Leak Detector. Model:
181 Tank Overfill II igh-Lcvel Sensor. Model: 847390-107 D Tank Overfill / High-Level Senw r. Model:
0 Other (specif'y equipment type and model in Section Eon Page 2). D Other (specif'y equipment type and model in Section Eon Page 2).
Dispenser 10: 1-2 Dispenser 10: 3-4
181 Dispenser Containment Sensor(s). Model: 794380-208 181 Dispenser Containment Sensor(s). Model: 794380-208
181 Shear Valvc(s). 181 Shear Valvc(s).
0 Dispenser Containment Float(s) and Chain(s). D Dispenser Containment Float(s) and C'hain(s).
Dispenser ID: 5-6 Dispenser ID: 7-8
181 Dispenser Containment Sensor(s). Model: 794380-208 181 Dispenser Containment Sensor(s). Model: 794380-208
181 Shear Valve(s). 181 Shear Valvc(s).
0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser ID: Dispenser 10:
0 Dispenser Containment Sensor(s). Model: D Dispenser Containment Sensor(s). Model:
0 Shear Valve(s). D Shear Valve(s).
0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment rloat(s) and Chain(s).
. . *If the facility contains more tanks or dtspensers, copy thts form. Include mformat10n for every tank and dtspcnscr at the facti tty.
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-up ~ Alarm history report
Technician Name Bradley Seykora Signature: ~::;;~~~--,....--a..~~====='-------
Certification No.: B40738 License. N?.f-=-ao=-4.::9::..:0:...4.:...._ ____________ _
Testing Company Name: Confidence UST Services, Inc. Phone No.: ~C8:...0:...0:L)_3=..3:...9:...·..:.9..:.9=-30.:..._ ____ _
Site Address: 8803 Camino Media Blvd, Bakersfield, CA 93311 Date ofTesting/Servicing: 1/6/2014
Page 1 of 3
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed: 327.04 ~~~---------------------------
c h ~ om pi ete t e ollowmg checklist:
181 Yes D No* Is the audible alarm operational?
181 Yes D No* Is the visual alarm operational?
181 Yes D No* Were all sensors visually inspected, functionally tested, and confirmed operational?
181 Yes D No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment
will not interfere with their proper operation?
DYes D No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem)
181 N/A operational?
181 Yes D No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
D 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) 181 Sumprfrench Sensors; 181 Dispenser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? 181 Yes; D No.
181 Yes D No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no
D 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%
DYes* 181 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.
DYes* 181 No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that app~v)
D Product; D Water. If yes, describe causes in Section E, below.
181 Yes D No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable
181 Yes D 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 3
Monitoring System Certification
F. In-Tank Gauging I SIR Equipment: 1:8:1 Check this box if tank gauging is used only for inventory control.
0 Check this box ifno 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:
1:8:1 Yes 0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
l8l Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup?
1:8:1 Yes 0 No* Was accuracy of system product level readings tested?
1:8:1 Yes 0 No* Was accuracy of system water level readings tested?
1:8:1 Yes 0 No* Were all probes reinstalled properly?
1:8:1 Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or wiiJ be corrected.
G. Line Leak Detectors (LLD): 0 Check this box ifLLDs are not installed.
c h ~ II h kf omplete t e o owmg c ec 1St:
1:8:1 Yes 0 No* For equipment start-up or annual equipment certification, was a leak simulated to verifY LLD performance?
0 N/A (Check a// that apply) Simulated leak rate: 1:8:1 3 g.p.h.; 0 0.1 g.p.h ; 0 0.2 g.p.h.
1:8:1 Yes 0 No* Were all LLDs confirmed operational and accurate within regulatory requirements?
1:8:1 Yes 0 No* Was the testing apparatus properly calibrated?
l8l Yes 0 No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
0 N/A
0 Yes 0 No* For electronic LLDs, does the turbine automatically shut offifthe LLD detects a leak?
l8l N/A
0 Yes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
1:8:1 N/A or disconnected?
0 Yes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system
1:8:1 N/A malfunctions or fails a test?
0 Yes 0 No* For electronic LLDs, have all accessible wiring connections been visually inspected?
1:8:1 N/A
1:8:1 Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe how and when these defic1enc1es were or w1ll be corrected.
H. Comments:
Page 3 of 3
Leak Detector Test Results Sheet
Customer Address: Work Order: 31888 Site Address:
Jeffries Bros., Inc.
145 Vultee Street
Shafter, CA 93263
Test Date: 1/6/2014 Shell
Site Contact: Matt Jeffries
Technician: Bradley Seykora
Phone: 661-758-3077
Phone: 800-339-9930
Product Type llDType Model Serial No.
Regular UNL Mechanical FX1V
Premium UNL Mechanical FXlV
Diesel Mechanical FXlDV
Check
Valve
8803 Camino Media Blvd.
Bakersfield, CA 93311
ICC No.: 8111231-UT
Bleed leak
Off Ml. Rate
Holding Tested:
Pressure
17 psi 70ml 3gph@
10 psi
15 psi 105 ml 3gph@
10 psi
13 psi 80ml 3gph@
10 psi
3 gph@
10 psi
3gph @
10 psi
3gph@
10 psi
3gph@
10 psi
3gph@
10 psi
Technician Name: B~e~k~ Technician No.:
Signature: __,;~~~;;::::;;~::-~~:::::::::==== Date:
B40738
1/6/2014
7
Pass/Fail
Pass
Pass
Pass
BROOI$10E MARKET
8803 CAMINO NEOlA
BAKERSFIELD CA 93311
JAN 6. 2014 8:53 AH
SYSTEM STATUS REPORT
ALL FUNCTIONS tlORI1AI.
ltiVEilTORY REPORT
T I :UNLEADED VOLUME • 14540 GALS
ULLAGE " 5542 GALS 9W. ULLAGE• 3533 GALS
TC VOLIJ1E • 14573 GALS
HEIGl« • 86.69 INCHES
WATER VOL • 16 GALS
WATER • 0.77 INCHES
TEMP " 56.7 DEG F
T 2:PREHIUM
VOLUME • 6005 CALS , .. :· ULLAGE 6036 GALS !~
90% ULLAGE" 4831 GALS
TC VOLUME • 6015 GALS
HEIGHT • 63.62 ltiCHES
WATER VOL " 9 GALS WATER " 0. 75 ltlCHES TEJ1P • 57.6 DEG F
T 3:DIESEL VOLUME • 411 7 GALS ULLAGE • 3910 GALS 90:l ULLAGE• 3107 GALS
TC VOLUME " 4109 GALS HEIGl« .. 65.04 INCHES WATER VOL • 0 GALS WATER • 0.00 INCHES
TEMP " 64.1 DEG F
)( )( )( )( )( EtiD )( )( )( )( )(
SOFTWARE REVISION LEVEL
VERSION 327.04 SOFTWARE~ 346327-100-E CREATED-07.02.06.10.28
S-MODULE~ 330160-004-a
SYSTEM FEATURES:
PERIODIC· JN;TAlll: TESTS
ANNUAL IN-TANI~ TESTS ISO PMC
SVSTEN SETUP ------------JAN 6. 2014 8:54 AH
SVSTEN UNITS u.s.
SYSTEM LANGUAGE ENGLISH
SYSTEM DATE/fiNE FORMAT
HOU DD WW HH:NH:SS l</1
BROOKSIDE MARKET 8803 CAI'UtlO MEDIA
BAKERSFIELD CA 93311
SHIFT TINE I : 2:00 AH 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 LitlE TEST
LINE PER TST NEEDED WRN DISABLED
Ll NE ANN TST NEEDED WRN DISABLED
PRitlT TC VOLUMES
ENABLED
TEMP COMPENSATION VALUE <DEG F >: 60.0 STICK HEIGHT OFFSET DISABLED ULLAGE: 90"
H-PROTOCOL DATA FORMAT
HEIGHT DAYLIGHT SAVING TIME
ENABLED START DATE
APR WEEK I SUN
START TIME
2:00 AH
END DATE OCT WEEK 6 SUtl
END TINE 2:00 AH
RE-DIRECT LOCAL PRWTOUT DISABLED
EURO PROTOCOL PREFIX s
SYSTEM SECURITY
CODE : 000000
MAINTENANCE HISTORY
DISABLED
TAtn: CW\RT SECURITY
DISABLED
CLSTOH ALARMS DISABLED
MASS/DENSITY DISABLED
COMMUNICATIONS SETUP
PORT SETTINGS:
CONH BOARD : I <EDIM > RS-232 SECURITY
CODE : DISABLED
CONH BOARD : 2 <S-SAT BAUD RATE : 9600
PARITY : NONE
STOP BIT : I STOP
DATA LENGTH: 8 DATA
RS-232 SECURITY
CODE : DISABLED DTR NORMAL STATE: HIGH
OOMM BOARD : 3 <RS-232> BAUD RATE : 9600 PARITY : NONE STOP BIT : I STOP
DATA LENGTH: 8 DATA
RS-232 SECURITY
CODE : DISABLED
AUTO TRANSMIT SETTit~:
AUTO LEAK ALARM LIMIT
DISABLED
AUTO HIGH WATER LIMIT
DISABLED
AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT
DISABLED
AUTO THEFT LIMIT
DISABLED AUTO DELIVERY START DISABLED
AUTO DELIVERY EtlD DISABLED
AUTO EXTERNAL JIIPUT ON
DISABLED AUTO EXTERNAL I tiPUT OFF
DISABLED AUTO SENSOR FUEL ALARM
DISABLED
AUTO SENSOR WATER ALARM
DISABLED
AUTO SENSOR OUT ALARM DISABLED
RECEIVER SETUP:
NONE
AUTO DIAL TIME SETUP:
NONE
RS-232 EtlD OF MESSAGE DISABLED
AUTO DIAL ALARH SETUP
IN-TAta{ SETUP
T I :UtlLEADED PRODUCT CODE THERMAL COEFF TAM: DIAMETER TANK PROFILE
FULL VOL
I
.000700 127.50
I PT 20082
FLOAT SIZE: 4.0 ttl.
WATER-wARtU 00 • HIGH WATER LIHIT:
MAX OR LABEL VOL: OVERFILL LIHIT :
HIGH PRODUCT •
DELIVER'! LIHIT .
2.0 3.0
20082 so:; 18073
SSY. IS078 tOY. 2008
LOW PRODUCT • 500 LEAK ALARM LIHIT: S9 SUDDEt~ LOSS LIMIT! 50
TANK TILT 0.00 PROBE OFFSET 0.00
SIPHON MANIFOLDED TANKS
Til: flOtlE
LINE HAtliFOLDED TAtiJ<S Til: NONE
LEAK Mltl PERIODIC:
LEAK HIN ANNUAL :
lOY. 2008
lOY. 2008
PERIODIC TEST T'/PE STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL ALARM DISABLED
GROSS TEST FAIL ALARM DISABLED
ANti TEST AVERAGING: OFF
PER TEST AVERAGWG: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAY.:OFF
DELIVERY DELAY : 15 HIN Pl.tlP THRESHOLD : IO.OOY.
T 2:PREtUUM PRODUCT CODE
THERMAL COEFF TANK DIAMETER
TANK PROFILE FULL VOL
FLOAT SIZE:
WATER WARNING :
HIGH WATER LIHIT:
MAX OR LABEL VOL: OVERFILL LIHIT :
HIGH PRODUCT
DELIVERY LIMIT
LOW PRODUCT : LEAK ALARM LIMIT:
2 .000700 127.50
I PT 12041
4.0 IN.
2.0
3.0
12041 90Y.
10837
SSY. 1143S
10% 1204
SUDDEN LOSS LIHIT:
500
99 50 o.oo TANK TILT
PROBE OFFSET o.oo
SIPHON MANIFOLDED TANKS Til: NONE LitlE MANIFOLDED TA!lKS Til: NONE
LEAK HIN PERIODIC: . .
LEAK HIN ANNUAL :
10'4
1204
lOY. 1204
PERIODIC TEST TYPE STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL ALARM DISABLED
GROSS TEST FAIL ALAAt1 DISABLED
ANf~ TEST AVERAGING: OFF
PER TEST AVERAGitlG: OFF
TANK TEST NOTIFY: OFF
TNY. TST SIPHON EREAK:OFF
DELIVERY DELAY : 15 HIN PUMP THRESHOLD : 10.00%
T 3:0IESEL PRODUCT CODE
THERMAL COEFF TANK DIAMETER
TANio: PROFILE
FULL VOL
FLOAT SIZE:
WATER WARtH NG :
HIGH WATER LIHIT:
HAX OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUv-r
DELIVERY LIMIT
3 .000450 127.50
I PT 8027
4,0 IN.
2.0 3.0
8027 SOY.
7224
SSY. 7625 JOY.
802
LOW PRODU...-r : 500 LEAX Al.AJ<t\ LIMIT: 99 SUDDEN LOSS LIMIT: 50
TANK TILT 0.00 PROBE OFFSET 0.00
SIPHON MANIFOLDED TANKS
Tit: NONE
LINE MANIFOLDED TAtlKS Tit: NONE
LEAl: Hltl PERIODIC: 10% 802
LEAK Hltl ANNUAL : I OY. 802
PERIODIC TEST TYPE STANDARD
AtlllUAL 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
TNK TST SIPHON BREA}::OFF
DELIVERY DELAY : 15 MIN PU1P THRESHOLD : I 0. 00%
LEAK TEST METHOD
TEST ANNUALLY: ALL TAU!: DEC WEEK 2 WED START TINE : 2:30 Al1
TEST RATE :0.20 CAL/HR
DURATION : 2 HOURS
TST EARLY STOP!OISABLED
LEAK TEST REPORT F0~1AT
ENHANCED
LIQUID SEIISOR SETUP
L l :87 ANilULAR TRI-STATE <SINGLE FLOAT>
CATEGORY : ANNULAR SPACE
L 2!87 STP TRI-STATE <SINGLE FLOAT>
CATEGORY : STP SU1?
L 3:87 FILL TRI-STATE <SINGLE FLOAT>
CATEGORY : OTHER SENSORS
L 4!91-DIESEL ANNULAR TRI-STATE <Sl NGLE FLOAT>
CATEGORY : ANNULAR SPACE
L 5!91 STP TRI-STATE <SWGLE FLOAT)
CATEGORY : STP SUMP
L 6!91 FILL
TRI-STATE <SINGLE FLOAT> CATEGORY : OTHER SENSORS
L ?:DIESEL STP TRI-STATE <SINGLE FLOAT> CATEGORY : STP SLt1P
L B!DIESEL FILL TRI-STATE <SINGLE FLOAT>
CATEGORY : OTHER SEtiSORS
L 9!DISP 1-2 TRI-STATE <SINGLE FLOAT>
CATEGORY : DISPENSER PAN
LlO!DISP 3-4 TRI-STATE <Sl NGLE FLOAT> CATEGORY : DISPENSER PAN
Ltt:DJSP 5-6
TRI-STATE <SINGLE FLOAT>
CATEGORY : DISPEtSER PAN
L12!DISP 7-8
TRI-STATE <Sl NGLE FLOAT> CATEGORY : DISPEtSER PAtl
OUTPUT RELAY SETUP
R l :87 STP TYPE:
STANDARD NORMALLY CLOSED
TANK II!
LIQUID SENSOR ALMS
L 1 !FUEL ALARM
L 2!FUEL ALARM
L 9!FUEL ALARM
LtO:FUEL ALARM
Lll !FUEL ALARM
Ll2!FUEL ALARM L 1 :SENSOR OUT ALARM
L 2!SENSOR OUT ALARt1 L 9:SENSOR OUT ALARM
LlO!SENSOR OUT ALARM
Lll !SENSOR OUT ALARM Ll2!SEtlSOR OUT ALARM
lSD SITE ALARMS ISO GROSS PRES FAIL lSD DEGRD PRES FAIL
lSD VAPOR LEAK FAIL
lSD HOSE ALARMS ALL:GROSS COLLECT FAIL
ALL!DEGRD COLLECT FAIL
R 2!91 STP
TYPE:
STANDARD NORMALLY CLOSED
TANK II! 2
LIQUID SENSOR ALMS L 4 :FUEL ALARM
L 5!FUEL ALARM L 9 !FUEL ALARM LIO!FUEL ALARM Lit !FUEL ALARM
L 12: FUEL ALARM L 4 !SENSOR OUT ALARM
L 5 !SENSOR OUT ALARM
L 9 :SENSOR OUT ALARM LtO:SEtiSOR OUT ALARM Lll :SENSOR OUT ALARM
L12!SENSOR OUT ALARM
lSD SITE ALARMS lSD GROSS PRES FAIL
ISO DEGRD PRES FAIL ISO VAPOR LEAK FAIL
lSD HOSE ALARMS ALL:GROSS COLLECT FAIL ALL!DEGRO COLLECT FAlL
R 3!DlESEL STP TYPE: STANDARD
NORMALLY CLOSED
TANK 11: 3
LIQUID SENSOR ALMS L 4!FUEL ALARM
L 7:FUEL ALARM
Ll2!FUEL ALARM L 4 :SENSOR OUT ALARM
L ?!SENSOR OUT ALARM LI2!SENSOR OUT ALARM
SHARTSENSOR SETUP
:s l!DISP 1-2 FM CATEGORY AIR FLOW METER
5 2:DISP 3-4 FM CATEGORY AIR FLOW METER
s 3:DISP 5-6 FM
CATEGORY AIR FLOW METER
s 4:DISP 7-8 FM CATEGORY AIR FLOW METER
5 S:PRESS SENSOR CATEGORY VAPOR PRESSURE
EVR/ I SD SETUP
EVR T'IPE: VACUll1 ASSIST VACUUM ASSIST TYPE HEALV VAC
NOZZLE A/L RANGE MAX: 1.15 MIN: 0.95
VAPOR PROCESSOR TYPE NO VAPOR PROCESSOR
ANALYSIS TIMES TIME: 10:00 AM DELAV MINlJTES:
ACCEPT HIGH ORVR : DISABLED
lSD HOSE TABLE JD FP FL HL AA RR ------------------------OJ 01 01 02 0<1 uu 02 02 02 02 04 uu 03 03 03 02 OJ uu 0<1 04 04 02 OJ uu 05 05 05 02 02 uu 06 06 06 02 02 uu 07 07 07 02 03 uu 09 09 08 02 03 uu
lSD AIRFLOW METER MAP ID SERIAL NUM LABEL ------------------------1 9129 DISP 3-4 F 2 13413 DISP 5-6 F
3 9132 DISP 7-8 F 4 9130 DISP 1-2 F
lSD FUEL GRADE HOSE MAP 1 2 3 4 FP MHH MHH MHH MHH AA
01 101 901 201 u u 4 02 102 902 202 u u 4 03 103 903 203 u u l 0<1 104 904 204 u u l 05 105 905 205 u u 2 06 106 906 206 u u 2 07 107 907 207 3 u 3 09 109 906 206 3 u 3
LABEL TABLE ------------------------1: UNASSIGNED 2: ELEND3 3: REGULAR 4: HID GRADE 5: PREHIU1 6: GOLD 7: BRONZE 9! SILVER 9! BLEND2 10: BLEND4
Pt1C SETUP
PROCESSOR CONTROL LEVEL:
t.ONE
ALARM HISTOP.Y REPORT
-----SENSOR ALARN -----L I :87 ANNULAR ANNULAR SPACE SENSOR OUT ALARM JAN 8. 2013 9!41 AM
FUEL ALARM JAN B. 2013 9:34 AM
ALARM HISTORY REPORT
-----SENSOR ALARM -----L 2:a7 STP STP SUMP SENSOR OUT ALARM JAN a. 2013 9:41 AM
FUEL ALARM JAN a. 2013 9!26 AM
ALARM HISTORY REPORT
-----SENSOR ALARM -----L 3!87 FILL OTHER SENSORS SENSOR OUT ALARM JAN a. 2013 9!41 AH
FUEL ALARM JAN a. 2013 9!32 AM
ALARM HISTORY REPORT
-----SEtSOR ALARM -----L 4!91-DIESEL ANNULAR ANNULAR SPACE SEtSOR OUT ALARM JAN e. 2013 9!41 AM
FUEL ALARM JAN e. 2013 9:35 AM
ALARM HISTORY REPORT
-----SEtSOR ALARM -----L 5:91 Sfp STP St.ttP SENSOR OUT Al.AP.t1 JAN e. 2013 9:41 AH
FUEL ALARM JAN e. 2013 9:27 AH
ALARM HISTORY REPORT
-----SENSOR ALARM -----L 6:91 FILL OTHER SENSORS SEtlSOR OUT ALARM
JAI~ e. 2013 9!41 AH
FUEL ALARM JAU e. 2013 9:31 AH
ALARM HISTORV REPORT
-----SENSOR ALARH -----L ?:DIESEL STP STP SLtiP SEtlSOR OUT ALARM JAN e. 2013 9:41 AM
FUEL ALARM JAN e. 2013 9:29 AM
ALARM HISTORY REPORT
-----SEtlSOR ALARM -----L e:OIESEL FILL OTHER SENSORS SENSOR OUT ALARM JAN a. 2013 9!41 f>l1
FUEL AlARM JAtl e. 2013 9:29 AH
ALARM HISTORY REPORT
----SEtlSOR ALARM -----L 9!DISP 1-2 DISPENSER PAtl SEtlSOR OUT ALARM JAN e. 2013 9!41 AM
FUEL AlARM JAN e. 2013 9!38 AM
ALARM HISTORY REPORT
-----SENSOR ALARM -----LIO:DISP 3-4 DISPENSER PAN FUEL ALARM JAN e. 2013 10:57 AM
SENSOR OUT ALARM JAN 9. 2013 9:41 AM
FUEL ALARH JAN e. 2013 9:38 AM
~ ~ ~ M ~ END K * * * *
ALARM HISTORY REPORT
-----SENSOR ALARM -----LII!DISP 5-6
DISPEtlSER PAN
SENSOR OI.Ir ALARM
JAN e. 2013 9!41 AM
FUEL ALARM
JAN e. 2013 9!36 AM
ALARM HISTOR'/ REPORT
-----SENSOR ALARM -----LI2!DISP 7-e
DISPENSER PAN
SENSOR OI.Ir ALARM
JAN e. 2013 9!41 AH
FUEL ALARM
JAN e. 2013 9!37 AM
-----SEIISOR ALARM ----L 9!DJSP 1-2
DISPENSER PAll
SEIISOR OUT ALARM
JAN 6. 2014 9!41 AH
-----SElSOR ALARM -----L 5!91 STP
STP Sli1P
SENSOR OUT ALARtl
JAN 6. 2014 9!42 AH
-----SENSOR ALARM -----L10!DISP 3-4
DISPENSER PAN
SENSOR OUT ALARM
JAN 6. 2014 9!42 AH
-----SENSOR ALAI"d1 L 1 : e7 ANNULAR
ANIIULAR SPACE 1 SENSOR OUT ALARM
JAN 6. 2014 9!42 AM
-----SENSOR ALARM -----L 3:e7 FILL
OTHER SENSORS
SEtlSOR OI.Ir ALARM
JAil 6. 2014 9!42 AM
----SElSOR ALARM -----
L 4!91-DIESEl. ANNULAR
ANNULAR SPACE
SEUSOR OUT ALARM
JAN 6. 2014 9!42 AM
-----SElSOR ALARM -----
L11 !DISP 5-6
DISPEIISER PAN
SEtlSOR OI.Ir ALAI\11
JAN 6. 2014 9: •12 tlt1
-----SElSOR ALARI1 -----
L12!DISP 7-8
DISPENSER PAN
SENSOR OI.Ir ALARM
JAN 6. 2014 9:42 AH
-----SENSOR ALARM -----L 6!91 FILL
OTHER SENSORS
SENSOR OI.Ir ALARM
JAN 6. 2014 9!42 AM
-----SENSOR ALARM -----L ?!DIESEl. STP STP Sll'IP
SENSOR OUT ALARM JAN 6. 2014 9!42 AN
-----SENSOR ALARM -----L S!DIESEL FILL
OTHER SEtlSORS
SENSOR OUT ALARM
JAil 6. 2014 9!42 AH
-----SENSOR ALARM -----L 2:e7 STP
STPSUNP SEtlSOR OI.Ir ALARM JAN 6. 2014 9!42 AM
-----SENSOR ALAIIM -----L 2:87 STP STPSUI1P
FUEL ALAIIM JAN 6. 2014 9!47 AM
-----SElSOR ALARH -----l:J. ?:DIESEL STP '"STP SUMP , FUEL ALARM JAil 6. 2014 ~:.16 1111
.:-:-
----SENSOR ALARM -----L 5:91 STP STP SUI1P FUEL ALAIIM JAN 6. 2014 9:50 AM
-----SENSOR ALARM -----LI2:DISP 7-8 DISPENSER PAN FUEL ALARM JAN 6. 2014 9:52 AH
-----SENSOR ALARM -----Ll1 :DISP 5-6 DISPENSER PAN FUEL ALARM JAN 6. 2014 9:53 AM
-----SENSOR ALAIIM -----L10!DISP 3-4 DISPEtlSER PAN FUEL ALARM JAN 6. 2014 9:54 AM
-----SENSOR ALARM -----L 9!D1SP 1-2 DISPENSER PAN FUEL ALARM JAN 6. 2014 9:57 AM
----SEtlSOR ALARM -----L B:DIESEL FILL OTHER SENSORS FUEL ALARM JAN 6. 2014 9!59 AM
----SENSOR ALARt1 -----
L 6:91 FILL OTHER SENSORS FUEL ALARM JAtl 6. 2014 9:59 AM
----SENSOR ALARM -----L 3:87 FILL OTHER SENSORS FUEL ALARM JAN 6. 2014 10:00 AM
-----SENSOR ALARM -----L I : 87 ANtlULAR ANNULAR SPACE FUEL ALARM JAN 6. 2014 10:01 AM
-----SENSOR ALARM -----L 4!91-DIESEL ANNULAR ANNULAR SPACE FUEL ALARM JAN 6. 2014 10:03 AM
BROOKSIDE MARKET 8803 CAMINO MEDIA BAKERSFIELD CA 93311
JAN 6. 2014 10:04 AM
S'ISTEM STATUS REPORT ------------ALL FUNCTIONS NORMAL
BROOKSIDE MARKET 8803 CAMillO t1EDIA BAKERSFIELD CA 93311
JAN 6. 2014 11:15 AM
S\'STEH STATUS REPORT
ALL FUtlCTIONS NORMAL
SWRC B, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completedform and
printouts f rom tests ar applicable), should be provided to the facility owner/operator for submit/alto the local regulatOiy agency.
1 FACILITY INFORMATION .
Facility Name: Shell I Date ofTesting: 1/6/2014
Facility Address: Camino Media Blvd., Bakersfield, CA 933 11
Facility Contact: Matt Jeffries _I Phone: 66 1-496-7006
Date Local Agency Was Notified of Testing: Ester Duran
Name of Local Agency Inspector (if present during testing): 1/2/2014
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bradley Seykora
Credentials': ~ CSLB Contractor ~ICC Service Tech. [' SWRCB Tank Tester 0 Other (Specify)
License Number(s): CSLB# 804904 ICC# 8111231 -UT
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: ~ Hydrostatic Vacuum [ Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identity Spill Bucket (By Tank 1 Regular 2 Super 3 Diesel 4
Number, Stored Product, etc.)
Bucket Installation Type: Direct Bury l Direct Bury u Direct Bury Direct Bury
X Contained in Sump X Contained in Sump X Contained in Sump l Contained in Sump
Bucket Diameter: 12.00" 12.00" 12.00"
Bucket Depth: 12 .00" 12.00" 12.00"
Wait time between applying 5 Min. 5 Min. 5 Min. vacuum/water and start of test:
Test Start Time (T1): 9:45am 9:45am 9:45am
Initial Reading (R1): 9.25" 9.50" 8.25"
Test End Time (TF): I 0:45am I 0:45am I 0:45am
Final Reading (Rr): 9.25" 9.50" 8.25"
Test Duration (T F-T1): 1 Hour I Hour I Hour
Change in Reading (Rr-R1): 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" Criteria:
Test Result: X Pass 0 Fail X Pass 0 Fail X Pass 0 Fail 0 Pass 0 Fail
Comments -(include infomwtion on repairs made prior to testing, and recommended follow-up for.fai/ed 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 Signature: ~ Date: 1/6/2014
__ __...A<~~-
1 State Jaws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
Shell
8803 Camino Media Blvd.
Bakersfield, CA 93311
1 TLS 350
2. 208 Sump Sensor
3. 420 Annuar Sensor
4. TankATG
5 Red Jacket FX1V
6 Red Jacket FX1DV
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