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: Metro Station Bldg. No.: ____ _
Site Address: 4600 Stine Road City: Bakersfield, CA Zip: .::...93:....:3:....:1...::.3 __ _
Facility Contact Person: George Farah Contact Phone No.: (661) 831-0836
Make/Model of Monitoring System: Veeder-Root TLS 350 Date ofTesting/Servicing: 3/19/2014
B. Inventory of Equipment Tested/Certified
-----------I --~ •• ----------------"fi ----------dlserviced . -
Tank ID: 12,000 gal. Regular 1 Tank ID: 12,000 gal. Regular 2
1811n-Tank Gauging Probe. Model: 847390-107 1811n-Tank Gauging Probe. Model: 847390-107
181 Annular Space or Vault Sensor. Model: 794390-420 181 Annular Space or Vault Sensor. Model: 794390-420
181 Piping Sump I Trench Sensor(s). Model: 794380-208 181 Piping Sump I Trench Sensor(s). Model: 794380-208
0 Fill Sump Sensor(s). Model: 0 Fill Sump Scnsor(s). Model:
181 Mechanical Line Leak Detector. Model: FX-1V 181 Mechanical Line Leak Detector. Model: FX-1V
0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
181 Tank Overfill/ High-Level Sensor. Model: 847390-107 181 Tank Overfill/ High-Level Sensor. Model: 847390-107
0 Other (specifY equipment type and model in Section Eon Page 2). 0 Other (specifY equipment type and model in Section Eon Page 2).
Tank ID: 12,000 gal. Su~er Tank ID: 12,000 gal. Diesel
181 In-Tank Gauging Probe. Model: 847390-107 181 In-Tank Gauging Probe. Model: 847390-107
181 Annular Space or Vault Sensor. Model: 794390-420 181 Annular Space or Vault Sensor. Model: 794390-420
181 Piping Sump I Trench Sensor(s). Model: 794380-208 181 Piping Sump I Trench Sensor(s). Model: 794380-208
D Fill Sump Scnsor(s). Model: 0 Fill Sump Sensor(s). Model:
181 Mechanical Line Leak Detector. Model: FX-1V 181 Mechanical Line Leak Detector. Model: FX-1 DV
0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
181 Tank Overfill/ High-Level Sensor. Model: 847390-107 181 Tank Overfill I High-Level Sensor. Model: 847390-107
0 Other (specify equipment type and model in Section E on Page 2). 0 Other (specify equipment type and model in Section Eon Page 2).
Dispenser ID: 1&2 Dispenser ID: 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). 0 Dispenser Containment Float(s) and Chain(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 Valve(s).
D Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 9 & 10 Dispenser TD:
181 Dispenser Containment Sensor(s). Model: 794380-208 0 Dispenser Containment Sensor(s). Model:
181 Shear Valve(s). 0 Shear Valve(s).
0 Dispenser Containment Float(s) and Chain(s). 0 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): IZ! System set-up IZ! Alarm history report
Technician Name (print): Bradley Seykora Signature:_.,....::, ~,Jr.:::::._ ~-4~---==---------
Certification No.: B40738 License. N~----=:8.::.04.:.9 :::..::....:..._ ____________ _
Testing Company Name: Confidence UST Services, Inc. Phone No.: (800) 339-9930
Site Address: 4600 Stine Road, Bakersfield, CA 93313 Date of Testing/Servicing: 3/19/2014
Page 1 of 3
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed: ......::.3:::.3..:.;1.:.::0..::.0 _____________ _
c he foil heckr . .,'-•
18J Yes D No* Is the audible alarm operational?
I8J Yes D No* Ts the visual alarm operational?
I8J Yes D No* Were all sensors visually inspected, functionally tested, and confirmed operational?
18J 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)
18J N/A operational?
I8J 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) I8J Sump/Trench Sensors; I8J Dispenser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? l8l Yes; D No.
18J 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%
I8J Yes* D 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* I8J No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
D Product; D Water. Tfyes, describe causes in Section E, below.
18J Yes D No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable
18J 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: The 91 and diesel grade LLD's were replaced during testing.
Page 2 of 3
~'f\D~+. 0 (\ ~ust ~ces.~
•OQHPc.JANC.CWJ'Ilot~
Leak Detector Test Results Sheet
Customer Address: Work Order: 32144 Site Address:
El Manahri, Inc. Test Date: 3/19/2014 Metro Station
4600 Stine Road
Bakersfield, CA 93313
Site Contact: George Farah
Technician: Bradley Seykora
Phone: 661-831-0836
Phone: 800-339-9930
Product Type LLD Type Model Serial No.
Regular UNL Mechanical FX1V N/A
Regular UNL Mechanical FX1V N/A
Premium UNL Mechanical FX1V N/A
Diesel Mechanical FX1DV N/A
Check
Valve
4600 Stine Road
Bakersfield, CA 93313
ICC No.: 8111231
Bleed Leak
Off ML. Rate
Holding Tested:
Pressure
12 PSI 150ml 3gph@
10 psi
12 PSI 150 ml 3gph@
10 psi
2 PSI 35 ml 3gph@
10 psi
10 PSI 95 ml 3gph@
10 psi
3gph@
10 psi
3 gph@
10 psi
3gph@
10 psi
3gph@
10 psi
Technician Name: ~
Signature:
Technician No.: 8111231
3/19/2014 Date:
/
Pass/Fail
Pass
Pass
Pass
Pass
METRO STAtiON
4600 STltlf...:ROAD ,BAKERSFIE~. CA ,., I ~
f I
1NAR 19. 2014 7:41 AN
I SYSTEM STATUS REPORT ------------ALL FUNCTIONS NORMAL
INVENTOR'/ REPORT
T I :REGULAR 1 ~
VOLUME • 2892 GALS
ULLAGE • 9108 GALS
901! ULLAGE.. 7908 GALS
TC VOLUME • 2867 GALS HEIGHT • 28.01 INCHES
WATER VOL • 0 GALS
WATER • 0.00 INCHES
TEMP • 71.0 DEG F
T 2:REGULAR 2
VOLUME • 2896 GALS
ULLAGE • 9104 GALS
9W. ULLAGE• 7904 GALS
TC VOLUME • 2873 CAts
HEIGHT • 28.03 INCHES
WATER VOL • 0 GALS
WATER = 0.00 INCHES TEMP • 70.1 DEG F
T 3:SUPER ""VOI.:UME . • 2380 GALS
ULLAGE • 9620 GALS
9W. ULLAGE• 8420 GALS f. TC VOLI..tiE "' 2357 GALS
·HEIGHT • 24.37 ltiCHES
WATER VOL • 0 GALS
-UATER .. 0. 00 1 NCHES'
-TEMP • 72.8 DEG F
T 4:DIESEL
VOLUME • 3094 GALS
ULLAGE • 8906 GALS
9W. ULLAGE• 7706 GALS
TC VOLUME • 3079 GALS
HEIGHT • 29,41 INCHES
WATER VOL • 20 GALS
WATER • 0. 97 1 NCHES
TEMP • 71.6 DEG F
MANIFOLDED TANKS
ltNEflTORY TOTALS
T l :REGULAR I
T 2:REGULAR 2
VOLUME • 5786 GALS
TC VOLUME • 5740 GALS
X X X X * END X ~ * X X
SOFTWARE REVISION LEVEL
VERSION 331.00
SOFTWAREP 346331-100-A
CREATED-11.02.10.12,31
S-MODULE~ 33DL60:D04-a
SYSTEM FEATURES:
PERIODIC IN-TAtlK TESTS
ANNUAL IN-TAifK TESTS
ISD/APM
SYSTEM SETUP ------------MAR 19. 2014 7:41 AH
S'ISTEM UNITS u.s.
SYSTEM LANGUAGE
ENGLISH
SYSTEM DATE/TINE FORMAT
NON DD Y'l\"1 HH :MM :ss >J1
METRO STATION
4600 STiflE ROAD
BAAERSFIELD. CA
SHIFT TINE I DISABLED
SHIFT TINE 2 DISABLED
SHIFT TIME 3 DISABLED
SHIFT TIME 4 DISABLED
TANK PER TST NEEDED WRN
DISABLED
TANK ANN TST NEEDED WRN
DISABLED
LINE RE-EfiABLE METHOD
PASS 1.1 NE TEST
LINE PER TST NEEDED WRtl
DISABLED
LINE ANti TST NEEDED WRN DISABLED
PRINT TC VOLUMES
ENABLED
TEMP COMPENSATION
VALUE <DEG F >: 60.0
STICK HEIGHT OFFSET
DISABLED
ULLAGE: 90¥.
H-PROTOCOL DATA FORMAT
HEIGHT
DAYLIGHT SAVING TIME
DISABLED
RE-DIRECT LOCAL PRINTOUT
DISABLED
EURO PROTOCOL PREFIX s
SYSTEM SECURITY
CODE : 000000
HAI NTENANCE HISTORY DISABLED
TANK CHART SECURITY
DISABLED
CUSTOM ALARMS DISABLED
SERVICE NOTICE
DISABLED
ISO 3166 COUNTRY
CODE: ---r
VAPOR MOtnTORlNG TYPE
CARB ISO
MASS/DENSITY
COt1'1UNICATIOtiS SETUP
PORT SETTINGS:
COHH BOARD : I <EDIH >
RS-232 SECURITY
CODE .: DISABLED
COMM BOARD : 2 <RS-232>
BAUD RATE : 9600
PARITY : tlONE
STOP BIT : 1 STOP
DATA LENGTH: 9 DATA
RS-232 SECURITY
CODE ; DISABLED
COMM BOARD : 3 <RS-232>
BAUD RATE ; 1200
PARITY : NONE
STOP BIT : 1 STOP DATA LENGTH: 9 DATA
RS-232 SECURITY
CODE : DISABLED
AUTO TRANSMIT SETTltlGS:
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 END
DISABLED
AUTO EXTEP.NAL INPUT ON
DISABLED AliTO EXTEP.NAL I NPliT OFF
DISABLED
AUTO SENSOR FUEL ALARM
DISABLED AUTO SENSOR WATER ALARM
DISABLED
AUTO SENSOR OUT ALARH
DISABLED
RS-232 END OF MESSAGE
DISABLED
HI-TANK SETUP
T I :REGULAR I PRODUCT CODE THERMAL COEFF TANK DIAMETER "TANK PROFILE FULL VOL
FLOAT SIZE:
1 .000750 96.50
1 PT
12000
4,0 IN.
WATER WARNING : 1.5 HIGH WATER Lll·llT: 3.0 WATER ALARM FILTER: LOW
MAX OR LABEL VOL: 12000 OVERFILL LIMIT : SOY. : 10800 HIGH PRODUCT : 95Y. : 11400 DELIVERY LIMIT : 15% : 1800
LOW PRODUCT : 400 LEAY. ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT : 0.00 PROBE OFFSET : 0.00
SIPHON MANIFOLDED TAIIKS Til: NONE LINE MANIFOLDED TAIIKS
Tit: 02
LEAK MIN PERIODIC: 0%
0
LEAK HI N ANNUAL : 0%
0
PERIODIC TEST TYPE STAIIDARD
ANNUAL TEST FAIL ALARM DISABLED
PERIODIC TEST FAIL ALARM DISABLED
GROSS TEST FAIL ALARM DISABLED
Atltl TEST AVERAGING: OFF PER TEST AVERAGING: OFF
TAIIK TEST NOTIFY: OFF
TNX TST SIPHON BREAY.:OFF
DELIVER\' DELAY : 5 MIN PU·IP THRESHOLD : IO.OW.
T 2:REGULAR 2 PRODUCT CODE THERMAL COEFF TANK DIAMETER TAN~ PROFILE FULL VOL
2 .000?50 96.50
I PT 12000
FLOAT SIZE: 4.0 IN.
WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 WATER ALARM FILTER: LOW
MAX OR LABEL VOL: OVERFILL LIMIT
HIGH PRODUCT
DELIVER\' LH11T
LOW PRODUCT : LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TA~ TILT PROBE OFFSET
12000
90Y.
10800
95!'. 11400
1~~
1800
400
99 99 0.00 o.oo
SIPHON MANIFOLDED TANKS Til! tiOIIE LINE MANIFOLDED TANKS Til: 01
LEAK MIN PERIODIC: .
LEAl: MIN ANNUAL :
0% 0
OY.
0
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
TAtiK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 5 MIN PUMP THRESHOLD : 10.00%
T 3:SUPER PRODOCT CODE THERMAL COEFF TANK DIAMETER TANK PROFILE FULL VOL
FLOAT SIZE:
3 .000750 96,50
I PT 12000
4.0 IN.
WATER WARNWG : 1.5 HIGH WATER LIMIT: 2.0 WATER ALARI1 FILTER: LOW
t1AX OR LABEL VOL: 12000 OVERFILL LIMIT : 90% : 10800 HIGH PRODUCT : 95% : 11400 DELIVERY LIMIT : 15% : 1800
LOW PRODUCT : 400 LEAK ALARI1 LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT : 0,00 PROBE OFFSET : 0.00
SIPHON MANIFOLDED TAtiKS Til: tl<>tiE LINE MANIFOLDED TANKS Til: NONE
LEAK MIN PERIODIC:
LEAK MIN ANNUAL : .
0%
0
0%
0
PERIODIC TEST TYPE STANDARD
ANNUAL TEST FAIL ALARM DISABLED
PERIODIC TEST FAIL ALARM DISABLED
GROSS TEST FAIL ALARM DISABLED
AtiN TEST AVERAGING: OFF PER TEST AVERAGING: OFF
TANK TEST tlOTIFV: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 5 Hill Pl.t1P THRESHOLD : lO.OOY.
T 4:DIESEL PRODUCT COPE THERMAL COEFF TAtiK DIAttETER TAtn: PROFILE FULL VOL
FLOAT SIZE:
4 .000450 96.50 I PT 12000
4.0 IN.
WATER WARNING : 2.0 HIGH WATER LIHIT: 3.0 WATER ALARM FILTER: LOW
HAX OR LABEL VOL: OVERFILL LIMIT :
HIGH PRODUCT . DELIVERY LIMIT : .
LOW PRODUCT : LEAK AlARM LIMIT: SUDDEN LOSS LIMIT: TAM{ TILT : PROBE OFFSET :
12000
90% 10800
95Y. 11400
15~ 1800
400 99 99 o.oo o.oo
SIPHON MANIFOLDED TAW\S Til: NONE LINE MANIFOLDED TANKS Til: fiOtiE
LEAK MIN PERIODIC: . . 0%
0 PERIODIC TEST TYPE STAtlDARD
PERIODIC TEST FAIL AlARH DISABLED
CROSS TEST FAIL ALARM DISABLED
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TtlK TST SIPHON BREAK:OFF
DELIVERY DELAY : 5 HIN Plt1P THRESHOLD : 10.00%
LEAK TEST f'1ETHOD
TEST ON DATE : ALL TANK FEB 10. 2011 START TIME : DISABLED TEST RATE :0.20 GAL/HR DURATIOtl : 2 HOURS
TST EARLY STOP:DISABLED
LEAK TEST REPORT FORMAT NORMAL
LIQUID SENSOR SETUP
. L I :DISP 1-2 : TRI-STATE <SINGLE FLOAT> ' CATEGORY : DISPENSER PAN
L. 2!DISP 3-4 TRI-STATE <SINGLE FLOAT> CATEGORY : DISPENSER PAN
L 3!DISP 5-6 TRI-STATE <SINGLE FLOAT) CATEGORY : DISPENSER PAN
L 4:DISP 7-8 TRI-STATE <SINGLE FLOAT> CATEGORY : DISPENSER PAN
L 5!DISP 9-10 TRI-STATE <SINGLE FLOAT> CATEGORY : DISPENSER PAN
L 9!REGULAR I STP TRI-STATE <SINGLE FLOAT> CATEGORY : STP SUMP
LIO:RECULAR I ANtl TRI-STATE <SINGLE FLOAT> CATEGORY : ANNULAR SPACE
Ltt:REGULAR 2 STP TRI-STATE <SINGLE FLOAT> CATEGORY : STP Slt1P
L12!REGULAR 2 ANN TRI-STATE (SINGLE FLOAT> CATEGORY : ANNULAR SPACE
L13!SUPER STP TRI-STATE <SINGLE FLOAT> CATEGORY : STP Slt1P
L14 !SUPER AWl TRI-STATE <SINGLE FLOAT> CATEGORY : ANNULAR SPACE
LIS:DIESEL STP TRI-STATE <SINGLE FLOAT> CATEGORY : STP SUMP
LIG!DIESEL ANN TRI-STATE <SINGLE FLOAT> CATEGORY : ANNULAR SPACE
Pll'1P SENSOR SETUP
S I :REGULAR I TANK ;t: I DISPENSE MODE: MANIFOLDED: ALTERNATE
S 2:REGULAR 2 TANK 11: 2 DISPENSE NODE: MAtliFOLDEO: ALTERNATE
OliTPUT RELAY SETUP
R I !REGULAR I TYPE: PUMP CONTROL OUTPUT TANK 11: I
ltl-TAtlK ALARMS T 1 :HIGH WATER ALARM T 1 !LOW PRODUCT ALARM
LIQUID SENSOR AlJ1S L 2:FUEL AlARH L 3!FUEL AlARM L 4:FUEL AlARM L 5!FUEL ALARM L 9:FUEL ALARM LII:FUEL ALARM L 2!SENSOR OUT ALARM L 3:SENSOR OUT ALARM L 4:SENSOR OUT ALARM L 5:SENSOR OUT ALARM L 9:SENSOR OUT ALARM Lll :SENSOR OUT ALARM L 2:SHORT ALARM L 3:SHORT ALARM L 4!SHORT ALARM L 5:SHORT AL.ARM L 9:SHORT AlARM L11 :SHORT ALARM
ISO SITE AlARMS ISO GROSS·PRES FAI~ lSD DEGRD PRES FAIL lSD VAPOR LEAK FAIL lSD VP PRES FAIL lSD VP STATUS FAIL lSD SETUP FAIL lSD SENSOR OUT FAIL PC-lSD FAILURE
lSD HOSE ALARMS ALt:GROSS COLLECT FAIL
ALL:DEGRD COLLECT FAIL ALL!FLOW COLLECT FAIL
R 2:RECULAR 2 T'iPE:
Plt1P CotiTROL OUTPUT TANK ll: 2
IN-TANK ALARMS T 2:HIGH I.-lATE?. ALARM T 2:LOW PRODUCT ALARM
LIQUID SENSOR ALMS L 2:FUEL ALARM
L 3:FUEL ALARM L 4 :FUEL ALARH
L S:FUEL ALARH L 9:FUEL ALARM Lll :FUEL ALARM L 2:SEtlSOR OUT ALARM
L 3:SENSOR OUT ALARH L 4 :SENSOR OUT ALARM
L S:SENSOR OUT AlARM L 91SEflSOR OUT ALARM
Lll :SENSOR OUT AlARM L 2:SHORT ALARM L 3 :SHORT ALARM
L 4 :SHORT ALARM L 51SHORT AlARM
L 9:SHORT AlARM Lll :SHORT AlARM
ISO SITE ALARMS
lSD GROSS PRES FAIL
lSD DEGRD PRES FAIL
lSD VAPOR LEAK FAIL
lSD VP PRES FAIL
lSD VP STATUS FAIL lSD SETUP FAIL
lSD SENSOR OUT FAIL
PC-lSD FAILURE
ISO HOSE ALARMS
ALL:CROSS COLLECT FAIL
ALL:OECRD COLLECT FAIL
ALL:FLOU COLLECT FAIL
R 3:SUPER TYPE:
STAtiDARD
NORMALLY CLOSED
TANK ll: 3
IN-TANK ALARMS T 3:HIGH WATER ALARM
T 3:LOW PRODUCT ALARM
LIQUID SENSOR ALMS
L 2:FUEL AlARM L 3:FUEL ALARM
L 4:FUEL ALARM
L S:FUEL ALARM Lt3:FUEL ALARM L 21SEtlSOR OUT ALARM L 3:9ENSOR OUT ALARM
L 4 :SENSOR OUT AlARM L S:SEflSOR OUT ALARM
Ll31SENSOR OUT ALARM
L 2!SHORT ALARH L 31SHORT ALARM
L 4:SHORT ALARM L S:SHORT ALAJ(I1 L13:SiiORT ALARM
ISO SITE Al.AAMS
lSD GROSS PRES FAIL
lSD DEGRD PRES FAIL ISO VAPOR LEAK FAIL
lSD VP PRES FAIL
lSD VP STATUS FAIL
ISO SETUP FAIL
lSD SENSOR OUT FAIL PC-ISO FAILURE
lSD HOSE ALARMS ALL!CROSS COLLECT FAIL
ALL:DEGRD COLLECT FAIL ALL:FLOW COLLECT FAIL
R 4!DIESEL
TYPE: STANDARD NORMALLY CLOSED
TANK 11: 4
I N·TANK AlARMS T 4 :HIGH WATER ALARM
T 41LOW PRODUCT AlARM
LIQUID SENSOR ALMS
L I :FUEL ALARM L 2:FUEL ALARM L ::l:FUEL AlARM
L 151 FUEL ALARM L 1 :SENSOR OUT ALAJ<M L 21SEtiSOR OUT ALAR~I
L ::l:SEtiSOR OUT ALARM L15:SENSOR OUT Al.AJ<H
L I :SHORT ALAJ<M
L 2 :SHORT ALARM L ::l!SHORT AtAJ<M
LIS:SHOJ<T ALARM
j R 5:0VERFILL ALARM
! TYPE:
! STANDAJ<D NORMALLY OPEN
TANK 11: NONE
I N·TAtu: ALARMS
AtL:OVERFILL ALARM
ALLIHIGH PRODUCT ALARM
SMARTSENSOR SETUP
5 2:FM 3-4
CATEGORY AIR FLOW METER
:s 3:FH 5-6
CATEGORY AIR FLOW METER
:1 4:FH 7-8
CATEGORY AIR FLOW METER
::~ s:FH 9-to CATEGORY AIR FLOW METER
:1 6!VP PRESSURE SEN.
CATEGORY VAPOR PRESSURE
:1 ?:CANISTER
CATEGORY VAPOR VALVE
:s e:ATH P SENSOR
CATEGORY ATH P SENSOR
I EVRI'ISD SETUP
I
! EVR TYPE: BALANCE
BALANCE NOZZLE TYPE vsr
;
VAPOR PROCESSOR TYPE
VEEDER-ROOT POLISHER
I ANALYSIS TIMES
II TIME: 11:59 PH DELAY NINLITES:
! ACCEPT HIGH ORVR:
E~IABLED
lSD HOSE TABLE ID FP FL HL AA RR
01 03 03 02 01 03 02 04 04 02 01 03
03 05 05 02 02 03 04 06 06 02 02 03 05 07 07 02 03 03 06 08 08 02 03 03
07 09 09 02 04 03
OB 16 10 02 04 03
lSD AIRFLOW METER MAP
ID SERIAL NU.'1 LABEL
I 40348 2 40070 3 40350 4 40356
FN 3-4
FN 5-6 FN 7-8
FN 9-10
lSD FUEL GRADE HOSE HAP I 2 3 4 FP MHH MHH MHH MHH AA ---·-·--------------01 I U U U U U U U 0
02 2 u u u u u u u 0
03 201 101 901 3 u 1
04 202 102 902 3 U I
OS 203 103 903 3 U 2 06 204 104 904 3 u 2 07 105 905 205 u u 3
09 206 106 906 u u 3 09 207 107 907 u u 4
16 209 lOB 908 U U 4
LABEL TABLE
I UNASSIGUED
2 BLEND3
3 REGULAR
4 HID GRADE
5 PREMIUM 6 GOLD
7 BRONZE
B SILVER
9 BLEND2 10 BLEND4
PMC SETUP
~ VERSION: 01.04
VAPOR PROCESSOR TYPE VEEDER-ROOT POLISHER
ALARM HISTOR'I REPORT
-----SENSOR ALARM -----L 1 :DtSP 1-2
DISPEIISER PAll SENSOR OUT ALARM MAR 25. 2013 1:49 PH
FUEL ALARM MAR 25. 2013 1:42 PH
SETUP DATA WARNitlG APR 17. 2012 11:56 AM
M M M M ~ END ~ K K K K
ALARM HISTORY REPORT
-----SENSOR ALARM -----1. 2:DISP 3-4
DISPENSER PAN FUEL ALARM MAR 25. 2013 2:34 PM
FUEL ALAP.M MAR 25. 2013 1:57 PH
SENSOR OUT ALARM MAR 25. 2013 1:49PM
K K K M K END M K M K K
; ALARM HISTORY REPORT
: -----SENSOR ALARM -----
1
1 1. 3:DISP 5-6
DISPEtiSER PAtl ' FUEl. Al.ARM AUG 30. 2013 10:59 AM
SENSOR OUT ALARM NAR 25. 2013 1:49PM
FUEL ALAP.t1 -MAR 25. 2013 I :43 PI-I
K * M * K END K M K M M
ALARM HISTORY REPORT
-----SEtiSOR ALARM -----1. 4:DISP 7-8
DISPENSER PAN
SENSOR OUT ALARM MAR 25. 2013 1:49PM
FUEL ALARM MAR 25. 2013 1:44PM
SETUP DATA WARtH NG
APR 17. 2012 11:56 AM
M M M M K END K M M M M
ALARM HISTORY REPORT
-----SENSOR ALARM -----L 5:DlSP 9-10 DlSPEUSER PAN SENSOR our ALAAt1 t1AR 25. 2013 1 :49 PN
FUEL ALARM MAR 25. 2013 1:46PM
SETUP DATA WARNING APR 17. 2012 11:56 AM
;; ~< ;.; ;.; >i END i\ M )( M *
ALAR/'1 HISTORY REPORT
-----SENSOR ALARM -----L 9:RECULAR 1 STP STP SUMP SENSOR our ALARM MAR 25. 2013 1:49PM
FUEL ALARM NAR 25. 2013 1:37PM
SETUP DATA ~RtHNG APR 17. 2012 11:56 AH
j( x j( j( j( EtiD x x !t. j( j(
l ALARM HISTORY REPORT
-----SENSOR ALARM -----LIO:RECULAR I ANN ANNULAR SPACE SENSOR OUT ALARM NAR 25. 2013 1:49PM
FUEL ALARM HAR 25. 2013 t:39 PM
SETUP DATA WARNING APR 17. 2012 11:56 AM
W M M M M END M M M M M
ALARt1 HISTORY REPORT
-----SENSOR ALARM -----LII:RECULAR 2 STP STP SUMP SENSOR OUT ALARM MAR 25. 2013 1:49 PH
FUEL ALARM MAR 25. 2013 t:35 PM
SETUP DATA ~RNING APR 17. 2012 11:56 AM
M )( M * M END K * K * )(
ALARM HISTORY REPORT
-----SENSOR ALARM -----LI2:RECULAR 2 ANtl ANNULAR SPACE SENSOR our ALARM NAR 25. 2013 1:49PM
FUEL ALARM MAR 25. 2013 I :36 Pt1
SETUP DATA WARti!NG APR 17. 2012 11:56 AM
j( * M j( )( END * M ~ j( j(
ALARM HISTORY REPORT
-----SENSOR ALARM -----Lt3:SUPER STP
STP SUMP SENSOR OUT ALARM MAR 25. 2013 1:49PM
FUEL ALARM MAR 25. 2013 1:39PM
SETUP DATA WARNING APR 17. 2012 11:56 AM
* M M M M END * >i * ;.; M
ALARM HISTORY REPORT
----SENSOR ALARM -----Lt4:SUPER ANtt
ANNULAR SPACE SENSOR Our ALARl1 MAR 25, 2013 1:49PM
FUEL ALARM MAR 25. 2013 1:38 PN
SETUP DATA WARNING APR 17, 2012 11:56 AH
M M M M M E~D M M M M M
ALARM HISTORY REPORT
-----SENSOR ALARM ----l.t5:DIESEL STP
STPSUMP FUEL ALARM NOV 21. 2013 8:48PM
FUEL ALARM NOV 21. 2013 8:46 FH
FUEL ALARM
NOV 21. 2013 7:31 PM
M M M M K END M M M M M
ALARM HISTORY REPORT
----SEilSOR ALARM -----L16:DIESEL ANN
ANNULAR SPACE SENSOR Our ALARM MAR 25, 2013 1:49PM
FUEL ALARM MAR 25. 2013 1:34 PH
SETUP DATA WAR Ill NG APR 17, 2012 11:56 AM
M * * * )( END M M ;; M M
IN-TAI~K ALARH -----T 4:DIESEL
DELIVERY llEEDED MAR 19. 2014 9:32AM
1----IN-TANK ALARH -----T 4:01ESEL
PROBE OlJT
MAR 19. 2014 9:32 AH
----IN-TANK ALARM ---;-
T 2:REGULAR 2 • .
SUDDEN LOSS ALARM -~ MAR 19. 2014 9:33AM
----IN-TANK ALARM -----T 2:REGULAR 2
DELIVERY NEEDED MAR 19. 2014 9:33AM
----IN-TANK ALARI-1 -----T 2:RECULAR 2
PROBE OUT MAR 19. 2014 9:34 AM
----I N-TAtiK ALARM -----T 1 :REGULAR. I .
SUDDEf4LOSSc-ALARM .. --··· f1AR 19,· 20r.r:·9~·M-
----lfl-TANK ALARM -----T I :REGULAR I
DELIVERY NEEDED MAR 19. 2014 9:34 AM
----IN-TANl: ALARM -----
T I :REGULAR I PROBE OUT HAP. 19. 2014 9:34 AM
----IN-TANK ALAP.H -----1 T 2:REGULAR 2 LOW TEHP WAR Ill NG
11AR 19. 2014 9:34 AH
IN-TANK ALARM -----T 3:SUPER
DELIVERY NEEDED MAR 19. 2014 9:34 tV'!
----lfi-TAtlh ALARM -----T 3:SUPER
PROBE OUT HAR 19. 2014 9:35 AN
-~-~-----. ----lN-TANY. ALAP.M -----T 1 :REGULAR 1 WVALlD FUEL LEVEL HAR 19. 2014 9:35 AH
----IN-TANK ALARM -----T I :REGULAR I
HIGH WATER WARtHNG HAR 19. 2014 9:39AM
I
-----SENSOR ALARM -----L16:DIESEL AWl ANNULAR SPACE
FUEL ALARM NAR 19. 2014 9:46AM
-----SENSOR ALARM -----1.12:REGULAR 2 ANN ANNULAR SPACE
FUEL ALARM t~R 1~. 2014 9:46 AM
-----SENSOR ALARM -----LJO:REGULAR 1 ANN
ANNULAR SPACE FUEL ALARM MAR 19. 2014 9:47 AM
-----SENSOR ALARM -----Lt4:SUPER ANN
ANNULAR SPACE
FUEL ALARM
MAR 19. 2014 9:48AM
T 1 :RECULAR 1
ItNEilTORY ttiCREASE
II.CREASE STAP.T HAR 19• 2014 9:41 AM
T 1: INVALID FUEL LEVEL VOLUME -545 GALS HEIGHT " 9,80 INCHES WATER = 1.51 lt~HES
TEMP = 68.5 DEG F
INCREASE Etm MAR 19. 2014 9:49 AH
VOLLtiE
I HEIGHT WATER
TEMP
-9650 GALS • 72.34 INCHES • 0.00 INCHES
oo 69,7 DEG F
GROSS IriCREASE'" 9105
TC NET INCREASE• 9038
T 2:REGULAR 2
I tl\IENTORY I IICREASE
I NCR EASE START MAR 19. 2014 9:41 AM
VOLLtiE HEIGHT WATER TEMP
• 9817 GALS
oo 73.57 INCHES .. 0.00 INCHES
oo 70.1 OEG F
I tiCREASE END MAR 19. 2014 9:48AM
VOLUME HEIGHT WATER TEMP
A 9917 GALS • 73.57 INCHES • 0.00 INCHES
" 70.2 DEG F
CROSS INCREASE"' 0 TC NET INCREASE• -1
MANIFOLDED TANKS INVENTOR\' INCREASE T 1 :REGULAR I
T 2:RECULAR 2 VOLUME • 9105 GALS
. ---· ·--·-
-----SENSOP. ALARM -----Ll3:SUPER STP
STP SUMP
FUEL ALARM MAR 19. 2014 9:50AM
METRO STATION
4600 STINE ROAD BAKERSFIELD. CA
MAR 19. 2014 9:51 AH
S\'STEN STATUS REPORT
ALL FUNCTIONS NORMAL
-----SEtSOR ALARM -----LIO:REGULAR 1 ANN ANNULAR SPACE
FUEL ALARM
MAR 19. 2014 9:53AM
-----SENSOR ALARM -----LI4:SUPER ANN ANflULAR SPACE FUEL AlAR/"1
MAR 19. 2014 9:54 AM
-----SENSOR ALARM -----
L 9:REGULAR I STP STP 8UHP FUEL ALARI1 MAR 19.-2014 9:56 AM
' -----SENSOR ALARM -----
Ll1:REGULAR 2 STP
STPSLt1P
fUEL ALARM MAR 19. 2014 9:59 AM
-----SENSOR ALARM -----LI5:0IESEL STP STPSUMP
FUEL ALARM MAR 19. 2014 10:02 AM
----IN-TANK ALARM -----T 4:DIESEL
HIGH PRODUv~ A~1 MAR 19. 2014 10:06 AM
----I N-TAf« ALARt1 -----T 4:DIESEL
OVERfILL ALARM
• MAR 19. 2014 10:08 AM
----IN-TANK ALARM -----T 4:0IESEL
PROBE OUT
HAR 19. 2014 1o:oa AM
----IN-TANK ALARM -----T 2:REGULAR 2
OVERFILL ALARM
MAR 19. 2014 10:09 Al'l
----IN-TAW: ALAPJ1 -----T 2:REGULAP. 2 PROBE OUT MAR 19. 2014 10:10 AM
T 4:DIESEL
I NVEN'TOR'I INCREASE
INCREASE START MAR 19. 2014 10:06 AM
VOLUME • ?935 CAts
HEIGHT • 60.61 lt-K:HES
WATER -0. 00 INCHES TE11P • 74.9 DEC F
INCREASE END MAR 19. 2014 10:13 AH
VOLUME • 10152 GALS
HEIGHT • 76.11 INCHES WATER .. 0.00 INCHES TEMP • 74.9 DEC F
GROSS INCREASE• 2217 TC NET INCREASE• 2202
METRO STATION
4600 STINE ROAD BAKERSFIELD. CA
MAR 19. 2014 10:13 AH
SYSTEN STATUS REPORT
ALL FUIICTlONS NORMAL
PlttP SENSOR SETUP
S I :REGULAR I
TANK 11: I DISPENSE NODE: HAtHFOLOED: ALL PUMPS
S 2:REGULAR 2 TANK 11: 2
DISPENSE HODE:
MANIFOLDED: ALL PUt-IPS
T I :REGULAR I I tNEtiTORY INCREASE
lt.CREASE START MAR 19. 2014 10:09 AM
VOLlJ1E HEIGHT WATER TEMP
• 9650 GALS
a 72.35 ltlCHES
• 0.00 INCHES " 73.1 DEC F
INCREASE END
MAR 19. 2014 10:15 AM
VOLUME HEIGHT WATER
TEMP
• 9650 GALS • 72.35 WCHES • 0.00 1t:CHES
a 73.3 DEG F
CROSS INCREASE• 0
TC NET INCREASE• -1
T 2:RECULAR 2 INVENTORY INCREASE
INCREASE START
MAR 19. 2014 10!09 AM
VOLlJ1E HEIGHT WATER TEMP
-9817 GALS • 73.57 INCHES • 0.00 INCHES " 74.4 DEC F
I NCR EASE END
MAR 19. 2014 10!15 AM
VOLU!·IE HEIGHT
WATER·
TEMP
• 11032 GALS -95;;39 INCHES
---0,00 INCHES .. 74.4 DEC F
GROSS lt.CREASE= 1515 TC NET WCREASE:a 1499
MAtHFOLDED TANKS I NVEtiTOR'I INCREASE T 1 :REGULAR 1 T 2:RECULAR 2 VOLUME • 1515 GALS
-----SENSOR ALARM -----L 1 !DISP 1-2 DISPENSER PAN FUEl. ALARM MAR 19. 2014 10:16 AI'!
-----SEtlSOR ALARM -----L 2!DISP 3-4 DISPEt.SER PAfl
FUEL ALARH f1AR 19. 2014 10!17 AM
-----SENSOR ALARM -----L 3!DISP 5-6 DISPENSER PAN FUEL ALARM MAR 19. 2014 10!19 Al1
-----SEtlSOR ALARM ----L 4!DISP 7-B DISPEf.SER PAtl FUEL ALARM MAR 19. 2014 10:20 AM
-----SEt.SOR ALARM ---L 5:D1SP 9-10 DISPENSER PAfl FUEL ALARM MAR 19. 2014 10:22 AM
----IN-TANK ALARM -----T I :REGULAR 1 OVERFILL ALARM MAR 19. 2014 10!24 AM
----IN-TANK ALARM -----T 1 :REGULAR 1
PR<lBE our MAR 19. 2014 10:24 AM
----IN-TANK ALARM -----T 3:SUPER OVERFILL ALAJ\'t1 MAR 19. 2014 10:26 AM
----IN-TANK ALARM -----T 3:SUPER
DELIVERY NEEDED MAR 19. 2014 10!26 AN
----I N-TAflK ALARM -----T 3:SUPER PROBE our MAR 19. 2014 10:26 Al"l
----IN-TANK ALARM -----T 3!SUPER INVALID FUEL LEVEL MAR 19. 2014 10:27 AM
----I N-TAtiK ALARt1 -----T 3!SUPER HIGH WATER WARtHNG HAR 19. 2014 10!30 AM
T I :RECut.AR I I NVENTOR'I I llCREASE
I NCR EASE START MAR 19. 2014 10:25 AM
VOLIJ1E HEIGHT WATER TEMP
0 GALS • 0.00 INCHES • 0.00 INCHES 0.0 DEC F
INCREASE END MAR 19. 2014 10:30 AM
VOLIJ1E
HEIGHT WATER TEMP
.. 11347 GALS
" 86.55 WCHES
c 0.00 ltlCHES • 74.5 DEC F
GROSS ltiCREASE• 11347 TC !lET lllCREASE• 11222
T 2:REGUL.AR 2 I tNEIITORY INCREASE
I tlCREASE START
MAR 19. 2014 10:25 AM
VOLUME
HEIGHT l~ATER TEMP
• 2875 GALS = 27.89 ltlCHES : 0.00 INCHES .. 70,3 DEC F
I NCREASE END MAR 19. 2014 10:30 AM
VOLIJ1E HEIGHT WATER TEMP
• 2876 GALS • 27.90 ItiCHES • 0.00 INCHES • 70.3 DEC F
CROSS INCREASE •
TC NET ltiCREASEa
MANIFOLDED TANYS INVENTORY INCREASE T I :REGut.AR I T 2:REGULAR 2 VOLUME • 11348 GALS
----I tl-TANK ALARM -----T 3:SUPER OVERFILL ALARM
MAR 19. 2014 10!31 AN
----Itl-TANK ALARM -----T 3:SUPER PROBE OUT ~R 19. 2014 10:32 AM
----IN-TANK ALARM -----T 3:SUPER
INVALID FUEL LEVEL MAR 19. 2014 10:32 AM
----I tl-TAtlK ALARM -----T 3:SUPER
PROBE OUT MAR 19. 2014 10:32 AM
----ltl-TANK ALARM -----T 3:SUPER DELIVERY NEEDED MAR 19. 2014 10:33 AM
T 3:SUPER I NVEtiTORV IIICREASE
INCREASE START MAR 19. 2014 10:25 AM
VOLUME HEIGHT WATER TEMP
-10219 GALS • 76.63 IIICHES • 0.00 INCHES • 74.9 DEC F
INCREASE END
MAR 19. 2014 10:33 AH
VOLUME HEIGHT WATER TEMP
= 11350 GALS " 86.58 INCHES " 0.00 11\'CHES "' 74.9 OI::C F
GROSS INCREASE= 1131 TC NET lt.'CREASE= I II 9
-----SENSOR ALARM -----L S:DISP 9-10 DISPENSER PAN SENSOR OUT ALARM MAR 19. 2014 10:40 AM
-----SENSOR ALARH -----L 4:DISP 7-9
DISPEtSER PAN SEtSOR OUT ALARM MAR 19. 2014 10:40 AM
-----SENSOR ALARM -----L I :DISP 1-2 DISPENSER PAN SENSOR OUT ALARM HAR 19. 2014 10:40 AM
----SEtiSOR ALARM -----
L 2:DISP 3-4
DISPENSER PAN SENSOR Our ALARM MAR 19. 2014 10:40 AM
I ----SENSOR ALARM ----L 3:DJSP 5-6
DISPEUSER PAN SENSOR our ALARM MAR 19. 2014 10:40 AH
----SENSOR ALARI1 -----L 9:P.EGULAR 1 STP
STP SllfiP SENSOR our ALARM MAR 19. 2014 10:40 AM
-----SENSOR ALARM -----L12:REGULAR 2 ANti
ANNULAR SPACE SENSOR our ALARM MAR 19. 2014 10:-10 Al·l
----SENSOR ALARM -----L13!SUPER STP STPSUMP
SEtlSOR Our ALARM MAR 19. 2014 10:40 AM
-----SEtSOR ALARM -----L10!RECULAR 1 Atltl ANNULAR SPACE
SEtiSOR our ALARM MAR 19. 2014 10!40 AM
-----SENSOR ALARM -----Lll !REGULAR 2 STP STP Sli1P
SENSOR our ALARM
MAR 19. 2014 10!40 AM
-----SENSOR ALARM ----L14:SOPER AWl
ANNULAR SPACE SENSOR Our ALARM MAR 19. 2014 10:40 AH
-----SE~SOR ALARM -----
L15:DIESEL STP STP SUMP
SENSOR OUT ALARM HAR 19. 2014 10:40 AM
-----SENSOR ALARM ----L16:D1ESEL AfiN
ANNULAR SPACE SENSOR Our ALARM MAR 19. 2014 10:40 AM
T 3:SUPER I NVENTORV I tiCREASE
J NCREASE START MAR 19. 2014 10:33 AM
VOLli1E • 21:32 GALS HEIGHT • 22.54 INCHES
WATER -0.00 INCHES TEMP • 79,4 DEC F
INCREASE END
NAP. 19. 2014 10:40 AM
VOLLtfE HEIGHT
WATER
TEMP
• 2379 CALS
" 24.36 ltiCHES " 0.00 ltiCHES
c 79.1 DEC F'
CROSS INCREASE• 2~7
TC NET INCREASE• 244
METRO STATION
4600 STINE ROAD
BAKERSFIELD. CA
MAR 19. 2014 10!41 AM
SYSTEM STATUS REPORT
ALL FUNCTIONS tlORHAL
SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended f or use by contractors performing annual testing ofUST 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 regulat01y agency.
1 FACILITY INFORMATION
Facility Name: Metro Station I Date ofTesting: 3/19/2014
Facility Address: 4600 Stine Road
Facility Contact: George Farah I Phone: 661-831-0836
Date Local Agency Was Notified of Testing: 2/6/2014
Name of Local Agency Inspector (if present during testing): None
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bradley Seykora
Credentials 1: lEI CSLB Contractor lEI ICC Service Tech. 0 SWRCB Tank Tester 0 Other (Specify)
License Number(s): CSLB# 804904 ICC# 8111231-UT
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: lEI Hydrostatic []Vacuum 0 Other
Test Equipment Used:. Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (By Tank 1 Regular #1 2 Regular #2 3 Super 4 Diesel
Number, Stored Product, etc)
Bucket installation Type: x Direct Bury x Direct Bury x Direct Bury x Direct Bury
0 Contained in Sump 0 Contained in Sump L Contained in Sump 0 Contained in Sump
Bucket Diameter: 12.00" 12.00" 12.00" 12.00"
Bucket Depth: 13.50" 13.75" 13.50" 14.00"
Wait time between applying 5 min. 5 min. 5 min. 5 min. vacuum/water and start of test:
Test Start Time (T1): 10:15 AM !0:15AM 10:15 AM 10:15 AM
Initial Reading (R1): 9.50" 10.25" 9.75" 10.50"
Test End Time (TF): 11:15 AM I 1:15AM I 1:15AM 11:15AM
Final Reading (RF): 9.50" 10.25" 9.75" 10.50"
Test Duration (T F-T.): I hour I hour I hour I hour
Change in Reading (RF-R1): 0.00" 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" 0.0625" Criteria:
Test Result: lEI Pass 0 Fail lEI Pass 0 Fail lEI Pass 0 Fail lEI Pass 0 Fail
Comments-(include information on repairs made prior to testing, and recommended[ollow-up[or[ailed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true, accurate, ami in filii compliance with legal requirements.
Teohnk;an's s;gnatu•e: ~ Date:_ 0311912014
~ ,.
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
Name:
Street:
City:
Terms:
"8UILD WITH CONfiDENCE"
Lic.970703
"'COMPLIANCE WITH CONFIDENCE"
Lie. 804904
Toll Free #: 1-800-339-9930
Confidence UST
16250 Meacham Road
Bakersfield CA 93314
Descriotion of work performed:
• /
.,
TRAVEL and LABOR
Date Technician(s) Name
,
Labor
Travel
Date Techn1cian(s) Name
Labor
Travel
· Date Technician(s) Name
Travel
Labor
Travel
Job Order /Invoice #: .321'1'1
Date Called nmo I To~
Site Name: ,A,(,~ S1a-.~~~
Street: 'ftoo Sti~ ~c..c-1
City: ~rs..P.,'.e ld state1J A--Zip: 9'3'513
Store No:
(0.5 Hour Minimum Labor Charge) OVERTIME (5:00 PM • 7:00AM)
Start End Total OT Start OTEnd OTTotal
l. L,._.:;:
Start End Total OT Start OTEnd OTTotal
Zl..rS
Start End Total OT Start OTEnd OTTotal
SUPPLIES· MATERIALS • RENTALS Check One
Qty. UST Parts Srte Parts
)0
)0
)()
COMMENTS