HomeMy WebLinkAbout2012 FMC RESULTS5vI
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State ofCalifornia
Authority Cited: Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations
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 ofthis fonn to the local agency regulating UST systems
within 30 days of this date.
A. General Information
Facility Name: Oswell Chervon
Site Address: 2700 Oswell Street
Facility Contact Person: Frank Sullivan
Make/Model ofMonitoring System: Veeder -Root TLS -350
B. Inventory of Equipment Tested /Certified
Check the appropriate ores to Indicate specific equipment Inspectedhersiced:
Bldg. No.:
City: Bakersfield Zip: 93306
Contact Phone No.: 661 - 327 -5008
Date ofTesting/Servicing: 6/11/2012
Tank ID: 10000 gal. Regular
x] In -Tank Gauging Probe. Model: 847390 -107
Tank ID: 10000 gal. Super
Lx] In -Tank Gauging Probe. Model: 847390 -107
Annular Space or Vault Probe. Model: Annular Space or Vault Sensor. Model:
Lx] Piping Sump / Trench Sensor(s). Model: 794380 -208 L] Piping Sump / Trench Sensor(s). Model: 794380 -208
x] Fill Sump Sensor(s) Model: 794380- 208 x] Fill Sump Sensor(s). Model: 794380 -208
x I Mechanical Line Leak Detector. Model: Electronic Lx] Mechanical Line Leak Detector. Model: Electronic
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
x] Tank Overfill / High Level Sensor. Model: 847390 -107 U Tank Overfill / High Leval Sensor. Model: 847390 -107
Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. type and model in Sec. E on Pg. 2)
Tank ID:10000 gal. Diesel Tank ID:
x] In -Tank Gauging Probe. Model: 847390 -107 In -Tank Gauging Probe. Model:
Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model:
x] Piping Sump / Trench Sensor(s). Model: 794380 -208 Piping Sump / Trench Sensor(s). Model:
Lx] Fill Sump Sensors(s). Model: 794380 -208 Fill Sump Sensor(s). Model:
n Mechanical Line Leak Detector. Model: Electronic Mechanical Line Leak Detector. Model:
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
Lx] Tank Overfill / High Level Sensor. Model: 847390 -107 Tank Overfill / High Level Sensor. Model:
Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. typs and model in Sec. E on Pg. 2)
Dispenser ID: 1 $ 2 Dispenser ID:_3&4
Dispenser Containment Sensor(s). Model: 794380 - 208 X] Dispenser Containment Sensor(s). Model: 794380 -208
7 Shear Valve(s). Lx] Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s)
Dispenser ID: 5 $ 6 Dispenser ID: 7 & 8
x] Dispenser Containment Sensor(s). Model: 794380 -208 Lx] Dispenser Containment Sensor(s). Model: 794380 -208
Lx] Shear Valve(s). U Shear Valve(s).
Dispenser Containment Float(s) and Chains(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).
Ifthe facility contains more tanks or dispensers, copy this fonn. Include information for every tank and dispenser at the facility.
C. Certification - 1 certify that the equipment identified in this document was inspected /services in accordance with the
manufacturers' guidlines. Attached to this Certification is information (e.g. manufacturers' checklist) necessary to varify that
this information is correct and a plot plan showing the layout of monitoring equipment. For equipment capable of generating
such reports, I have attached a copy of the report; (check all that apply) x System Set -up r-0 Alarm history report
Technician Name (print): Kristopher Karns Signature: A _, 0_A14_%__*,_
Certification No: 834106 License No: 804904
Testing Company Name: Confidence UST Services, Inc. Phone No: 800 - 339 -9930
Site Address: 2700 Oswell Street, Bakersfield, CA 93306 Date of Testing/Servicing: 6111/2012
D. Results of Testing /Servicing
Software Version Installed: 329.01
Complete the following checklist:
x] Yes No* Is the audible alarm operational'?
jxj Yes No* is tT-e—Visual alarm operational'?
x I Yes I I No* Were all sensors visually inspected, functionally tested, and confirmed operational'?
Fx1 Yes No* Were all sensors installed at the lowest point of secondary containment and positioned so that other
equipment will not interfere with their proper operation?
Yes No* Ifalarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) Hx N/A operational'?
x Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary
N/A containment monitoring system detects a leak, fails to operate, or is electrically disconnected'? If yes:
which sensors irritate positive shut- down'? U Sump/Trench Sensors [x] Dispenser Containment Sensors
Did you confirm positive shut -down due to leaks and sensor failure /disconnected'? L] Yes; No;
X] 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 visual and audible at
the tank fill point(s) and operating properly? If so, at what percent of tank capasity does the alarm
trigger'? L9p %
Yes* U 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'?
Product; Water. I fyes, describe causes in Section E, below.
x No* Was monitoring system set -up reviewed to ensure proper settings'? Attach set -up reports, if applicable.
x yes No* Is all monitoring equipment operational per manufacturer's specifications'?
In Section E below, discribe how and when these deficiencies were or will be corrected.
E. Comments:
F. In -Tank Guaging / SIR Equipment: M Check this box iftank guaging is used only for inventory control.
Check this box iftank guaging or SIR equipment is installed.
This section must be completed if in -tank guaging equipment is used to perform leak detection monitoring.
Complete the following checklist:
Fx] Yes I No* Has all input wiring been inspected for proper enter and tennination,including testing for ground faults'?
x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
x Yes No* Was accuracy of system product level readings tested'?
x Yes No* Was accuracy of system water level readings tested'?
x Yes No* Were all probes reinstalled properly'?
U Yes I No* 1 Were all items on the equipment manufacturer's maintenance checklist completed?
In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): Check this box if LLD's are not installed.
Complete the following checklist:
x] Yes No* For equip. start-up or annual equipment certification, was a leak simulated to varify LLD perfonnance'?
Check all that apply) Simulated leak rate: E3 g.p.h.: 0.1 g.p.h.; 0.2 g.p.h.;
x Yes No* Were all LLD's confirmed operational and accurate within regulatory requinnents?
x Yes No* Was the testing apparatus properly calibrated?
Yes No For mac anica LLD's, does the LLD restrict product flow if it detects a leak'?
x N/A
x] Yes No* For electronic LLD's, does the turbine automatically shut off ifthe LLD detects a leak'?
N/A
Lx] Yes No* For electronic LLD's, does the turbine automatically shut off ifany portion of the monitoring system is
N/A disabled or disconnected'?
x] Yes No* For electronic LLD's, does the turbine automatically shut off ifany portion of the monitoring system
N/A malfunction or fails a test'?
U Yes No* For electronic LLD's, have all accessible wiring connections been visually inspected?
N/A
x Yes 10 No I Were all items on the equipment manufacturer's maintenance checklist completed'?
In the section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
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JI,)N 14. 2'012 6:22 PH
LI1,.IE FhIL
JAN 12, 2W 2 7 08 PH
L I I'JE Fo I L
JAN I :J 2A 2 5: 37 PH
TLL,11 SHIJTD(j!,..1N HLARI-I
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JAN 13. 2M2 0 09 PM
H12Tti :RY REPORT
SEN-'()R ALARM
APR _Cl CI 1 -1 1 PH
PLLFs
IIIAR 15 2012 10: 02' (iM
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FEB 20. 2012 W:04 iii-I
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FEB 5. 21112 12:10 Pil
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PLLI, = ;HUTDOL)h
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1_111LB'DEL, ERODE :ZPIHL, I-JU11 O"J6570
NO TEST [,T, ili"i4dl_ABLE
T :--:: lJNLEi)[jE[l
JIJ N I I '-'01 1 :rly T-I'l
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LHS'f `Pi TE'l Ph;S's'ED
0
OLIJr1E= . 2
1, EPC _' 'ENT 'C" - 'Jl,,IE = " i .
TEST TYPE = `,I _'HEIA"RE,
TEST
TEST Pte; .:;ED
FULLEST HNIT-Ii-d, TEST
N 71 T1:2T PA QED
J LlH
TENT LEI'-J,']'H
TART I WC; -.A)I.IJI**IE= I C
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PA:-"ED E",,-.'H f-KH'ITH:
JAN 1'. 2012 12:47 ;'d•*1
TEST LENl_;TH ',_20 I-K)URS
ST,-RTINC; O'LU-1E= 3150
EP(-*El)'F-,.,'-l-L'Ijl"IE :36 . 0
TEE"T TYPE = LUl
FED y. -'FI I _ 4 - !U ril-!
I'Ll',T LENCITH __'q -
dOLLIHE
TE'T T',"PE = i_:SLE)
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PI:'PC:F'ITf vViLl-111E = 32. LI
TEST TYPE = JLD
4,R .7, 1 - 2C11 5: 1 *2 HH
TEST LEI-11"TH 29 1K)UR',
j I Ll 5
F1 (':EI,JT
T'E:F TYPE
I "lF 'r 27. 2012' -(%'1
TEST LEN13TH 31 H-AiRS.
ST FITIN,_' V ' _UUME= 341,-
PERCENT VoLUME = 35. 1
TEc r T`,T'E =- I - D
AIN 12 Ij: 41
TEST LEI*7GTH 29 HQIJR'r
351 7
T E r , F,,; F, E LE
J LIL 21 • 20 1 1 4 ; 21 i "I"I
TENT LEI-,J,';TH 28 HCIUR.-',
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PERC:EVJT VOLIIIE -11 . I
TE::5T TYPE = `SL[l
T E:,-;T LL11,;TH 2a
ST.,RTING' VOLUME= j
PEP(.'Ef'-fF VOLI-11"IF
FE.'-,.T T:,T,E
TE=,T LEN11"'TH :311
PERIA-ATF VoLOPIE
TEST T'ZPE
T RT I Hl-; 'AjLJjI-1F-
PERC:EITF '' ";1lJP,IE
TE',T r,,,,v•E
TEST LEI11"TH 2), HOIJR.-
T PTING V(;Ll.lHE=
PEPi_:EIAT VCILUIE = 314.
TENT TVPE =
I, El'
TILSr I_DIl_;TH 28
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PERC E[`JT %,','1LlJt1E = 37
TEST TYF,E = -',-L11
L
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r',61 JU
21
EHI: TF.`_',T HIS —
F :: : r. ' 1 E.,-3EL
FTI
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TE-11
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TEST LEHI;Tf-l
TE'.:"T TYPE
TF-T
E-V-11 .6-iTH:
4b
1 2
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TEST 'I
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T ART I I'll, %-Ll il-IL
Epk EI,jT ''JOLT IME
LlL 31 , 2 ID I I I ; 5' 1
TEST I_Pill,TH -,7 Hi)UR,11! FIJL,LE:-D*T TENT
F. N, I D_111E I El 21
T F JAN 12, 1 2-3 i-ill F I FIA, TEST LEI-41-I'TH '2; H('1IR"21 661 -E=71TARTPIGVOLUME= 7044
I
P'ERC'ENT %,eOLUPIE j ji'l I ITE12;1' 1.1111"TH H(URO. TENT TYPE
F'tPr_FNT VOLI-It'll
FEB j - 2tj 1 2 1 54 A41 I ILI I'M
TEST LENGTH 26 HOURS
r1'T`"RTII,Jj` ',JOLLRIE= 7-15
Ef, ' 'D 0 1 1 PEFCFJ•JT ",A._ U_JME 7tD
TEST 1-11,11-2TH 54 HOURS TEST T',iPE = C;SLlt T I :SLI REI"IEiOLLII-11: I C4 l
F-'ERj,_'ENT
0I 2 47 N,,l cj Hk' TEST LEI-11TH 27 H•.'_iURS F%FF.I: J U1 I I I • 1' STtAPT1 111 V(%LUI1E= bF, I I
W:T 201 1 7 5;, T11 FIEFI(':EI,IT +OLUME
rbS'f I_F_I•J,TH 4';-
ST,L:iRTINCI, VViLL111E=
TEST T,,,F5E = C1211-D T 2:1-JEOE1_
PLRCEI-IT 1.' i - '.LlJHE 2, PROBE 11 11IHL I j I Q.11 ri 8 41
TEc,,T I-,,I• APR P-f. _'012 1 56 :#'l 0.2, HR TESPTESTI-ENt-'TH 25 H.:_ , A IR12; EP JUN I I
T
E' P 71
TE LU-It, 'TH 36 HC: - UR 5 TEST r,,,Fi CSI-Ei
T6PT 1 [16` ',,(A.U11E= 1,:41-15 T IJNLB)DED
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PER: N I I 12 F HST(RT I VC)LIJI-112 8
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PER-C'ENT ' ;(CLLJME _ 2,1.-1 . I
TEc"T T!P-_- = C-3-D JUN I CI . 21D 121 1
TV HOURS
EN1) 2'T PT I Nt V(JLUl1E= SlDtS.)
PEPC'ENT 'VOLUP'lE = b_
TEST TYPE = C:S, LD
JUL J I - '20 1 1 6:15 HI'l
TEST I.Et•)GTH 2' H,.'_)UR:S
TART I IAG \/C',1_1JI1E= 71 15
PERCENT ')QLUME = 7 1
TEST T"'PE -:SjJI
HE'aR` H
70u - ""WELL ._'T
PHKER2F11'l_D ci-) J. 2101 1 2, 39
TEST L,E1-jC,TH I5 HOURS
J, 1LIME = 81
JIJIq 1 1 2111 1 1 1) P11
ST "RTIhIG VC)LUl"IF= 6' :4 1
PERCENT HE IG'HT = 1 4 L; I 1%l, HE:
TENT T ZPE C'SLD I.JHTER - iI . Ou I I'll' 'HE'7'
TEPIP
Tfi1 1),' LEH).'. TENT H1:3TJ)R`,'
T 3:IJI11 FHI)EL., TEAT 1 1, - lt_ T- H 25 H LIRS El%* 7
I PH
L;18T -_RCXS` TE-ST
uH I I :11 TE,T TYPE— = c7ART I Ni . j L IJ1411I' - HE 1 C;HT
FIEK',_'ENT ')LUME = WATER
TEST TYPE T El DD; F
TEST LD-•IC'TH `IS H,`rLIRS,
PT F, 1_."`8T A-NI'll-l"''L TEST Y -,SS ED se., J
TEST T',,'F,F = CSLI+ Tl-: I,,IET
FLJUES_T 1-1111OHL TE21'
W' TEST
Jljl-I 11, 2,01, 1 E, im
TEST LEIIIL' 'TH 215 HOURS'
ST RTI V )L.LIHE= 1,7D•
PEP(_`ENT !3
TF-T T','PE = C.:ILD
NOV 7, ''2011 6:U6 Pill')
TEST LEI,jj.,TH 216 HOJRS
71'2"8
PEP,_.'Ef-,JT N)OLUVIE = 7:3
TENT T%*PE - L LI
DEC: _1' - 201 1 5 : Or-f Al.-I
TEST LF,J,_,TH :_110 H`IiURIS-
PER'"'ENT vC)LI-VIE ?CI. 9
TE':,:'T TYPE = l',E:LD
END
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E I >R, i-iLHRT,I
1. 9:111,71r, I_--,
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J u Ili 11 2, A 1 4 Pri
HE I GHT
WVITER
T El,,l P -'7' f)E,",' F
EN- P L RI,I PRESSURE LIHE LE: -I
V( L. c"HL2
V
1. J, :,.;IJF 2-, p
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HE I .;H'r :,-4 I Jqt-:HE:-,
WATEP I NCHES F,UFL. AL"R11 Ili 1 1 201 1 PM
TEMP [,E(-' F jUN I I - 201 2 1 1 .1 FTI
TC.' NET I 1,A;PTH .E= 2, R: 5
i:LIESEL X2,H UTEt,-4I HI-iiRTI
F,L,Lf,; HL,431 u N I I I
1IJYJ It. 2
PPE! , 'E L & I HE L,)" i-LHPI-I
LHPI
LIN I 1 '2,012, 1 Vm
JANE LEHE
L`RTI
L 35 D ;,' L.
10N I I I
FUEL
Jufll I1 LIU;
PAFL ALAP.rt
IIJN I I 201'
1-1 HE LEH-'
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2012 1 19 [.11
T
STiR r
201 t 1 PPL''URF, LIM-
L1-11 IE f XF.SSURE L I HE I-Ei-O: HLI-1111
HE I r HT S UPPE11 PLI-E, ',-HIJT'L,11 1 ri LLAPI-1
I-TER F-LLD 'm,HUT176WH Il. 21112, 1 1 f I.-I
B-IPT f,E, F J UN FTI
PEH-E EI,1[j
0'2) L:
HE I C;H F = 4? 12 1
WATER = C1 I-10 I kl": HE.Z
Ellp = ? 6 f)Et', F" PPE::.: - ,LIRE. LTI'JE LE I: HL,- 3,1PPES ',URE LIhE LEHK Al-i F:11
3: 11 I E;'-; EL,
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JUN II. AN 2 1:21 &1
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L ONO, 5-6
DISPEriSER f--iiii
FUEL ALARI,l
J U H I I. ''-01'21 1 : -A F11
L I HE LED f: r;LHRII
0 1 : WILEXID
PL[11 'HUTDOIJH tiL,';Rll
JUN I I - 2W 2 1 Q2 FV
113H I I , '201 1 : z2 F11
PRBS'
rl-
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Q MIDIESEL
PIA-D
JUN I I. IN 2 1: 2y 01
SENSOR
L 7-r":
IDIKENER PQJ
FUEL ALARH
JUN 11. 2012 1 : 22 PI-1
L ?:1-111L FILL.
poqp3 Sylp
FUEL. ALAW1
J U 1.1 1 1. '21:1 1 2:1 P-1-11
L CSUP FILL
PIP[Al Soll,
FUEL AD F11
JUN 11. 201 2 1 PI-1
L. t:D'SL FILL
F IF) I 11G 2111p.
FUEL ALAA-1
JUN 11. 2'1012. 1 :'-!4 PH
KHEVR01-1
000 ORALL ST
EAKER,,-;FIELD Cr 9:3306
661-I71-1200
JUN I I - 2ID I PH
CSI.D TEST RECULTS
11_I f•1 11 01 2 1 c FT .1
17 1 :KPRDIE
BERIK NSI 098644
HP TE'S.7
PER: JUN I I - 200 F'US'S
F 2: D I ESEL
Nol
TEST
PER; JUN I I ,
T UNLEMEED
PKME SEITAL N 1 09HO
0.2 r -;AL, HR TEST
PER : JUN I I - 21-11
END 4 -- • 4
j N
wKERSFI ELT .Cam; 93306
1 1 FULLE:;T Lf',ST PH'S'2,
1 2u 1 1 :26 f'l"l
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31-:RIAL
TEST
PI :R 3111,1 = 2101'.'
T 2:DIESEL
P101HE SERI(A. ITRI 098641
0.2 GAL OR IEST
PER: JUN 7, 201'
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Pl`."Fil: SERIAL jidl-I 13965?4
11.2 TEST
MR: JUN 10. 2012
EHD -
1 fj-'17r4-JK
EUIA
PROM fmi,
11. zi-11,2 I ::!fl P1,11
T I :QVIATIE
llf(;H PP01'111-T
II IN I I I :'III:' 1 ::-11-. 1-11
r'RESSURE LINE LEAF HL,4.11
6 1 :IJNLD'- DED
PLLF , SIRITIDUAN iiI_ViRd
J ijfNI I 1 :43 Pill
7 LIN I 1 20 12 1 : 1:", PI I
T I ::WPPDIE
L U1lJL ETC'
1 PI _'RFA- E 1'1 P,*I'
I I , 1 : =to -1Jmi10N jIj 1.1 1 1 710 1
IF I ;.SuPREME HE GI IT = 51 41 1 14,"HE', PFC>FJE til IT WATER = JUN I1 2131 1 Pl, TFI•IP - 105. 5 F
i END
3Ll11 1 1 20 1 '2 1
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HE I GHI = Si?. 7_ P 111";
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TRIP I DEC" F JUN I 1 11
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HE I C;HT - 7,
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TET-IP = DD, F LIME LET:
F,I,,i 3 Lill) I1 '=u1? 1 :4:--: Ph
F, E !,.: HT I I*_ FIEZ, I - WATER 00 1 1,11 ' :HE ' c; T 2:L,IE,1!El., TEMP 11D F TE1,1F,
L
T,_, WEI I N"F, E;-; 3681
T f,
TP
J LlI I 1 201 1 PI";
BAK.EP:,F[ ELL
L-.61 -0? 1 - 1,2,00
IN-T hl' JUN 11. '21-11'-' 1 :41) P111
HIC,H T Rt' Elj,-:T ;LARD
JUN I I _'01'= 17,:: 0 :3 Ef!
I-El FILLD
T - :1.':1,i "'EMP IJApf"I I I,-K,
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6 1 :IJNLD'- DED
PLLF , SIRITIDUAN iiI_ViRd
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7 LIN I 1 20 12 1 : 1:", PI I
L 2:LNL FILL
F, IF, I I v-, suf IFt T
FUEL iiLAPIA I ELI' 93
1 :44 PH 66 I -e7l -1 '21AI
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JUN ll. 21C112 pf-I
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bt. i - 12 nij
RN
Gjul-i I I , 21ol',, .I:: PH
3TEM RE.
T DFJ Hi
E t
T L
HE I IT
TEMP = Fit .4 DEC; F
T C ) I EFLL
Tf': VOLU-117- =
I IF I (,HT = 2 s.'.1 I I*`HE2;
WATER V 'L - q ','AL ' -
WiiTER = CQ I PK* HES
TEllP = i , i DU'
ll
F
T
Dco, lJLDiC;E- 1 J I I -
HE I HT 42,
w`TFP (1.7i I 111-: HE' :
TErIP 71.1 DEG F
E
ENC;l, 1:::*H
l27F -11 l"TE I'll"IE i-. ,Mli f
I-V, , N Db HH '1111 A I
700
Slit FT T IF I DDFJ Hi
LANE P.E-ENoBLF. I-IFTHOF,
LINE TEST
LINE PER F:---,T 1,1EEDED ORN
ElViLlED
LfNE PEY., TST NEEDED lJPN
L I HE T`7 NEEDED hLh
NN
EN,,'jBLF, T
TEMP T i C fl
i LUC DLK; F r,U . u
HEIGHT :'+FF`,'ETIi -. I
EP
9fr:
F-PE%--' I S I H TEST F, IJR T I C ").N
lu-'L1G4fr TIME
E1,1ABLE1,
STF -'F'T F-TF
IIW R WEEF 2 IV
START T 111E
E1.111 1,HTE
V WEEP I S, UIN!
E;,If- TIME
CIO Hm
R DI F.21-7 L.- AL R 1•TC Ij-
Lfjp*> '11v PPEF
7.
1 B EF
T,'-if-))" [-;HIF.T SE(IUPFIP,'
DISABLED
fID,FvT2
11 1 2i-tBI F. D
T ICE
LED ,
I S ( , -,I Er. ("ll-INTRY
1, F
D; SI",PLED
ETUF
PORT T I :,SUV"--F'I1E
I Ell I r'I UI)
T illll: lli,,I'FJER ULJ
F) I St, -Er, T-WII' 11. F:
FULLF; '-HRD 2 i RS :_'32'
DAI ITi RATF 9i,U11 4
3EVEN2 1 S I S
STOP BIT I '-"TOP
DATA
FL:-WdODE
COI" N PULAPF1 6'S>
B JF, P," , TE '24 1-1A
Flt:;;,., 17,
11
FVF.I,J 97
STOP $1T I JEPF1L)- I,Im!TL1ftI-EiJ(.-1 H:
SE,UPIT",
1 67
BAUD RHTE - 61 -10
PAR 17/ NONE
urop, BIT I 2jTor, MIT:
DAT,:i LEP-I,-,'TH UEN O L I H I TSDDL: 99
Ei JR I TV TAN). 'r I I T clu
B 1, : EjI - F;ET
liTO TPi 0,1011 T SETT I
Al IT; 1.11-11T T o
Llf.iESi-iPLEII TO
olil'U OVERFILL 1-11*11T LD,11: SiBLED
a1JTC,) THEFT LIHIT
D lst-RLJLED
AUTO L,ELI1/EP,,-' STl-'-,F-.T
D I SABLED
riW'o DELIVEK".'
DISABLED
rUT -D F' TERNAL t ijP-u'r m L&vjU-L TE:;T Fi-dL2HULED
ALID.) iiwu'r OFF
I I I BLED PERfUDIC I`D'. 7 ' , F ""d 1. oTQ FUEL (,L(F.11
2APLEE,
E[-,IS P WCiTER Al
UTO -SEINIS'P OUT fiLHPI-I
4w•l TE,111
Pip FF.11.1 FF
TA I F,': F F
TINI): FF
DFLAVEF",' IFIEI-7Y I91 ra
Ef-.1D OF
I S"A8LEE)
T 2:DIESEL.
PTODUIVT CODE 2
THERrIAL '-OEFF 1-100450
TWAK DIAMI&TR 92 M
ThM: 1-•0FILE 4 1
69.10 IP-V-'H 00L 7910
46-11 11,11.'+l -'OL 4' 64
2 2. ci I NCH '-)a 181 8
FLOAT SIZE: 4. 0
I JER I PlG 1 .0
H1,51 WmTER LIMIT: 2.0
f16:;< %:-F,' LABEL *,?(L: ! ,, 22e.
CA`Efr.Fl LL L I f-I I i,
Hk>l VR_1110:7
DIDAVEIT: Lmu-,
LOW 4100
LEHK ALAR11 IIANIT: 99
LOS,:--; L111IT: 99
T(',PJP' TI LT 0.0L1
PROBE OFFSET 0.00
SIPHONI f1mNIFOLEID TAWSTO: NONE
LINE 11ANIFOLDED TAWS
TV NONE
LEA): Pflf,i F'ERjO[)p-,: I %
LE,il' I-II N
PlR11'rDIC MST TYT'E
ST,Nfj;4.T,
iL4 ,NI -IAL TEST FAIL
GNSS TEK Fm L
ALARM Cr I SHBLEIi
AMA TEST MiERY11m: OFF
P'ER TE2.1' .-)FF
TAJAK TEST IIK TlFv: OFF
TNIK TST s aNi BREAEOFF
DEL i 1,EP-,' : I III I N
P,UI-IF' THRESHOLD : 10.00 °;.
T !--:: UPILEHLIEL,
THERP,IAL :`-iEFF .000700
TAW D METER 9 00
TAIAK PROF ILE 4 PTS
FULL %QL 9728
69. Ci INCH 71 I Fj
c_16.0 114CH VOL 486,4
Fj I NCH VOL I 8 1 H
FLOAT SIZE: 4.0
1•6ATER
Hlf-;H WATER LIP1IT: 2.0
0NX OR LABEL %!1-)!.: 9728
CA,'EPFILL LIPIIT 90%-
8 1=i13
L,DIA F'RODUUT -11:1cl
LEAF LIHIT: -j -j
SUDDEN LOSS 1-1111T.: 99
TAW: TILT owo
F,KODE OF 0 . 00
WREN NANIFOINED
TO: NNIF
LINE rA•FOUED TAKS
TO: PONE
LEAF ION WHOM: 1%
97
LEHI: rill'.1 HPIPJU(-;L I
9
PEPIoldf-' TES'1 T',1'F
3TAPJDARD
i,1IAP,I1.4)L JE'sT FAIL
ALABI DISABLED
TEST FAIL
ALAR(1 DIS-ABLED
GRG ,S TEST FAIL
ALoRPI Lll'r;P,BLED
ANN TEST HVERA1-;j191-,': OFF
V,ER TEST IIK;: i::FF
TANI: TEST 1ACJIFY: C FF
THN T.7*T SlF-HOVJ DREA)..:,OFF
DELI%YERI' DELI.' : I h I PAI
F,Uilf- : 111. uIX,
L,Ei4: TEST' HETHOD
TEST 1-:SL11 ALL TA(,11:
p d - 9
i1.111HTE
TEST
DISADLED
REPORT ONLY:
I. IsAEILED
TST EARLY --Ji-`iV,:EPoABLED
LEAD: TEST RFP,0PT FORP-IHT
P-ORI'lAL
LTIPJE LEA --): ;--,ETUF5
I :UIIJLEAI.iErl
2,0114 DIA LEPJ: 11-15 FEET
DIA LEN: 115 FEET
HUTD%:A-JI I Ri-;TF 3.! 1-4 H
Lok) SHl-Ir-I---,FF:I-10
I-C,bi F,R.E:--ISURF 0 1
T 3: UIALEmDED
DISF EPISF 11"HIE:
TAPIDARD
NOIA DEIATED
OFF.--3ET: 0 -1JI`Si
TYQ-j ':3 - FJ 114 F I
DIA LEN: 10y FEET
DIA LEFT: il5 FEET
HLITFji,,,JJN RATE: 3, L1
LOW SHOTOFF: NO
LOIJ P,RFS;31JPF 1:1 PSI
T I :SUPFEf-IE
DI SPENT E !'IODE:
STANDARD
E;ENSOR: NO
F-RESSUKE OFFSET:
4r • --,) : fi I E EL
DIH LEH: 109 FEET
L1 LEPI: ll'- , FEEL'
HUTEo,A,JH RATE: 3. u C,F•H
LOIJ FIRESSURE
T 2: D I ESEL
DfSf-EPISE ri(;r,&
PION 'v'El,TfE1j
i-RFS,:URE )FFSET:
LINE LE,11'. L('11"EOUT : - ;ETIJF'
D_ . _:,".oljT 1::j':HLEjIJLE
JART TII-IE: UIE,HBLED
IE — - PT,F, T11 : I, I-." LED
LICWID SETUP
I - - - - - - - - -- - - -
L I : U! IL ;'-"TF-
c-11hi-I'LE
STF 21111P
I- FIL.1,
TRI -STATE FLC-T1
IF, IF rt
L 3 SUP 1T,
TPI -:JWf'E
TE,- ', R' j 1 : 3Tl-
FLo_-T;
HTUI,uP%l F-IF:1ki,, SUMP
L 5: :--ITF-
TPI 1-11'. ::-J*Ihf-;LE FL, --T>
L FILI.
TRI-P,THTE
L 7:1ill-if, 7-E!
TRI -SlHTL FLOHT1
TRI-,-"THTE
P;,,N
L -J:N P 1-?
7F.1j-S'fATE iRIN,_"LE FLo"C'.
Ed.--V-Evj:ER PHN
L 1 1-1 : I I I E; P :__; -I
TR I -ST; ATE t S I FD-j,,-T
DISF'EIt!,SEF PHN
JIJ'I'FIJT ;ET UP
R I :(A/FPFILI_
T'-,`F'E:
STHI%j[,r,Rfj
h0R11oLL'-,1 C4,Ef)
THI`jI
L.L. ALH1.11
t-;LL:HI(_;Ii PPoDUC'T oLi-iRll
H RHLL:I-,Io: 1- PR OU IJ,
ISD SI"FE HLHE'l°I: _5
Ic'D PRE2" FHIL
1 SG DE,-.;Rfj PREP; PH I L
12@ VHF,C'-1R " LD-4' F" 11.
I Kj VP LF'AI
1. D VP F(:,IL
HLL:,-"RoSS FAIL
HL.L:1jE,_1'RD `OLLE,_'T FAIL
ALL:FLOIJ _:OLLEC'T FAIL
N.LD LINE DI'HBLE SETUP
N-THNI': AD-iRl:`-
T 3:H1 l-"H WATER HD411
1. 1 : FUEL FiLi`,Rfl
1. 7: FUEL. (D-011
L 6:F1JEL f
L 9:FUEL HLH- P11
L 10 : FLIEL ALoPf I
L I :2Er•2()'R C ) IJT LA' R. I " I
L 7 : -,' EI - IS. C; R OUT HI-HRI"I
L 6:210.2,OR ALIT HL.HRI-1
LIT AL R11
L I U : f:, ENS,:* ;R OUT
L I :'.:311ORT HL7F,1•
L. 7:: H RT H- LHRI "I
L S, , -1, H RT HLA,RM
L :2 H RT L, RTI
L I Ii : S HVIRT 'Llipl"I
PRE"=.SURE LINE LE _-K
IJ I :PLLI'l oPEIII HL1,ARI,,1
Ts1D-j1-'P1`),.-,.,,;: PRE;. FAIL
121) DE, RI, PRE--', FAIL
I SD '-)i4-OR LEAf' FH I L
1'.-H) PRE2 FtH I L.
ALL:1,* k`,)LLE,:T Fi-dL
oLL )LLECT PH I L
H,LI_:FL( W FAIL.
a
I N-TANV ' ITS,
T I : H 1-.-; 1-1 1:4JER of -HRIM
L11DI - I I D '-EN.SC)P
T :FUEL
E 7:FUEL HDHRfl
L R:FiJEL f-iDM,J
L ~:FUEL A-LHRI-I
L 10: F1 IFI_ HLhkIl
I OR ULIT AL_`RI'I
L S E. N,:-, R oUT "LAR11
L 7q:2 ;ENS()R (' UT HLARl' I
El L-I N2,C)P OUT HLHRH
L. 1-*:,-_'HuRT HLH-O' -I
L 7:-H()RT HLHRI•I
L :,;-D,H(-)RT HI-HRI"I
L ' 'T
L I 1_1:2;HURT
LINE I,Dil:
PLL1l (PEN ALHRII
181) SITE HLHR11S,
PRE': 1'H I I.
I SD DFC; R[ 1 F - I FA, I L
VHPOR I-El"11'. F_` I L
I SD VP PRES, F61 L
I SD VF- -1-D2T1_1'S, F_` I L
l_:(:-LLEs_:T F I L
LL: DE ;RD '!,',,,LLEl-,T PH 11.
ALL:FLO[d
T
L 5:FLIEl
7 Fl.JFI- HI-HRI"I
L J: 17LIEL HDIM"I
9: FL IEL
I I: FUEL. r 1_1431
L 5:SEN _;R :'+LIT
L. 7 OUT HLAF-J, I
L - SEhJS iR CiLJT HEAP
L C)LIT 4_-HRT'l
L t:z'E M"'R C HLiARH
L D43* I
L 7: :HORT IU)Pll
L 8 :'S_'HORT cil_i-iRll
SHORTRT mDHRll
LINE LB)'
OPEN HL14.1-1
2 R-i I -'2
ITD361-'Y p I'l."A'-A L
r91 t' FL',Ad I IETEF-'
R FL• i-IE,ru,
JUN I 1 201' =' 4: 47 I'll
ASSIST T','PE IlCjfj OS•ELL ST
HR oZ EMAKERSFIELD CA 93306 SYSTEM UmTS,
LE 661 -871 -1200 U
JUN I I ;C11 2 .4 : 47 PI-I IE11•ICIL I I
13
1) ISTEI-1 DhTE 'I'l ME F, RllhT
Dr, PYYY HH:1'11'1:'3.c3 xM
THTUS) REPORT 1"HEdRON
ALL FUNC71ONS NORfIAL 700 G2WELL ST
BAI-l'.ERSF I ELD C7A 92:31 Cl6
MINUTES. I N%yENTi'tR" REPORT G61-871-1200
21-11 FT T I MF. 1 5:00 AM
HIGH T i :PUT-R.EtIE SHIFT TIME 2 DISABLED
LI I1 ABCFU, VOLUME - 3561 GALS SHIFT TIME 3 111 SABLED
Tf4BLY.- ULLAGE . 616' SHIFT TIME 4 D I &AiBLELP
c,, 1-joSE
FP f L JiL PR 90';1 ULLFGE- 5194 GAL.l
507 TANK PER TST NEEDED 1.1PNTi: - VOLUME D I SABLED
i3 17 131 o 01 HEIGHT = 3E• . 63 INCHES TANK TST 14EEEIED 14PIqirUO0jIWATERJOL - a GALS DISABLED
1 0";! 1ju WATEP . 0.80 1141-'HEID
00
04 rj jDa 02 1 131J TEMP . 81.4 DEG F LINE RE-INALILE METHOD
05 02 02, IJU
ju PASS LINE TEST
136 ULI
Ul-1
T 2: D I FSEL
VOLUME 15.37 CmLS L I NE PER TST NEEDED W?1'4
OS 2i1 06 ULLAGE 7731 GALSLS ENABLED
90% ULLAt E= E 75 ,' Cl'r'iLln' LINE PER TST NEEDED 1,1RH
IIETU ('14" TO 'VOLUME - 1977 GALS
24
DAYS = 2F
L I NE PER TST NEEDED ALH
ID SERIAL 1011 LAPEL H I CH = .1 i N--: T 5 HES DAYS - 20
WAE
TER 0VOL - CALS
0.0- 1WATER11 11HP2 LINE ANN T.-;T NEEDED WRN
8307 3-4 TEMP 01.1 DI G F D I SABLED
b-6 "IF 5-621 PRINT Ti; V('LUIIEI,-,
4 26218? F11
T 3: UNI-Ei'llIED ENABLED
VC LUME = 6 ?E7 GALS TEIIP
12'Ll FUEL ':;Rr,DE H E ""Ap lJLL4.,E 29;11 GALS VALUE (DEt' , F 60.0
3 50'. ULLA,-;F- 1968 GALS
TC' VOLUME = 669,3 C ALS ciTICK HEIGHT OFFSET
FP V114H 11HH Hi`iH HE I GHT = 59.59 1 14f.; HES D I SABLED
30 1 9C' I- WATER v'oL = Fj GALS ULLAGE: 901
17
2 1:12 :3112 5 U WATF.R . 0 7 1 lq(,HES18UTDIP . 79.4 DEG F
Cl 2Cjeljj!5 :.-l(b -305 u31t' L 4 '4 ;'r 4 ENDcjr' j
7, :31-
31;
q07 S
op
LABEL TABLE
1 11Ef
BLEM)3
REGULi-;T:
F-PE"'I I Ull Scf'TwARE REvINON LF,VEL
7: BRl",+JZ'E VF. R'S I {3N 01
i
S I LVER cSOFTW.i REP8:
q: BLEl`lD'2' CREATED - 09.01.29.15.44
I u: BLE;IN S-f'1- All-ILEO :3301 60-006-a
IN-TH't,w TESTS
IN -TANK TESTS
E
PRE,--jSkOld TE=:T L;l_lKlHTIC)[.i
HOURE'.": 1-2
Lle)',111317 THIEEV16ELEL,
ScT'rlPT DATE
IAP WEEK 2 cl-Ul-I
START T I f-•lE
GO R-1
END DHTE
NOV I-IEEr I -jILIN
END TIME
2: DID HJl
RE DIRECT L,`C';sL PPIHT(AITrlIEABLE15 '' -
Iii 'HBLEG
T"'NK CHiip,r SEt-*IJRIT%,,
DISABLED
r. UST' 7M' I HLORHS:
DISHBLED
ERVIL`E N T I C-E
ISO '1166 C-OUNTRY
CODE:
S- ET- UP - - - IN-Tr011: _L -Ui,
P(•PT 2;ETT I I-11"S: T 1
1-INE fl 41',IIPJLDED
DISABLED
F•R0flU'_:T '-:,' - )DE
Alll'o HIGH WATER LIMIT
THERr"i_ i_-:OEFF f
kS- 231-21'12ECUP. Il", 111HPIETER
AUTO 1_011d Ppci[IUC_ T
GICHBLEG
11S BLEF) Tr20W PR")FILE
97
1) 1 SABLED
FIJI-L 'A__'L
HUTO FiELIVEP'
ll
START
E()HPD Ij I H_'H
B J Ri TE 96CICI Nf
111 SABLED
i UT' ' E:• TEPNAL I HPUT C,;,i
F R I TY EVEN 3.11 1 Nl_:H VC-1 1 13 1
2TOP, Ij Fl, I S'r, P
PER I _D I TE'-T I-H i L
AUTO S Et,F"OR FUEL AL Pll
GAT:; LENC,TH: 7 I HTH
RS-232, SECURITY FL()HT S12E: W.
r `()IjE : DISABLED LdATEP kj;;PN I tti,3
AUTO HN-OP OUT "'LAR11
OMM BOARD 5 i R6- 4::_ 5 Hlf.-;H -'J;., 1.11-IIT: I'L
Br'AU-,] RATE 24 11u
PER I E U T R N I-- F
PAR I TY P' O,j 97
c,TC?, HIT I -;T( P O"./Ek'FILL L1111T
1j-`T;` LE4_,TlI: ? L16T " HI :;H F)RCiDL11- RS El' UP I T
CODE SHBLE1, DELIVERY' L I [,-I T 1
C-CAll BOARD 6 : KIS-.'J'_,l
B,UD FHTE :iEuo
PARITY M3NESTOPLTIST P Llfl)T: i
DATA I.ENC"TH: 113 F,AT,:i IUDLjLN
R-13-_-_l'_-' SECURITY TANK TIL- 0. CIO
lIS'ABLE' L I, E F PROBE :,FR-LT
AUTO TF.Af't f I I T SETT IN1,'S: Td: N-NEj
HUTO LEAK HLrRil LIMIT 1-INE fl 41',IIPJLDED
DISABLED T;l
Alll'o HIGH WATER LIMIT
SHBLED
OTC) OVERFILL LIMIT LE- 11 i hJ F.Ep jOL, 1,
DISABLED
AUTO 1_011d Ppci[IUC_ T
GICHBLEG LEH):'. HIN IJPJIJrL
AUT" , THEFT L1111T 97
1) 1 SABLED
HUTO FiELIVEP'
ll
START EF I (.A&,., D I "HBLE11
AUTO DELIVERY END
111 SABLED
i UT' ' E:• TEPNAL I HPUT C,;,i fJIIt TES7 F ilL
D INHOI.-:TETII-ihL I NTlJT _,:-F
D I TABLED PER I _D I TE'-T I-H i L
AUTO S Et,F"OR FUEL AL Pll
D I SABLED
HUTI-', SLNS-l'_.)R Wl_'TEF ;-;Li Rll P F H I L
D IS- BI ED HLHR.Tl lil'i"HBLEE, AUTO HN-OP OUT "'LAR11
PER I E U T R N I-- F
TANI! OFF
TNK 1' _:T PH , d4 BR&H)::OFF
DELoY
PU11P, THPESHCJIJ,
R2-- END 0,F 1-!E:_I'._IAGE
D I In-;-ibLE L)
T 2:DIESEL T :3 JACENDED LEAF{ 'I E: "f !IETH-:)DPROblil-7 CC)DE I, CODE 3
THERP-AL C,o.EFF 1:1 [-- 1-] 4 F, A i,-EFF : . TESLDIAP-IETER i2. 00 Ttil,ll: DIAI-IETER : 512. ou 2;LD
P11 - 95111
F,RbFILE
FULL
4 PTS
97' H
T;-01),. PROFILE
FULL 04.
1 PTS
q72A 17LII,Ii TF FH':TOR.:P,I(-.)DEPHTE
I I91:!H \R,,L 791 cl i,'-, CI I ll(? I I VC,,L 91 0 1 - TEST46.0 INCH 00L
2_, .O "RH VOL
40rl4
ITG
46 0 1 Ilkl'H VOL
23.0 R(: H VOL
l8til
18 181
R02,,73
DISABLED
pqrswr uNo.,:
Fl-(-.)i;T I H. FLGHT 'Sl"?E: 4.0 IN. D Ir3mBLED
wWTER LARN I N1 1 .0 LATER WARM NG 1 .0 T'= ;T EARL`,' ',-z;TC.',P:ENiF.,LED
Hll-,'H WATER WHIT: I] HIGH WATER IAKHT: 2.0 LEAK rE,::*,,r FORNAT
Pik:: OR LABEL %eOL: u MmX OR LOBEL 'fOL: 97:_'8 NOWAL
OVERFILL LIMIT 90";. OVERFILL LIMIT 9K
3755 045
HIGH PRODUCT 95n HIGH F-RoDIJUT 95"';,
q241 9241
DELIVER`,- LIMIT DELI iER',, L.I("11T 1 2%
116.7 1 167
IIII:[ Lol,-) P ROPUC] 400
LEHY: ml-r -iFfl 1-111IT: l LEAK At LIMIT: 9 1-
VADDEN LOSS LIFHT: 99 SIDDEN LOSS LIMIT: 99
TmNV TILT
HOBE OFFSET
ovo
0. Acl
TANI,.* T I LT
PR'()EiE OFI--`.-3ET
I*]. I-jIj
0. cio RE-:SURE LINE I-Frd'. FTijr,
SIPHON PlYNIFOLLIED TWA:S
Tp: NONE
LINE PA1*11F-,')LDED TA1,11:.s
IS : NONE
LEQ WN PENODIP: 1%
97
ETA IARD
HPINUHL TEST FAIL
ALOPP'l DISABLED
PER ICEOG' TEST FAIL
A4.HRI'l Dk-iHLILED
GWAS TEST FA L
ALARI DISABLED
ANPI liFE,T C)FF
PER TEST , : )FF
TAM( TEST 15910: OFF
IT111, TST _IPHON BREW -.':OFF
DEW VE• DUnY I P-HN
P1111P THRES11C)LI-1 I U .IIII?,
21PNON MANIFOITED ICS
TO: NONE
LINE MiL;NIF(/LDED TO14ES
TA: PONE
LEK PAN PERIODIC: 1%
97
I-EAI'. NIH ANNUAL I %
97
PLPIODIC TEST I'YPE
R
PIr,JUAL TEST FAIL
HLOPP-1 [112HELED
I•EST FOIL
ALMRI-I D I SABLED
FE,.-.;T Fri lt..
Allrl IEtiT OFF
PER TEST OFF
TANK 'I*Ec.1' 1-10TIF",”: OFF
15K TST SIPTNN BREAK :OFF
DEL I SSE!?`! CELW! 1 1 111 PI
F-1-111P THRESHOL.F.; : 10.00%
FIBERGLAS:
hill bli-i LEPI: 105 FEET
3&QN DRAL&K "5 FEET
FAUDYWN RATE: 3 & 12,H
2-HUTc „FF:N0
CI P.S. I
T 3 =.EmDED
DISPEH:E 110DE:
c"I'ANDHPD
SEN-2)R: PIC-P-J'wENTED
Pkf' -USURF OFFSET; F,.upj-jI
T4T:Ijl KOIN FIBEBJIAS-.a
2.01PI G1A LF:Pj: 105 FEET
I. 1:11 LEN: 115 FEET
T I :bLII-REHI7.
DISPENSE IT)DE:
PPES:-;IjKlE oFFSET: 0 .LIP21
G 3: D I ESEL
ID -3 1 tI F I BERC, LAS"'.
01H 111A LFf,,I: 11-15 FEET
DlH I-Ell: 115 FEET
SHLtTD.,_jWl•l RATE: 3. 0 GPH
L0.W PRESSURE SHUT -.:)FF:I,K_:,
pJR:U;',_7:;URE I PS I
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SWRCB, January 2006
Spill Bucket Testing Report Form
This forryn is intendedfor use by contractors performing annual testing of UST spill containment structures. The completed, form and
printoutsfrom tests (ifapplicable), should be provided to the.facility owner /operator-for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: Oswell Chevron Date ofTesting: 6/11/2012
Facility Address: 2700 Oswell Street, Bakersfield, CA 93306
Facility Contact: Frank Sullivan I Phone: 661- 327 -5008
Date Local Agency Was Notified of Testing : 5/29/12
Name of Local Agency Inspector (ifpresent during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials: M CSLB Contractor x ]CC Service Tech. x SWRCB Tank Tester Other (Specify)
License Number(s): CSLB# 804904 ICC# 85264406 TT # 09 -1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic Vacuum Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (Bv Tank
Number, Stored Product, etc.)
1 Regular 2 Super 3 Diesel 4
Bucket Installation Type: Direct Bury
Z Contained in Sump
Direct Bury
Z Contained in Sump
Direct Bury
Z Contained in Sump
Direct Bury
Contained in Sum
Bucket Diameter: 12.00" 12.00" 12.00"
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 Start Time (Ti): 1:15pm 1:15pm 1:15pm
Initial Reading (Rj): 10.75" 10.50" 10.50"
Test End Time (TF): 2:15pm 2:15pm 2:15pm
Final Reading (RF): 10.75" 10.50" 10.50"
Test Duration (TF — Ti): 1 hour 1 hour 1 hour
Change in Reading (RI.- Ri): 0.00" 0.00" 0.00"
Pass /Fail Threshold or
Criteria: 0.0625" 0.0625" 0.0625"
Test Result: Z Pass Fail OO Pass Fail El Pass Fail j Pass Fail
Comments — (include information on repairs made prior to testing, and recomnaencledfollow -upforfailed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician's Signature:® A ot,t N-' Date: 6/11/2012
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
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0
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Job Order / Invoice # cq q l 7.!
Toll Free #: 1- 800 - 339 -9930 Date Call Made Time To Whom
3 Station Control Number Repair Date
6-1!4a
Invoice Date
s
Name Confidence UST Services, Inc.
p
Site Name: CSSw L .vevnJ
Street 16250 Meacham Road Street a D v dSu i•LL
City Bakersfield,Ca 93314 City Stateog, Zip O
Terms
t' tZtixP _ s r
Store Number:
Description of work performed: CC>aC,/ - " ewM_Yr
G > o- - P ,E
wG i kVu0 T C o r
2 1 Z A fl
c — 4 Ir tN<+ _ , v c T<4 C
v(...ci'TGNGO/
Labor
Date Name / Number Class Hours Hourly
Rate Amount
Arrived Departed Labor Travel Total
Rate Total Sub Total
P
M
cc hr 2- I x.00
Tax ( If applicable)
AM
PM
AM
PM
Total B
May we please have your comments regarding service / equipment provided by the above named contractor:
Store Employee Printed Name
Store Employee Signatu
AM
PM
AM
PM
Date
Contractor Supplied - Materials - Rentals Amount Sub -Total
Total A Labor
1
Total B Material
ran
Total C Mileage
Total Amount
Invoice A + B + C
Accounting Breakdown
Mileage
Miles Rate Total Sub Total I,O
Handling %
Tax ( If applicable)
Total C Total B
May we please have your comments regarding service / equipment provided by the above named contractor:
Store Employee Printed Name
Store Employee Signatu D to
is r1 z Approved By Will" Date