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HomeMy WebLinkAboutFMC RESULTS 2-21-12C, P, S F,2t BSSR, Inc. 6630 Rosedale Hwy., # B, Bakersfield, CA 93308 Phone (661) 588 -2777 Fax (66 1) 588 -2786 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the lank 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 General Information -; Facility Name: ICU S E Li-1Z ( ©U M Bldg. No.: Site Address: 1 S r5 i R O S t 6 A LE H t:,) •q city: k) KFj*?_5 C I E x-16 zip: 9 3 S U F, z 16 588 - C 5 b-4FacilityContactPerson: IZOy SL.1 1 t T I t Contact Phone No.: (_ Make/Model of Monitoring System: GMC /j?A69, ,v 0 (U0r_1O U Date of Tesdng/Servicing: a / A 1/ 0L0 1 OA Inventory of Equipment Tested /Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: Tank ID: Io ow Tank ID: O C C7 In -Tank Gauging Probe. Model: In -Tank Gauging Probe. Model: 5 aQQ 10 0 Annular Space or Vault Sensor. Model: P raoa, 5 di0 I q '1100 A Annular Space or Vault Sensor. Model: 639a, 5c C O Piping Sump / Trench Sensor(s). Model: Piping Sump / Trench Sensor(s). Model: _ W Sump Sensor(s). 5T F Model: faMSump Sensor(s). 5'C? Model: Mechanical Line Leak Detector. Model: E Mechanical Line Leak Detector. Model: e. C Electronic Line Leak Detector, Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: tank Overfill / High -Level Sensor. Model: Other s eci equipment a and model in Section E on Page 2 . Other (specify equipment a and model in Section E on Page 2). Tank ID: E rYl Tank ID: In -Tank Gauging Probe. Model: In-Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: i I Annular Space or Vauft Sensor. Model: Piping Sump / Trench Sensor(s). Model: Piping Sump / Trench Sensor(s). Model: QWSump Sensor(s). ST Model: u Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: Tank Overfill I High -Level Sensor. Model: Other s aci equipment type and model in Section E on Page 2 . Other s eci a ui ment type and model in Section E on Page 2). Dispenser „1D: % 1 a Dispenser Containment Sensor(s). Model: QflO , 00001 l Dispenser ID: Dispenser Containment Sensor(s). Model: 000 1. 0 Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: c Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Floats and Chains . Dispenser Containment Floats and Chain(s). Dispenser to: 9, 10 Dispenser ID: it A la Dispenser Containment Sensor(s). Model: ?W I SCja %1CJOOlO v-' Dispenser Containment Sensor(s). Model: lal3-^n <,ya. 10( 0 r(i Shear Valve(s). Shear Valve(s). Dispenser Containment Floats and Chains Dispenser Containment Floats 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/servioed In accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verity 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 histor port e, 7TechnicianName (print): DAV I TFjCi<E I Signature: Certification No.: A 3 1 3 y 5 License. No.: A 6a t 8 1 a2 Testing Company Name: _35S lZ I N Phone No.:( 111 ) 588 Testing Company Address: 662>O Rn5E bR LE HW-q 41 B Date of Testing /Servicing: /-21 / a 0 1 , Monitoring System Certification Pagel of 4 12/07 2/21/07 Dispenser ID: % 5 1 Li O Dispenser Containment Sensor(s). Model: pooj 5cj,4,Q00O I U 0 Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: O Dispenser Containment Sensor(s). Model: Shear Valve(s). O Dispenser Containment Float(s) and Chain(s). Dispenser ID: O Dispenser Containment Sensor(s). Model: O Shear Valve(s). OD spencer Containment Float(s) and Chain(s). Dispenser ID: li J Dispenser Containment Sensor(s), Model: PHO 59 OCC0tO 3'Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: O Dispenser Containment Sensor(s). Model O Shear Valve(s). Dispenser Containment.Float(s) and Chain(s). Dispenser ID: O Dispenser Con tainment.Sensor(s). Model Shear Valve(s). Dispenser Containment Float(s) and Chain(s). V Dispenser ID: Dispenser ID: j 'D Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model Shear Valve(s). O Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Floats and Chain (s) Dispenser ID Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model. Shear Valve(s). Shear Valve(s). O Dispenser Containment Floats and Chain(s). Dispenser Containment. Floats and Chain(s) Dispenser ID: Dispenser ID: O Dispenser Containment Sensor(s). Model: O Dispenser Containment Sensor(s). Model Shear Valve(s). Shear Valve(s). ODispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s) _ V D. Results of Testing /Servicing Sof,vare version Installed: 3 a9. O Complete the following checklist: es No' Is the audible alarm operational? i "" Yes No' Is the visual alarm operational? Yes No' Were all sensors visually inspected, functionally tested, and confirmed operational? Yes No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with then proper operation? Yes No' If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? N /A y Yes No' For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system NIA detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (Check all that apply) I,-'Sump /Trench Sensors; Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensof failure /disconnection? Yes; No. Yes No' For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no mechanical overfill prevention N/A 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 j of tank capacity does the alarm tri erl 0% i t,/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. Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product, Water It Ls, describe causes in Section E. below. es No' Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, if applicable wYes TO 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: 7E_P LC),cE LERK 1:,EiECTO 12- I I-J el MO ( ANK LEAK i'_'E TECTO)Z MODEL FX I \( SEZtAL -Ii HOS l I Monitoring System Certification Page 2 of 4 12/07 2/2 1 X07 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 followina checklist: CYYes No' Has-all input wiring been inspected for proper entry and termination, Including testing for ground faults? G Yes 0 No' Were all tank gauging probes visually Inspected for damage and residue buildup? 3- Yes No* Was accuracy of system product level readings tested? Y Yes 0 No' Was accuracy of system water level readings tested? V Yes 0 No' Were all probes reinstalled properly? N/Yes 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 will be corrected. G. Line Leak Detectors (LLD): _] Check this box if LLDs are not installed. Complete the following checklist: Yes No' For equipment start -up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all N/A that apply) Simulated leak rate: V3 g.p.h.; 0 0.1 g.p.h ; 0.2 g.p.h. Yes 0 No' Were all LLDs confirmed operational and accurate within regulatory requirements? r -' Yes No' Was the testing apparatus properly calibrated? R,-' Yes 0 No' For mechanical LLDs, does the LLD restrict product flow if It detects a leak? N/A Yes No' For electronic LLDs, does the turbin&automatically shut off If the LLD detects a leak? 7 N/A Yes No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or R N/A disconnected? Yes No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or i N/A falls a test? 0 Yes 0 No' For electronic LLDs, have all accessible wiring connections been visually inspected? t. N/A Yes 0 No' Were ail items on the equipment manufacturer's maintenance checklist completed? in ine section m, Deiow, aescnDe now ana when these aenciencies were or win De correctea. H. Comments: RE PACE lb L CPiI K _N>ET ECTQ Z fJ 8--T rnA "1 TA-J lk Monitoring System Certification Page 3 of 4 12/07 3 2/21/07 Monitoring System Cerdfleatlon UST iV.l`onitoring Site Plan Si!e Address: {8'j 1 WOSIGDgLE HWIJ Date map was diawn: Instructions ou already have a diagram that shows all required information, you may include it, rather than this page, with your lomioring System Certification. On your site plan, show the general layout of tanks and piping, Clearly identify oca[ions of the following equipment, if installed; monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak cietecwrs; and in -tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan prepared. Page q of 1 05 /00 SWRCB, Januan, 200( Spill Bucket Testing Report Form hisform is intendedfor use by contractors performing annual testing ofUSTspill containment structures. The completedform ona printoutsfrom tests (ifapplicable), should be provided to the facility owner /operatorfor submittal to the local regulotory agency. 1. FACILITY INFORMATION Facility Name: Q S E DA CE PLjq Z c CZUJ F, A rv-r "' n'1 Date of Testing: a - 1 - Facility Address: L F Lz) Facility Contact: -r iZO• / E L-r, r,, O Phone: 861 - 5 P2; -055-4 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (ifpresent during testing): E ST (41E fZ 2. TESTING CONTRACTOR INFORMATION Company Name: e5s-L I N C• Tecluiician Conducting Test: -T-AC CET T Credentials': 0 CSLB Contractor VCC Service Tech. SWRCB Tank Tester Other (Specify) License Number(s): 3. SPILL BUCKET TESTING INFORMATION Test Method Used: SK4 drostatic Vacuum 0 Other Test Equipment Used: Equipment Resolution: Identify Spill Bucket (By Tank Number, Stored Product, etc.) 1 8 J 2 8 m A t tJCF ' 3 8 Sy r10N 4 2CCYl V M Bucket Installation Type: 0 Direct Bury GLEontained in Sum Direct Bury 9- Contained in Sum Direct Bury 9-Contained in Sum Direct Bury 9- Contained in Swn Bucket Diameter: I Bucket Depth: 1 6` 2" 15 Wait time between applying vacuum/water and start of test: 10 M' ^I °TES 10 rn t rJ.t -t E 5 10 rte J v-(ES 10 rn rJ i E S Test Start Time (TI): q ,, Ll p A rrN q, y p A r -N Ci `• y Q R M c . L( 0 Initial Reading (R4): if 1 '' 11 1 11'' Test End Time (TF): Bb R d() A n O 0 R M O O R Final Reading (RF): it of Test Duration (TF -T,): 1 14R O MtrJ Irji"L ol0 MtrJ jt4jZ a0 rr`tr., I HQ_ a0 rmtr; Change in Reading (RF - RI): ar Pass/Fail Threshold or Criteria: Test Result: amass Fail .. B'Paw :(] Fail .. BrPass :. Fail Pass Fail Comments - (include information on repairs made prior to testing, and recommendedfollow -up forfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING 1 hereby certify that all the informati conthined in this rep rt ' e, accurate, and in full compliance with legal reyuirenrent Techiiician's'Signature: Date: o-2 -a State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may Fw mnra ctrinnant 1ZCCD Ar'' I I rn ALARM 1-1 i5-TOS2 HLARM HISTORY REPORT IN -TANK ALARM - - - -- T (:UNLEADED R OVERFILL ALARM FEB 'D I , 201 2 10:,56 AM DEC 25, 2011 8:06 All MAY 6, 2011 1 :09 All ALARM HISTORY REPORT IN -TANK ALARM - - - -- T 2:UNLEADED R OVERFILL ALARM FEB 21. 2012 10:44 AI °1 140V 17, 2011 12 :18 PP1 HLARM HISTORY REPORT IN -TANK. ALARM - - - -- T 3: UL PREMIUM OVERFILL ALARM FEB 21. 2012 10:52 All HLARI`( HISTORY REPORT SENSOR ALARM - - - -- L 2 :UNL 2-PREM ANNULARANNULARSPACE FUEL ALARM FEB 21, 2012 12 :34 PM HLARM HISTORY REPORT SENSOR HLARI'1 - - - -- L 3 :UNL 1 ANNULAR ANNULAR SPACE FUEL HLARM FEB 21, 2012 10:09 AM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 4: UNL 2 SUMP STP SUMP FUEL ALARM FEB 21, 2012 9:42 API LARPI HISTORY REPORT SENSOR ALARM - - - -- L 5: UNL 1 SUMP 5TP SUMP FUEL ALARM FEB 21, 2012 9:44 AM HLARM HISTORY REPORT SENSOR ALARM -- - -- L 6: PREPI SUMP 5TP SUMP FUEL ALARM FEB 21, 2012 9 :46 AM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 9:DISP 1 -2 DISPENSER PAN SENSOR OUT ALARM FEB 21, 2012 10 :23 All FUEL ALARM FEB 21, 2012 10 :15 Ail ALARM HISTORY REPORT SE19SOR ALARM - - - -- L1O :DISP 3 -4 DISPENSER PAN SENSOR OUT ALARM FEB 21, 2012 10 :23 AM FUEL ALARM FEB 21, 2012 10 :14 AM ALARM HISTORY REPORT. SENSOR ALARM -- LII :DISP 5 -6 DISPENSER PAN SENSOR OUT ALARM FEB 21, 2012 10 :23 All jZ C)R T 01 ALARM HISTORY REPORT FUEL ALARM FEB 21, 2012 10 :13 All ALARM HISTORY REPORT SENSOR ALARM - - - -- L12 :DISP 7 -8 DISPENSER PAN SENSOR OUT ALARM FEB 21, 2012 10:23 API FUEL ALARM FEB 21, 2012 10 :13 AM ALARM HISTORY REPORT SENSOR ALARM L13:DISP 9 -10 DISPENSER PAN SENSOR OUT ALARM FEB 21, 2012 10:23 Ail FUEL ALARM FEB 21, 2012 10 :12 All SENSOR ALARM - - - -- L14:DISP 11 -12 DISPENSER PAN SENSOR OUT ALARM FEB 21, 2012 10 :23 AM FUEL ALARM FEB 21 o ^201 '2 10: 1 1 All ALARM HISTORY REPORT SENSOR ALARM - - - -- L15 :DISP 13 -14 DISPENSER PAN SENSOR OUT ALARM FEB 21. 2012 10:23 Al FUEL ALARM FEB 21, 2012 10 :11 AM ALARM HISTORY REPORT SENSOR ALARM L16 :DISP 15 -16 DISPENSER PAN SENSOR OUT ALARM FEB 21, 2012 10:23 Am FUEL ALARM FEB 21, 2012 10:10 Ail FES 21, 2012 2:12 Plhl SYSTEM UNITS U.S SYSTEM LANGUA_:E ENGLISH SY 'TEI °I DATE/TIME FORMAT HON DD YYYY HH : I°lf'I : SS x1 l riRC'V ain pvi 81838 851 ROSEDALE HW`! iial <ar f field rte 93308 SHIFT TIME 1 6:00 AM SHIFT TIME 2 : DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED Li K.. PER TST NEEDED WRN D, ! SHBLED ANN TST NEEDED WRN Ii I SABLED LINE RE- ENABLE METHOD PASS LINE TEST NE PER TST NEEDED WRN L,! SABLED LINE ANN TST NEEDED WRN DISABLEDI PR! NT TC VOLUMES E1IABLED TEMP COMPEN'SAT I ON vr,LUE (DEC F ): 60.0 ST 1 C): HEIGHT OFFSET DISABLED ULLAGE: 90% H- PROTOCOL DATA FORMAT HFIGHT 4 PTS DAYLIGHT SHV I Nt TIME ENABLED 8751 STt+RT DATE 5362 mAR WEEK 2 SUN START TIME 4.0 111. 00 AM 2.0 END DATE 3.0 P.Ov WEEK l SUN EPJD TIME 96.0 x:00 AM VOL RE- DIRECT LOCAL PRINTOUT DISABLED EURO PROTOCOL PREFIX 2 SYSTEM SECURITY CODE : 000000 fliHINTENHNCE HISTORY DISABLED THNY CHART SECUk1TY DISABLED i'USTOm HLARMS DISABLED SERVICE NOTICE ENABLED DELIVERY OVERRIDE DISABLED iSO 3166 COUNTRY uDF : I °LASS; DENSITY D!SABLEI'I vl'll lU1'11 l'H 1 1'JI''G7 `t 1 Up PORT SETTINGS: COMM BOARD : 3 (EDIM > RS -232 SECURITY CODE : DISABLED RECEIVER :SETUP: NONE AUTO DIAL TIME SETUP: NONE RS -232 END OF MESSAGE DISABLED AUTO DIAL ALARM SETUP IN -TANK SETUP T 1:UNLEADED R PRODUCT CODE 1 THERMAL COEFF :.000700 TANK DIAMETER 120.00 TANK PROFILE 4 PTS FULL VOL 10725 90.0 111CH VOL : 8751 60,0 INCH VOL 5362 30,0 INCH VOL 1974 FLOAT SIZE: 4.0 111. WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 10725 OVERFILL LIMIT 90% 9652 HIGH PRODUCT 95% 10188 DELIVERY LIMIT 10% 1072 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 0.08 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TO: NONE LINE MANIFOLDED TANKS TO: NONE LEAK MIN PERIODIC: 10% 1072 LEAK HIN ANNUAL.: 10% 1072 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 TANK. TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 2 MIN PUMP THRESHOLD 10.00% s - /STErn SET AiZco tz'sm M T 2:UNLEADED R PRODUCT CODE 1 THERMAL COEFF :.000700 TANK DIAMETER 120.00 TANK PROFILE 20 PTS FULL VOL 19947 114.0 INCH VOL 19619 108.0 INCH VOL 19003 102.0 INCH VOL 18201 96.0 INCH VOL 17257 90.0 INCH VOL 16201 84.0 INCH VOL 15056 78.0 INCH VOL 13843 72.0 INCH VOL 12581 66.0 INCH VOL 1 1 285 60.0 INCH VOL 9974 54.0 INCH VOL 8662 48.0 INCH VOL 7367 42.0 INCH VOL 6104 36.0 INCH VOL 4891 30.0 INCH VOL 3746 24.0 INCH VOL 2690 18.0 INCH VOL 1746 12.0 INCH VOL 944 6.0 INCH VOL 328 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 19947 OVERFILL LIMIT 90% 17952 HIGH PRODUCT 95% 18949 DELIVERY LIMIT 10% 1994 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 1.30 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TO: NONE LINE MANIFOLDED TANKS TO: NONE LEAK. MIN PERIODIC: 10% 1994 LEAK MIN ANNUAL : 101% 1994 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 TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 2 MIN PUMP THRESHOLD : 10.00% 0e 385( RosEvAL G a - a - +aZ T 3: UL PREMIUM 500 PRODUCT CODE" 3 THERMAL COEFF 000700 TANK DIAMETER 120.00 TANK PROFILE 4 PTS FULL VOL 11975 90,0 [NCH VOL 9750 60,0 INCH VOL 5987 30,0 INCH VOL 2224 FLOAT SIZE: 4,0 IN, WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 1)t4X OR LABEL VOL: 11975 OVERFILL LIMIT 10777 HIGH PRODUCT 95% 11376 DELIVERY LIMIT 10% 1197 LOW PRODUCT : 500 LEAK ALARM LIMIT : 99 SUDDEN LOSS L t hl I T: TANK T[LT 1,38 ppOBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TV NONE LINE rIANIFOLDED TANKS TO: IJONE LEAK MIN PERIODIi: 1I 97 LEAK f °1I fJ ANNUAL 1 197 PERIODIC TEST TYPE TAIJDAkD NIJUAL TEST A L ALARM DISABLED PERIODIC TALARMADISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK. TEST NOTIFY: OFF TNK TST SIPHON BREAK :OFF DELIVERY DELAY 2 MIN PUMP THRESHOLD : 1D.OU`j LEAK. TEST METHOD TEST ON DATE : ALL TANK JAN 29, 2009 START TIME : DISABLED TEST RATE :0,20 GAL /HR DURATION : 2 HOURS TST EARLY STOP :DISABLED LIQUID SENSOR SETUP L 2 :UNL 2 -PREM ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 3 :UNL I ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 4 :UNL 2 SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 5:UNL 1 SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 6 :PREM SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 9 :DISP 1 -2 TRI -STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L10:DISP 3 -4 TRI -STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN LII :DISP 5 -6 TRI -STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L12 :DISP 7 -8 TRI-STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L13 :DISP 9 -10 TRI -STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L14 :DISP 11 -12 TRI -STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L15:DISP 13 -14 TRI-STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L16:DISP 15 -16 TRI -STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN PUMP SENSOR SETUP LEAK TEST REPORT FORMAT S 1:UNLEADED RNORMAL TANK 0; 2 DISPENSE MODE: MANIFOLDED: ALTERNATE OUTPUT -RELAY SETUP - - - R 1 :UNL 20.000 TYPE: PUMP CONTROL OUTPUT TANK 9: 2 LIQUID SENSOR ALMS L 5 :FUEL ALARM L 9 :FUEL ALARM L10:FUEL ALARM L11 :FUEL ALARM L12 :FUEL ALARM L13:FUEL ALARM L14:FUEL ALARM L15 :FUEL ALARM L16 :FUEL ALARM COMM SIDE DIM ALM ALL :DISABLED DIM ALARM ISD SITE ALARMS ISD GROSS PRES FAIL ISD DEGRD PRES FAIL ISD VAPOR LEAK FAIL ISD VP PRES FAIL ISD VP STATUS FAIL MISSING RELAY SETUP MISSING HOSE SETUP MISSING TANK SETUP MISS VAPOR FLOW MTR MISS VAPOR PRES SEN MISSING VP INPUT ISD SETUP FAIL ISD SENSOR OUT FAIL PC -ISD FAILURE ISD HOSE ALARI.19 ALL:GROSS COLLECT FAIL ALL :DEGRD COLLECT FAIL ALL :FLOW COLLECT FAIL ALL :AIRFLOW MTR SETUP PMC ALARMS VP RUNTIME FAULT VP EMISSIONS FAIL VP PRESSURE FAIL VP DUTY CYCLE FAIL r': UNL SYPHON T'1 PE PUMP CONTROL. OUTPUT THNK. ; : 1 L l i-iU I D SENSOR ALMS L a:FUEL ALARM L 9:FUEL ALARM L1U:FUEL ALAR11 L!i:FUEL ALARM L! :FUEL ALARM LI'3:FUEL ALARM L! a :FUEL ALARM L!a:FUEL HLARM L1a:FUEL ALARM SITE ALARMS SD GROSS FIRES FAIL 1:D DEGRD PRES FAIL Sri VAPOR LEAK FAIL 15D VP PRES FAIL SD VP STATUS FAIL I -I! S' I NG RELAY SETUP I.1 l ;HS 1 NG HOSE SETUP TANK SETUP I`1 I SS VAPOR FLOW MTR mlSS VAPOR PRES SEN Ohl ! SS I NG VP INPUT 15D SETUP FAIL ISD SENSOR OUT FAIL C-ISD FAILURE SD HOSE ALARMS LL:GROSS COLLECT FAIL HLL :DEGRD COLLECT FAIL L : FLOW COLLECT FAIL i!L:AIRFLOW MTR SETUP f-1(-' ALARMS VP RUNTIME FAULT VP EMISSIONS FAIL vP PRESSURE FAIL vie DUTY CYCLE FAIL R .G : PkEf °I STANDARD f :OKIIALLY CLOSED uU I D SENSOR ALI11S L o:FUEL ALARM L y:FUEL ALARM L 1 0: FUEL ALARM L!1 :FUEL ALARM L12:FUEL ALARM L13:FUEL ALARM L!,4: FUEL ALARM 5: FUEL ALARM 6: FUEL ALARM SD SITE ALARMS ISD GROSS PRES FAIL SD DEGRD PRES FAIL SD VAPOR LEAK FAIL ED VP PRES FAIL 1SD VP STATUS FAIL I.1I SS 1 110 RELA`! SETUP I -I I SS 1 NG HONE SETUP I°1 I SS I NG TANK SETUP I °1155 VAPOR FLOW MTR I-!! SS VAPOR PRES SEN m!SSING VP INPUT SD SETUP FAIL ISD SENSOR OUT FAIL PC -ISD FAILURE SD HOSE ALARMS ALL:GROSS COLLECT FAIL ALL:DEGRD COLLECT FAIL HLL:FLOW COLLECT FAIL HLL:AIRFLOW MTR SETUP ALARMS P RUNTIME FAULT VP EMISSIONS FAIL V" PRESSURE FAIL VP DUTY CYCLE FAIL R 4:OVERFILL ALARM TYPE: MOMENTARY R E : EXTERNAL ALARM WARN NORMALLY OPEN TYPE: STANDARD NORMALLY OPEN IIV -TANK ALARMS ALL :OVERFILL ALARM TANK #: N +JIVE R 5 :EX7ERNAL ALARM TYPE: IN -TANK ALARMS STANDARD ALL:LOW PRODUCT ALARM NORMALLY OPEN ALL:HIGH PRODUCT ALARM ALL :HIGH WATER WARNINrG TANK 0: NONE ALL:DELIVERY NEEDED ISD SITE ALARMS IN -TANK ALARMS ISD STAGE I WARN ALL :LEAK ALARM ISO GROSS PRES WARN ALL :OVERFILL ALARM ISD GROSS PRES FAIL ALL :LOW PRODUCT ALARM ISD DEGRD PRES WARN ALL:SUDDEN LOSS ALARM ISD DEGRD PRES FAIL ALL :HIGH PRODUCT ALARM ISD VAPOR LEAK WARN ALL :PROBE OUT ISD VAPOR LEAK FAIL ALL :DELIVERY NEEDED ISD VP PRES FAIL ALL :MAX PRODUCT ALARM ISD VP STATUS WARN ALL :GROSS TEST FAIL ISD VP STATUS FAIL MISSING RELAY SETUP LIGiUID SENSOR ALM") MISSING HOSE SETUP ALL :FUEL ALARM MISSING TANK SETUP MISS VAPOR FLOW MTR ISD SITE ALARMS MISS VAPOR PRES SEN ISD GROSS PRES FAIL MISSING VP INPUT ISD DEGRD PRES FAIL ISD SETUP WARN ISD VAPOR LEAK FAIL ISD SETUP FAIL ISD VP PRES FAIL ISD SENSOR OUT WARN ISD VP STATUS FAIL ISD SENSOR OUT FAIL MISSING RELA`! SETUP PC -ISD FAILURE MISSING HOSE SETUP MISSING TANK SETUP ISD HOSE ALARMS MISS VAPOR FLOW MTR ALL :GROSS COLLECT FAIL MISS VAPOR PRES SEN ALL :DEGRD COLLECT FAIL MISSING VP INPUT ALL :FLOW COLLECT FAIL ISD SETUP FAIL ISD SENSOR OUT FAIL ALL :AIRFLOW MTR SETUP PC —ISD FAILURE PMC ALARMS ISD HOSE ALARMS VP RUNTIME FAULT ALL :GROSS COLLECT FAIL VP EMISSIONS WARN ALL :DEGRD COLLECT FAIL VP EMISSIONS FAIL VP PRESSURE WARN ALL :FLOW COLLECT FAIL VP PRESSURE FAIL ALL :AIRFLOW MTR SETUP VP DUTY CYCLE WARN VP DUTY CYCLE FAIL PI °10 ALARM,-.) PMC SETUP FAIL VP RUNTIME FAULT PMC SENSOR FAULT VP EMISSIONS FAIL VP PRESSURE FAIL VP DUTY CYCLE FALL PI11C SETUP FAIL SI.1RRTSENSOR SETUP s 1:DISP 1 -2 CATEGORY AIR FLOW METER s 2:DISP 3 -4 CATEGORY AIR FLOW METER s 3:DISP 5 -6 CATEGORY AIR FLOW METER s 4 :DISP 7 -8 CATEGORY AIR FLOW METER s 5:DISP 9 -10 CATEGORY AIR FLOW METER s 6:DISP 11 -12 CATEGORY AIR FLOW METER s ?,DISP 13 -14 CATEGORY AIR FLOW METER s B :DISP 15 -16 CATEGORY AIR FLOW METER s 9:VAPOR CANISTER CATEGORY VAPOR VALVE s11:VAPOR PRESSURE CATEGORY VAPOR PRESSURE sl6 :ATM P SENOR CATEGORY ATM P SENSOR EVR /ISD SETUP EVR TYPE: BALANCE BALANCE NOZZLE TYPE VST VAPOR PROCESSOR TYPE VEEDER -ROOT POLISHER ANALYSIS TIMES TIME: 10:00 AM DELAY MINUTES: 1 ACCEPT HIGH ORVR: DISABLED ISD HOSE TABLE 1 -2 2 ID FP FL HL AA RR 01 01 01 02 01 UU 02 02 02 02 01 UU 03 03 03 02 02 UU 04 04 04 02 02 UU 05 05 05 02 03 UU 06 06 06 02 03 UU 07 07 07 02 04 UU 08 08 08 02 04 UU 09 09 09 02 05 UU 10 10 10 02 05 UU 11 11 11 02 06 UU 12 12 12 02 06 UU 13 13 13 02 07 UU 14 14 14 02 07 UU 15 15 15 02 08 UU l0 16 16 02 08 UU ISO AIRFLOW METER MAP ID SERIAL NUM LABEL 1 29095 DISP 1 -2 2 29106 DISP 3 -4 3 28931 DISP 5 -6 4 36531 DISP 7 -8 5 31328 DISP 9 -10 6 28967 DISP 11 -12 7 24962 DISP 13 -14 8 31783 DISP 15 -16 ISO FUEL GRADE HOSE MAP BLEND3 1 2. 3 4 5: FP MHH MHH MHH MHH AA 01 101 901 501 U U 1 02 102 902 502 U U 1 03 103 903 503 U U 2 04 104 904 504 3 U 2 05 105 905 505 U U 3 06 106 906 506 U U 3 07 107 907 507 U U 4 06 108 908 508 U U 4 09 109 909 509 U U 5 10 110 910 510 U U 5 11 111 911 511 U U 6 12 112 912 512 U U 6 13 113 913 513 U U 7 14 114 914 514 U U 7 15 115 915 515 U U 8 16 116 916 516 U U 8 LABEL TABLE 1: UNASSIGNED 2: BLEND3 3: REGULAR 4: MID GRADE 5: PREMIUM 6: GOLD 7: BRONZE 8: SILVER 9: BLEND2 10: BLEND4 PMC SETUP PMC VERSION: 01.02 VAPOR PROCESSOR TYPE VEEDER -ROOT POLISHER SOFTWARE REVISION LEVEL VERSION 329.01 SOFTWARE# 346329 -100 -B CREATED - 09.01.29.15.44 S- MODULE# 330160 -004 -a SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN -TANK TESTS ISD H i.i5 SE-L- -- BSSR, Inc. 6630 Rosedale Hwy., # B, Bakersfield, CA 93308 Phone (661) 588 -2777 Fax (661) 588 -2786 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Tide 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: IZO SE D LE ?l Fiz f1M I t Bldg. No.: Site Address: 8 6I ZOSIE N) LIE I tw City: ID 11 <E j2SFt E Li) Zip: 9,3-308 Facility Contact Person: T Z0 -` 1 SV-PE RT' fV 0 Contact Phone No.: 6t611588 - D 5 5 -4 Make/Model of Monitoring System: ubrclz-IzooT LOSL(gac(0 '0 Date of Testing/Servicing: ' / oZ I/ (301 a. B. Inventory of Equipment Tested/Certified Check the aoorooriate boxes to Indicate soecific eauioment insoected/serviced: Tank ID: D I E S E L Tank ID: In-Tank Gauging Probe. Model: - 00 a In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Trench Sensor(s).STP Model: v Piping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). Model: - O Fill Sump Sensor(s). Model: Mechanical Line Leak Detector, Model: Mechanical Line Leak Detector. Model: 6- Electronic Line Leak Detector. Model: E T Aq It Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: VIZ01W Tank Overfill / High -Level Sensor. Model: Other (specify equipment a and model In Section E on Page 2). Other equipment type and model in Section E on Page 2). Tank ID: Tank ID: In -Tank Gauging Probe. Model: In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Piping Sump / Trench Sensor(s). Model: Piping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: Tank Overfill / High -Level Sensor. Model: Other s eci ui ment =a and model in Section E on Page 2L Other a ui a and model In Section E on Pape 2). DispenserAD: I Dispenser ID: Dispenser Containment Sensor(s). Model: Ea OR r Dispenser Containment Sensor(s). Model: - O Shear Valve(s). Shear Valve(s). Dispenser Containment Float (s) and Chain(s). Dispenser Containment Float (s) and Chain(s). Dispenser ID: a Dispenser 10: Dispenser Containment Sensor(s). Model: - 1108 Dispenser Containmerd Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Floats and Chain(s). Dispenser Containment Floats and Chain(s). Dispenser ID: DispenserID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Floats and Chains Dispenser Containment Floats 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 verity 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 hiissttoo reppoortt Technician Name (print): DA`4 IC3 1ACI(E 1 T Signature: / Ta Certification No.: A 313 y 5 License. No.: 6-1 AR 1;3L Testing Company Name: _ BSS P_ 1 N C - \ Phone No.:( 661 , S - P Testing Company Address: _G ,30 1Z 0 5U- 6 ALF HW-( 4 Date of Testing/Servicing:a—/,A I OQ 01 0 Monitoring System Certification Page 1 of 4 12/07 2/21/07 D. Results of Testing /Servicing Software Version Installed: 3.1A 6, O Complete the followin g 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 confirmed operational? Yes No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with thou proper o eration? Yes No' If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? N/A v--Yes No' For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system N/A detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (Check all that apply) Sump/Trench Sensors; Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure/disconnection? --Yes; No. Yes No' For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no mechanical overfill prevention N/A 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? d % Yes' e 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' X No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product, Watei If es, describe causes in Section E, below. Yes No' Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, if applicable Yes No' Is all monitoring equipment operational per manufacturer's specifications? In Section E below, describe how and when these deficiencies were or will be corrected. Comments: r C lig r \ Monitoring System Certification Page 2 of 4 12/07 2 /2 1/0 7 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 followina checklist: R--Yes No' Has-all Input wiring been Inspected for proper entry and termination, including testing for ground faults? iY Yes No' Were all tank gauging probes visually inspected for damage and residue buildup? Yes 0 No' Was accuracy of system product level readings tested? 5e' Yes 0 No' Was accuracy of system water level readings tested? Y Yes No' Were all probes reinstalled properly? CYYes 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 will be corrected. G. Line Leak Detectors (LLD): :1 Check this box if LLDs are not installed. ComDlete the followina checklist: 5,-Yes No' For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all N/A that apply) Simulated leak rate: P,3 g.p.h.; 0 0.1 g.p.h ; 0.2 g.p.h. es No' Were all LLDs confirmed operational and accurate within regulatory requirements? S1- Yes No' Was the testing apparatus property calibrated? Yes 0 No' For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ii N/A 3 1 es No' For electronic LLDs, does the turbine, automatically shut off if the LLD detects a leak? N/A L,-Yes No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or N/A disconnected? N,-Yes No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or 0 N/A fails a test? N__-`fes 0 No' For electronic LLDs, have all accessible wiring connections been visually inspected? N/A V/Yes No' Were aA 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: Monitoring System Certification I Page 3 of 4 12/07 3 2/21/07 Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors LG 163 -1, Enc 1. Results of Vacuum/Pressure Monitoring Equipment Testing This page should be used to document testing and servicing of vacuum and,pressure interstitial sensors. A copy of this form must be included with the Monitoring System Certification Form, which must be provided to the tank system owner /operator. The owner /operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Manufacturer: VE- EDl=1-2— RO0 % Model: 33ooao ygp System Type: Pressure; Vacuum Sensor ID Component(s) Monitored by this Sensor: PRO 61J C'C L i N Ic Sensor Functionality Test Result: E?Tass; Fail Interstitial Conununication Test Result: Pass; Fai Component(s) Monitored by this Sensor: E N T L r-! E 7- Sensor Functionality Test Result: ['Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: i Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass-,_0 F Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass, Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass, Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail How was interstitial communication verified? Leak Introduced at Far End of Interstitial Space;' Gauge; 9 Visual Inspection; Other (Describe in Sec. J, below) Vacuum was restored to operating levels in all interstitial spaces: yes No (Ifno, describe in .Sec. J, below) J. Comments: If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor, vacuum/pressure has been demonstrated to be conunuiucating throughout the interstice. SWRCB,,January 200( Spill Bucket 'Testing Report Form This form is intendedfor use by contractors performing annual testing of UST spill containment structures. The completedform anu printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: O S E7 LC- - Z G Oj 7eon . M Date of Testing: - L% - 1 a Facility Address: 5 i 51E A LF W Facility Contact: ( IZO. 5Q ER-Tt ,v p Phone: 6 % - 588 - O 5 5-T Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (ifpresent during testing): E S-rH E Z 2. TESTING CONTRACTOR INFORMATION Company Name: fB 5- Z t C. Technician Conducting Test: -rAC'I/- G-r T Credentials`: 0 CSLB Contractor 94CC Service Tech. 0 SWRCB Tank Tester 0 Other (Specify) License Number(s): 3. SPILL BUCKET TESTING INFORMATION Test Method Used: gfi drostatic 0 Vacuum 0 Other Test Equipment Used: Equipment Resolution: Identify Spill Bucket (By Tank Number, Stored Product, etc.) 1 N t. S L- 2 3 4 Bucket Installation Type: 0 Direct Bury Contained in Sump Direct Bury Contained in Sum2 Direct Bury Contained in Sump Direct Bury 0 Contained in Sum Bucket Diameter: I 0a ' Bucket Depth: I ' Wait time between applying vacuum/water and start of test: Test Start Time (TI): Initial Reading (RQ: Test End Time (TF): a PM Final Reading (RF): I `J o Test Duration (TF - TI): Change in Reading (RF - R;): Pass/Fail Threshold or Criteria: Test. Result: ass . Fa<l : Pass :`: a7 Fail Pass Fail 0 Pass Fail Comments - (include information on repairs made prior to testing, and recommendedfollow -up forfailed tests) CERTIFICATION OF TECRNICIAN RESPONSIBLE FOR CONDUCTING TMS TESTING I hereby certify that all the informatio ontained in this report ' tr , accurate, and infull compliance with legal reyuirement Technician's'Signature: Date: State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements mov KP mnrP ctrinnnnt Monitoring System Certification 1 UST Monitoring Site Plan Site Address: 18 5 1 R os e iJ A L E K W-/ FON r . . . . . . I TAn1 K r1oN iTO tZ: i . CoJar.iZ LEc- rz cA: Roar. . S:I: O :IZ: ::.......... .................... I .................. I....... Date map was drawn: o? / at / aQ1 p3- Instructions If you already have a diagram that shows all required Information, you may Include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly Identify locations of the following equipment, if Installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas;. mechanical or electronic line leak detectors; and in -tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Monitoring System Certification Page 4 of 4 12/07 4 2/21/07 E b t '(D 0f9 L t HW-1 j L:i I I OF I SETUP 21: 15 Pf'] T l:DlESEL Rc 0m m rn. PRODUC;T CODE THERMAL COEFF :.000045 TAI -.IK Di t4METER C1 6, 00 TmIlK PROF I LE I PT LIQUID SE[-)S -DR SETUP TEM 'E FULL V('L 12000 7.'TEI,I ljhTE-,'l'[ME FOR11HT L I :FjlSPENSER I PAN FLOA• ::JIZE: 4.13 IN. Tf*.'I- STATE tSlf'-JGLE FLOAT) DISPENSER PAN WATER WHRI11111C, 2.0 Iflt"H WATER Lli-ilT: :3. 0 ELL, (-'H-qJ:J0G,' El. OR LHBEL .A'L: 1 2000 L -':DISPE[I'SER I ANNULAR C.,VERFILL. L1111T 9041 TRI -SlWTE (SINCiLE FLOAT) J I I'lE 1 1) 1 :-:, A, BLED 10800 i..'ATE(30R` , DISPENSER PAN FT T I ME 2 1) BLED Hl(-,'H PRCJDUC:T 95% F ', T] mE 3 D I ' BLED 1 1400 i! F1 T I NE 1) 1 SriBLED DELIVERY LIMIT I 0%1 12106 L 3:111SPE1,1SER -' Pf4l li): Ek' T-. ST f-jEEDED WRP-J TP I -STATE S I I%i(.,LE FLI' AT:, j i EL Eli 1-01,J PRODUCT 500 t>-lTE(-,'ORlt,' DIS'PENSER PAN i),' " I 1 f'-,I TST HEEDED W RI'l LEAP ALHRI.1 LIMIT: 99 SUDDEN LOSS LIMIT: 99 TfAlql' T I LT 6.60 E RE -Ei-1,8LF METI-Ic[) PROBE OFFSET 0.00 L 4:1)ISPENSER ANNULAR LINE TEST TR I -,'r)TE S I NGLE FLOAT) DISPENSER P 44 I IE PER TST NEEDED WR N SIPHON MAN IFIDLL)ED TANKS 1-HBLED Tg: NONE I ih TST HEEDED WR11 L. I NE 111AN 1 FOLDED Tr'lf'-IKE; SLED TP : [+') NE bL5: DI SER 3 F'ri 'NPEHE TRI —STHTE (Sll,-KL.E FLOFiT) Tt' v'C'LUMES DJ,.--l'F-EN,!l'ER PAN LE J : : M I N PER I ":,li I 0' 0 T 10 I'J r,LUE -:EJEI:'-' F tDu. u LEA}: M I P-J Af••V'-JUAL 0% L 6:D1,13PENSER :3 WINULHR Cl' HE I :;H1' F FS 'ET 0 TR I -STHTE I NGLE FLOAT, CATEGORY • DISPENSER PAN TEST [)URM'AT1()('-1 IJRI::: 12, PER I OD I C TEST T`/PE 0 klPH LINE TEST STAl'-JEJARD 01'dF I P. 1-1 EMABLED L 7:%,/El'IT BOX D ;PH L I I'-IE TEST, TEST F'11L TRI -STATE (SING FLOAT? LE I P,,m: ENABLED ALARM D [SABLED C'ATE(-','OR'-/ : OTHER SENSORS z! IlT PREC" I S I !)I'J LINE RE=:ULTS: 1)1SABLED v-Ep i c)i) i c TEST FA I L I ,_:HT S•- V I 1-4( T I ME ALr-1 ` Ri -1 DiSfABLED L G:VENT ANNULAR C;ROS'S 'PEST FAIL TRI -STATE (SJf*,'LE FLC)imiT) TEM ALARM Cl I SABLED CATEGORY : OTHER SENSORSEJE : oiDucioo TEST t'iv'ERH(-,'l Pli ..OFF PER TEST r"I'VERAGING: OFF I i' (':HHRT S'EC'URITY L. 9:DIESEL TANK ANNULAR TAIll" 'TEST NOTIFY* OFF DUAL POINT HYDROSTATIC ATEGoRV : ANfqULAR SPACE TNK TST SIPHON BREAK:QFF DEL IVERY DELAY I N PUl"IP THRESHOLD :.'10.00% L10:STP SUMP TRI -SMATE FLOAT) liE 1'-IC-• I T LEAK TEST IIETHOD CATEGORY : STF' SUMP TEST ON [A*TE : ALL TANK J-6 SETUP JA N 16.1 u i :s'u SI-111P ANNULARSTARTTIME : E)ISABLED TR I -STATE (S71 NC."LE FLOAT) EST RATE :10.20 GAl- HR i_;ATE(:;ORY : STP SUI,lPDUPHTIONHOURS TST EARL`, STOP : D I SABLED Ll'--':FILL SUMP TRISTATE (Slt.3LE FLOAT) Il- ATEG'ORILE" "K TEST REPORT FC RMAT OTHER SENSORSNORMAL LINE LEAK LOC'KeJUT SETUP L-:i_ c.'};uUT SCHEtiULE Ll'-':FILL SUMP ANNULAR TPI -STATE (SlNILE FLOAT) T11"IE: DISABLED CATE(3'ORV : OTHER SENSORS TlI',IE : D12"ABLED PRESSURE LINE LEAX SETUP DIESEL T;F'_.0 %3.GIhJ FIBEkGLtiSN DIA LEN: 500 FEET 3 . 01 ld D l; LEN: 150 FEET 0.3u PH TEST: DISABLED u. I'D 'PH T5S'T : D I SABLED SHUTDOWN RATE: 3.0 GPH L(JW F'RES,;:;UP.E S'HUTOFF:YES LiW PRESSURE . 20 PSI T I:DIESEL G I SPENSE MODE: STANUAkL 3Eri'OR ; NON--VENTED PRE °;SURE OFFSET: 0.OPSI UTPUT RELAY SETUP R 1 : U I ESEL. OVERFILL T`,—PE: f °K)ME NTARY f lGPM LLY OPEN I f•d— TAPJ}: FLHkI °i5 T 1:GVERFILL ALARM T 1 :HIGH PRODUCT ALARM PLLD —LINE DISABLE — SETUP_ G 3:DIESEL LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL : SHORT ALARI °I PRESSURE LINE LEAK ALL:PLLD OPEN ALARM SMARTSENSOR ALARMS ALL:SETUP DATA WARNING ALL:SENSOR FAULT ALARM ALL:FUEL WARNING ALL:FUEL ALARM ALL: NO VACUUM ALARM SI °IARTSENSOR SETUP I:PRODUCT LINE CATEGORY VAC SENSOR PUMP # : 0 3:DIESEL VOLUME: 20.0 GALLONS RELIEF VALVE: : NO 2:VENT LINE CATEGORY VAC: SENSOR PUMP 9: 0 3:DIESEL VOLUME: 25.0 GALLONS RELIEF VALVE: : NO F, E : ATI °1 PRESSURE CATEGORY ATM P SENSOR SOFTWARE REVISION LEVEL VERSION 326.01 SOFTWARE# 346326 -100 —B CREATED — 176.01.16.17.13 S— I°IODULE4 330160 -060—A SYSTEM FEATURES: PERIODIC IN —TANK TESTS ANNUAL IN —TANK TESTS F'LLD 0.10 AUTO 0.20 REPETITIV WPLLD 0.10 AUTO 0.20 REPETITIV L 1: D iS'PEI'JSER 1, PAN D I - PENSER PAN FUEL ALARM - ARCO AM -Pf °1 7851 ROSEDALE HWYFEB21, 2012 1 : 1 1 Pill i RAKERSFIELD CA,93308 ENSOR HLARI °1 - - - -- DIESEL' jZC j AM / 1 1Yl 1. ' :DISPENSER I ANNULAR. FEB 21 ., 2012 1 :16 Pf °1DISPENSERPAN FUEL HLHRI °I Fi(,' N1 STo ZAP ©Z FEB '= l . 2012 1 : 1 0 PM S',/STEM STATUS REPORT SENSOR ALARM - - - -- Di ES GL L 3:DISF'ENSER 2 PAN 1:HIGH LIQUID ALARM Fi I SPENSER PAN FUEL HLARm 5 2:HIGH LIQUID ALARM FEB 21 , 201 2 1 : U8 Pf °1 SEI'JSOk ALARM - SMARTSENSOR ALARM -- L 4: D I SPEIVSEk 2 ANNULAR 5 I :PRODUCT LINE IVO VACUUM ALARMD1SPENSERPAN FUEL HLARM FEB 21, 2012 1 : 16 Pf °I FEB 21 . 201'2 1:09 PI °I SENSOR ALARM - - - -- SMARTSENSOR ALARM -- L 5:1jl'PENSER 3 PAN 2 :VENT LINE D 1 SPEI,JSER PAN NO VACUUM ALARM FUEL HLHRM FEB 21. 2012 1 .15 PI °1 FEB 21. 2'01'2' 1 :13 Pf °I SEPJSC >R HLARf°1 - - - -- L r.:UISPENSER 3 ANNULAR SMARTSEIVSOk ALARM - DISPENSER PHhd g 1:PRODUCT LINE FUEL HLH HIGH LIQUID ALARM FF.B 21. 2 =0 12 l 12 Pf °10 : FEB 21, 2012 1:16 PM SENSOR ALARM - - - -- SMARTSENSOR ALARM -- L ?:VENT BOX 2: VENT LINE OTHER SENSORS HIGH LIQUID ALARM FUEL ALARM FEB 21, 2012 1 : 16 PI °1 FEB 24. 2012 8:41 AM SENSOR ALARM - - - -- L B:VENT BOX ANNULAR THER SENSORS FUEL HLAkf °I I N -TANK' ALARM - - - -- FEB 24. 2012 8 :4l AM T I :DIESEL OVERFILL ALARM FEB 21, 2012 1:23 PI °1 SENSOR HLAkf °I - - - -: L ;:DIESEL TANK ANNULAR NNULHR SPACE I_CaJ LIQUID ALARM PRESSURE LINE LEAK ALARM i= EB 21 . 2O 12 1:20 PM Q 3: D I ESEL PLLD SHUTDOWN ALARM SENSOR HLikRM - - - -- FEB 21, 2012 1:f2 Pill L y:DIESEL 'TANK ANNULAR HNNULHR SPHCE Hfi ,'H LIQUID ALARM FEB 21 . 2012 1 :20 PM ARCO AI °1 -PI °1 - - SEIdSOk HLHRf °I - - - -- 7851 ROSEDALE HWY Su°IP BAKERSF I ELD CA.,'33308 STP SUM DIESEL FUEL HLAkf °I FEB ? I , 2012 1 : 14 P111 FEB 21 . 2012 1 : '21 PI °1 SEPJSOk HLHkh1 - - - -- L1I:STP SUMP ANNULAR SUM SYS'fEf °1 STATUS REPORT FUEL HLARM I d FEB 21 . 2U l 2 1 : 13 Pf °I ALL FUNCTIONS NORMAL SENSOR ALARM - - - -- L12:FILL SUMP THER SENSORS FUEL "bHRM FEB 21 . '20 1 2 1 :47 PI °1 SEI'40OR ALARM - - - -- L l 3: F I LL SUMP ANNULAR OTHER SENSORS FUEL ALARM FEB 21, 2012 1 :04 Pf °I TV 6630 Rosedale Hwy # B Bakersfield, California 93308 Phone: 661 588 2777 Fax: 661 58$ 2786 To: City Fire Dept From: Kelly Tackett Fam 852 -2171 Date: 3 -1 -12 Phone: Pages: Re: Rosedale Plaza Group CC: Urgent For Review Please Comment Please Reply Please Recycle Comment -s: Attached are monitor certification results for Arno 7851 Rosedale Hwy, Bakersfield, CA Please call if you have any questions. Thanks, Kelly