HomeMy WebLinkAbout#781 FMC RESULTS 7-17-12MONITORING 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 perlorms 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: #7781 Fastrip #22 (South) Bldg. No.:
Site Address: 4013 South H Street City: Bakersfield Zip: 93304
Facility Contact Person: Omero Garcia
Make /Model of Monitoring System: Veeder -Root TLS -350
B. Inventory of Equipment Tested /Certified
Check the appropriate boxes to indicates ecific equipment inspected/serviced:
Contact Phone No.: (661) 393 -7000
Date of Testing/Servicing: 7/17/2012
Tank ID: 12000 gal. Regular 1 Tank ID: 12000 gal. Regular 2
Z In -Tank Gauging Probe. Model: 847390 -107In -Tank Gauging Probe. Model 847390 -107
Annular Space or Vault Sensor. Model: 794390 -420 Annular Space or Vault Sensor. Model: 794390 -420
Z Piping Sump /Trench Sensor(s). Model: 794380 -208 Piping Sump /Trench Sensor(s). Model: 794380 -208
Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model: FX1V Mechanical Line Leak Detector. Model: N/A
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
Z Tank Overfill / High -Level Sensor. Model: 847390 -107 Tank Overfill / High -Level Sensor. Model: 847390 -107
Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2).
Tank ID: 12000 gal. Super Tank ID: 12000 gal. Diesel
In -Tank Gauging Probe. Model: 847390 -107ZIn -Tank Gauging Probe. Model: 847390 -107
Z Annular Space or Vault Sensor. Model: 794390 -420 Z Annular Space or Vault Sensor. Model: 794390 -420
Z Piping Sump /'French Sensor(s). Model: 794380 -208 Z Piping Sump / Trench Sensor(s). Model: 794380 -208
Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model:
Z Mechanical Line Leak Detector. Model: FX1V Z Mechanical Line Leak Detector. Model: FX1DV
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
Z Tank Overfill / High -Level Sensor. Model: 847390 -107 Z Tank Overfill / 1 -ligh -Level Sensor. Model: 847390 -107
Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2).
Dispenser ID: 1 & 2 Dispenser ID: 3 & 4
Z Dispenser Containment Sensor(s). Model: 794380 -208 Z Dispenser Containment Sensor(s). Model: 794380 -208
Z Shear Valve(s). Z Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Floats) and Chain(s).
Dispenser ID: 5 & 6 Dispenser ID: 7 & 8
Z Dispenser Containment Sensor(s). Model: 794380 -208 Z Dispenser Containment Sensor(s). Model: 794380 -208
Z Shear Valve(s). Z Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Floats) and Chain(s).
Dispenser ID: Transition Sump South Dispenser ID: Tranition Sump North
Z Dispenser Containment Sensor(s). Model: 794380 -208 Z Dispenser Containment Sensor(s). Model: 794380 -208
Z Shear Valve(s). Z 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 form. Include information for every tank and dispenser at the facility.
C. Certification - 1 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, 1 have also,
attached a copy of the report; (check all that apply): ® System set -up Z Alarm history report
Technician Name (print): Bryan A Self Signature: 'W.
Certification No.: B37501 License. No.: 804904
Testing Company Name: Confidence UST Services, Inc. Phone No.: (800) 339 -9930
Site Address: 4013 South H Street, Bakersfield, CA 93304 Date ofTesting/Sery icing: 7/17/2012
Page 1 of 3
Monitoring System Certification
D. Results of Testing /Servicing
Software Version Installed: 326.01
Complete the following 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 their proper operation?
Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem)
N/A operational?
Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate
positive shut -down? (Check all that 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
N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank
fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 90%
Yes* No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced
and list the manufacturer name and model for all replacement parts in Section E, below.
Yes* No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
Product; ® Water. If yes, describe causes in Section E, below.
Yes No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, ifapplicable
Yes No* Is all monitoring equipment operational per manufacturer's specifications?
In Section E below, describe how and when these deficiencies were or will be corrected.
E. Comments: I replaced.the annular sensor on the regular 87 71" tank. I also pulled out APPX .5 gallons of water
from that annular.
Page 2 of 3
Monitoring System Certification
F. In- Tank Gauging / SIR Equipment: ® Check this box if tank gauging is used only for inventory control.
Check this box if no tank gauging or SIR equipment is installed.
This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring.
Complete the following checklist:
Yes No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
Yes No* Were all tank gauging probes visually inspected for damage and residue buildup?
Yes No* Was accuracy of system product level readings tested?
Yes No* Was accuracy of system water level readings tested?
Yes No* Were all probes reinstalled properly?
Yes No* Were all items on the equipment manufacturer's maintenance checklist completed?
In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD):
Complete the following checklist:
Check this box if LLDs are not installed.
Yes No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
N/A Check all that apply) Simulated leak rate: ® 3 g.p.h.; 0.1 g.p.h ; 110.2 g.p.h.
Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements?
Yes No* Was the testing apparatus properly calibrated?
Yes No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
N/A
Yes No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
N/A
Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
N/A or disconnected?
Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions
N/A or fails a test?
Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected?
N/A
Yes No* Were all items on the equipment manufacturer's maintenance checklist completed?
In the Section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 3
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04 04 04 02 02 1111
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06 06 06 02 03 U]J
07 07 07 02 04 UH
08 08 08 02 04 1111
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114 2i111 :_i 0 14 90z1 5 11
05 205 305 905 11 H A
06 206 :--:06 9Ci L; 11 11 1
07 -.C17 :-iij7 907 5 11 d
IDS '21-18 :-30 1-1 9138 5 U J
ID9 9 11 U 3 IJ 5 11 it
10 11 LI 9 IJ 5 11 1-1
11 1J IJ 9 U 11 11 ID
12 2 11 U 9 U 11 11 1:1
LABEL TABLE
1: IPIASS I CV,lEE)
2: BLEI%:3
RDAILAR
I-I I 1i :RAGE
5: PRE1,11 U 1
6: GOLF,
7: BRKEE
8: ID ER
9: BLM52
1 0: M.FNQ
i-A,HRI'l REPORT
PAPER OUT
NOV 27 - 2131 1 7: 35 41
PR HTEY-.' ERR-,-P.
VQV 2n AN 1 7:35 Al"I
ENE) :- :-w - - 4
ALARM 1-119100 MORT
T I : UNl-
ILL AD4F.T-1
NOV 28, 2W I I
OCT 10 . <'Ci I I E. 5,1 API
Ot-'T 4 211--i1 I 6:•18 AH
Hi. IVER',"
FEB 5 - 2012 5K :.36 PM
ENE, - .
HtSTOPY REPORT
T 2 ARE -'
O`-.`ERF I LL i L.ARI-1
OCT 1 -1 - 20 1 1 7: ut. Al 1
SUDDEW LOSS ADAR.T,l
6: 111D PH
1:5d Ftl
M f 2. 2M I I :51 P11
El%lD 4: - -'
REPORT
F 3: PNL
7. 2012 11 :07 Al'l
6:1)7 "-1
APR 22. 2012 8:52 PKI
t - - - ENE, > - . .t
ALARl I H I PEF,--RT
PEpriPT
RE F =.F1
T D I ESEL El L 6 F. El:-"
L 3:[,IE'--'-EL STP
DEL P.'ERZ I,IEEDED STP FUEL ";IARfl
V T 5. 2Cl I I 4' I'M
2101,21 1 1 CIF AP11
I IA. u 2ID 53 ...11 FUEL ",ILAPI
27
4 '. 4: . F* 1'.1 [.1 ..
EflD .. - .- --; t - ' EHP '-: 4 .
R[,-1 HI-T.I- Rr' REPORT
L -1:DIESEL, ANN
AIAMULAP SPACE
Al ldf,-l*•**,F.',' REP: RT
R
STF SllrlF
FULL AL 4.1 I
EIJD - - - - -`
EHD
L 15:REC"2 STF.
21T,
FLIEI- -LHF.'H REF, ;.APT
Hi f-. : 1 All1UtjI
FIET-C.IFT JINUL P SPA -:E
c EI-12,e 'T, 'L..Rll
END .- ..
EIAII 'p;
E Nli
REPO -RT
SEIGOR t;LAPH
L 9 : 1) f2jP 1
rjlS,T-EN.`,ER P61'.1
t .. E 11 D - . r
F;LpiRll REP,-;RT
SEN)R'
L I I :DI S1, 5 -C,
l[.-;FEN'sER FH[.j
END . - -t
ALAR11 FUSTORY REPORT
Ljl.SPEH'2ER Pi4l
r D'ID
rLil,riRll PEPOk"I'
IA 3 :NO ARA NC--;
EW; f f t 4 4
ALAWI FUSTOW REPS R7
L I C 80 ARM,,
OVER SENSOR'S,
END- < L, ,
PWI SERIF,
NONE
PRC' C'Ec'-S,0F., LDVEL:
NONE
T I NL I 3 F"'PT
HE 1 H
I N"P.Ea'S:7E
1 I'-h_:HES
I.JoTEP
j UL 1 7. 12
kAl"LLIHE 8LJj
HE I GHT 1 78 f PJC: H E'r-"
I-V'iTEP O-CIF - I I NC'HE"
TE11P 85. , DFC; F
IN, ' 'F.*Ei-i' SE END
JUL 17.- 1 1 : j5
HE I .> IT = 74.05 1 Pll-*HE-'
kViTEP = 0. 00 1 Ph: HF.
TE.11P = C5.5 DD-1 F
T'_7 HE r I r41, PEA:' I i I t.
ONL 2.,
STAP7
JUL 17..
HE I -;HT = 1 NC:HD_I
I.JmTEP . 0.00 INC'HE'STE11P =
HE I __;HT 1 N"HE2,
TE11P
ID
T, 1-iET ID
T I : UHL I
T UML 2 -
I
T F.NL
PROBE iAIT
jI_IL I ; - 2Ci 12 11 ::-2
il
m
T
DELP-)EFi'), I-JEEFlEf)
JUL 17. _20)2, 1 1 ::2,:-, Al-,l
T J : D I F.:-,F
JUL Fj I
L.H'- Ell
T 4:DIE::EL
Ft 171 L LEVEL
11JL
T I I
I N, 1,D 2E 3 F"'PT
HE 1 H 74. 95 1 I'-h_:HES
I.JoTEP FI . 00 1 NC: H E 'S.
HE I i""HT 51 1 E I I,jj`HE._.
I;_,TER J.00 1
TFIlY, F
I H, 'PLO1,21E EIAD
HE I l'Hl'
JUL I jj 1 71 11 ::31:, r1,1
TRIP 85.'2' DEJ-4 F
W(;TEFI I llll"HEE'.
I F, DO' F
Tr' NET 1 30,1
F __':UNL
I I1% E NT :)PY 1
fNl_'R'Lo'SE '.=:fHPT
J0. 1 7 . rf I _
21
11 ::33 HI, I
0- LL PIE 8622 L
HE 1 H 74. 95 1 I'-h_:HES
I.JoTEP FI . 00 1 NC: H E 'S.
35.':' DEC; F
END
JUL 17. 11 :35 ll
I IE
HE I l'Hl' 74. 94 1 Nl':HE__'
TRIP 85.'2' DEJ-4 F
17" NET Ci
T I :M'-IL I
T I
OCILUVIE - L2'.
IN-TH1,1K I : HHL I
T 2 MAE 2 L I UHL I 'TP
PWB (AT
L (
T Sn' S11,117,
JUL 17.- 2o 11 :3E. rlI-I
JUL IV. 11 :41 All FUEL L Rfl
11-IL 17. 11:44 rill
4:DIESEL
I IT-iEhTt-,Rv
I I,,i(: RED ;_E =:TmRT
11-IL t 7 - x'11 1 '-' I I
I1 -111.1 t- - AL'S
HEIGHT = I Q 50 1 NQM
LATER = 0.00 Wiss
TEMP AW6 W F
I NOREASE END 2
JUL P. 2012 11:, -,avWl
V,DLIJI'!E = 4t,r8
HE 1 HT = 45 .-,30 ff -JCHF.R
LATER = 0, 00 HKHEc'-
TEMP 84.:3 DEC,' F
I HCREH:IE= 3569
Ti' NET J,52:
PR' TE OUT
J1 JL 1 7 . 20 1'-' 1 1 :39 fill
UOLI-111E 0 1 -; :
HE 1 ;HT = 0 . CIO I Nt-'HE.--`
1,1;-;TER = 0. CIO I I*:'HEI.-'.
TEI*1P = 0. 0 DE,- F
I F-ND
JUL 17, 2M2 HWQI
V,:')LUME = 8503 -
HE I GHT = 7c!.03 INr:'HE.`-
ATER = 0,00 Ihf:'HE:'.
TEI•IP = 25.5 DEG F
W NET WREASE- 8351
T 2: WE 2
HVEMYNINCIDAF.
I IK:PEH!,L*, TiLfl;!T
3 11L 17. 201'-' I I : LI I All
VOUKE 810 ALS
HE I C4HT 7,1. 35 1
WWER 0, 00 INES
TEf1F' 85.5 DE,-; F
I EN[i
JI-E 17. 2012 11 :43 W
HE I (,HT = 74.,-35 1I,-)(::HE2",
1 ;k -TER = 0.00 INI::HES.
1,0111P m 3. L, LID.; F
T(' NET 111-:'REASE= -1
rWW FNVED TW.".
T 1 : UPE I
T 2 MAE 2'
Muls 9503 isALi
1. 5:RE,-;2 2',17F
sTr. ::Jji-ir,
FUEL ;)L.;4.H
1 U1, 17. 1 : I 1 4 *1
L SUPER .2-TT,
on*
FUEL ALF)PH
II L IV - 201 2 11 147 W-1
L 7:.:'.UT'EP STP
STP SUP*IF'
FLIEL ALHPI1
J UL. 17, till p H : 4 V Af-I
L -1:IAESEI., :_TP
so Sul
FUEL ALARP-I
UL 1'7. ;;11i1'C' 11 :4u rill
T I : HNL I
Hl,:;H PPODI-Ii:'T ;,,D-;RI-I
A LIL 17 - I- I I: 4 cl r-if-1
i'A/EPF ILL HLHRl'l
3 I-IL 1' • '--'IJ I'-' 11
1-0:-"T., IF, I
40I:-i F1.H 9T
EllKF.P. F I E LD 9:-3:71'
111). 11. 21-1112 11 :J9 t4I
REPORT
T I ','A"ERT I LL AD F.T'!
L 1-2
I' 'F'ElTrIER PH'14
FUEL
JUL 17. 201' • I t :F0 1-11
IH-TAI`! }: AL(APH
T 1111L -,
11 -'T ALARVI1 , H F
JUL 1 7 201 ---' I I: 5L
L U-IE 7140
HEIGHT = E3. D'-: I PI H
Jt`FER = 1-1.91-1 1 HCHES
TPIP = :1-4. 1 DEG* F
I END
JIJI 17• .7, 1- 1 '71 1 1I - -1
HE 16 'HT =1L16.90 1
1;.1, -;TER IJ. 9iI I ICHES
TE1,117, 9i DEC,, F,
4 '7
Tf-' I'-IET a b- 4:2
T 2:1-114L 2
1141 EiGE
START
JUL 17. 2012 11:48 i-Ill
HEIGHT = ?4.:=5 1 N,'.:HE2'
I.-JoTER = ID. 01-1 1 11CHE"',
TDIP = 85.3 IlEt" F
I N1-; PEA 'S'E END
I I JL 17• '2111'2 I I :511 ill 'I
HE 1,,HT
1,16TER F-1.00 P11-:1-1EE.".
TEPIP DE,-,' F
INCRE(iSE=
T,-' IIET
T I : UNL I
T 2: UIAL "
Id'ol-lil -IE 4 752, L:"
FUEL ALHPri
JUL I I _: -1f 1 2 1 1 51 iA -1
LI I : E,
FL IEL ALARV•1
JUL 17. ;5-. i%41
F'""STRIP 7e1
101:) - S H S. T
B6)::EP'S'FIELD
JUL 17. 2111'-.' 11:52
T
HI1'.;H PRA.-)U(1' F;Lr F.19
JUL 17. '201'2 11:5:1 41
L I 'i : F, I 'S' P 7,
DI""PE'VISER FAN
FUEL t"'Lt+Pll
JUL I'i'.
EftPz"OR1
pf:4qC-.
THEE' Fs STRI I` I
FUEL ALAM-f L n00; 2 PAN 403 S.H ST
JUL 17. 2012 11:54 H4-1 HHNULt)R :P C'E BAKERSFIEIIj W.90304
FUEL f:iLoRll
JUL 17. '2012 11 :5E All
Ttl. 17. ',V11 59 Al I
L ":FUEI- AL PH
T WIESEL L -4:T-LJFJ-- ALAPI-)
Hll.';H PPCN-k T :,LiRt-1
1121E I L, Ci 12 1 1 : 55 Ai,l L L H:FUEI- ALARI'l
FUEL. ALHW'l
17. 1 1 :57 A)H
2
Ti-' HET 1 '7284
IN 'rAic' At,4Fi•i
T b I ESE].
PKAL our
JUL 1'.'. 20 1.-, 11 :55 it -1 T
PMDE Out'
SENSOR ALARI'l
F H S T);., I P L 4:C, I ESEL 'NIA
4012 S-H ST HNNIJI-AR Sf,A cE
Bi;l,,'LRSFfELL' ('m.93'104 FUEY, ALAPP-1 -- I fll -Ti4fiV i-;LART•1
JUL 17.- '201'_ I1 :5'F AM T
PlVi LID FUIL
JUL I", - 20 12 1 1 :5t, Ai-i -P-11- D:112 1*2:131
L L':0A. I ANN
OTHET-*.,
FUEL ALARM
JUL 17• 2012 11 :56 All
PRODI-IC:T HLi:4P.rl
JUl. IT 2012 H :55 W-1 T 3:PNL
HlGH PP( DU-:1 ALARrl
JUL 1?. 2012 11:54 041
4669 C4,,I-12'
A I( BHT - 4!DD. 1:: 1 1 [117.:HES
WATER = Ci 00 1 Hf-:HES
TEIIP - DE13' F
T 4TIESEL
O'•-ERF ILL mi-ARri END
JUL 17. zol'-, I I JUL 17. 2131*-' 11 57 All T 3: F-111-
i)',iERF I LL
0C. I Lrj JUL 17 - _012 11 59 "-1
HE I (,HT p I I I jl l I NCHE.-;
1,1 TEP I-1.1hi 111(liFS
TEHP z . ', : IIF- I -.; F
2
Ti-' HET 1 '7284
IN 'rAic' At,4Fi•i
T b I ESE].
PKAL our
JUL 1'.'. 20 1.-, 11 :55 it -1 T
PMDE Out'
SENSOR ALARI'l
F H S T);., I P L 4:C, I ESEL 'NIA
4012 S-H ST HNNIJI-AR Sf,A cE
Bi;l,,'LRSFfELL' ('m.93'104 FUEY, ALAPP-1 -- I fll -Ti4fiV i-;LART•1
JUL 17.- '201'_ I1 :5'F AM T
PlVi LID FUIL
JUL I", - 20 12 1 1 :5t, Ai-i -P-11- D:112 1*2:131
L L':0A. I ANN
OTHET-*.,
FUEL ALARM
JUL 17• 2012 11 :56 All
T 2; PNL
5,'556
BEIVOR AWAY
L 2: UPIL I i4101 L 5:
sn. 2UPIP,
1 IT::HES
UHER SEI'Cv.)R'S,
L ATER iD. ?F
SENSOR' OUT
1. ":D[E'2;Fl. c4p
JUL 1'7. 201'% 11 :5::: i:'I'l JUL 17• :21:112 FT'l 111L 171 F
RTP SINIP
49,49 l_.4ALS
HE 1,OHT d7.87 MC H0
WATER 0 A0 I MAE.=,
TEMP 934 PEG F
I WCRE08E END
JUL 17. 71012 12:01 PH SENSOR ;-;LARI,l ENSOR
VC) L UllE 11590 L 2:1-111L I AIT-1 L t:R'Et.;
A01110D&,'
isiGHT m02.31 I4 HEM: OTHER SDISORE SENSOR
WTER 0,00 HCAES SMQOR OUT AUAI,l UL
TEMP 93-D DD, F0 JUL 17, 2W2 12:09 P11
GWSS 6011
I'C: 14FT I R9
FA: arm P 701
4W3 S.11 31' L XF
ELD Sul SHIP
S0'1 OR Gm' AL ARl"I
JUL 17•
JUL. [7. !_'012 12:09 Fl-I
T 3ANIL
IMEMODIWAIRE
I (+:RFASE STi4FT
JUL 17. Cll:_-' 12:01 V-1.1 L Yff 6L(;Kel
VOLUIlE 517? i;HLS iLARNHEIGHT19.54
DATER 0.75 lfl('HE:' Eosr-ENSEF., Pf-inTEMP9's.? [,E(.,' F SENOR 09r NVRI-.l
JUL 17. *21JI:' 1-2:12 FT-I
I El't,
JUL 17• '21012 12:00 FTI
IE 5,'556 CALS
HE I,'.,Hl' T'Cl. 84 1 IT::HES
L ATER iD. ?F I t+"HEE 1. ":D[E'2;Fl. c4p
TEMP 93.2 EGO F RTP SINIP
OUT ALARI-I
179 L 8:SUPEFl ;.JjqTf:' NET 114l:'REASE 176
OIIT HL,'iRTI
JUL 17. _2012 Pill
L I:UNL I STP
90 sollf.
JuL 17. 21:11"' FT.;
L 13: IT) ARANS
L 2: U1,4L 1 + 111'4 OTHER WNSORS
THER SElt,Ok
FUEL AL iRll J LI L 17
JUL I ? - 12: 04 PI"I
L 4:DIESEL ml,114
Soso? ow, MAKI
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11!
1"., pI*I
DER rau
GECX)P "')LIT mLeRfl
3 IJL 17 1
L I I r.) I P 5 -E
L I I
JUL
0 HLHPIA
j 1) L ;2:
SEA GLHPII ----
L 2:1WIL I 1%II - I
SFm OT iALHF.TI
JUL 1 7 - 2m '--' 12 : 12 R:
SEA R ". L RIPI
JNL I ;LOJu
iJTHER SEAa
FUEL -Fll
Ml- 17. S 1
I r RDeE EIALI
ImENTP I Wi- . F- F
PI-1
i REA'- F RT
L IS 232!2 2
HE I C'= 5"Ca. ::;,:4 1
I'li"T P" q19 HES
I 97,n DEC. F
I r RDeE EIALI
J 11L !7. 20 12 112 :24 PI-1
HE I
0
IlET I
T 2: 11111 L 2
NVENTORV I
JUL 17. 2012 FTI
7F) ES
clY I NCHD'
0 Fit) !&w
FDD; ' TEHP
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HE I f-AiT
TER = u.0o
TFI--IP = eSgnl-t,' F
T"-WE-2
T 1:1,11,IL 1
T 2:UNL 2
A)LI-11 IF 520
T"-WE-2
T 1:1,11,IL 1
T 2:UNL 2
A)LI-11 IF 520
LIT- )R )R
1 1-1: 11 P-;P 7-8
FUEL -,LARTI
RIL 17 - 20 12 1 2 : '2!S PH
T I : OHL I
JUL 17. -,jjI I5 Y M
111-1--hL i"LAR11
JUL 17. 2012' 1 :2'X PH
Fr STR I P 7.8i
4ID I :- S. . H ;-DT
JIIL t7.
REI%'T-.,T
ALL FI ll%Ji.:
THE -'E 1, F.,17
FLIEL ALI
THEE.'
FUEL
JIC 17.
FHS_TRIP '7:.-1
S-H
E:,1,)).F.R1.-'-F I ELL,
JUL 17. 201 1
STEM -THd'u` R' I- P,,' PT
LL F1.11' IC'j HC RI'l-L
SWRCB, January 2006
Spill Bucket Testing Report Form
Thisform is intendedfor use by contractors performing annual testing ofUSTspill containment structures. The completedform and
printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: #7781 Fastrip 422 (South) I Date of Testing: 7/17/2012
Facility Address: 4013 South H Street , Bakersfield, CA 93304
Facility Contact: Omero Garcia I Phone: 661- 393 -7000
Date Local Agency Was Notified of Testing : 6/19/2012
Name of Local Agency Inspector (rfpresent during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bryan A Self
Credentials: 9 CSLB Contractor Z ICC Service Tech. xN SWRCB Tank Tester Other (Specify)
License Number(s): CSLB #804904 ICC #8022804 -UT Tank Tester# 11-0756
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: N Hydrostatic Vacuum Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (By Tank
Number, Stored Product, etc.
1 Regular 1 2 Regular 2 3 Super 4 Diesel
Bucket Installation Type: Direct Bury
Nx Contained in Sump
Direct Bury
xN Contained in Sump
Direct Bury
xNContained in Sump
Direct Bury
xNContained in Sum
Bucket Diameter: 12.00" 12.00" 12.00" 12.00"
Bucket Depth: 14.00" 13.75" 14.00" 14.50"
Wait time between applying
vacuum /water and start of test:
5 min. 5 min. 5 min. 5 min.
Test Start Time (Ti): 1 1:10 am 1 1:10 am 11:10 am 1 1:10 am
Initial Reading (Rj): 9.00" 8.50" 9.25" 9.00"
Test End Time (TF): 12:10 am 12:10 am 12:10 am 12:10 am
Final Reading (RF): 9.00" 8.50" 9.25" 9.00"
Test Duration (TF — Ti): 1 hour 1 hour I hour I hour
Change in Reading (RI, - Ri): 0.00" 0.00" 0.00" 0.00"
Pass /Fail Threshold or
Criteria: 0.0625" 0.0625" 0.0625" 0.0625"
Test Result: Nx Pass Fail x Pass Fail x Pass Fail I x Pass Fail
Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
hereby certify that all the inforNation contained in this report is true, accurate, and in full compliance with legal requirements.
Technician's Signature: 4f— Date: 7/17/2012
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
SITE PLOT PLAN for:
LEGEND015 - 021 -03022 ESO EMERGENCY SHUT -OFF
721/ #781 FASTRIP #22 OFA OVERFILL ALARM
4013 SO. "H" STREET
B PRODUCT
VAPOR SPILL
SPILL
BAKERSFIELD, CA 93304 ANNULAR
FIRE EXTINGUISHER
GAS METER SHUT -OFF
WATER METER SHUT -OFF
O HEALY CAS
EVACUATION MEETING POINT
3 - 12,000 GALLON 1 20019 721 "L" SENSOR SETUP:
L1 87 STP
I _ L6 Q V
LISTS
sL -
L2 87 ANNULAR
L3 91 STP
L L5 ESO
H r-- TP, 1 1
721
1 7
L4 91 ANNULAR
L4 OA P'Jf Y 91 1
LS DSLSTP
L6 DSL ANNULAR
L2 A r v 87 Ll
L9 UDC 9/10
L..4- - -- --
1 16 1s
L10 UDC 11/12
L11 UDC 13/14
9 1 L12 UDC 15/16
L13 UDC 17/18
L14 UDC 19/20
1
R1IT
BREAKER
0
P/V I TLS350
VENTS #781 #721
qOFA
Lit Q L9 i
LI
II
l5
II
L7
II
L3
781 87 -1 87 -2 91 DSL1
2 1
OA"IllI
II
I.
Q 111 5
I
4.
USTs
R
V MrM LAM
781 "L" SENSOR SETUP:
Ll 87 -1 STP
FIRE L2 87 -1 ANNULAR
HYDRANT L3 DSL STP
L4 DSL ANNULAR
L5 87 -2 STP
L6 87 -2 ANNULAR
L7 91 STP
L8 91 ANNULAR
L9 UDC 1/2
L10 UDC 7/8
Lll UDC 5/6
L12 UDC 3/4
L13 NO. TRANS
L14 SO. TRANS
Rr#ls M4
SCALE:
1 ° = 30'
W JAMIESON H1%CO
3101 STATE R
BAKERSFIELD CA.,
SITE PLAN FASTRIP - 7 -721 rums
CONVENIENCE MARKET FOR: SHEff N0.
JAMIESON HILL COMPANY ADO4013S. H STREET
BAKERSFIELD, CALIFORNIA OF 1
t`+*IDoti 0 ID4oa `o C,
UST= UST
rAUcs% °CES+ Job Order / Invoice # 2°/ 3 2
BUILD WITH CONFIDENCE
co.u.nck ....nca+Froenn
Date Call Made Time To Whom Station Control Number Repair Date Invoice DateTollFree #: 1- 800 - 339 -9930 1' -r2
Name Confidence UST Construction Inc.
rne-s -Pa r a
Work performed at Station number:
W c
U
Street 16250 Meacham Road Street ) U 13 Gam`
City Bakersfield, Ca 93314 City tat Zpg OuJ
Total C Mileage
Terms Store number:
Description of work performed:
Total Amount
Invoice A + B + C
a - lcti
1 v < <CAC ' -664 1
r
Labor
Date Name / Number Class Hours Hourly
Rate
AmountArrivedDepartedLaborTravelTotal
f o'1 f' Ti
AM
PM
AM
PM
Tax ( If applicable)
Total C Total B
C Cp 33-
May we please have your comments regarding service / equipment provided by the above named contractor:
PM PM
Store Employee Printed Nant
Store Employee Signet re 1 Date p
AM AM
PM PM
Employee Signature Date Vendor Signature Date
Contractor Supplied - Materials - Rentals Amount Sub -Total
Quantity
Total A Labor
rne-s -Pa r a
Cam' Total B Material
bo,f+ c-f Y o -f Le— TL's i c% Total C Mileage
Total Amount
Invoice A + B + C
Z } Y9,1,1-1&,Y- `
Accounting Breakdown
Mileage
Miles Rate Total Sub Total
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 Nant
Store Employee Signet re 1 Date p
INVOICE - 4 HITE 'A U V SITE - CANARY