The URL can be used to link to this page

Home My WebLink About1125 COFFEE ROAD FMC 2011 Test ResultsI,- -PPTanknology 11000 N. MoPac Expressway, Suite 500 Austin, Texas 78759 Phone: (512) 451 -6334 Fax: (512) 459 -1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR CRAIG PERKINS 1501 TRUXTUN AVE. BAKERSFIELD, CA. 93301 Test Date: 10/18/2011 Order Number: 3187188 Dear Regulator, Date Printed and Mailed: 11/04/2011 Enclosed are the results of recent testing performed at the following facility: CHEVRON 203576 1125 COFFEE RD. BAKERSFIELD, CA. 93308 Testing performed: Impact Valve Leak detector tests Monitor Certification Secondary Containment -Spill Container Sincerely, Dawn Kohlmeyer Manager, Field Reporting 1 Work Order: 3187188 PERMIT # ENHANCED LEAK DETECTION LINE TESTING SB-989 SECONDARY CONTAINMENT TANK TIGHTNESS 1(_PUEL MONITORING CERTIFICATION SITE INFORMATION BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANKS ME NE NSF ONT tA Prevention Services e w.,.b .,,: , ,•. -,,, ,v. 11 .r 2101 H Street APPLICATION EIRE A` r Bakersfield, CA 93301 TO PERFORM ELD /LINE TESTING/ Phone: 661 - 326 -3979 . Fax: 661-852-2171 SB989 SECONDARY CONTAINMENT T Page I of 1 TESTING/TANK TIGHTNESS TEST AND YES NO TANK # FUEL MONITORING CERTIFICATION VOLUME Please note that these are separate individual tests and will be charged per separate type test accordingly.) PERMIT # ENHANCED LEAK DETECTION LINE TESTING SB-989 SECONDARY CONTAINMENT TANK TIGHTNESS 1(_PUEL MONITORING CERTIFICATION FD209S(Rev 03/08) Tanknology Inc. 11000N. MoPac Expressway, Suite 500, Austin, Texas 78759 SITE INFORMATION FAC C.n .-* go 3 ,51 t ME NE NSF ONT tA ADDRESS c } (. S l-,V 1 i ee_ OWry g AME 1 atzly% OPERA? R NAME Uro" PERMIT TO OPERATE A OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES NO TANK # VOLUME CONTENTS 3 a IL fie u1 TANK TESTING COMPANY TESTING C NPAN NAME & PHONE # OF CONTACT PER ON c lIp MAILING ADDR SS. t35 ULWrlse l r(__ &,ti, #]> h IeCu a C F4 oi5 0 E 8 PHON OFT STER O SPECI L INSPECTOR ei oa a CERTIFICATION • DATE 6 TIM 0 TEST TO BE C NDUCTED W et-me 1/IA. ICC TEST METHOD APPLICANT SIGNATURE 94Wn DATE T S APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY DATE FD209S(Rev 03/08) Tanknology Inc. 11000N. MoPac Expressway, Suite 500, Austin, Texas 78759 Tan PURPOSE: COMPLIANCE TEST DATE: 10/18/11 CLIENT: CHEVRON PRODUCTS COMPANY 145 S. STATE COLLEGE BLVD SUITE 400 BREA, CA 92821 TINA SCOLARO 714)671 -3356 TANKNOLOGY CERTIFICATE OF TESTING 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451 -6334 FAX (512) 459 -1459 TEST RESULT SUMMARY REPORT WORK ORDER NUMBER: 3187188 CUSTOMER PO: 15071518 SITE: CHEVRON 203576 1125 COFFEE RD. BAKERSFIELD, CA 93308 PATTY 661)588 -9066 TEST TYPE: TLD -1 Product Pine Tinhtness Test Results LINE ID LINE PRODUCT LINE MATERIAL DELIVERY TYPE TEST RESULT A B C D FINAL LEAK RATE (gph) A B C D IMPACT VALVE FUNCTION 12k 1 SUPREME DW FIBERG PRESSURE SERIAL # ID Y 12k 2 PLUS DW FIBERG PRESSURE MODEL # SERIAL # Y 12k 3 REGULAR DW FIBERG PRESSURE P Y Fxicfinn I ina I aair natartnr Tacf LINE EXISTING LEAK DETECTOR #1 EXISTING LEAK DETECTOR #2 MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESULT 12k 1 VEEDERROOT ELECTRONI 011505 P 12k 2 VEEDERROOT ELECTRONI 013652 P 12k 3 VEEDERROOT ELECTRONI 013649 P Npw Rnnlar_ampnt I inp I Pak nefer_tnr TP_Stf LINE ID REP AGE LEAK DE ECTOR #1 REP ED LEAK DET ECTOR #2 MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESULT ror owner Qetaded report mtormauon, visit www.tanicnoiogy.com ana select un -Line Keports -wKAr, or contact your iocai t amcnoiogy omce. Tester Name: EDWIN PINEDA Technician Certification Number: 8026748 Printed 11/04/2011 08:06 MTUTTLE INDIVIDUAL TANK INFORMATION AND TEST RESULTS op Tanlvio cW TEST DATE: 10 /18/11 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3187188 CLIENT:CHEVRON PRODUCTS AUSTIN, TEXAS 78759 (512) 451 -6334 SITE:CHEVRON 203576 TANK INFORMATION Tank ID: 12k 1 Tank manifolded: NO Bottom to top fill in inches: 165.0 Product: SUPREME Vent manifolded: YES Bottom to grade in inches: 170.0 Capacity in gallons: 12,068 Vapor recovery manifolded: YES Fill pipe length in inches: 54.0 Diameter in inches: 111.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 292 Overspill protection: YES Stage 1 vapor recovery: DUAL Material: Dw STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: COMMENTS TANK TEST RESULTS Test Method:VacuTect LEAK DETECTOR TEST RESULTS Test method: FTA Start (in) End (in) Dipped Water Level: New /passed Failed /replaced New /passed Failed /replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VEEDERROOT Ingress Detected: Water Bubble Ullage Model: ELECTRONIC Test time: S /N: 011505 Open time in sec: Inclinometer reading: Holding psi: VacuTect Test Type: NOT Resiliency c s NOT VacuTect Probe Entry Point: TESTED Test leak rate ml /m: 189.0 TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: 3.00 Water table depth in inches: Results: Pass Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: TLD -1 LINE A B C D Material: Dw FIBERG Diameter (in): 2.0 Length (ft): 225.0 Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: YES Printed 11/04/2011 08:06 INDIVIDUAL TANK INFORMATION AND TEST RESULTS r Tan TEST DATE: 10 /18/11 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3187188 CLIENT:CHEVRON PRODUCTS AUSTIN, TEXAS 78759 (512) 451 -6334 SITE:CHEVRON 203576 TANK INFORMATION Tank ID: 12k 2 Tank manifolded: NO Bottom to top fill in inches: 166.0 Product: PLUS Vent manifolded: YES Bottom to grade in inches: 171.0 Capacity in gallons: 12,068 Vapor recovery manifolded: YES Fill pipe length in inches: 55.0 Diameter in inches: 111.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 292 Overspill protection: YES Stage I vapor recovery: DUAL Material: Dw STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: COMMENTS TANK TEST RESULTS Test Method:VacuTect LEAK DETECTOR TEST RESULTS Test method: FTA Start (In) End (in) Dipped Water Level: New /passed Failed/replaced New /passed Failed /replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: VEEDERROOT Ingress Detected: Water Bubble Ullage Model: ELECTRONIC Test time: S /N: 013652 Open time in sec: Inclinometer reading: Holding psi: psi: VacuTect Test Type: NOT Resiliency NOT VacuTect Probe Entry Point: TESTED Test leak rate ml /m: 189.0 TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: 3.00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: TLD -1 LINE A B C D Material: Dw FIBERG Diameter (in): 2.0 Length (ft): 225.0 Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: YES Printed 11/04/2011 08:06 INDIVIDUAL TANK INFORMATION AND TEST RESULTS i 713nimol cW TEST DATE: 10 /18/11 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3187188 CLIENT:CHEVRON PRODUCTS AUSTIN, TEXAS 78759 (512) 451 -6334 SITE:CHEVRON 203576 TANK INFORMATION Tank ID: 12k 3 Tank manifolded: No Bottom to top fill in inches: 165.0 Product: REGULAR Vent manifolded: YES Bottom to grade in inches: 170.0 Capacity in gallons: 12,068 Vapor recovery manifolded: YES Fill pipe length in inches: 54.0 Diameter in inches: 111.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 292 Overspill protection: YES Stage I vapor recovery: DUAL Material: Dw STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: COMMENTS TANK TEST RESULTS Test Method:VaCUTeat LEAK DETECTOR TEST RESULTS Test method: FTA Start (in) End (in) Dipped Water Level: New /passed Failed /replaced New /passed Failed /replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VEEDERROOT Ingress Detected: Water Bubble Ullage Model: ELECTRONIC Test time: S /N: 013649 Open time in sec: Inclinometer reading: Holding psi: VacuTect Test Type: NOT Resiliency c s NOT VacuTect Probe Entry Point: TESTED Test leak rate ml /m: 189.0 TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: 3.00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: TLD -1 LINE A B C D Material: Dw FIaERG Diameter (in): 2.0 Length (ft): 225.0 Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: YES Printed 11/04/2011 08:06 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of Califomia 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. If more than one monitoring system control panel is installed at the facility, 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 form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: CHEVRON 203576 Site Address: 1125 COFFEE RD. Facility Contact Person: PATTY Make /Model of Monitoring System: B. Inventory of Equipment Tested /Certified Check the appropriate boxes to indicate specific equipment inspected /serviced City: BAKERSFIELD Contact Phone No: 588 -9066 Date of Testing /Service: 10/18/2011 Work Order Number: 3187188 CA Zip: 93308 Tank ID: T1 SUPREME Tank ID: T2 PLUS X In -Tank Gauging Probe. Model: MAG PROBE X In -Tank Gauging Probe. Model: MAG PROBE X Annular Space or Vault Sensor. Model: VR-420 Annular Space or Vault Sensor. Model: VR-420 X Piping Sump/Trench Sensor(s). Model: VR208 Piping Sumprfrench Sensor(s). Model: VR -208 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 X Electronic Line Leak Detector. Model: ELECTRONIC X Tank Overfill/High -Level Sensor. Model: PROBE /FLAPPER Tank Overfill /High -Level Sensor. Model: PROBE /FLAPPER 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: Tank ID: In -Tank Gauging Probe. Model: MAG PROBE In -Tank Gauging Probe. Model: X Annular Space or Vault Sensor. Model: VR-420 Annular Space or Vault Sensor. Model: X Piping Sumprrrench Sensor(s). Model: VR -208 Piping Sumprrrench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector. Model: ELECTRONIC Electronic Line Leak Detector. Model: Tank Overfill /High -Level Sensor. Model: PROBE/FLAPPER Tank Overfill /High -Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other eci equipmentsptymentqp type and model in Section E on page 2). Dispenser : 1 -2 Dispenser ID: 7 -8 Dispenser Containment Sensor(s) Model: BE[ -406 X Dispenser Containment Sensor(s) Model: BEI -406 Shear Valve(s). X] Shear Valve(s) Dispenser Containment Float(s) and Chain(s). 7 Dispenser Containment Float(s) and Chain(s). Dispenser ID: 3-4 DispenserlD: 9 -10 X Dispenser Containment Sensor(s) Model: BEI -406 X Dispenser Containment Sensor(s). Model: BEI -406 FRI Shear Valve(s). Pq Shear Valve(s). Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5-6 Dispenser ID: RI Dispenser Containment Sensor(s) Model: BEI -406 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). If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification I certify that the equipment identified in this document was inspected /serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): System set -up Alarm history report Technician Name (print): EDWIN PINEDA Signature: l,j i 1) AV Certification No.: License. No.: 743160 (Class 'A' General Enginering Contractor License) Testing Company Name:Tanknology Phone No.: (800) 800 -4633 Site Address: 11000 N. MoPac Expressway, suite 500, Austin, TX 78759 Date of Testing /Servicing: 10/18/2011 Monitoring System Certification Page 1 of 3 Based on CA form dated 03/08 Site,Address 1125 COFFEE RD. D. Results of Testing /Servicing Software Version Installed: 327.04 Complete the following checklist: Monitoring System Certification Date of Testing /Service: 10/18/2011 El Yes No' Is the audible alarm operational? 0 Yes No' Is the visual alarm operational? x Yes No' Were all sensors visually inspected, functionally tested, and confirmed operational? x 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? x Yes No' N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? x Yes No N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (check all that apply) x Sump/Trench Sensors; Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure /disconnection? Yes No x Yes No' N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanicaloverfillpreventionvalveisinstalled), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? so 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 re lacement arts in Section E, below. R x No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) Product; x Water. If yes, describe causes in Section E, below. No' Was monitoring system set -up reviewed to ensure proper settings? Attach set -up reports, if applicable. No' Is all monitoring equipment operational per manufacturers' specifications? In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: 7EPI_T ESTP.UP•111 r9_1LVE i7aids'SiMIKD11ETO yi11LrI.G Lffl, & DETECTOR TES Page 2 of 3 Based on CA form dated 03/08 Monitoring System Certification Site Address: 1125 COFFEE RD. F. In -Tank Gauging / SIR Equipment Check this box if no tank gauging or SIR equipment is installed. Date of Testing /Service: 10/18/2011 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: 0 Yes No' Has all input wiring been inspected for proper entry and termination, including testing for ground faults? 0 Yes No - Were all tank gauging 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? El Yes NO * Were all probes reinstalled properly? X Yes No. Were all items on the equipment manufacturers' 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 * N/A For equipment start -up or annual equipment certification, was a leak simulated to verify LLD performance? Check all that apply) Simulated leak rate: 0 3 g.p.h 0.1 g.p.h 0.2 g.p.h x Yes No * Were all LLDs confirmed operational and accurate within regulatory requirements? X Yes No " Was the testing apparatus properly calibrated? Yes No * Q N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? a Yes No * N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? M Yes No * N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? M Yes No * N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? M Yes No * N/A For electronic LLDs, have all accessible wiring connections been visually inspected? rull L^J Yes No * Were all items on the equipment manufacturers' 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 Based on CA form dated 03/08 SWRCB, January 2002 Page 1. Secondary Containment Testing Report Form This form is intendedfor use by contractors performing periodic testing ofUST secondary containment systems. Use the appropriate pages ofthis form to report results for all components tested. The completedform, written test procedures, and printouts from tests (ifapplicable), should beprovided to the facility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: CHEVRON 203576 Date of Testing: 10/18/2011 Facility Address: 1125 COFFEE RD. , BAKERSFIELD, CA, 93308 Facility Contact: PATTY Phone: ( 661) 588 -9066 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): ERNIE MEDINA 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Technician Conducting Test: EDWIN PINEDA Component Imm Credentials: X CSLB Licensed Contractor RIM SWRCB Licensed Tank Tester Spill Box I SUP FILL License Type: A -UT I License Number: 743160 - 8026748 Manufacturer Manufacturer Trainine Component(s) Date Training Expires PHILTITE SPILL BUCKET 08/02/2012 Spill Box 2 PLU FILL 000 3. SUMMARY OF TEST RESULTS Component Component Imm RIM Spill Box I SUP FILL 000 00 Spill Box 2 PLU FILL 000 00 Spill Box 3 REG FILL 0000 00 0000 00 0000 00 000 00 0000 00 0000 00 0000 00 000 00 0000 00 D00 001 If hydrostatic testing was performed, describe what was done with the water after completion of tests: WATER WAS PLACE IN DRUMS FROM SITE AFTER TESTING CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best ofmy knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: e Date: 10/18/2011 SWRCB, January 2006 9. Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing ofUST spill containment structures. The completedform and printouts from tests (ifapplicable), should be provided to the facility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: CHEVRON 203576 DateofTesting: 10/18/2011 Facility Address: 1125 COFFEE RD. , BAKERSFIELD, CA, 93308 Facility Contact: PATTY Phone: ( 661) 588 -9066 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (ifpresent during testing): ERNIE MEDINA 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Technician Conducting Test: EDWIN PINEDA Credentials I : E CSLB Contractor ICC Service Tech. SWRCB Tank Tester 1fl Other (Specify) A -UT License Number: 743160-8026748 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic Vacuum Other Test Equipment Used: TAPE MEASURE Equipment Resolution: VISUAL Identify Spill Bucket(By Tank Number, Stored Product, etc. 1 1 SUP FILL 2 2 PLU FILL 3 3 REG FILL 4 Bucket Installation Type: X Direct Bury Contained in Sump X Direct Bury Contained in Sump X Direct Bury Contained in Sump Direct Bury Contained in Sump Bucket Diameter: lift illy 11 " Bucket Depth: loll 10 " 1011 Wait time between applying vacuum/water and starting test: 10 MIN 10 MIN 10 MIN Test Start Time (TI ): 0930 0930 0930 Initial Reading (RI ): 9.75" 9.75" 9.75" Test End Time (TF ); 1030 1030 1030 Final Readin (RF ); 9.75" 9. 75" 9. 75" Test Duration: 1 HR 1 HR 1 HR Change in Reading (R F - RI ): 0 0 0 Pass/Fail Threshold or Criteria: 0 0 0 Test Result: El Pass Fail 0 Pass Fail 0 Pass 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 I hereby certify that all the information contained in this report is true, accurate, and infull compliance with legal requirements. Technician's Signature: n :: . Date: l-- v 10/18/2011 I State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements Work Order: 3187188 ESo) & (ESV) Testing Form - Manion 1- 625)2007 Emergency Shut Off (ESO) & Dispenser Emergency Shutoff Valve (ESV) Test ANNUAL TEST RECORD LOCATIONS AND TEST DATATesting - n U dComan ; Date. b , Location Name: 5 Store #• State 1D #- Address: 1' City: state: Emer enc Shut Off SO Testin Results11 _ in accordance with "ESO Vendor Letter (3- 21- 05).doc "; from Valero's RetailComplianceDepartment, as a part of annual compliance testing, this representative tested theEmerencShutOffSOswitchesindicatedonthissketch. Findin s listed below: Emergency Shut Off (ESO) If No, ProvideOperational) Y N M tenance Log # Date Called : L•, „ac, r.mer enc shutoff valve ES Testin ResultsOninaccordancewithNFPA30Athisrepresentativetestedtheautomatic- closing featureoftheispenserEmergencyShutoffVALVE(S) (ESV) located in the supply lines at the base ofeachindividualislandtypedispenserindicatedonthediagrambelow. Each device ( #) _ 1$ in allwouldautomaticallclose. Findin s listed below: , Disp. Emergency Shut Off IfNo, ProvideValve (ESV) Operational? Y N Maintenance Log # Date Called rJ Tanknology Inc. 11000 N. MoPac Expressway, Suite 500, Austin, Texas 78759 0p 7J3nkwkPgy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 512) 451 -6334 FAX (512) 459 -1459 TEST DATE:10 /18/11 WORK ORDER NUMBER3187188 CLIENT:CHEVRON PRODUCTS COMPANY SITE:CHEVRON 203576 COMMENTS COCO SITE, Conducted Witness Annual Monitor Certification Testing with Inspector Ernie Medina Bakersfield Fire Department. site contacted 10 /11 /11 and confirmed testing with "KATHY ". Technician checked in with 2ndSite and WO # 111018 -146 was given. Replaced (1) Siphon jet assembly, (1/2) hour for labor for parts replaced and troubleshooting. The sensor for Disp# 7/8 failed. All other tests passed. PARTS REPLACED QUANTITY DESCRIPTION 1 SIPHON JET ASSEMBLIES HELIUM PINPOINT TEST KE5ULT5 (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 11/04/2011 08:06 MTUTTLE SITE DIAGRAM i Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 512) 451 -6334 FAX (512) 459 -1459 TEST DATE: 10/18/11 WORK ORDER NUMBER3187188 CLIENT:CHEVRON PRODUCTS COMPANY SITE: CHEVRON 203576 L2coLSTPAI 89 O O O OVF 3 #4 #5Q 1>#6 #1 l< 1>#1 2 m Cn 12K ZmpC L3 87 L6 CANOPY cn cn STP (: ) O O O Z D 12K U) C Z z 1 #2 #7 #8 #9 10 0 r L4 91 L5 cAz m STP 12 O O O ( s ESO DUMP - STER C -STORE AIR/ breakers TLS ICE a S H2O R WASHHS Printed 11/04/2011 08:06 MTUTTLE ATG Information Work Order # 3187188 110100 OCT 18, 2011 1:53 PM C.S.I.CHEVRON 1842 1125 COFFEE RD. BAKERSFIELD,CA 93312 661- 588 -9066 203576 SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL 150301 OCT 18, 2011 1:54 PM 1:C.S.I.CHEVRON 11542 150302 OCT 18, 2011 1:54 PM 2:1125 COFFEE RD. 150303 OCT 18, 2011 1:54 PM 3:BAKERSFIELD,CA.93312 cl 150304 OCT 18, 2011 1:54 PM 4:661 - 588 -9066 203576 151700 OCT 18, 2011 1:54 PM SYSTEM TYPE AND LANGUAGE FLAG SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYYY HH:MM:SS xM O I50F00 OCT 18, 2011 1:54 PM MON DD YYYY HH:MM:SS xM 160100 OCT 18, 2011 1:54 PM TANK CONFIGURATION DEVICE LABEL CONFIGURED 1 SUPREME ON 2 PLUS ON 3 REGULAR ON 4 OFF 160200 OCT 18, 2011 1:54 PM TANK PRODUCT LABEL TANK PRODUCT LABEL 1 SUPREME 2 PLUS 3 REGULAR 4 160300 OCT 18, 2011 1:54 PM TANKPRODUCTCODE TANK PRODUCT LABEL 1 SUPREME 2 PLUS 2 3 REGULAR 4 4 3187188 ATG Information 160400 OCT 18, 2011 1:54 PM TANK FULL VOLUME TANK PRODUCT LABEL GALLONS 1 SUPREME 12068 2 PLUS 12068 3 REGULAR 12068 4 0 160700 OCT 18, 2011 1:54 PM TANK DIAMETER TANK PRODUCT LABEL INCHES 1 SUPREME 111.50 2 PLUS 111.50 3 REGULAR 111.50 4 0.00 160900 OCT 18, 2011 1:54 PM TANKTHERMAL COEFFICIENT TANK PRODUCT LABEL 1 SUPREME 0.000700 2 PLUS 0.000700 3 REGULAR 0.000700 4 0.000000 Q 161200 OCT 18, 2011 1:54 PM TANK MANIFOLDED PARTNERS TANK PRODUCT LABEL SIPHON MANIFOLDED TANKS LINEMANIFOLDED TANKS 1 SUPREME NONE NONE 2 PLUS NONE NONE 3 REGULAR NONE NONE 4 NONE NONE 162100 OCT 18, 2011 1:54 PM TANK LOW PRODUCT LIMIT TANK PRODUCT LABEL GALLONS 1 SUPREME 500 2 PLUS 500 3 REGULAR 500 4 0 162200 OCT 18, 2011 1:54 PM TANK HIGH PRODUCT LIMIT TANK PRODUCT LABEL GALLONS 1 SUPREME 11464 2 PLUS 11464 3 REGULAR 11464 4 0 162300 OCT 18, 2011 1:54 PM TANK OVERFILL LEVEL LIMIT TANK PRODUCT LABEL GALLONS 1 SUPREME 10861 2 PLUS 10861 3 REGULAR 10861 4 0 162400 OCT 18, 2011 1:54 PM TANK HIGH WATER LEVEL LIMIT TANK PRODUCT LABEL INCHES 1 SUPREME 3.0 3187188 Work Order# 3187188 ATG Information Work Order # 3187188 2 PLUS 3.0 3 REGULAR 3.0 162800 OCT 18, 2011 1:54 PM TANK MAXIMUM VOLUME LIMIT TANK PRODUCT LABEL GALLONS 1 SUPREME 12068 2 PLUS 12068 3 REGULAR 12068 4 0 162900 OCT 18, 2011 1:54 PM TANK DELIVERY REQUIRED LIMIT TANK PRODUCT LABEL GALLONS 1 SUPREME 1209 2 PLUS 1209 3 REGULAR 1209 4 0 170300 OCT 18, 2011 1:54 PM LIQUID TYPE SENSOR LOCATION TYPE 1 SUPREME TURBINE SUMP TRI -STATE (SINGLE FLOAT) 2 SUPREME ANNULAR TRI -STATE (SINGLE FLOAT) 3 REG TURBINE SUMP TRI -STATE (SINGLE FLOAT) 4 PLUS ANNULAR TRI -STATE (SINGLE FLOAT) 5 PLUS TURBINE SUMP TRI -STATE (SINGLE FLOAT) 6 REGULAR ANNULAR TRI -STATE (SINGLE FLOAT) 7 TRI -STATE (SINGLE FLOAT) 8 TRI -STATE (SINGLE FLOAT) 178500 OCT 18, 2011 1:54 PM PRESSURE LINE LEAK TANK NUMBER LINE TANK NUMBER Q 1:SUPREME 1 Q 2:PLUS NONE Q 3: REGULAR 3 190200 OCT 18, 2011 1:54 PM SOFTWARE REVISION LEVEL VERSION 327.04 SOFTWARE# 346327 -100 -E CREATED - 07.02.06.10.28 S- MODULE# 330160-004 -a SYSTEM FEATURES: PERIODIC IN -TANK TESTS ANNUAL IN -TANK TESTS ISO PMC 120600 OCT 18, 2011 1:55 PM C.S.I.CHEVRON 1842 1125 COFFEE RD. BAKERSFIELD, CA.93312 661 -58B -9066 203576 TANK ALARM HISTORY TANK 1 SUPREME HIGH WATER ALARM OCT 18, 201112:14 PM OCT 27, 2010 11:00 AM NOV 6, 2009 10:20AM OVERFILL ALARM OCT 18, 2011 12:08 PM JUN 17, 2011 2:59 PM OCT27, 2010 11:16 AM 3187188 ATG Information SUDDEN LOSS ALARM OCT 18, 2011 12:24 PM OCT 18, 2011 12:04 PM APR 7, 2011 8:41 AM HIGH PRODUCTALARM OCT 18, 2011 12:08 PM OCT 18, 2011 12:06 PM JUN 17, 2011 3:02 PM INVALID FUEL LEVEL JUN 17, 2011 3:03 PM JUN 15, 2011 9:19 AM MAR 1, 2011 1:01 PM PROBE OUT OCT 18, 2011 1:23 PM OCT 18, 2011 12:50 PM OCT 18, 2011 12:46 PM HIGH WATER WARNING OCT 18, 2011 12:14 PM OCT 27, 2010 11:00 AM NOV 6, 2009 10:20 AM DELIVERY NEEDED OCT 18, 2011 1:28 PM OCT 18, 2011 12:06 PM MAY 9, 2011 8:18 AM MAX PRODUCT ALARM OCT 18, 2011 12:08 PM OCT 18, 2011 12:06 PM JUN 17, 2011 3:02 PM LOW TEMP WARNING OCT 18, 2011 1:24 PM OCT 18, 2011 12:55 PM OCT 18, 2011 12:47 PM TANK 2 PLUS HIGH WATER ALARM OCT 18, 2011 12:15 PM OCT 27, 2010 10:58 AM NOV 6, 2009 10:14 AM OVERFILL ALARM OCT 27, 201011:24 AM NOV 6, 2009 10:56 AM NOV 17, 2008 10:50 AM LOW PRODUCTALARM NOV 6, 200910:10AM HIGH PRODUCT ALARM OCT 18, 2011 12:12 PM OCT 27, 201011:24 AM NOV 6, 2009 10:56 AM INVALID FUEL LEVEL OCT 27, 2010 10:55 AM NOV 6, 200910:57 AM NOV 6, 2009 10:09 AM PROBE OUT OCT 18, 2011 12:30 PM OCT 18, 2011 12:10 PM OCT 27, 201011:25 AM HIGH WATER WARNING OCT 18, 2011 12:15 PM OCT 27, 2010 10:58 AM NOV 6, 2009 10:14 AM DELIVERY NEEDED OCT 6, 2011 2:59 PM SEP 26, 2011 7:48 PM SEP 17, 2011 7:34 PM MAX PRODUCT ALARM OCT 18, 2011 12:12 PM OCT 27, 2010 11:25 AM NOV 6, 2009 10:56 AM LOW TEMP WARNING OCT 18, 2011 12:11 PM OCT 27, 2010 11:25 AM NOV 6, 2009 10:11 AM TANK REGULAR HIGH WATER ALARM OCT 18, 2011 12:22 PM OCT 27, 2010 10:59AM NOV 6, 2009 10:13AM OVERFILL ALARM OCT 18, 2011 12:13 PM OCT 27, 2010 11:19 AM NOV 29, 2009 8:28AM SUDDEN LOSS ALARM OCT 18, 2011 12:08 PM OCT 27, 2010 10:55 AM OCT 1, 201010:16AM HIGH PRODUCT ALARM OCT 18, 2011 12:14 PM OCT 18, 2011 12:09 PM OCT 27, 2010 11:19 AM INVALID FUEL LEVEL OCT 18, 2011 12:09 PM OCT 27, 2010 10:56 AM JUL 20, 2010 6:14 PM PROBE OUT OCT 18, 2011 12:31 PM OCT 18, 2011 12:09 PM OCT 27, 2010 11:21 AM HIGH WATER WARNING OCT 18, 2011 12:22 PM OCT 27, 201010:59 AM NOV 6, 2009 10:13 AM DELIVERY NEEDED JUN 4, 2011 10:49 AM 3187188 Work Order# 3187188 ATG Information T Work Order # 3187188 DEC 20, 2010 2:43 PM OCT 27, 2010 10:56 AM MAX PRODUCT ALARM OCT 18, 2011 12:14 PM OCT 18, 2011 12:09 PM OCT 27, 2010 11:21 AM LOW TEMP WARNING OCT 18, 2011 12:32 PM NOV 6, 2009 11:04 AM 3187188 130200 OCT 18, 2011 1:55 PM C.S.I.CHEVRON 1842 1125 COFFEE RD. BAKERSFIELD, CA.93312 661 -588 -9066 203576 LIQUID ALARM HISTORY REPORT SENSOR LOCATION 1 SUPREME TURBINE SUMP OCT 18, 2011 9:41 AM FUEL ALARM OCT 18, 2011 9:35 AM SENSOR OUT ALARM OCT 27, 2010 10:22 AM FUEL ALARM 2 SUPREME ANNULAR OCT 18, 2011 9:42 AM FUEL ALARM OCT 18, 2011 9:35 AM SENSOR OUT ALARM OCT 27, 2010 10:37 AM FUEL ALARM 3 REG TURBINE SUMP OCT 18, 2011 9:43 AM FUEL ALARM OCT 18, 2011 9:35 AM SENSOR OUT ALARM OCT 27, 2010 10:18 AM FUEL ALARM 4 PLUS ANNULAR OCT 18, 2011 12:22 PM FUEL ALARM OCT 18, 2011 9:47 AM FUEL ALARM OCT 18, 2011 9:35 AM SENSOR OUT ALARM 5 PLUS TURBINE SUMP OCT 18, 2011 9:46 AM FUEL ALARM OCT 18, 2011 9:35 AM SENSOR OUT ALARM OCT 27, 2010 9:54 AM FUEL ALARM 6 REGULAR ANNULAR OCT 18, 2011 9:45 AM FUEL ALARM OCT 18, 2011 9:35 AM SENSOR OUT ALARM OCT 27, 2010 10:12 AM FUEL ALARM 138200 OCT 18, 2011 1:55 PM C.S.LCHEVRON 1842 1125 COFFEE RD. BAKERSFIELD, CA.93312 661 -588 -9066 203576 PRESSURE LINE LEAK ALARM HISTORY REPORT O 1:SUPREME OCT 18, 2011 12:14 PM PLLD SHUTDOWN ALARM OCT 18, 2011 11:30 AM PLLD SHUTDOWN ALARM OCT 18, 2011 11:30 AM GROSS LINE FAIL OCT 18, 2011 9:42 AM PLLD SHUTDOWN ALARM OCT 18, 2011 9:41 AM PLLD SHUTDOWN ALARM OCT 18, 2011 9:35 AM PLLD SHUTDOWN ALARM OCT 27, 2010 10:51 AM PLLD SHUTDOWN ALARM OCT 27, 2010 10:51 AM GROSS LINE FAIL OCT 27, 2010 10:37 AM PLLD SHUTDOWN ALARM OCT 27, 2010 10:22 AM PLLD SHUTDOWN ALARM O 2:PLUS OCT 18, 2011 12:15 PM PLLD SHUTDOWN ALARM OCT 18, 2011 10:59 AM PLLD SHUTDOWN ALARM OCT 18, 2011 10:59 AM GROSS LINE FAIL OCT 18, 2011 9:47 AM PLLD SHUTDOWN ALARM OCT 18, 2011 9:46 AM PLLD SHUTDOWN ALARM OCT 18, 2011 9:35 AM PLLD SHUTDOWN ALARM OCT 27, 2010 10:40 AM PLLD SHUTDOWN ALARM OCT 27, 2010 10:40 AM GROSS LINE FAIL OCT 27, 2010 9:54 AM PLLD SHUTDOWN ALARM OCT 27, 2010 9:54 AM PLLD SHUTDOWNALARM O 3:REGULAR OCT 18, 2011 12:22 PM PLLD SHUTDOWN ALARM OCT 18, 2011 11:02 AM PLLD SHUTDOWN ALARM OCT 18, 2011 11:02 AM GROSS LINE FAIL 3187188 ATG Information OCT 18, 2011 9:45 AM OCT 18, 2011 9:43 AM OCT 18, 2011 9:35 AM OCT 27, 2010 10:44 AM OCT 27, 2010 10:44 AM OCT 27, 2010 10:18 AM OCT 27, 2010 10:12 AM 110100 OCT 18, 2011 1:56 PM C.S.I.CHEVRON 1842 1125 COFFEE RD. BAKERSFIELD, CA.93312 661- 588 -9066 203576 SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL 3187188 PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM GROSS LINE FAIL PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM Work Order # 3187188