HomeMy WebLinkAboutFMC 2011MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State ofCalifornia
Authority Cited: Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each
monitoring system control panel by the technician who performs the work. A copy ofthis form must be provided to the tank system owner /operator.
The owner /operator must submit a copy pf this form to the local agency regulating UST systems within 30 days oftest date.
A. General Information
Facility Name: STOCKDALE FOODMART Bldg. No.:
Site Address: 5321 STOCKDALE HWY City: BAKERSFIELD Zip:
Facility Contact Person: FONG CHAO Contact Phone No.: ( )
Make/Model of Monitoring System: TLS-360 Date ofTesting/Servicing: 91712011
B.. Inventory of Equipment Tested/Certified
Check the aporopriate boxes to indicates ecific equipment inspected/serviced:
Tank ID: UNL87 Tank ID: PREM91
In -Tank Gauging Probe. Model: MAG In -Tank Gauging Probe. Model: MAG
Annular Spike or Vault Sensor. Model: 4201463 10 Annular Space or Vault Sensor, Model: 4201463
Piping Sump / Trench Sensor(s). Model: 208/304 Piping Sump / Trench Sensor(s). Model: 2081304
Fill .sump ensor(s). Model: 2081304 Fill Sump Sensor(s). Model: 2081304
Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model:
Electronic Line Leak Detector: Model:. VEEDER -ROOT Electronic Line LeakDetector. Model: VEEDER -ROOT
Tank Overfill / High -Level Sensor. Model: GOA Tank Overfill / High -Level Sensor. Model: GOA
El Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and modelin Section E on Page 2),
Tank ID: DIESEL Tank ID:. VENT BOX
In -Tank Gauging Probe. Model: In -Tank Gauging Probe. Model: MAG
Annular Space or Vault Sensor. Model: 4021463 Annular Space or Vault Sensor. Model:
Piping Sump / Trench Sensor(s). Model: 2081304 Piping Sump / Trench Sensor(s). Model: 2081304
Fill Sump Sensor(s). Model: 2081304 Fill Sump Senwr(s). Model:
Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model:
Electronic Line Leak Detector. Model: VEEDER -ROOT Electronic Line leak Detector. Model:
Tank Overfill / High -Level Sensor. Model: GOA E1 Tank Overfill / High -Level Sensor.. Model:
Other.(speq.ify equipment type and model in Section F. on. Page 2). Other (specify equipment type and model in Section E on Page 2).
Dispenser II?: 1/2 Dispenser ID: 314
Dispenser Containment Sensor(s). Model: 2081304 Dispenser Containment. Sensor(s). Model: 2081304
ShearValve(s). Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 516 Dispenser ID: 718
Dispenser Containment Sensor(s). Model: 2081304 Dispenser Containment Sensor(s). Model: 208/304
Z Shear Valve(s). Shear Valve(s).
DispcnserContainmentFloat(s) and Chain(s). Q Dispenser Containment Float(s) and Chain(s).
Dispenser ID,: 9/10 Dispenser ID:
Dispenser Containment Sensor(s). Model: 2081304 DispenserContainment Sensor(s): Model:
Shear Valve(s). Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s).
N
Ifthe facility contains more tanks or dispensers, copy this form. Include information for every.tank and dispenser atthe facility.
C. Certification -1 certify that the equipment identified in this document was inspected/serviced in accordance with the mantlfactgrers' .
guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is .
correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also
attached a copy of the report; (check all that apply): ® System set -up ® Alarm history report
Technician Name (print): RYAN MASON Signature:
Certification No.: A27367/ ICC# 8029371-UT License. No.: 611 809850
Testing Company Name: RICH ENVIRONMENTAL,* Phone No.: (661) 392 -8687
Testing Cor9pany Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date of Testing/Servicing: 9/7/2011
Page 1 : of 5
LT-036 —1 /4 www.uniducs.org Rev. 01/17/08
Monitoring System Certification
1. A Results of Testing/Servicing
Software Version Installed: 330.02
Coro lete 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) E Sump/Trench Sensors; E 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 oftank capacity does the alarm trigger? 90%
Yes* No Was any monitoring equipment replaced? . Ifyes, identify specific sensors, probes, or other equipment replaced
and list the manufacturer name and model for all replacement parts in Section E, below.
Yes* E No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply).
Product; Water. ifyes, describe causes in Section E, below.
Yes No* Was monitoring system set -up reviewed to:ensure proper settings? Attach set up reports, if applicable
E Yes p 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: BRINE SENSORS IN DISP # 9-10 AND DSL STP SUMP DID NOT WORK AND' WILL BE REPLACED
JAMES RICH REPLACED BOTH BRINE -SENSORS 9/26/11 - ALL PASS
Page 2 of 5
UN -036 — 2/4 www.rinidocs.org Rev. 01117108;
Monitoring System Certification
F. In-Tank Gauging / SIR Equipment: Check this box iftank 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 monitonng..
Complete the following checklist:
Yes No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
Yes D 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 ofsystem water level readings tested?
Yes J No* Were all probes reinstalled properly?
Yes No* Were all items on the equipment manufacturer's maintenance checklist completed?
In Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): Check this box ifLLDs are not installed.
Complete the following checklist:
Yes No* For equipment start -up or annual equipment certification, was a leak simulated to verify LLD perQrrnance?
N/A Check all that apply) Simulated leak rate: ® 3 g.p.h.; [10. 1 g.p.h ; 0.2 g.p.h.
Yes No* Were all LLDs confirmed operational and accurate within.regulatory requirements?
Yes El No* Was the testing apparatus properly calibrated?
Yes p No* For mechanical LLDs; does the LLD restrict product flow if it detects a leak?
N/A
0-Yes No For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
Cl N/A
Yes No* For electronic LLDs, does the. turbine automatically shut off if any portion of the monitoring system is disabled
p N/A or disconnected?
Yes No* For electronic LLDs, does the turbine automatically shut off ifany portion ofthe 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 Section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 5
UN -036 -3/4 ; www.uhidocs.org Rev.Ot37 /08
Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors
I. Results 'of Vaeuum/Pressure Monitoring Equipment 'Iesting
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,owrier /operator must submit a copy ofthe Monitoring System Certification Form :to,the
local agency regulating UST systems within 30 days oftest date.
Manufacturer: VEEDER -ROOT Model: 463 System "type: Pressure;.® Vacuum
Sensor ID
Component(s) Monitored by this Sensor: 87 ANNULARS:1
Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: Z Pass; Fail
Component(s) Monitored by this Sensor: 87 PRODUCTS:2
Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail
Component(s) Monitored by this Sensor:. 87 VAPOR
S;4
Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: [R Pass; Fail
Component(s) Monitored by this Sensor: 87 VENT
S:3 Sensor Functionality Test Result: ®Pass; Fail Interstitial Communication Test Result; E Pass; Fail
Component(s) Monitored by this Sensor: 91 VENT
S:5
Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: Z, Pass; Fail
Component(s) Monitored by this Sensor: 91 PRODUCT
S:6 Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ®Pass; `. .Fail,
Component(s) Monitored by this Sensor: DIESEL 91 ANNULAR
S:7
Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail
Component(s) Monitored by this Sensor: DIESEL PRODUCT
S :8 Sensor Functionality Test Result: Z Pass; Fail Interstitial Communication Test Result: ® Pass; Fail
Component(s) Monitored by this Sensor: DIESEL VENTS:9
Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; El FEW
Components) Monitored by this Sensor:
Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail
How was interstitial.communication verified?
beak Introduced at Far End of Interstitial Space;' Gauge; ® Visual Inspection; Other (Describe in Sec. j, below)
Was vacuum /pressure restored to operating levels in all interstitial. spaces? ® Yes No (Ifno, describe in Sec. J below)
J. Comments:
Page 4 of 5
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 communicating throughout the interstice.
UN -036A -1/t www.u6idGcs.org Rev. 01/26/06
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RICH ENPYRONMENTAL
5643 BROOKS CT. BAKERSFIELD, CA. 93308
OFFICE (661)392 -868.7 FAX.(661)392 -0621
PRODUCT LE"4E LEAK DETECTOR TEST
WORK SHEET
W /4 #:
FACILITY NAME: STOCIMALE F'OODMART
FACILTIY ADDRESS: 5321 STOCKDALE HWY, BAKERSFIELD
PRODUCT LINE TYPE: PRESSURE
PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS
BELOW P.S.I. OR
SERIAL NUMBER 3 G.P.H. FAIL
87 L/D TYPE: VEEDER -ROOT YES 0 PASS
SERIAL # ELECTRONIC
91 L/D TYPE: VEEDER -ROOT YES 0 PASS
SERIAL # ELECTRONIC
DIESFI. L/D TYPE: VEEDER -ROOT YES 0 PASS
SERIAL # ELECTRONIC
L/D TYPE: YES PASS
SERIAL # NO FAIL,
I CERTIFY THE ABOVE, TESTS WERE CONDUCTED ON THIS DATE ACCORDING TO RED
JACKET PUMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMITATION'S.
THE MECHANICAL LEAK DETECTOR TEST PASS / FAIL IS DETERMINED BY USING A.
LOW FLOW THRESHOLD TRIP RATE OF-3 GALLONS PER HOUR OR LESS AT 10 P.S.13
ACKNOWLEDGE THAT ALL DATA COLLECTED IS TRUE AND CORRECT TO THE BEST
OF MY KNOWLEDGE.
TECHNICIAN RYAN MASON
SIGNATURE: Ta - DATE: 9/7/11
4"")q '-7
SWRCB, January 2006
Spill Bucket 'Vesting Report Form
Thisform is intendedfor use by contractors performing annual 'testing of UST spill containment structures. The completedform:and
printoutsfrom tests (if applicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACII.ATV INIFORMATI[ON
Facility Name: STOCKDALE FOODMART Date of Testing: 9/7111
Facility Address: 5321 STOCKDALE HWY, BAKERSFIELD
Facility Contact: FONG CHAO Phone:
Date Local Agency Was Notified of Testing:
Name of Local Agency Inspector (tfpresent, during testing): ERNIE MEDINA
2_ TESTING CONTRACTOR MF(IRMATIM
Company -Naine: RICH ENVIRONMENTAL,
Technician Conducting Test: RYAN MASON
Credentials': 0 CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other (Specify)
License Number(s): 8029371 -UT
3. SPILL .BUCKET TESTING MORMATION
Test Method Used: X Hydrostatic ovacuum Other
Test Equipment Used: VISUAL Equipment Resolution: 0
Identify Spill Bucket (By Tank
Number, StoredProduct, etc)
1 87 2 91 , 3 DIESEL 4
Bucket Installation Type: Direct Bury
X Contained in Sump
Direct Bury
X Contained in Sump
11 Direct Bury
X Contained in Sump
El Direct Bury
Contained.in Sump
Bucket Diameter: 12" I211 12"
Bucket Depth: 14" 14" I4"
Wait time between applying
vacuum/water and start of test:
30 MEN 30 MIN 30 MIN
Test Start Time.(T,): 1200 0845 0845
Initial Reading (111): 14" 14" 14"
Test End Time (TF): I300 0945 0945
Final Reading (RF): 14" 14" 14"
Test Duration (TF -Tf): 1 -HOUR 1 -HOUR 1 -HOUR
Change in Reading (RF - R): 0 0 0
Pass/Fail 'threshold or
Criteria:
0.00 0.00 0.00
IMiN1111,5111110 10 R.
N1
iiiiiii1l't. P. WK NJ 100wwl
Commehts - (include. information on repairs made prior to testing, and recommendedfollow -upforfailedtests)
CLEANED DRAIN ON 87.— RETEST - ALL PASSED
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING.
Thereby that all the information contained In this report is true, accurate, and Infull compllance with legal requirements.
Technician's
State laws and regulations do i
may be more stringent.
Date: 9/7/11
require testing to be performed by a qualified contractor. However, local requirements
COMMUNICF;TIOPJS ETUF' IN -TANK SETUP
SOFTWARE RED,+ IS I ON LE', EL PORT SETTINGS : T 1 DUCPRODUCT CODE
VERSION 330.02 THERMAL COEFF :.0007
SOFTWARE0 346330 -100 -C COMM BOARD I (EDIM > TANK DIAMETER : 113..
CREATED 11.01.11.11.2'3 RS -232 SECURITY TANK PROFILE 1
CODE : DISABLED FULL VOL :' 15C
S7MODULE# 33U16u -UU4 q
SYSTEM FEATURES: COMM . BOARD 2 (PS-2-32,
PERIODIC IN- -TANK TESTS BAUD RATE. 1200 FLOAT SIZE:
ANNUAL IN -TANK; TESTS PARITY ODD,
ISD STOP BIT. 1 STOP WATER WARNINGDATALENGTH:. 7 DATA HIGH WATER LIMIT:` RS -232 SECURITY
CODE : DISABLED MAX OR LABEL.VOL: 15(
OVEkFILL LIMIT
COMM BOARD 3 (FXMODS 101
BAUD _RATE 2400 HIGH PRODUCT
PARITY ODD I1
STOP BIT: 1 STOP DELIVERY LIMIT
DATA LENGTH: 7 DATA 1:
RS -232 SECURITY
SYSTEM SETUP CODE DISABLED LOW, PRODUCT
DIAL TYPE TONE LEAK ALARM LIMIT'
SEP 7. 2011 3:48, PhI ANSWER ON : 1.RING SUDDEN LOSS LIMIT: MODEM SETUP STRING TANK TILT
PROBE OFFSET 0
DIAL TONE INTERVAL: 32
SNISTEm UNITS
U.S. SIPHON MAtIIFOLDED TAN .
SYSTEM LANGUAGE AUTO TRANSMIT SETTINGS:. TO- NONE
ENGLISH LINE MANIPOLDED TANKS
SYSTEM DATE /TIME FOR11"T AUTO LEAK ALARM LIMIT T#: NONE.
MON DD YYT HH:MM:SS xM DISABLED
AUTO HIGHWATER LIMIT
S7QCKDALE FOOD MART DISABLED LEAK MIN PERIODIC:
5321 STOCYDALE HWY AUTO OVERFILL LIMIT 1
BAKERSF.IELD CA 933.09 DISABLED '
AUTO LOW PRODUCT LEAK MIN ANNUAL.
DISABLED 1
SHIFT TIME 1 DISABLED AUTO THEFT LIMIT
SH IFT T I t °IE 2 DISABLED D I SABLED :
SHIFT TIME 3 DISABLED AUTO DELIVERY START PERIODIC TEST TYPE
SHIFT TIME 4 DISABLED D I SABLED : STAN[.
AUTO DELIVERY END
TANK PER TST NEEI +£D WRN DISABLED
AUTO EXTERNAL INPUT ON
ANNUAL TEST: FAIL.
ALARM„D I SAIDISABLED
T.ANK.ANN TST NEEDED WRN
DISABLED
DISABLED
AUTO EXTERNAL INPUT OFF PERIODIC ;TEST FALL
D I SABLED ALARM' .DI SAI.
LINE RE- ENABLE METHOD AUTO SENSOR FUEL ALARM
PASS. LINE TEST DISABLED GROSS TEST FAIL.. AUTO SENSOR WATER ALARM ALARM DISAI.
LINE PER TST NEEDED WRN
DISABLED
DISABLED;
AUTO SENSOR OUT ALARM ANN TESTAVERAGING:
LINE. ANN TST NEEDED WRri DISABLED. AVERAGNGPERTEST - I:
D.I S€BLED
TANK TEST, NOTIFY :
PRINT TC VOLUMES
ENABLED TNK TST SIPHON BREAK
TEMP COMPENSATION RECEIVER SETUP: DELIVERY;DELAY t 15
VALUE +DEG,F }: 60,0 PUMP THRESHOLD : 10
STICK HEIGHT OFFSET NONE
DISABLEIi
ULLAGE: 90%
H= PROTOCOL DATA FORMAT
HEIGHT
PRECISION TENT DURATION
HOURS: 12
DAYLIGHT SAVING TIME
ENABLED
START DATE
APR WEEK, 1 SUN
START TIME AUTO DIAL TIME `SETUP:
2::170 AM
END DATE NONE
OCT IJEEY 6 SUN
END. T I ME
PRESSURE LINE LEAK SETUP
G 1:87
TYP:2.0i3.01N FIBERGLASS
2..OIN'DIA LEN: 120:FEET
3.OIN DI.A LEN: 0 FEET'
SHUTDOWN RATE: 3.0 GPH.
LOW PRESSURE SHUTOFF:NO
LOW PRESSURE 0 PSI
T 1:87
DISPENSE MODE:
STANDARD
SENSOR: NON - VENTED
PRESSURE OFFSET: O.OPSI
MECHANICAL BLENDER:: NO
G 2:91
TYP:2.0.i3.0IN FIBERGLASS
2.OIN DIA LEN: 120 FEET
3.0IN DIA LEN: 0 FEET
SHUTDOWN RATE: 3.0 GPH
LOW PRESSURE SHUTOFF:N0
LOW PRESSURE O'PSI
T 2.91
DISPENSE MODE.
STANDARD
SENSOR: NON— VENTED
PRESSURE OFFSET: 0-.OPSI
MECHANICAL BLENDER: NO
G 3:DIESEL
T'YP:2.0 /3.01N FIBERGLASS
2.01N PIA LEN: 60 FEET
3.0IN DIA LEN: 0 FEET
SHUTDOWN RATE:. 3.0.GPH.
LOW PRESSURE SHUTOFF:NO
LOW PRESSURE O PSI
T 3:DIESEL
DISPENSE MODE:
STANDARD
SENSOR: NON- VENTED .
PRESSURE OFFSET: O.OPSI
MECHANICAL BLENDER: NO
T _3:DIESEL
PRODUCT CODE 3
THERMAL COEFF :.000450
T 2:91 DIAMETER t11PRODUCTCODETANKPR PTTANKEVOLTHERMALCOEFF :.000700 FULL 7070
TANK DIAMETER 113.75
TANK PROFILE 1 PT
FULL VOL B042 FLOAT SIZE: 3.0 IN.
o FLOAT SIZE: 3.0 IN.
WATER WARNING : 2.0
HIGH WATER LIMIT: 3.0
WATER WARNING 2.0 MA,{ OR LABEL VOL: 7070
HIGH WATER LIMIT: 3.0 OVERFILL LIMIT 90i
6363
M° iX OR LABEL VOL: 8042 HIGH PRODUCT 96%
OVERFILL LIMIT 90% 6716
7 DELIVERY LIMIT 10%
HIGH PRODUCT 95% 707 .,
7639
DEL 1 VEI?': LIMIT 10% LOW PRODUCT 500
804 LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 50
LOW 1 RODUCT 500 TANK TILT 0.00
LEAK "ALARM LIMIT: 99 PROBE OFFSET 0.00
SUDDEN LOSS LIMIT: 50TANKTILT0.00
PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS
TO: NONE
LINE MANIFOLDED TANKSSIPHONMANIFOLDEDTANSTO: NONETtt: NONE
LINE HANIFOLDED TANKS
TO: NONE LEAK 111 PERIODIC: 10%
707
LEAF MIN PERIODIC : 10 %. LEAK MI N ANNUAL 10%
904 707
LEAK MIN ANNUAL 10%
804 PERIODIC, TEST TYPE
STANDARD
PERIODIC TEST TYPE ANNUAL TEST FAIL
STANDARD ALARM DISABLED
ANNUAL. TEST FAIL PERIODIC TEST FAIL
ALARM DISABLED ALARM D I SAI3LED
PERIODIC TEST FAIL GROSS TEST FAIL
ALARM DISABLED ALARM DISABLED
GROSS TEST FAIL ANN TEST AVERAGING: OFF
ALARM DISABLED PER TEST AVERAGING: OFF
ANN TEST (AVERAGING: OFF TANK TEST NOTIFY: OFF
PER TEST AVERAGING: OFF
TNK TST SIPHON BREAK:OFFTANKTESTNOTIFY: OFF
DELIERY ELAY 15 MIN
TNK TST SIPHON BREAK:OIF PUMPSJTHRESHOLD 10.00%
DELIVER:' DELA"i 15 MIN
PUMP THRESHOLD : 10,00%
LEAK TEST METHOD
TEST ANNUALLY: ALL TANK
DEC WEEK I SUN.
START TIME : 2 :15 AM
TEST RATE :0.20 GAL:'HR
DURATION 2. HOURS
TST EARLY STOP:DISABLED
PRESSURE LINE LEAK SETUP
G 1:87
TYP:2.0i3.01N FIBERGLASS
2..OIN'DIA LEN: 120:FEET
3.OIN DI.A LEN: 0 FEET'
SHUTDOWN RATE: 3.0 GPH.
LOW PRESSURE SHUTOFF:NO
LOW PRESSURE 0 PSI
T 1:87
DISPENSE MODE:
STANDARD
SENSOR: NON - VENTED
PRESSURE OFFSET: O.OPSI
MECHANICAL BLENDER:: NO
G 2:91
TYP:2.0.i3.0IN FIBERGLASS
2.OIN DIA LEN: 120 FEET
3.0IN DIA LEN: 0 FEET
SHUTDOWN RATE: 3.0 GPH
LOW PRESSURE SHUTOFF:N0
LOW PRESSURE O'PSI
T 2.91
DISPENSE MODE.
STANDARD
SENSOR: NON— VENTED
PRESSURE OFFSET: 0-.OPSI
MECHANICAL BLENDER: NO
G 3:DIESEL
T'YP:2.0 /3.01N FIBERGLASS
2.01N PIA LEN: 60 FEET
3.0IN DIA LEN: 0 FEET
SHUTDOWN RATE:. 3.0.GPH.
LOW PRESSURE SHUTOFF:NO
LOW PRESSURE O PSI
T 3:DIESEL
DISPENSE MODE:
STANDARD
SENSOR: NON- VENTED .
PRESSURE OFFSET: O.OPSI
MECHANICAL BLENDER: NO
ri
L11 :91 FILL
TRI -STATE (S I lsiGLE FL,-)CAT}
cATEGORV : PIPING BUMF
14- e c. 7I T I LL ANN
SETUP
TRI —STATE
CATEGORY
SINGLE FLOAT)
ANNULAR SPACE PLLD LINE DISABb E
LINE LEAK LOCKOUT
LOCKOUT hQHEDULE
i7A 1 LY
START TIME: DISABLED
I DISABLED
L13:DIES£L FILL
TRI-STATE LIQUID.SENSOR,.ALMS
STOF T ME SUMP L 1.FUEL:
ALA2M
FUEL- ALARML
L i 5.: FUEL. ALARM.
L14- DIESEL FILL ANN L17:FUEL. ' ALARM
L19:FUEL ALARMTRI -STATE SINGLE FLOAT) L21 -FUEL ALARM. CATEGORZ ANNULAR SPACE L23 :FUEL ALARM
L 'SENSOR OUT ALARi
L 9 : SENSOR OUT ALAR]
L15 ;DISP 3 -2 L15:SENSOR OUT ALAM
L1 ?: SENSOR UL1T ALARTRI-STATE SINGLE FLOAT) L 15-SF 6UT At»FwRCATEGORYDISPENSERPANkSOR
L21 =SENSOR OUT, F1LARLI4)Ui,U 4EN(7R SETUP L23 :SENSOR OUT ALAR
L 1:a7 STP L1b:FiISP 1 -2 ANN ISD 81TE :ALARMSISID. GROSS, PRES FAI L
TRI -STATE (SINGLE FLOAT) TRI- STATE SI.NGLE FLOAT) 1Sp pEGRU.PRES FAILi,.i3T£GC}RY' 'STP Sump CATEGORY.: ANNULAR SPACE ISD VAPOR LEAK FAIL
ISD Vp PRES FAILISDVPSTATUSFAIL
L 2 :87 STP ANN
TRI --STATE (: I N6LE FLOAT) L 17 : L1I SP 3 -4 ISD NOSE aLARi S,
CATEGORY : ANNULAR SP' E TRI -STATE SINGLE FLOAT) ALL:GROSS G.OLLECT'FCATEGORYDISPENSERPANALL:DEGRD COLLEUT FALL :FLOW CDLLECr FF
1 3:91 STP
TRI —STATE ( SINGLE FLOAT) L18:DISP 3 -4 ANN G 2:91
CATEGORY : STP SUMP TRI-STATEJSINGLE LIQUID SENSOR ALMSSPACEL -3FUEL ALARI'`1
L1a:FUEL ALARM:
L 4 :91 STF''ANN L17:FUI;I rL
TRI - STATE (;SINGLE FLOAT)
RM.
L19:FUEL ALA
CATEGORY : A14NULAR SPACE L19:DISP 5 -6 L n :FUEL. ALAWTRI -STATE SINGLE FLOAT) L23 :FUEL_ALARM. CATEGORY IIISPENSER FAN L );SENSOR OUT. ALA!
L 15 : SENSOR OUT ALAI
L 5 : I; I ESEL STP L.1 ?.SENSOR OUT ALAI
TRI -STATE tcijlGLE FLOAT)
CATEGORY : STP SUMP L2D:DISP 5 s ANN 1.1.9:$ENSOR OUT ALA,
L21 :SENSOR `Otl'f ALA' TRI -STATE SINGLE FLOAT) L. 23 :SENSOR, OUT ALA. CATEGORY ANNULAR:SPACE F
L 6:DIESEL STP ANN IF;D SITE
TRI -STATE ( SINGLE FLOAT)
ALARMS"
ISTi GR4SSs pRES FAI.
CATS aORY : ANNULAR aPN;E
L2 I : D I SP E ISD . DEGRD. ;PIES. `FA I
SD ti1Ai'PR >1 I
TR:I —STATE SINGLE FLOAT) I FAILICUp::
StAtu . CATEGORY DISPENSER PAN ISD VP :: gTATIJS .FAIL
L ' ° DENT :. 18D SETUP FAIL.
TR I - -STATE (of WLE FLOAT)
CATEGORY OTHER SENSORS L22 :DISP 7 -8 ANN ISD HOSE ALARMS
TRI -STATE SINGLE FLOAT), DB
SS
CQLLECT
CATEGORY ANNULAR SPACE
L 8:UENT ANN
TRT -STATE (SINGLE FLOAT) G a :DIESEL
CATEGORY : ANNULAR SPACE L23:BTSP 9 -1U Ll]UID &ENSOR " S.
TRI -STATE SINGLE FLOAT) L 5:FUEL NLAI1
L13.:FOl L. ALARMCATEGORYDISPENSERPANL19 :FUEL ALA
L FILL t2-3-FUEL ALARM
TRI - SPATE (E;11dGI.E FLOAT) L 5 : SEidSOR OUT Aj
CATEGORY : 1:'IPING +UMP
L24:DISP 9 -10 ANN L13:SENSOOR OUT ALf
1-14 :StNsop OUT Ali
TRI -STATE cSINGLE FLOAT) L >3:SENSOR OUT ALiLto :87 FILL ANI'I CATEGORY ANNULAR SPACE
TRI -STATE t fi I NGLE FLOAT)
CATEGORY : AN14UI -AR SPAC -E
L11 :91 FILL
TRI -STATE (S I lsiGLE FL,-)CAT}
cATEGORV : PIPING BUMF
E'VR 1SD SETUP 0 MLf
SMARTSENSOR SETUP ALARM HISTORY REPORT
SYSTEM 'ALARM __
s 1'87 TANY ANN EVR TYPE: VACUUM ASSIST PAPER OUT
CATEGORY VA" SENSOR VACUUM ASSIST TYPE SEP 7. 2011 1:26 PM
PUMP #: HEALY VAC PRINTER ERROR
Q 1.87 SEP 7. 2011 1:26 PM
VOLUME: 205.7 GALLONS NOZZLE H/L RANGE
RELIEF VAL1iE: : NO MAX.: 1.15 MIN: 0.9.5
s 2:67 VENT VAPOR PROCESSOR TYPE
F CATEGORY' VAC SENSOR NONE
PUMP tt
0.1:37
VOLUME: 128.8 GALLONS ANALYSIS TIMES
REL I.EF VALVE : NO TIME: 9 ; 59 'AM
DELAY MINUTES. I
s. 3..87 PROD n X * A A END x ; *' *:.
CATEGORY VAC SENSOR ACCEPT HIGH ORVR: PUMP #: DISABLED01:97
VOLUME: 64.4 GALLONS ISD.HOSE TABLERELIEFVALVE: : NO ID FP FL HL AA RR
s :$7 -VAPOR 01 01 01 02 01 00CATEGORYVACSENSOR02020202O100PUN1F' 7: 03 03 03 02 00 0001`87
VOLUME: 99.0 GALLONS 04 04 04 02 00
05 05 05 02 03
00
OU ALARM HISTORY REPORTRELIEFVALVE: : 1510 06 06 06 02 03 00 INX, 07 D7 017 02 04 00 IN-TA ALARM, -- s 5: 91 VENT 08 08 08 02 04 00CATEGORY.'., VAC.: SENSOR 09 09 09 02 05 00 T 1:87PUMP
2 911 : 10 16 10 02 05 00
VOLUME: 64.4 GALLONS OVERFILL ALARM
SEP- 3. 201'11 4,:09 PMRELIEFVALVE: NC> I SD AIRFLOW METT:R MAP AUG 24, 2611 W:08 AI~I
IDSERIAL NUM LABEL_ AUG 22, 2011 8.:21 'AMs6t51PROU..
CATEGORY VAC SENSOR 1 7231 DISP 1 -2 F HIGH PRODUCT•ALARM. PUMP 4: 2 51729 DISP 3 -4 F AUG 24. 2011 1.0:09 AM
3 50776 DISP 5 -6 F AUG 1 -0. 2011 2:04 PMVOLUME: 110.4 GALLONSAL 4 7020 DISP 7 -8 F AUG 3. 20.11 9:11 AMRELIEFVALVE: 5' 7021 DISP 9 -10
5.7;DIE2-,EL -91 TANK ANN DELIVER`i NEEDEDCATEGORY'. VAC SENSOR ISD FUEL GRADE HOSE MAP JUN 17. 2011 4:23 PMPUMPp:
Q 1 3 4 JUN 11, 20:1.1 10:59 All3: DIESEI. MHH M-- AAVOLUME: 205.7 GALLONS
RELIEF VALVE: : NO 01 101 9.01 201 U U 1
s 8::DIESEL PROD 02 102 902 202 U U
p3 1 0 9 >U 2 U U U
1
0CATEGORYVACSENSOR041U9U20000PUMP ;t: 05 105 905 205 3 U 30' 3 : U I ESEL 06 106 906 206 '3 U 3VOLUME: 110.4 GALLONS 07 107 907 207 U U 4RELIEFVALVE: : NO 08 108 908 208 U U 4.
s y,:DIESEL VENT 09 109 909 209 3'U
16 11.0 91:0 210 3 U
5
5 ENDCATEGORY:: VAC SENSOR
PUMP r3:
0 3:DIESEL LABEL TABLEVOLUIIE : . 64.4 GALLONS
RELIEF VALVE: NO 1: UNASSIGNED-----
10 : D I SP 1 -'? FM 3:
BLEND 3
3: REGULARCATEGORYAIRFLOWMETER4: MID GRADE
s1.1.:DISP 3 -4 FM 5: PREMIUM
GHTEG +JRY fi I k FLOW METER 6: GOLD
7 : BRONZE
8: SILVER ALARM HISTORY REPORTX12 : DIwP 5 -6 FM 9: BLEND2CATEGORYAIRFLOWMETER10: BLEND4 IN-TANK ALARM -
s13*18P 7 -9 FM T 2`91CATEGORYAIRFLOWMETER
s1,4:DISP 9710 FM
CATEGORY AIR FLOW METER
515:DISP -t VP
CATEGORY .VAPOR PRESSURE
XEND OEX xx x- X x A x X END X. X,
ALARM HISTOR"i' REPORT
SENSOR r'll-ARf"I -----
L 2:87 STP ANN ALARM HISTORY REPORT ALARM HISTORY REPO' ANNULAR SPACE
SENSOR OUT ALARM ----- SENSOR ALARM ----- SENSOR ALARMSEP7, 2011 2:45 Pm L 5:DIESEL STP
STP SUMP L B:VENT ANN
FUEL riLARI SENSOR OUT ALARM ANNULAR SPACE,
SET, 7. 2011 1-:52 PH SEP 7, 2011 2:46 PM :SENSOR 60T ALARM
SEP 7; 20tt 2:45
FUEL ALARM FUEL ALARMSEP7- . 2011 1:42 PM SEP 7 2011 2 . :35
END
ALARM HISTORY REPORT ALARM HISTORY.,: ALARM HISTORY REPORT
IN.-Tm`NI' ALARM
SENSOR ALARM -----
L 3:91 STP SENSOR: A'LAPh
STP SUMP L G..l:,DIF$EL STP ANN
T 3:DIESEL SENSOR OUT ALARM ANNULAR SPACE
SEP 7. 2011 2:45.PM SENSOP.--OUT ALARM
SEP 7, 2611 2-4'E
FUEL ALARM
SEP 7, 2011 1:38 PM FUEL ALARM
SEP 7. 2011 1r-,55,
END
x END END
ALARM HISTORY REPORT
SENSOR ALARM
L 1:8? STP ALARM HISTORY REPORT ALARM kifSTORY REPO' STP Sump
SENSOR OUT ALARM SENSOR ALARM SENSOR ALARMSEP .7, 2011 2*:45 PVI L 4:91 STP ANN L 7,'VENT: ANNULAR SPACE OTHER SE
I
NSORSFUELALARMSENSOROUTALARMSENSOR °.:OUT ALARMSEP7. 2011 1:45 PM SEP 7, 2011 2:45 PM SEP 7; 2011 '2:4.5.
FUEL ALARM FUEL ALARMSEP7, 2011 1:51 PM SEP 7. 2011 . 2:01
E ND
XEND OEX xx x- X x A x X END X. X,
ALARM HISTOR"i' REPORT
SENSOR r'll-ARf"I -----
L 2:87 STP ANN ALARM HISTORY REPORT ALARM HISTORY REPO' ANNULAR SPACE
SENSOR OUT ALARM ----- SENSOR ALARM ----- SENSOR ALARMSEP7, 2011 2:45 Pm L 5:DIESEL STP
STP SUMP L B:VENT ANN
FUEL riLARI SENSOR OUT ALARM ANNULAR SPACE,
SET, 7. 2011 1-:52 PH SEP 7, 2011 2:46 PM :SENSOR 60T ALARM
SEP 7; 20tt 2:45
FUEL ALARM FUEL ALARMSEP7- . 2011 1:42 PM SEP 7 2011 2 . :35
END
ALARM HISTORY REPORT
SENSOR ALARM
L.9:87 FILL
P I PI Ni3 SUMP .
SENSOR OUT ALARM
SEP 7. 2011 2:45 PM
FUEL ALARM
SEP 7. 2011 1:45 PM
FUEL ALARM
SEP 7, 2011 1:43 PM
END k * n K
ALARM HISTORY REPORT
SENSOR. ALARhi - - - --
L10:87 FILL ANN
ANNULAR SPACE
SENSOR. OUT ALMR11
SEP 7, 201 t 2:45 PM
FUEL ALARM
SEP 71 2011 1:51 FIN
x X e« END X 0- * X
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L11.:9.1 FILL
PIPING SUMP
BENS +DR OUT ALARM
SEP 7, 2011 2:45 Pll
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L12:J1 FILL ANN
ANNULAR SPACE
SENSOR OUT ALARM
SEP 7, 2011 2:45 PM
FUEL ALARM
SEP 7. 2011 1:51 PH
x A END * X * * 'jt
ALARM HISTORY REPORT
SENSOR "R11 - - - --
L13:DIESEL FILL
PIPING SUMP
SENSOR OUT ALARM
SEP 7, 12011 2:45 PM
FUEL ALARM
SEP 7, 2611 1:42 PM
FUEL ALARM
SEP 7, 2011 1:39 PM
ALARM HISTORY REPORT
SENSOR ALARM -----
L14:DIESEL FILL ANN
ANNULAR SPACE
FUEL ALARM
SEP 7, 2011 3:20 PM
FUEL ALARM
SEP 7. 2011 3:17 PM
FUEL ALARM
SEP 7. 2011 2:46 PM
ALARM HISTORY REPORT
SENSOR ALARM - - --
L15:DISP 1 -2
D1 SPE14SER PANSENSOROUTALARM
SEP 7, 2011- 2:45 PK
FUEL ALARM .
SEP 7. 2011 1:46 PM
o END .x.
ALARM HISTORY REPORT
SENSOR ALARM.- -
1- 16 :DISP 1 =2, ANN
ANNULAR SPACE.
SENSOR OUT. ALARM
SEP 7, 20,11 2:45 PM
FUEL ALARM
SEP 71 2011 1:52 PM
ENpxri *
ALARM HISTORY REPORT
SENSOR ALARM.
L17:DISP' 3 -4
DI,$PENSER PANSENSOROUTPLARl -1
SEP 7, 2.011 2:45 1
FUEL ALARM
SEP 7. 2011 1:47
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L18`.DISP 3 -4 ANN
ANNULAR SPACE
SENSOR OUT ALARM
SEP 7, 2011 2:45 PM
FUEL ALARM
SEP 7, 2011 1:52 Pil
FUEL.ALARM
JUL 14, 2011 5:31 AM
x** x x END x x* x
ALARM HISTORY REPORT
SENSOR ALARM — - --
L19:D.ISP 5 -6
DISPENSER PAN
SENSOR OUT ALARM
SEP 7, 2011 2:45 PM
FUEL ALARM
SEP 7, .2Ci11 1:48 PM
x x :x o x END x* x x*
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L20 *1SP 5 -6 ANN
ANNULAR SPACE
SENSOR OUT ALARM
SEP 7, 2011 2:45 PM
FUEL ALARM
SEP 7, 2011 1:53 PM
ALARM HISTORY REPORT
SENSOR ALARM
L21:DISP 7 -8
DISPENSER PAN
SENSOR OUT ALARM
SEP 7, 2011 2:45 PM
FUEL ALARM
SEP 7. 201.1 1:48 PM
x * END
ALARM HISTORY REPORT
SENSOR ALARM
L22:DISR 7 -8 ANN
ANNULAR SPACE
SENSOR OUT ALARM
SEP 7, 201 1 2;45 PM
FUEL ALARM
SEP 7, 2011 1:53 PM
END x x x x *.
ALARM HISTORY REPORT
SENSOR ALARM
L23:DISP 9 -10
DISPENSER PAN
SENSOR OUT ALARM
SEP 7, 2011 245 PM
FUEL ALARM
SEP 7, 2011 1:50 PM
ALARM, H I STORY REPO .T
SENSOR ALARM --
L24:DISP 9 =10 ANN
ANNULAR SPACE
FUEL ALARM
SEP ' 7, 2 1I 1 2 `.46 . Ph
SENSOR OUT ALARM
SEP 7, 2011, 2:48 Ph.
FUEL ALARM
SEP 7, 2011 1:53 -Ps
ENO
ALARM HISTORY REPORT
SENSOR ALARM --
L 1 -:87 STP
STP SUMP
SENSOR OUT ALARM'
SEP 7, 2011 2:45 Pt
FUEL ALARM
SEP 7. 2011 1:45 Pr
ALARM HISTORY REPORT
SENSOR. ALARM
9 1
OTHER SENSORS
ALARM HISTORY REPORT ALARM HISTORY 'REPORT
SENSOR ALARM - - - -- SENSOR ALARM - - - --
Q 1;: 87 ia ?'S.1PLLDSHUTDOWNALARMSHUTDOWN ALARM
SEP 7, 2011 2:59 PM PN1SEP ?. SEP
GROSS LINE FAIL GROSS LINE FAILSEP7. 2011 F2:59 PM SEP 7, 2011 3 :03 PM
PLL11 SHUTDOWN ALARM PLLD SHUTDOWN. FILARPISEP7. 20.11 2:45 PM SEP 7, 2011 2:45 PM
PLLD SHUTDOWN ALARM PLLD SHUTDOWN 1.50SEP7, 2011 1:50 PP'i SEP 7, 2011
PM
PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALf+RMSEP7. 2011 1:48 PM SEP 7, 2011 1 :48 PM
PLLD.;SHUTDOWN ALARM PLLD SHUTDOWN ALARMSEP7. 2011 1:48 PM SEP 7, 2011 1:48 PM
PLLD:. SHUTDOWN ALARM PL.LD SHUTDOWN ALARMSEP7, 2011 1:47 PM SEP 7, 2011 1:47 PM
PLLD SHUTDOWN ALARM PLLD SHUTDOWNS ALARMSEP7, 2011 1:46 PH SEP 7, 2011 1:46 PM
PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARMSEP7. 2011 1:45 PP1 SEP 7,2011 1:38 PM
PLLD SHUTDOWN ALARM PLLD SHUTDOWNi ALARMSEP7, 2011 1:45 PM AUG 21.2011 10:04 AM
h < END END
ALARM HISTORY REPO" RT
SENSOR ALARM
G1 3 :DIEBEL
PLLD SHUTDOWN ALARM
SEP 7. 2011 3 :06 PM
GROSS LINE FAIL
SEP 7, 2011 3:06 FPM
PLLD SHUTDOWN ALARM
SEP 7, 2011 2:4`5 PM.
PLLD SHUTDOWN ALARM
SEP 7, 2011 1 :50 FM
PLLD SHUTDOWN ALARM
SEP 7, 2011 1:48 PM
PLLD SHUTDOWN ALARM
SEP 7, 2011 1:42 PM
PLLD SHUTDOWN ALARM
SEP 7. 2011 1.:42 PM
x #DID XA * *:
ALARM HISTORY REPORT
SMARTSENSOR ALARM --
s 1:87 TANK ANN
NO VACUUM ALARM
SEP 7, 2011 2:07 PM
COMMUNICATION ALARM
AUG 26. 2011 10:48 PM
COMMUNICATION ALARM
AUG 19, 2011 4 :22 PM
A A ENEI X x x x
ALARM HISTORY REPORT
S°1ARTSENSOR ALARM --
s 2:.87 VENT
NO VACUUM ALARM
SEP 7, 2011 2:14 PM
ALARM HISTORY REPORT
SMARTSENSOR ALARM --
s 3:87 PROD
No VACUUM ALARM
SEP 7, 2011 2 :06 PM
43441
ALARM HISTORY REPORT
SMARTSENSOR ALARM --
s 4:87 -VAPOR
NO VACUUM ALARM
SEP 7, 2011 2:11 PM
NO VACUUM ALARM
SEP 7, 2011 2:08 PM
ALARM HISTORY REPORT
SMARTSENSOR ALARM
s 7:DIESEL -91 TANK ANN
NO VACUUM ALARM
SEP 7, 2011 2:02. PM
END * * A * x
ALARM HISTORY REPORT ,
SMARTSENSOR ALARM.--
8:DIESEL PROD
NO VACUUM ALARM
SEP 7. 2011 2:02 PM
u 3 *11
MONITOR CERT.: FAULURE REPORT
SITE NAME: STOCKDALE FOODMART DATE: 9 -7 -11
ADDRESS: 5321 STOCKDALE HWY TECHNICIAN: RYAN MASON
CITY: BAKERSFIELD SIGNATURE:
REPAIRS:
BRINE SENSORS ON DISP #9 -10 AND DSL STP SUMP DID NOT WORK AND NEED
TO BE REPLACED
PARTS INSTALLED: 9/26/11 JAMES RICH REPLACED TWO (2) BRINE
SENSORS ON DISP #9/10 (OWNER SUPPLIED PARTS)
THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING
THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR
THE ABOVE LISTED PROBLEMS AND NOTHWUNG RICH ENVIRONMANTAL FOR
ANY NEEDED RETESTING. THIS ALSO RELEASES RICA ENVIRONMENTAL; OF
ANY FINES OR PENALTIES.00CURING FROM NON-COMPLIANCE.
A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR
CONVIENENCE.