Loading...
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 a t r a 4 1 t I A A:.1 a 1 1% t I t 1• 0 f, 4 4 a a' 1 v I o v c P. t I . s. 9 1 v t v I 1.. 9 1 I 4 9- 0 t I A 0 1 9 . I a a f a 1• a I a 0. :1 0 1: 1" :4 I d 0 4 1 Q 0 '1 a,} D. ;Q 9. V 1 1 1 1 M .4 j. 4: P: 0 e r IL 4 0 .,A 1. # V 4 •1 1 S 0 4i. 0 .L1.1 4 A I 9: ;1 f 1 .6 4 1 0. 1 0 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.