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HomeMy WebLinkAboutFMC 2012MONITORING 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 monitorine 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 of this form to the local agency regulating UST systems within 30 days oftest date. A. General Information Facility Name: FREEWAY LIQUORS Site Address: 2140 EAST BRUNDAGE Facility Contact Person: Make /Model of Monitoring System: TLS -350 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: City: BAKERSFIELD Contact Phone No.: Bldg. No.: Zip: Date of Testing/Servicing: 3/3012012 Tank ID: 91 Tank ID: 87 Z In -Tank Gauging Probe. Model MAGAZIn -Tank Gauging Probe. Model: MAG -1 Z Annular Space or Vault Sensor. Model: 409 Z Annular Space or Vault Sensor. Model: 409 Z Piping Sump / Trench Sensor(s). Model: 208 Z Piping Sump / Trench Sensor(s). Model: 208 Z Fill Sump Sensor(s). Model: 208 Z Fill Sump Sensor(s). Model: 208 Mechanical Line Leak Detector. Model: RED JACKET Z Mechanical Line Leak Detector. Model: RED JACKET Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: Tank Overfill / High -Level Sensor. Model: 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: WASTE OIL TANK Tank ID: in -Tank Gauging Probe. Model: WA In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: 420 Annular Space or VaultSensor. Model: Piping Sump / Trench Sensor(s). Model: 208 Piping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: 208 Tank Overfill / High -Level Sensor. Model: Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2). Dispenser ED: 112 Dispenser ID: 314 Z DispenserContainment Sensor(s), Model: 208 Z Dispenser Containment Sensor(s). Model: 208 10, Shear Valve(s). Z Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: 516 Dispenser ID: 718 Z DispenserContainment Sensor(s). Model: 208 Dispenser Containment Sensor(s). Model: 208 Shear Valve(s). i 'Dispenser Containment Floats) and Chain(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Mispeoser ID: Dispenser fD: it -Dispenser Containment Sensor(s). Spear Valve(s). Model: Dispenser Containment Sensor(s). Shear Valve(s). Model: DispenserContainment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). j *lf'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 /seryiced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of erating such reports, I have also attached a copy of the report; (check all that apply): ® System set -up ® Alarm his report Technician Name (print): RICH PHILLIPS Signature: Certification No.: A29084 / 1035169 -UT License. No.: 61/ D40 809850 Testing Company Name: RICH ENVIRONMENTAL Phone No.: (661) 392 -8687 Testing Company Address: 5643 BROOKS CT, BAKERSFIELD, CA 93308 Date of Testing/Servicing: 3/30/2012 Page 1 of 5 UN- 036 -114 www.uaidoe&org Rev. 01 /17 /08 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: d— mm-lafP +hP;nnnwiner PhPt-k1ie +- Yes No* IIs the audible alarm operational? Yes No* IIs the visual alarm operational? Yes No* WWere all sensors visually inspected, functionally tested, and confirmed operational? Yes No* WWere all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes No* IIf alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) IS N/A ooperational? Yes No* FFor pressurized piping systems, does the turbine automatically shut down if the piping secondary containment N/A mmonitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (Check all that apply) ® Sump/Trench Sensors; ® Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure /disconnection? ® Yes; No. Yes No* FFor tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no N/A mmechanical 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? % Yes* No WWas any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. Yes* ® No WWas liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product; Water. If yes, describe causes in Section E, below. Yes No* WWas monitoring system set -up reviewed to ensure proper settings? Attach set up reports, if applicable Yes No* II Is all monitoring equipment operational per manufacturer's specifications? In Section E below, describe how and -when these deficiencies were or will be corrected. Comments: i Page 2 of 5 UN -036 — 2/4 www.unidoes.org Rev. 01/17/08 Monitoring System Certification F. In- Tank Gauging / SIR Equipment: 05%Qk E Check this box iftank gauging is used only for inventory control. Check this box ifno tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Yes No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes p No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes No* Was accuracy of system product level readings tested? Yes No* Was accuracy of system water level readings tested? Yes I No* Were all probes reinstalled properly? Yes No* I 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): Gomnlete the following checklist: Check this box if LLDs are not installed. 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: ® 3 g.p.h.; [3 0.1 g.p.h ; El 0.2 g.p.h. Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes O. No* Was the testing apparatus properly calibrated? Yes No* N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Yes No* N/A For electronic LLDs, does the turbine automatically shut off ifthe LLD detects a leak? Yes No* N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? O ,Yes; No* N/A For electronic LLDs, does the turbine automatically shut off ifany portion of the monitoring system malfunctions or fails a test? Ye's' No* 0 N/A For electronic LLDs, have all accessible wiring connections been visually inspected? z Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? 1n Section FL below. describe how and when these deficiencies were or will he corrected_ Comments: jdA@ -036 — 3/4 I., Page 3 of 5 www.unidocs.org Rev. 01/17/08 Monitoring System Certification UST Monitorim Site Plan Site Addm. Lk,5-W e . O • _ .. 1 - _ 9. • . _ . . . . . . . . _ w . . • . . • _ . . . . . . _ _ _ . a w V . . • . r • r. • - - _ •L . • . . . . . . . . • _ - • _ - _ PP ,, • r r _ - . _ - e• . _ • . _ • • r • _ . _ . . • . . . . . . . « • • Y - r - m . . . . . m . . . / . . . • . . . . . . . • . . . . . . . . r . . . . . • . . . r . . . . I ::: ::: -- - ::: = == ... ...... . D* map was &m Instmedons 0 If you already have a diagram that shows all required information, you may include it, rather than this page, with your Mmikni motion- On yom site per• slow the general layout oftanks andpiping• Clearly identify locations oftine following eq:ipme: if iaatallod: monitoring n' -.catiol pawls, sensors monitoring took annular spaces, sumps, dispenserpans, spill gainers, or otber secondary caui Y areas; mechanical or electronic line leak detectors; and in -tank liquid level probes (ifused to :eak detection). in "w : +ce provided, note the date this Site Plan was prepared. Page ot . 05100r L SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing ofUSTspill containment structures. The completedform and printoutsfrom tests (cfapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: FREEWAY LIQUORS 7 Date of Testing: 3/30/12 Facility Address: 2140 EAST BRUNDAGE LANE, BAKERSFIELD Facility Contact: I Phone: Date Local Agency Was Notified of Testing: 2/23/12 Name of Local Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RICH PHILLIPS Credentials: CSLB Contractor X 1CC Service Tech. 0 SWRCB Tank Tester Other (Specify) License Number(s): 1035169 -UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic Vacuum Other Test Equipment Used: VISUAL Equipment Resolution: 0 Identify Spill Bucket (By Tank Number, Stored Product, etc. 187 2 91 3 4 Bucket Installation Tyam' X Direct Bury Contained in Sump X Direct Bury Contained in Sump Direct Bury Contained in Sump Direct Bury Contained in Sum Bucket Diameter: 12" 12" Bucket Depth: 14" 14" Wait time between applying vacuum/water and start oftest: 30 MIN 30 MIN Test Start Time (Ti): 9:15 9:15 Initial Reading (Ri): 14" 14" Test End Time (TF): 10:15 1 0:15 Final Reading (RF): 14" I4" Test Duration (TF — Ti): 1 -HOUR 1 -HOUR Change in Reading (RF - Rj): 0 0 Pass/Fail Threshold or Criteria 0.00 0.00 Test Result:. X Pass 0 Fail X Pass Fail 0 Pass Fail 0 Pass Fail Comments — (include information on repairs made prior to testing, andrecommendedfollow -upforfailed tests) a. . CERTIFICATION OF TECHNI 1AN RESPONSIBLE FOR CONDUCTING THIS TESTING Ihereby certify that allthe information con ed in this report is true, accurate, and infull compliance with legal requirements. Technician's Signature: Date: 3/3Q/12 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. RICH ENVIRONMENTAL 5643 BROOKS CT. BAKERSFIELD, CA. 93308 OFFICE (661)392 -8687 FAX (661)392 -0621 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET FACILITY NAME: FREEWAY LIQUORS FACILITY ADDRESS: 2140 E. BRUNDAGE LANE, BAKERSFIELD PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL UNL87 L/D TYPE: RED JACKET YES 10 PASS SERIAL #_ pREM91 L/D TYPE: RED JACKET YES 11 PASS SERIAL # _ LID TYPE: _ YES PASS SERIAL # _ NO FAIL 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 LIMITATIONS. 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.I. I ACKNOWLEDGE THAT ALL DATA COLLECTED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. TECHNICIAN: RICH PHIL SIGNATURE: DATE: 3/30/12 AUTO TRANSMIT SETTINGS: SOFTWARE REVISION LEVEL VERSION 329.01 SYSTEM SECURITY AUTO LEAK ALARM LIMIT SOFTWARE# 346329 -100 -B 09.01.29.15.44 CODE: 000000 DISABLED AUTO HIGH WATER LIh TCREATED - S- MODULE# 330160 -004 -a MAINTENANCE HISTORYDISABLED DISABLED AUTO OVERFILL LIMIT SYSTEM FEATURES: DISABLED PERIODIC IN -TANK TESTS AUTO LOW PRODUCT ANNUAL 1N -TANK TESTS TANK CHART SECURITY DISABLED LIMITISDDISABLEDDDISABLEDDISABLED AUTO DELIVERY START CUSTOM ALARMS DISABLED DISABLED AUTO DELIVERY END DISABLED AUTO EXTERNAL INPUT ON SERVICE NOTICE DISABLED DISABLED AUTO EXTERNAL INPUT OFF DISABLED AUTO SENSOR FUEL ALARM SYSTEM SETUP ISO 3166 COUNTRY DISABLED CODE: AUTO SENSOR WATER ALARM MAR 30. 2012 11:02 All DISABLED AUTO SENSOR OUT ALARM MASS /DENSITY DISABLED DISABLED SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT RECEIVER SETUP: N,1DD YYYY HH:MM:SS xM NONE FR&EWAY•GAS- LIQUORS 2,140•E BRUNDAGE HAKERPFI,ELD. CA 77b254 SHIFTSHIFT TIME 1 11:00 PM COMMUNICATIONS SETUPSHIFTTIME2DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED PORT SETTINGS: TANK PER TST NEEDED WRN DISABLED COMM BOARD ' 1 (ED1M > AUTO DIAL TIME SETUP: TANK ANN TST NEEDED WRN RS -232 SECURITYDISABLEDCODE : DISABLED NONE LINE RE- ENABLE METHOD COMM BOARD 2 (RS -232) PASS LINE TEST BAUD RATE 9600PARITYODDLINEPERTSTNEEDEDWRNSTOPBIT1STOPDISABLEDDATALENGTH: 7 DATALINEANNTSTNEEDEDWRNRS -232 SECURITY DISABLED CODE : DISABLED PRINT TC VOLUMES COMM BOARD 3 (FXMOD) ENABLED BAUD RATE 2400PARITYODDTEMP,COMPENSATION STOP BIT 1 STOPVALUE:(BEG F ): 60.0 DATA LENGTH: 7 DATAi3T,1CK' :HEIGHT OFFSET RS -232 SECURITY RS -232 END OF MESSAGE D19ABLED' CODE : DISABLED DISABLED UYLAGE: 90: DIAL TYPE TONEANSWERON AUTO DIAL ALARM SETUP H- PROTOCOL DATA FORMAT 1 RING MODEM SETUP STRINGHEfGHT DAYLIGHT SAVING TIME DIAL TONE INTERVAL: 32DISABLED RE- DIRECT LOCAL PRINTOUT DISABLED EURO PROTOCOL PREFIX s T 3': 87 2.0 PRODUCT CODE 3 THERMAL COEFF 000700 TANK DIAMETER 90.00 TANK PROFILE 4 PTS FULL VOL 11527 67.5 INCH VOL 9397 45.0 INCH VOL 5857 22.5 INCH VOL 2289 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 11527 OVERFILL LIMIT 901/9 TANK PROFILE 10374 HIGH PRODUCT 95Yo 67.5 INCH VOL 10950 DELIVERY LIMIT 12% 22.5 INCH VOL 1383 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TO: NONE LINE MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 0'0 0 LEAK MIN ANNUAL 0% 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 5 MIN PUMP THRESHOLD 10.00% IN —TANK SETUP T 2:91 PRODUCT CODE 2 THERMAL COEFF 000700 TANK DIAMETER 90.00 TANK PROFILE 4 PTS FULL VOL 11527 67.5 INCH VOL 9397 45.0 INCH VOL 5857 22.5 INCH VOL 2289 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 11527 OVERFILL LIMIT 90% 10374 HIGH PRODUCT 95vo 10950 DELIVERY LIMIT 12% 1383 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TO: NONE LINE MANIFOLDED TANKS TO: NONE LEAK MIN PERIODIC: 0% 0 LEAK MIN ANNUAL 0• 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 5 MIN PUMP THRESHOLD 10.00% LEAK TJk T MI~THQU TEST MONTHLY : ALL TANKWEEKIMON START TIME : 12:00 AMTESTRATE :0.20 GAL /HRDURATION :'2 HOURS TST EARLY STOP:DISABLED LEAK TEST REPORT FORMAT ENHANCED LIQUID SE14SOR SETUP L 1:87 STP SUMP TRI —STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 2:91 STP SUMP TRI —STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 3:87 FILL TRI —STATE (SINGLE FLOAT) CATEGORY : PIPING SUMP L 4:91 FILL TRI —STATE (SINGLE FLOAT) CATEGORY : PIPING SUMP L 5:DISP 1 -2 TRI —STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L 6:DISP 3 -4 TRI —STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L 7 :DISP 5 -6 TRI —STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L 8:DISP 7 -8 TRI —STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L 9:87 ANNULAR TRI —STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L10:91 ANNULAR TRI —STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE OUTPUT RELAY SETUP - - - R 1:DISP RELAY TYPE: STANDARD NORMALLY CLOSED TANK 0: 3 LIQUID SENSOR ALMS L 1 :FUEL ALARM L 2:FUEL ALARM L 5:FUEL ALARM L 6:FUEL ALARM L 7:FUEL ALARM L 8:FUEL ALARM L I:SENSOR OUT ALARM L 2:SENSOR OUT ALARM L 5:SENSOR OUT ALARM L 6:SENSOR OUT ALARM L 7:SENSOR OUT ALARM L B:SENSOR OUT ALARM ISD'SITE ALARMS ISD GROSS PRES FAIL ISD DEGRD PRES FAIL ISD VAPOR LEAK FAIL ISD VP PRES FAIL ISD VP STATUS FAIL ISD HOSE ALARMS ALL:GROSS COLLECT FAIL AI::DEGRD COLLECT FAIL L. '! FLOW COLLECT FAIL SMARTSENSOR SETUP 5 i:DISP 1 -2 CATEGORY AIR FLOW METER s 2:DISP 3-4 CATEGORY AIR FLOW METER s 3 :DISP 5 -6 CATEGORY AIR FLOW PIETER s 4:DISP 7 -8 CATEGORY AIR FLOW METER s 5:VP SENSOR CATEGORY VAPOR PRESSURE s B:'OARBON CANISTER CATEGORRY VAPOR VALVE 5 B :ATM PRESSURE CATEGORY ATM P SENSOR EVR /ISD SETUP EVR TYPE: BALANCE BALANCE NOZZLE TYPE VST VAPOR PROCESSOR TYPE VEEDER -ROOT POLISHER ANALYSIS TIMES TIME: 7:59 AM DELAY MINUTES: 1 ACCEPT HIGH ORVR: DISABLED ISD HOSE TABLE ID FP 'FL HL AA RR 01 00 01 02 01 UU 02 01 02 02 01 UU 03 02 03 02 02 UU 04 03 04 02 02 UU 05 04 05 02 03 UU 06 05 06 02 03 UU 07 06 07 02 04 UU. 08 07 08 02 04 UU ISD AIRFLOW DIETER MAP ID SERIAL NUM LABEL 1 35011 DISP 1 -2 2 34033 DISP ,3 -4 3 35513 DISP 5 -6 4 32000 DISP 7 -8 ISD FUEL GRADE HOSE MAP 1 2 3 4 FP MHH MHH MHH MHH AA 00 401 901 501 U U 1 01 402 902 502 U U 1 02 403 903 503 U U 2 03 404 904 504 U U 2 04 405 905 505 U.0 3 05 406 906 506 U U 3 06 407 907 507 U U 4 07 408 908 509 U U 4 LABEL TABLE 1: UNASSIGNED 2: BLEND3 3: REGULAR 4: MID GRADE 5: PREMIUM 6: GOLD 7: BRONZE 8: SILVER 9: BLEND2 10: BLEND4 VEEDER- ROOT POLISHER q ALARM HISTORY REPORT SENSOR ALARM - - - -- L 1:87 STP SUMPSTPSUMP SENSOR OUT ALARM MAR 30,. 2012 9 :41 AM FUEL ALARM MAR 30, 20I2 9:11 AM FUEL ALARM NOV S. 2011 2:21 PM ALARI -I HISTORY REPORT L - 2:91SSTpOSUMPARM - - - -- STP SUMP SENSOR OUT ALARMMAR30, 2012 9:41 AM FUEL ALARM MAR 30, 2012 9:15 AM FUEL ALARM NOV 8, 2011 2:02 PM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 3:87 FILL PIPING SUMP SENSOR OUT ALAYO MAR 30. 2012 9 :41 All FUEL ALARM MAR 30, 2012 9:16 AM FUEL ALARM I,IOV 13, 2D11 4:13 AM ALARM HISTORY REPORT SENSOR ALARM ----- L 4 :91 FILL PIPING SUMP SENSOR OUT ALARM MAR 30, 2012 9:41 AM FUEL ALARM MAR 30, 2012 9:16 AM SENSOR OUT ALARM NOV 8, 2011 11:12 AM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 5:D1SP 1 -2 DISPENSER PAN SENSOR OUT ALARM MAR 30, 2012 9:41 AM FUEL ALARM MAR 30. 2012 9:37 AM SENSOR OUT ALARM NOV B. 2011 11:12 AM s,RVOR. TORS LAR ENR ALW g 0 g:DIV 4a1`1 MtsptlapRUT41A 5050 U• 2p% M FuEL30LA 012 g:` M+ O $ O20 ALA 2 AM av ALARM HISTORY REPORT SENSOR ALARM - - - -- L 7:DISP 5 -6 DISPENSER PAN SENSOR OUT ALARM MAR 30, 2012 9:41 AM FUEL ALARM MAR 30. 2012 9:35 AM SENSOR OUT ALARM NOV 8, 2011 11:12 AM ARM HISTORY REPORT SEAISORI* ALARMe1 ; DISA 7_8 SENSOLASER PAN MAR ''30ALARM20129;41 AM FUEL ALARMMAR '30. 2012 9;33 Am SENSOR OUT ALARMNOV9, 2011 11:12 AM 1. .,. ALARM H 1 STORY !{trux i SENSOR ALARM - - - -- L 9:87 ANNULAR ANNULAR SPACE SENSOR OUT ALARM MAR 30, 2012 9 :41 AM FUEL ALARM ` MAR 30, 2012 9:30 AM FUEL ALARM NOV 8, 2011 2:45 PM ALARM HISTORY REPORT SENSOR ALARM - - - -- L10:91 ANNULAR ANNULAR SPACE SENSOR OUT ALARM MAR 30, 2012 9:41 AM FUEL ALARM MAR 30, 2012 9:28 AM FUEL ALARM NOV 8. 2011 4:19 PM MONITOR CERT. FAILURE REPORT SITE NAME: FREEWAY LIQUORS DATE: 3/30/12 ADDRESS: 2140 EAST BRUNDAGE LANE TECHNICIAN: R CITY: BAKERSFIELD po a PARTS INSTALLED: AIDA,,f SIGNATURE: k ilel !f y THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICK ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE.