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HomeMy WebLinkAboutFMC 2011iz5aY MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California 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 seoarate certification or report must be prepared for each monitoring "gym control parcel 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: GOSFORD SHELL Bldg. No.: Site Address: 4050 GOSFORD RD. City: BAKERSFIELD Zip: 93309 Facility Contact Person: HENG Contact Phone No.: (661) 304 -4083 Make/Model of Monitoring System: TLS -350 Date ofTesting/Servicing: 61212011 B. Inventory of Equipment Tested/Certified Cheek the appropriate boxes to indicate specific equipment inspected/serviced: Tank ID: REG. 87 #1 Tank ID: REG. 87 #2 Z In -Tank Gauging Probe. Model: MAG In -Tank Gauging Probe. Model: MAG Annular Space or Vault Sensor. Model: 304 Annular Space or Vault Sensor. Model: 301 Z Piping Sump / Trench Sensor(s). Model: 208 Piping Sump / Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: 208 Fill Sump Sensor(s). Model: 208 Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: VEEDEROOT Electronic Line Leak Detector. Model: VEEDEROOT Tank Overfill / High -Level Sensor. Model: FLAPPER Tank Overfill / High -Level Sensor. Model: FLAPPER Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section Eon Page 2). Tank ID: PREM 91 Tank ID: DIESEL Z In -Tank Gauging Probe. Model: MAG Z In -Tank Gauging Probe. Model: MAO Z Annular Space orVault Sensor. Model: 301 Z Annular Space or Vault Sensor. Model: 301 Z Piping Sump / Trench Sensor(s). Model: 208 Z Piping Sump / Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: 208 Z Fill Sump Sensor(s). Model: 208 D Mechanical Line Leak Detector. Model: D Mechanical Line Leak Detector, Model: Z Electronic Line Leak Detector. Model: VEEDEROOT Z Electronic Line Leak Detector. Model: VEEDEROOT Z Tank Overfill / High -Level Sensor. Model: FLAPPER Z Tank Overfill / High -Level Sensor. Model: FLAPPER D Other (specify equipment type and model in Section E on Page 2). D Other (specify equipment type and model in Section E on Page 2). Dispenser ID: 112 Dispenser ID: 314 Dispenser Containment Sensor(s). Model: 208 Dispenser Containment Sensor(s). Model: 208 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 Dispenser Containment Sensor(s). Model: 208 Z Dispenser Containment Sensor(s). Model: 208 Shear Valve(s). Shear Valve(s). D Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser ID: Dispenser Contaimnent Sensor(s). Model: D 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). Ifthe 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) necess o verify that this information is correct and a Plot Plan showing the layout of monitoring equipmenL For any equi ment capabl enerating such reports, 1 have also attached a copy of the report; (check all that apply): ® System set -up g Alarm ' report Technician Name (print): RICH PHILLIPS Signature: Certificatiori No.: A29M 1 1035169 -UT License. No.: C61 I D40 809860 Testing Company Name: .RICH ENVIRONMENTAL Phone No.: (661) 392 -8687 Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA. 93308 Date ofTesting/Servicing: 612/2011 Page 1 of 5 UN-036 —1/4 www.unidocs.org Rev. 01/17/08 17— 5 $`f Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: 327.04 Com lete the foliowin 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 1notinterferewiththeirproperoperation? 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? Ifyes: which sensors initiate positive shut -down? (Check all that apply) ® Sump/Trench Sensors; ® Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure /disconnection? ® Yes; No. Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? Ifso, at what percent oftank capacity does the alarm trigger? % 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* ® 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 p No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, if applicable Yes No* Is all monitoring equipment operational per manufacturer's specifications? In Section E below, describe bow and when these deficiencies were or will be corrected. F. Comments:. Page 2 of 5 UN -036 — 2/4 www.unidocs.org Rev. 01/17/08 Monitoring System Certification F. In -Wank Gauging / SIR Equipment: Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Yes No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes No* Was accuracy of system product level readings tested? Yes No* Was accuracy ofsystem water level readings tested? Yes No* Were all probes reinstalled properly? Yes I 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): ramnlwtp thr fnllnwinv eheckliat- Check this box ifLLDs are not installed. Yes No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? N/A Check all that apply) Simulated leak rate: ® 3 g.p.h.; 0.1 g.p.h ; 0.2 g.p.h. Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes No* Was the testing apparatus properly calibrated? Yes No* For mechanical LLDs, does the LLD restrict product flow ifit detects a leak? N/A 0 Yes No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/A or disconnected? Yes No* For electronic LLDs, does the turbine automatically shut offif any portion of the monitoring system malfunctions N/A or fails a test? Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? 0 N/A Yes p No* Were all items on the equipment manufacturer's maintenance checklist completed? In Section H, below, describe bow and when these deficiencies were or will be corrected. H. Comments: L N- 036 — 3/4 . Page 3 of 5 www.unidocs.org Rev. 01/17108 Ming System Certification Monitorine .Site Bite Address: i IQs: = - - -, b - - - . . . . . . . . . . . . . . . . . . . . . . e . . . • - - - - - .. r - . r . .. . r - - - - - . - - - . - - - - . . r - - - - - - - - - - - - - - - - • • - - - J- 3 - - - - - - - - - - - - - - -- -...... -.. Date map was drawn: . Ins' - actions zags If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitori4g S.ystesn Certification. On your site plan, show the general layout`oftanks and piping. CIearly identify locations of the following equipment, if installed: monitoring systetit control panels; sensors monitoring tank annularspaces,'sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and:in ;tank liquid level probes (ifused for leak detection). In the space provided, note the date this Site Plan was prepared. Page _ o f_ 0510D za Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors 1. Results of Vacuum/Pressure Monitoring Equipment Testing 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 owner /operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days oftest date. Manufacturer: NIA Model: System Type: Pressure; Vacuum Sensor IID Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail How was interstitial communication verified? Leak Introduced at Far End ofInterstitial 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: N/A Page 4 of 5 If the sensor successfully detects a simulated vacullm/pressure leak introduced in the interstitial space at the furthest point from thesensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice. UN -036A -1 /1 www.uftidDcs.org Rev. 01/26/06 23Lki " , SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing ofUST spill containment structures. The completedform and printouts from tests (fapplicable), should beprovided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: SHELL STATION Date ofTesting: 6/2/11 Facility Address: 4050 GOSFORD RD. BAKERSFIELD Facili Contact: HENG Phone: (661) 3044083 Date Local Agency Was Notified of Testing : Name of Local Agency Inspector (fpreseni during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RICH PHILLIPS Credentials': CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other (Spec) License Number(s): 1035169 -UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic Vacuum Other Test Equipment Used: VISUAL Equipment Resolution: 0.00 Identify Spill Bucket (By Tank Number, StoredProduct, etc. ) MMM 1 REGULAR 87 -FILL 2 PREMHUM 91- FILL 3 DIESEL FILL 4 REG 87 #2 Bucket Installation Type: Direct Bury X Contained in Sump Direct Bury X Contained in. Sump Direct Bury X Contained in Sump Direct Bury X Contained in Sum Bucket Diameter: 12" 12" 12" 12" Bucket Depth: 14" 14" 14" 14" Wait time between applying vacuum/water and start oftest: 30 MIN 30 MIN 30 MIN 30 MIN Test Start Time (T): 10:00AM 10:00AM 10:00AM 10:00AM Initial Reading (Ri): 12" 12" 12" 12" Test End Time (TF): 11:00AM 1 l :00AM 11:00AM 11:00AM Final Reading (RF): 12" 12" 12" 12" Test Duration (TF — Tj): 1 -HOUR 1 -HOUR 1 -HOUR I -HOUR Change in Reading (RF - Ri): 0 0 0 0 Pass/Fail Threshold or Criteria: 0.00 0.00 0.00 0.00 IBM my ®r Comments -- (include information on repairs made prior to testing; andrecommendedfollow -upforfailed tests) CERTIFICATION OF TEICHN!lPfiN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the Information co in this report is true, accurate, and infull compliance with legal requirements. Technician's Signature: Date: 6/2/11 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. c1z3 &y RICH ENVIRO"ENTAL 5643 BROOKS CT. BAKERSFIELD, CA. 93308 OFFICE (661)392 -8687 FAX (661)392 -0621 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET W /O#: FACILITY NAME: GOSFORD SHELL FACILITY ADDRESS: 4050 GOSFORD RD. BAKERSFIELD PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL REG87 L/D TYPE: VEEDEROOT YES 11 PASS SERIAL # 150749 PREM91 LID TYPE : VEEDEROOT YES 11 PASS SERIAL # 150747 DIESEL LID TYPE : VEEDEROOT YES 11 PASS SERIAL # 210783 L/D TYPE YES PASS SERIAL # NO FALL 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 PHILL SIGNATURE: DATE: 6/2/11 SOFTWARE REVISION LEVEL VERSION 327.04 SOFTWf3REO 346327 -100 -E CREATED - 07.02.OE.10.28 S- MODULEP 330160 -004 -a SYSTEM FEATURES: PERIODIC IN -TANK TESTS ANNUAL IN-TANK TESTS ISD PMC SYSTEM SETUP - - - - - - JUN 2. 2011 2:16 PM SYSTEM UNITS Ury,S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE. /TIME FORMAT MON DD YYYY HH : Mtll : SS xM GOSFORD SHELL 4050 GOSFORD RD BAKERSFIELD CA RE- DIRECT LOCAL PRINTOUT DISABLED EURO PROTOCOL PREFIX S SYSTEM SECURITY CODE : 000000 MAINTENANCE HISTORY DISABLED TANK CHART SECURITY DISABLED CUSTOM ALARMS DISABLED MASS,,DENS I TY DISABLED COMMUNICATIONS SETUP SHIFT TIME 1 5:00 AM aSHIFTTIME2DISABLED PORT SETTINGS: SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE RE- ENABLE METHOD PASS LINE TEST j LINE PER TST NEEDED WRN I DISABLED LINE ANN TST NEEDED WRN 1 DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F >: 60.0 STICK HEIGHT OFFSET DISABLED ULLAGE: 904 H- PROTOCOL DATA FORMAT HEIGHT PRECISION TEST DURATION HOURS: 12 DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK I SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM COMM BOARD I (FXMOD) BAUD.RATE 2400 PARITY ODD STOP BIT I STOP DATA.LENGTH: 7 DATA RS- 232.SECURITY CODE : DISABLED DIAL TYPE TONE ANSWER ON I RING MODEO,,:SETUP STRING DIAL TONE INTERVAL: 32 COMM BOARD : 2 (EDIM 1 RS -232 SECURITY CODE : DISABLED COMM BOARD. 3 (RS -232) BAUD RATE 9600 PARITY NONE STOP BIT :.2 STOP DATA LENGTH: 8 DATA RS -232 SECURITY CODE : DISABLED AUTO TRANSMIT SETTINGS AUTO LEAK ALARM LIMIT DISABLED AUTO HIGH WATER LIMIT DISABLED AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT DISABLED AUTO THEFT LIMIT DISABLED AUTO DELIVERY START DISABLED AUTO DELIVERY END DISABLED AUTO EXTERNAL INPUT ON DISABLED AUTO EXTERNAL INPUT OFF DISABLED AUTO---SENSOR FUEL ALARM DISABLED AUTO SENSOR WATER ALARM DISABLED AUTO-SENSOR OUT ALARM DISABLED RECEIVER SETUP: j NONE AUTO DIAL TIME SETUP: NONE RS -232 END OF MESSAGE DISABLED AUTO DIAL ALARM SETUP YZ 38 f N_TANK SETUP - - - - - --------- -- -- - - T 1:87 -1 PRODUCT CODE 1 THERMAL COEFF :.000? 00 TANK DIAMETER 92.00 TANK. PROFILE 1 PT FULL VOL 11627 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 11627 OVERFILL LIMIT 90% 2 10464 HIGH PRODUCT 95% 000700 11045 DELIVERY LIMIT 15% 92.00 1744 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK•. TILT 3.75 PROBE OFFSET 0.00 SIPHON IIIANIFOLDED TANKS T #: NONE LINE MANIFOLDED TANKS T#: 02 LEAK. MIN PERIODIC: 10% 1,162, LEAK MIN ANNUAL 10% 1162 PERIODIC TEST TYPE STANDARD T 2:87 -2 PRODUCT CODE THERMAL COEFF TANK DIAMETER TANK PROFILE FULL VOL FLOAT SIZE: 4,0 IN. FLOAT SIZE: 4.0 IN. y2 3S''j 2,0 T 3:91 2.0 HIGH WATER LIMIT:. 2 PRODUCT CODE 3 MAX OR LABEL VOL: 000700 THERMAL COEFF 000700 OVERFILL LIMIT 92.00 TANK DIAMETER 92.00 TNK TST SIPHON BREAK:OFF. 1 PT TANK PROFILE I PT H I GH PRODUCT 9728 FULL VOL 9729 FLOAT SIZE: 4,0 IN. FLOAT SIZE: 4.0 IN. WATER WARNING 2,0 WATER WARNING : 2.0 HIGH WATER LIMIT:. 3.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 9728 MAX OR LABEL VOL: 9728 OVERFILL LIMIT 500.1 OVERFILL LIMIT 90% TNK TST SIPHON BREAK:OFF. 8755 8755 H I GH PRODUCT 95y HIGH PRODUCT 95% 9241 9241 DELIVERY LIMIT. 14% DELIVERY LIMIT 14% 1361 1361 LOW PRODUCT 500 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 SUDDEN LOSS LIMIT: 50 TANK TILT 2,29 TANK TILT 2.19 PROBE OFFSET 0.00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS T#: NONE LINE MANIFOLDED TANKS T#: 01 SIPHON MANIFOLDED TANKS T#: NONE.. LINE MANIFOLDED TA14:S T #: NONE LEAK MIN PERIODIC: 10% LEAK MIN PERIODIC: 10 972 972 LEAK MIN ANNUAL 1.0% LEAK MIN ANNUAL 10% 972 972 PERIODIC: TEST TYPE PERIODIC TEST TYPE STANDARD STANDARD PUMP THRESHOLD 10.00% 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 3 MIN PUMP THRESHOLD 10.00% ANNUAL TEST FAIL ANNUAL PEST FAIL ALARM DISABLED ALARM DISABLED I PERIODIC TEST FAIL PERIODIC TEST FAIL ALARM DISABLED ALARM DISABLED GROSa. %ST FA I L ,.., GROEw TEOT FAIL i ALARM *D] A LEb ALARM DISABLED- ANN TEST AVERAGING: OFF ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF PER TEST AVERAGING: OFF 1" TANK TEST - NOTIFY: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF. TNK TST SIPHON BREAK:OFF DELIVERY DELAY 3 MIN DELIVERY DELAY 3 MIN PUMP THRESHOLD 10.00% PUMP THRESHOLD 10.00% 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 3 MIN PUMP THRESHOLD 10.00% ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER 'LEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 3 MIN PUMP THRESHOLD 10.00% Q 2:91 TYP:2.Oi3.0IN FIBERGLASS 2.0IN DIA LEN: 400 FEET 3.0IN DIA LEN: 0 FEET' SHUTDOWN RATE: 3.0 GPH LOW PRESSURE SHUTOFF:NO LOW PRESSURE O PSI T 3:91 DISPENSE MODE: STANDARD SENSOR: NON - VENTED PRESSURE OFFSET: O.OPSI L l;Mlt 1 t5'f METHOD T 4:DIESEL TEST WEEKLY ALL TANK Q 3:DIESELPRODUCTCODE4MON THERMAL COEFF :•000450 TANK DIAMETER 92.00 START TIME : DISABLED TYP:2.0r3.0IN FIBERGLASS TANK PROFILE 1 PT TEST.RATE :0.20 GAL /HR 2.0IN DIA LEN: 400 FEET FULL VOL 9728 DURATION 2 HOURS 3.OIN DIA LEN: 0 FEET TST EARLY STOP:DISABLEFi FLOAT SIZE: 4.0 IN. LEAK TEST REPORT FORMAT SHUTDOWN RATE: 3.0 GPH LOW PRESSURE SHUTOFF:NO WATER WARNING 2.0 NORMAL LOW PRESSURE 0 PSI HIGH WATER LIMIT: 3.0 T 4:DIESEL MAX OR LABEL VOL' 9926 DISPENSE MODE: STANDARDOVERFILLLIMIT90% 8955 SENSOR: NON- VENTED HIGH PRODUCT 95%: PRESSURE OFFSET: O.OPSI 9241 DELIVERY LIMIT 14: 1361 LOW PRODUCT : 500 PRESSURE LINE LEAK SETUPLEAKALARMLIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 0.91 PROBE OFFSET 0.00 Q 1;87 TYF:2.O, /3.OIN.FIBERGLASS SIPHON MANIFOLDED TANKS. SI 2.0IN DIA LEN: 400 FEET TO: NONE LINE MANIFOLDED TANKS 3.0IN.DIA LEN: 0,FEET LINE -LEAK LOCKOUT- SETUP- TO: NONE LOCKOUT SCHEDULE SHUTDOWN RATE: 3.0 GPH DAILY LEAK MIN PERIODIC: 10i LOW PRESSURE SHUTOFF:NO LOW PRESSURE 0 PSI START TIME: DISABLED STOP TIME DISABLED972 T 1: ENSLEAKMINANNUAL : 10% DISPENSE MODE: 72 MANIFOLDED: ALTERNATE SENSOR: NON- VENTED PRESSURE OFFSET: O.OPSIPERIODICTESTTYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER 'LEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 3 MIN PUMP THRESHOLD 10.00% Q 2:91 TYP:2.Oi3.0IN FIBERGLASS 2.0IN DIA LEN: 400 FEET 3.0IN DIA LEN: 0 FEET' SHUTDOWN RATE: 3.0 GPH LOW PRESSURE SHUTOFF:NO LOW PRESSURE O PSI T 3:91 DISPENSE MODE: STANDARD SENSOR: NON - VENTED PRESSURE OFFSET: O.OPSI L 1:87 -1 STP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 2:07 -2 STP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L '3:91 STP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 4 :DIESEL STP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 5:07 -1 FILL- TRI -STATE (SINGLE_FLOAT) CATEGORY : OTHER SENSORS L 6:87 -2 FILL TRI-STATE (SINGLE FLOAT) CATEGORY : OTHER SENSORS L 7:91 FILL TRI -STATE (SINGLE FLOAT) CATEGORY : OTHER SENSORS L 6:DSL FILL TRI -STATE (SINGLE CATEGORY : OTHER L.9:87 -1 ANN TRI -STATE (SINGLE CATEGORY : ANNULAI L]0:87 -2 ANN TRI -STATE (SINGLE CATEGORY : ANNULAI L11:91 ANN TRI -STATE (SINGLE CATEGORY : ANNULAF L12:DSL ANN TRI -STATE (SINGLE CATEGORY : ANNULAF 13:DISP 1 -2 FRI -STATE (SINGLE ATEGORY : DISPENS 14:DISP 3 -4 RI-STATE ( SINGLE ATEGORY : DISPENS L15:DISP 5 -6 TRI -STATE (SINGLE. FL CATEGORY : DISPENSER 16 :DISP 7 -6 TRI -STATE (SINGLE FL CATEGORY : DISPENSER EXTERNAL INPUT SETUP NONE` -- - - - -- OUTPUT — RELAYtuP.;.a_,...,r R 1:87 - 2 STP TYPE: PUMP CONTROL OUTPUT TANK, 4: 2 IN -TANK ALARMS T 2:HIGH'WATER ALARM T 2:LOW PRODUCT ALARM LIQUID SENSOR ALMS L. I rFZL ALARM L 2:FLIL ALARM L13:FUEL ALARM L14:FUEL ALARM L15 :FUEL ALARM L16:FUEL ALARM L ]:SENSOR OUT ALARM L 2::SENSOR OUT ALARM L13:SENSOR OUT ALARM L14:.SENSOR OUT ALARM L15:SENSOR OUT ALARM L16:SENSOR OUT ALARM PRESSURE LINE LEAK 0 I:GROSS LINE FAIL PLLD LINE DISABLE SFTU Q 1:87 III -TANK ALARMS T ]:HIGH WATER ALARM T ]:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 1 :FUEL ALARM L 2:FUEL:ALARM L13 :FUEL ALARM L14:FUEL ALARM L15:FUEL ALARM L16:FUEL ALARM L ]:SENSOR OUT.ALARM. L 2:SENSOR OUT ALARM L13:.SENSOR OUT ALARM LIA :SENSOR OUT:ALARM L15:SENSOR OUT ALARM L]6:SENSOR OUT ALARM ISD SITE ALARMS ISD. GROS PRES 'FA IL ISD DEGRD PRES 'FAIL ISD VAPOR LEAK.FAIL ISD HOSE ALARMS ALL:GROSS COLLECT FAI ALL:DEGRD COLLECT FAI Q 2 :91 IN-TANK ALARMS T 3:HIGH WATER ALARM T 3:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 3:FUEL ALARM L)3:FUEL ALARM L14:FUEL ALARM L15 ;FUEL ALARM L16:FUEL ALARM L 3:SENSOR OUT ALARM L13:S£NSOR OUT ALARM L14:SENSOR OUT ALARM L15:SENSOR OUT ALARM L)6:SENSOR OUT ALARM ISU SITE ALARMS ISD GROSS PRES FAIL f'SD DEGRD PRES FAIL ISD..VAPOR LEAK FAIL I.SD :Ho5z. ALARM'SALL 'GROSS-' COLLECT FAI; A -.DEGRD COLLECT FAI G.3:DIESEL IN -TANK ALARMS T 4:HIGH WATER ALARM T 4:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 4:FUEL ALARM L14:FUEL ALARM L 16 : FUEL ALARM L 4:SENSOR OUT ALARM L14:SENSOR OUT ALARM L16:SENSOR OUT.ALARM 7 y SMARTSE14SOR SETUP s 1:DISP 1 -2 FM i CATEGORY AIR FLOW METH -,l a 2 :DISP 3 -4 FM CATEGORY AIR FLOW METE{ s ":DISP 5 -6 FM CATEGORY AIR FLOW METER41; s 4:DIGP 7 -8 FM I CATEGORY AIR FLOW METED s 5:DISP 5 -6 PS CATEGORY VAPOR PRESSURE EVR /ISD SETUP EVR TYPE: VACUUM ASSIST VACUUM ASSIST TYPE HEAL`! VAC . NOZZLE A/L RANGE MAX: 1.15 MIN: 0.95 VAPOR PROCESSOR TYPE NO VAPOR PROCESSOR ANALYSIS TIMES TIME: 10:00 AM DELAY MINUTES: 1. ALARM HISTORY REPORT ALARM -- L 1:Ei7 -1 STPSTPSUMP FUEL ALARMJUN212011 ,1.0:01 -NJ FUEL ALARMJUN2, 2011 9 :46 AM LARM HISTORY REPORT SENSOR ALARM -- 2:67-2 STP ___ fP SUMP JEL ALARMJN2, 2011 l o : 01 AI °I IEL ALARM iN 2- 201 1 ' 9: 35 AM ACCEPT HIGH ORVP,.: AD SERIAL DISABLED 1 12173 ISD HOSE TABLE 2 12179 ID FP FL HL AA RR -- 01 01 01 02 -01 LIU 02 02 02 02 01 UU,, 03 03 03 02 02 UU 04 04 04 02 02 UU 05.'05 05 02 03 UU 06 06 06 02 03. UU 07 07 07 02 04 UU 08 00 08 02 04 UU ISD AIRFLOW METER MAP AD SERIAL NUM LABEL 1 12173 DISP 1 -2 F 2 12179 DISP 3 -4 F 3 12182 DISP 5 -6 F 4.1765 DISP 7-8 F ISD FUEL GRADE HOSE MAP 1 2 3 4 FP MHH MHH MHH MHH AA 01 -201 101 901 U U 1. 02 202 902 102 U U 1 03 203 103 903.3 U 2 04 1.04 204 904 3 U 2 05 205 105 905 U U 3. 06 206.106 906 U U 3 07 207 107.907 3 U 4 08 20B 1.0.8 908 3 U 4 LABEL TABLE 1: UNASSIGNED 2: BLEND3 3: REGULAR. 4: MID.GRADE 5 PREIl I UH 6: GOLD 7: BRONZE 13: SILVER 9: BLEND2 10 BLEND4 PHC SETUP PROCESSOR CONTROL LEVEL: ALARM HISTORY REPORT SENSOR ALARM - L 3:91 STPSTPSUMP FUEL ALARMJUN2, 2011 10:01 AM FUEL ALARMJUN2, 2011 9 :40 AM YZ ALARM HISTORY REPORT SENSOR ALARM - - -- L 4 :DIESEL STP STP SUMP FUEL ALARM JUN 2, 2011 10:0.1 AM FUEL ALARM JUN 21.2011 9:92 AM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 5:87 -1 FILL OTHER SENSORS FUEL ALARM JUN 2. 2011 10:01 Ahl FUEL ALARM JUN 2. 2011 9:48 AM ALARM HISTORY REPORT SENSOR ALARM -- -- L 6:87 -2 FILL OTHER SENSORS FUEL, ALARM JUN 2, 2011 10:02 AM FUEL ALARM JUN 2, 2011 9:36 AM ALARM HISTORY REPORT SEI4SOR ALARM - - - -- L 7:91 FILL OTHER SENSORS FUEL ALARM JUN 2, 2011 10:02 AM UEL- AL ARM JUN -2 201:1 9:40 AM ALARM HISTORY REPORT L B:PS -ENSOR ALARM - - -- OTHER SENSORFUELALNMSORS JUN 2, 2011 10:02 AM FUEL ALARMJUN2. 2011 9:33 AM ALARM HISTORY REPORT SENSOR ALARM - ---- L 9:87 -1 ANN ANNULAR SPACE SENSOR OUT ALARM JUN 2, 2011 10:01 AM FUEL ALARM JUN 2. 201.1. 9:46 AM iLARt °1 HISTORY REPORT SEI4SOR ALARM 1_10:07 -2 ANNANNULARSPPI -E SENSOR OUT ALARM JUN 2. 2011 10:01 AM FUEL ALAR 2 11 9:36 AM JUPJ • ALARM HISTORY REPORT SENSOR ALARM L11:91 ANN 111INULAR SPACE SENSOR OUT ALARM JUN 2, 2011 10:01 AM l.1EL ALARhI JUN 2. 2011 9:40 AM ALARM HISTORY REPORT SENSOR ALARM - - - -- L12:DSL ANN ANNULAR SPACE FUEL ALARM JUN 2. 20t1 10:14 AM FUEL. ALARM .. JUN 2, 2011 10:02 AM SE14SOP OUT ALARM JUN 2, 2011 10 :01 AM i -ARPI HISTORY REPORT SENSOR ALARM - - - -- A3:IjISP 1 -2 1SPENSER PAN SENSOR OUT ALARM JUN 2. 2011 10 :01 AM UEL ALARM 7UN 2. 2011 9 :55 AM F LARil HISTORY REPORT SENSOR ALARM - - - -- J 4:DISP 3 -4 A SPENSER PAN SENSOR OUT ALARM JUN 2, 2011 10:01 Aft iUEL ALARM UN 2, 2011 9:54 AM I ALARM HISTORY REPORT SENSOR ALARM -- L15:DISP 5 -6 DISPENSER PAN SENSOR OUT ALARM JUN 2. 2011 10:01 AM FUEL ALARM JUN 2, 2011 9:53 AM ALARM HISTORY REPORT SENSOR ALARM L16:DISP 7--8 DISPENSER PAN SENSOR OUT ALARM JUN 2, 2011 10:01 AM FUEL ALARM JUN 2, 2011 9:53 AM ALARM HISTORY REPORT SENSOR ALARM - - - -- Q 1:87 PLLD SHUTDOWN ALARMJUN2, 2011 10:45 AM Yz ry ALARM HISTORY REPORT SENSOR ALARM - -- -- Q 2:51 PLLD SHUTDOWN ALARM JUN 2, 2011 10:41 AM GROSS LINE FAIL JUN 2, 2011 10:41 AM PLLD SHUTDOWN ALARM JUN 2, 2011 10:01 AM PLLD SHUTDOWN ALARM JUN 2, 2011 9 :55 AM PLLD SHUTDOWN ALARM JUN 2. 2011 9:54 AM PLLD SHUTDOWN ALARM JUN 2. 2-011 9:53 AM PLLD SHUTDOWN ALARM. JUN 2, 2011 9.:53 AM PLLD SHUTDOWN ALARM JUN 2. 2011 9 :.40 AM PLLD SHUTDOWN ALARM APR. 20. 2011 10 :02 AM GROSS, LINE FAILJUN2; 2011 10:45 AM ALARM HISTORY REPORT PLLD SHUTDOWN ALARM SENSOR ALARM -- - JUN 2, 2011 10:01 AM 0 3:DIESEL PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM JUN 2, 2011 10:36 AM JUN 2, 2011 9:55 AM GROSS LINENE FAIL PLLD"--V4UTDOWN ALARM 2- 2011 10: 36 AtK JUN 2,'2011 9:54 AM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM JUN 2, 2011 10:01 AM JUN 2, 2011. 9:53 AWI PLLD SHUTSDOWN ALARM PLLD SHUTDOWN ALARM JUN 2011 9:54 AM JUN 2. 2011 9:53 AN.. PLLD SHUTDOWN ALARMJUN. 2. 2011 9:53 AMPLLDSHUTDOWNALARMJUN2, 2011 9:46 AM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM JUN 2, 2011 9:32 AM JUN 2, 2011 9:35 AM PLLD SHUTDOWN ALARMAPR20, 2011 10:02 AM VZ,3 MONITOR CERT. FAILURE REPORT SITE NAME: GOSFORD SHELL DATE : 6/2/11 THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS; L LABOR: PARTS INSTALLED : jl- o — NAME : TITLE: SIGNATURE 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 RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE.