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Home My WebLink AboutFMC 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 of Regulations 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 of this form must be provided to the tank system owner /operator. The owner /operator must submit a copy ofthis form to the local agency regulating UST systems within 30 days ofthis date. A. General Information Facility Name: Arco AM PM Site Address: 2301 F Street Facility Contact Person: Alondra Hernadez Make /Model of Monitoring System: Veeder -Root TLS 350 B. Inventory of Equipment Tested /CertifiedChecktheappropriateboxestoindicatespecificequipmentinspectedlserviced: City: Bakersfield Bldg. No.: Zip: 93304 Contact Phone No.: 835 -8044 / FAX:(0279) Date of Testing/Servicing: 1/31/2012 Tank ID: 20000 gal. Regular Tank ID: 10000 gal. Regular x] In -Tank Gauging Probe. Model: 847390-107 In -Tank Gauging Probe. Model: 847390 -107 x] Annular Space or Vault Probe. Model :794390 -409 U Annular Space or Vault Sensor. Model: 794390 -409 x] Piping Sump / Trench Sensor(s). Model: 794380-208 Lx] Piping Sump / Trench Sensor(s). Model: 784380 -208 Fill Sump Sensor(s) Model: Fill Sump Sensor(s). Model: J Mechanical Line Leak Detector. Mode I:FX -1V x] Mechanical Line Leak Detector. Model: FX -1V Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: X] Tank Overfill / High Level Sensor. Model: 847390-107 x] Tank Overfill / High Leval Sensor. Model: 847390 -107 Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. type and model in Sec. E on Pg. 2) Tank ID: 10000 gal. Super Tank ID: J In -Tank Gauging Probe. Model :847390 -107 In -Tank Gauging Probe. Model: x] Annular Space or Vault Sensor. Model:794390 -409 Annular Space or Vault Sensor. Model: X] Piping Sump / Trench Sensor(s). Model:794380 -208 Piping Sump / Trench Sensor(s). Model: Fill Sump Sensors(s). Model: Fill Sump Sensor(s). Model: F] Mechanical Line Leak Decector. Model.FX -1DV Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: x] Tank Overfill / High Level Sensor. Model: 847390-107 Tank Overfill / High Level Sensor. Model: Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. typs and model in Sec. E on Pg. 2) Dispenser ID: 1 & 2 Dispenser ID: 3&4 Fx1 Dispenser Containment Sensor(s). Model: 794380 - 208 X] Dispenser Containment Sensor(s). Model: 794380 -208 X] Shear Valve(s). x] Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s) Dispenser ID: 5 & 6 Dispenser ID: 7 & 8 rx] Dispenser Containment Sensor(s). Model: 794380 -208 Dispenser Containment Sensor(s). Model: 794380 -208 Lx] Shear Valve(s). x] Shear Valve(s). Dispenser Containment Float(s) and Chains(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: 9 & 10 Dispenser ID: 11 & 12 x] Dispenser Containment Sensor(s). Model: 794380 -208 J Dispenser Containment Sensor(s). Model: 794380 -208 x] Shear Valve(s). x] Shear Valve(s). Dispenser Containment Float(s) and Chain(s) Dispenser Containment Float(s) and Chain(s). If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification -1 certify that the equipment identified in this document was inspected /services in accordance with the manufacturers' guidlines. Attached to this Certification is information (e.g. manufacturers' checklist) necessary to verify that this information is correct and a plot plan showing the layout of monitoring equipment. For equipment capable of generating such reports, l have attached a copy of the report; (check all that apply) x System Set -up E Alarm history report Technician Name (print): Bradley Seykora Signature: Certification No: 840738 License No: 804904 Testing Company Name: Confidence UST Services, Inc. Phone No: 800- 339 -9930 Site Address: 2301 F Street, Bakersfield, CA 93304 Date of Testing/Servicing: 1/3112012 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, Calf rnia 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 of this 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 of this date. A. General Information Facility Name: Arco AM PM Site Address: 2301 F Street Facility Contact Person: Alondra Hernadez Make /Model of Monitoring System: Veeder -Root TLS 350 B. Inventory of Equipment Tested /CertifiedChecktheappropriateboxestoindicatespecificequipmentinspected /serviced: City: Bakersfield Bldg. No.: Zip: 93304 Contact Phone No.: 835 -8044 / FAX:(0279) Date of Testing/Servicing: 1/31/2012 Tank ID: Tank ID: In -Tank Gauging Probe. Model: In -Tank Gauging Probe. Model: Annular Space or Vault Probe. Model: Annular Space or Vault Sensor. Model: Piping Sump / Trench Sensor(s). Model: 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: Tank Overfill / High Leval Sensor. Model: Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. type and model in Sec. E on Pg. 2) Tank ID: Tank ID: In -Tank Gauging Probe. Model: In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Piping Sump / Trench Sensor(s). Model: Piping Sump / Trench Sensor(s). Model: Fill Sump Sensors(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Decector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High Level Sensor. Model: Tank Overfill / High Level Sensor. Model: Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. typs and model in Sec. E on Pg. 2) Dispenser ID: 13&14 Dispenser ID: 15 &16 L7 Dispenser Containment Sensor(s). Model: 794380 -208 E Dispenser Containment Sensor(s). Model: 794380 -208 LX] Shear Valve(s). LX] Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s) Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chains(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s) Dispenser Containment Float(s) and Chain(s). If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification -1 certify that the equipment identified in this document was inspected /services in accordance with the manufacturers' guidlines. Attached to this Certification is information (e.g. manufacturers' checklist) necessary to verify that this information is correct and a plot plan showing the layout of monitoring equipment. For equipment capable of generating such reports, 1 have attached a copy of the report; (check all that apply) x System Set -up x Alarm hi tory report Technician Name (print): Bradley Seykora Signature: Certification No: B40738 License No: 804904 Testing Company Name: Confidence UST Services, Inc. Phone No: 800 - 339 -9930 Site Address: 2301 F Street, Bakersfield, CA 93304 Date ofTesting/Servicing: 1/31/2012 D. Results of Testing /Servicing Software Version Installed: 331.01 Complete the following checklist: Yes No* Is the audible alarm operational? Yes No* Is the Visua a arm operationa ? x'-Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational? x Yes No* Were all sensors installed at the 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) x N/A operational? x Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary N/A containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initate positive shut -down? E Sump /Trench Sensors U Dispenser Containment Sensors Did you confirm positive shut -down due to leaks and sensor failure /disconnected? Cx] Yes; No; U 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 visual and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 90 % Yes* U No Was any monitoring equipment replaced? I Yes, identi speci is sensors, pro es, or of er 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? Product; Water. If yes, describe causes in Section E, below. Ix No* Was monitoring system set -up reviewed to ensure proper settings? Attach set -up reports, ifapplicable. x YeS No* Is all monitoring equipment operational per manufacturer's specifications? In Section E below, discribe how and when these deficiencies were or will be corrected. E. Comments: F. In -Tank Guaging / SIR Equipment: [X] Check this box if tank guaging is used only for inventory control. Check this box if tank guaging or SIR equipment is installed. This section must be completed if in -tank guaging equipment is used to perform leak detection monitoring. Complete the following checklist: U Yes No* Has all input wiring been inspected for proper enter and termination,including testing for ground faults? x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup? x Yes No* Was accuracy of system product level readings tested? Fxj Yes No* Was accuracy of system water level readings tested? x Yes No* Were all probes reinstalled properly? Yes No* I Were all items on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Check this box if LLD's are not installed. Complete the following checklist: Cx] Yes No* For equip. start-up or annual equipment certification, was a leak simulated to varify LLD performance? Check all that apply) Simulated leak rate: E3 g.p.h.: 00.1 g.p.h.; 0.2 g.p.h.; x Yes No* Were all LLD's confirmed operational and accurate within regulatory requirments? x Yes No* Was the testing apparatus properly calibrated? L] Yes No* For machanica LLD's, does the LLD restrict product flow if it detects a leak? N/A Yes No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? x] N/A Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is x] N/A disabled or disconnected? Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system U N/A malfunction or fails a test? Yes No* For electronic LLD's, have all accessible wiring connections been visually inspected? U N/A x Yes U No I Were all items on the equipment manufacturer's maintenance checklist completed? In the section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: i,RCO an, I I" ._:5 17 301 17 :-j I I , , i I d JAN 31 - -.'I I I _' 8:37 ol•I SYSTDI STr,TlJ:, F%I:P",RT o,iLL NC+Th[_ T I P VOLIJ11E = i ,I.s IJLLi_W,;E . 1-:141. :; I W;JEF VO[Urlh, 1'17 rd.t-; HE ],.;ffr 17 11,11" 11E. 14;iTEP V1,L n WmTER n. 00 1 1-Ji'HES TEMP = 6,'/ . 9 1 - 1GY. F T VU LUl 1E I -- 3 (';o-iLli ULLH,sF_ a 1 I1%• 13 I 90'. "it .1-j'A TC V01-011E 39 GoLS HE I GHT 5Ll. -14 114f IIE.1 WATER VOL 0 ."riLS WATER 11:1 1 N1.'HE16 TEMP `17.'2- IsEV.; V T :::Ul,. 1113111111,1 VOLL11,1E 7 t.#ALS H E I C; IIT I W;JEF Wi-JEP Ci. 1'10 11,11 14ES TEMP Se.. 0 DEG F SvFTLJ,tRE k1VI!_;I.d,I H.WEL VERS1,A1 3*_'I .(I) u';l. Z13 S I uAI% _11t.tl SYSTF1.1 FETUPE:3: PERI()hic IN-Twl) TE-STS I Fir, i-&m S/t TFI ; - H 'SETUP JArl 3 1 _-Cj 12 8: "1'7 mm Umll`S U, S. s !,-_STEN LH11i; -4,1. ENGL I l I SYP;rEH I)i-;I'E TIME FORtItiT ION H', Y"'Y', HH:11111:z;S Aps--o aft, pw ID2517 2-:301 F Strcit uesrl iwr z I swirl 1111`7 TIME I DISF+DLEII C-111IFT TIME '_'i SHIFT -rimy:. 4 DfSf-03LErj rwo, rEp NEEDEL, UIRN D I SABLE[ I TIAN): i4IN TST NEEDED WRN D I SfiBLED L I HE RE FNABI.ff NETHr,[j PHL3S7 LINE TEST LINE PER TST 111EI-T-EL, WPH 1; 1 SABI-Ell LINE fArm 'rsn NEFL-1-F, lJRN L, I,.-imBLE11 VPINT TC VOLLUES ENABLED TEMP C'CYHPFIt3HTI0N Vf-,,LUE ?I*1D'.*. F 61-1. 0 HEsi, icx i6m, oFf`,,Uf DISHBLED IILLJ.V-.E: 91'1% it-PP-3TOi`C*1L 1,HT;, FuH.4il' HE I 1._;HT Si-iv)NC; Tir,iE E1,lFiIJLE1 Sl):4RT Di4TE MAR WEI-D," :'i Slim START 11 I,,IE 2:05 HI-I END DHTE NOIJ WEEK I Cul.l END TIME 2: 00 Ali 11 SySTEM 5E11-UPIT"' C-oc,E . 0000uc) TrtNK t-.IiHR,r SEPV I i-f_ NOT t VUIVTRY VAPOR C:I:kpr-i I t.jHS,:,, DENS I T DISf-;bLEI1 TI IF C. GC,E'' -IT" LEt 'JI I fj 4 STGF I'l bHT 51 T EVE I STop CUhiM L{!} ;1111 7 IF) 1 1 rE ou s 0F I -rDAT") LENcTj.j: . I STOPK".), - :1 . j.., SEctir, 7 ITy HI IT(> UTO b ISHbI LI) LIPUT AUTO 6VERrILLNsi4L41Er, LIMIT AUTO E04,"I ppi,E) I, I.C HM 1-711 LIC-7- 71 IPI L I i.j I T b(L [:I-, AUTO 111 8f4bL Fr, NPUT 0 JNPLj- U%. It I!if4f:u 6, 1 ILL rlROrq F 10TO Srllir.o HuTo D I S*h BL ED Lj NE F,'2-212 1:h)E, 1) 1 SO;13LEL, AUTO DIAL S'ETUP 1-ETUP LEmj' MIN PER IOL)lc: T 3.0 WATER LJH;;.I.j hIljq TIIER;11;il- I P-MI)•.* PROF I LE 4 PrS FIILL VOL R: Low fq1.AI VOL I y,Irj 9.3 1 NCH VOL 4,:79 HIGH PRoL)u(.,I• 9, FLOAT S1--E: LEmj' MIN PER IOL)lc: F ('0DE 3.0 WATER LJH;;.I.j hIljq Tt-011' I'll I P-MI)•.* PROF I LE 4 PrS FIILL VOL R: Low OP VOL: OVERFILL 1-11.1'IT I y,Irj 1,18. r I (1b.1H Vi, 11, 4,:79 HIGH PRoL)u(.,I• 9302 DELIVER`, LIMIT 95'. Xiii' "I.HRM LIMIT: 0% 103E. L014 F F-ODUCT 00 LEH). 1.1111T: U. CIL] I - 0'_55 L 17TANKTILT ri 11.00 0.00 S11"_1O)14 "HNIFOLE)rr) TO: IYr NI. LINE I'LL, Tr3: lqf)14E LEmj' MIN PER IOL)lc: F ('0DE 3.0 THEPI•ImL .'OEFF hIljq Tt-011' I'll I P-MI)•.* PROF I LE P'f-'RIOLOC TE :T ANNUAL TEST FAIL TEST FAIL Aboikjq IJ I P""SS TEST Fat L Fib4Rm fj I HNIV TE2T TUC: PEI;? ." HVER.'C -1 N' OFFT04VER;i(.. I p)(;: OFF Topn,, 7"E.S'j, NOTIFy: OFF TNK I C; "'O1F : OFF DEL VuPpy l,LI W, PUMP 5 MIN I o - OL)-,. T ':IJNLR iF)Ell R 2. tj F ('0DE 3.0 THEPI•ImL .'OEFF LOW Tt-011' I'll I P-MI)•.* PROF I LE 4 PrS FIILL VOL I 9? t IJ H7 . tj I IkF1 Vvj_ I y,Irj 1,18. r I (1b.1H Vi, 11, 4,:79 9. 3 1 Ncli V(1*11. 31,01 FLOAT E:1::E: 4.6 W%TFk wi*j,j1Ph; 2. tj Hik , ;H WATEP L1111T: 3.0 wi-JEk ;ili-431 FILTEk: LOW 4)R 1_jqLjj7j_ VOL : I C1•11113 ovERFILL LIMIT LT HI(;H I'POPUCT IR718 LiELIVERY LIMIT I c1% 1.(A.j T R,X,LCT iUu Xiii' "I.HRM LIMIT: T;-iNK 7 1 LT 00 PROBE ()FFSET U. CIL] S111i.1014 MAN IFOLDEb TNA'S To: NONE LINE 1'0111.`i TV NONE LEAK 1*11111 PEP, IOCIIC': 251. LE;%Y' HIN mNNIJV-iL PER PI)DIC TI : "r TYPE a 'H +, ANNUAL TEST FHI1_ ALE431 PERIODIC TEf,.T FAIL tiLiiRM 111 GROSS TEST Pi-ill- oiNiq TEST oFF PER 'TEST AVERW41-1,1: )FE' TAM, TF;T 110TIFY: OFF TNK TST SIPW 1,1 FjRFiAK:OFF GEL IVERY DELAY 5 1 N PUMP THRHIjf(_YLrl T 3: A. P RDO LIM 2. 0 PPO[Itlk--T C•,',FjF 3.0 THERMAL -",.,EFF o00700 T,;NK. Gtr-ii-IL-TEP 117. 1-1fi TONY, FRC)FILE 4 1,11". FULL. VOL 10369 87.8 1111:'H VGL 81460 5K 5 INCH VOI. 5199 2'9.'-j I I Vol- 1 '333 FLOAT Sl::E: 4.0 114, WATEP WmRNINC; 2. 0 HIGH WATER LMfT: 3.0 WATER gib -;RI -1 F I LTER: LOW MAX. OR LABEL 10--',L: t C1369 OVERFILL LIMIT 9 0n; 9332 HIGH 957. 9850 1;EL I VER`Y L 11-11 T 10%, 1036 LOW PPUL-04:7 600 LEAK MARM LHUT: 99 rurjc) -11 LImIT: 9G TH i,q:. T I LT 2.35 PROBE OFFSET 0.00 SIPHON MCF&I-EI) TANKS TO: NONE LINE MAKFATEE, TANKS TO: NONE LEHY MIN PEP I(kic: 25-; 2519; -' LEMK HUN mMgML 2% 2592 PERIODIC 110117 ME ANNUAL. TEST FAIL PERIOFjI(: TEST FAIL cp.o-,F: TEST F., I L i-0111 TENT OFF PER TEST o-NEFe;-o, JNi:;; OFF TANK TE!j'I' OFF I*i w 'rsT E,ELI',/ER',' F)ELoY 5 1,11 N PUMP 10. LEM IEST NITNUE1 TEST ON T.,IJE HI-L TANK rIAR .--I'--,. _'011 STHRT TIME ;i Hu-u; TEST RATE "F,' NEVA ON p"Mi InT EM•Y LEAK TE`ST FORMAT Miml. FTIIP L I : 91 -H? hl'41'11-11-R TR I -S*fTaE S HOLE FLTU TECuF.,y L 2:91 TURBINE TRI -ST,in FLOAT L 3:87 TURBINE TICKS= WHOLE FLIvAT; ATF*.tA>f?',' : 2,'Tf' SLI11P L 4:07 101 N WOMI-MR TI,:i-.-jTATI- (SI1,11::LL FLOAT) Cm1"E'30F."-/ : CwiubiR L 5:07 T1.1kB'INE FLOAT) 6i'rE'-;0RY : TP `-*-1.1111-' 1, 9:1 2 IMC TPI-STti'I'E (;iNCA1 I--'f-OFiT) P12-fSwi:XR P%tlf S 1-10:3-4 IJLI( - , ri;,,I-sTH*I'F (siNt-LE, FLC*-,T) C,TEt'.,ORN1 : tilspElvER FAN Ll I 1-12-:7-8 U111" TM 9QaE 1-13:9-10 Uf"-" L15:13-14 I - Ll E': 15- b ULC -;' - FlTRI -STFATE CATEC;ORY T;-0-41F 2 -.'.HUTDC)WH 1 'd it F T k& SITE Vp IED V YTblvi VOLP& 20 up jr, I L IT i L. E _T FB I ETI IV i" I P. I. 'ILot. 5 3:4-6 Hill Tl,,))E: bid-oNCE FLOW 54114 I P. FLOW METE? 1-L 2 HFI• 7 5394t 13-la mFPI T sw@2 15'-16 AFMI T J:LOW 1"Al tALL:FUEL sLiPH tlT t-4-ARIN T PE: 9 I j, DLLI-,Y 1111%1111L:,: c.ji: j DE-:;kD 1 +.F, Ft, I L Pvp: VHP)k 1.1--till F"IL I i.Fl VP f Fh I L b I vmbi 1 so K F salF a Tm ; I BD v• SOCN5 Foll, ISD 1,,IIILISDSETIjPFt, IL lit FY FI_ SD SOUNk uUr FHIL 1 c3l, HC)-'k fiUipl-lc' 01 1:11 - IJ2J• -if, ALL FI-CAJ :'ILIAD:'T FnIL ri li'l U. r'Z I '-* usCj'_jI LI _ u1 1 04 C14 04 U2 12 Uj I I'iC, (15 C,`' rl cla 0:1 j L: Fl,')l I Fj ? 117 L17 C 0.1 09 CjFJ u6 (1 114 2:-"- 1-i"jil 09 139 02 05 G.i TAh: 10 1 i 10 i I:' 11 ", CL' 11 1I I I I Q UJI, 12 12 1 (;'-' 1_16 a 1 02 07 SL I til I'l 1'l 11 _' 1.0 15 Iss 15 Lj " Cle 03 t).3 Q 1r_, I 1, 02 u8 113 1 'd it F T k& SITE Vp IED V YTblvi VOLP& 20 up jr, I L IT i L. E _T FB I lk FI-01A HETER z 5: 1 ! 1 ., HFI•1 D',TEC;0I-,",l A I F., FL--'jL.l NE FEE 7 4 , 0.1 CH 'FFC;ok ! ;, I k, FU• HETER W 15-16 AFM k f LOW METER SIKVIVP 0AWAY s 16: t,TMP QJD%RV AKI P SECAP I SD A I alow MOIR M ID BERPI NUM LABEL i" I P. I. 'ILot. 5 3:4-6 Hill I Lt::ORV o I h' FLOW 54114 I P. FLOW METE? lk FI-01A HETER z 5: 1 ! 1 ., HFI•1 D',TEC;0I-,",l A I F., FL--'jL.l NE FEE 7 4 , 0.1 CH 'FFC;ok ! ;, I k, FU• HETER W 15-16 AFM k f LOW METER SIKVIVP 0AWAY s 16: t,TMP QJD%RV AKI P SECAP I SD A I alow MOIR M ID BERPI NUM LABEL 3 041 l:± 34i7 7 54114 E 3 o 75 2 HFI• 7 5394t 13-la mFPI a sw@2 15'-16 AFMI I 'Lj FUEL iiOSE HAP RLEND2 1 2, 3 1 L(All Fl, •HH HHH IIHI, HIM V-i A: ;iLviPt• - - - - - L Ti RB I IlF VkR 01 1 11 tI I 10: PLEI.jr)a C12 104' 902, 5U32, U Ll I 03 1:403 10*3 tr)3 1.1 U l C14 "Iri'l I[-il 50,1 0 u 05 qo`_• 505 105 li u 06 906 106 5016 11 11 1 0'l 907 107 507 3 tj I 0fi 908 1 CIO S08 li 0 4 09 909 509 109 U U 5 1G 510 110 910 U 1.1 5 11 911 111 S I I U 11 6 1L 1 1 :. 91 512 U Ll 6 X LND 913 1 1 1 F.1 3 li 11 7 114 91,1 514 LI Ll 7 113 115 915 515 u 11 a 16 1 It, 91 t. 51* U 11 El LABEL TtAPLE I U11I•S-S I GPIED RLEND2 Ra,owr S PPEm I I n I A: ;iLviPt• - - - - - L Ti RB I IlF VkR 17' BLEND2 10: PLEI.jr)a LIJI,, • -i r. k .. P1,111" 5r_TUP r'r'P:' VIEF ION: 01 .04 WAI-OR I P(W*E: ':+ T.TE 1EELID., Pool, POLISHER HI'S'loRY RIPI SE"NSOR ob-,Rll L 4:87 MAIN iNNUhiR iii-JOI F.'LFNj'PT L 1 :91 -Y7 0,1I,IlJL;iR AlqlqljLt,P SPHCE END L. i . -. EHE, iA.o,kII L ll,:.'37 TtlK'Dl(A:* STP I;SlA•lf, FUEL HLORI-I NcjV l4. ;.1111 1:37 Pl n .i ,k w. 1:141 r .- . AIjiRI-1 HISTOKY I-A_I-',_)VF L 9: 1Elk3PEIT-7'Ek PAN2;E'FlJr '6iT,-, WARIIIIWC, JUL '_' , *011 1 :56 i4i END !-% , . • P LAPH Hl',-*,*'I,'+,, kn.vovr R DISPENSER PoN FTUP DriTi, J Ul. " _Ii 56 HI t A ;.;. .. .< % Lf,jr) a , 7i A - f,D,Rh HISRWY WEPwr L TIA:f-flilE. STP w"P FUEL MW LI 1 :5-1 ury L 1 -1 : I I - I- LID: -1 U1 "' DISPEITA.".R PON SETIA WTA UMMING SETIA, 15% L&THIC JUL 'Q. _,ul I I :3L HI-I JUL 2, _,0 I 1 1:56 Jail L 3:W7 TUK:1NE sn. 2u IP FHO. KwRli J,-iM s1 - 21,1)2 AI'l L TURT:INE STF SIM, FUEL jp-01 31 • 2012 9:44 "11.1'-:13 III Vf1C Lik'ATHSLE Fiil,1 1:M Sf-Tti firsTH wAR(,I1HC. 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The completedform and printoutsfrom tests (if applicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Arco AM PM Date of Testing: 1/31/2012 Facility Address: 2301 F Street, Bakersfield, CA 93304 Facility Contact: Alondra Hernadez Phone: 835 -8044 / Fax: (0279) Date Local Agency Was Notified of Testing: 1/10/2012 Name of Local Agency Inspector (rfpresent during testing): Ernie Medina 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. Technician Conducting Test: Bradley Seykora Credentials: x CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other (Specify) License Number(s): CSLB# 804904 ICC# 81 1 1231 3. SPILL BUCKET TESTING INFORMATION Test Method Used: x Hydrostatic Vacuum Other Test Equipment Used: Lake Test Equipment Resolution: 0.0625" Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 Regular 1 2 Regular 2 3 Super 4 Bucket Installation Type: Direct Bury X Contained in Sump Direct Bury X Contained in Sump Direct Bury X Contained in Sump Direct Bury Contained in Sum Bucket Diameter: 12.00" 12.00" 12.00" Bucket Depth: 12.00" 12.00" 13.50" Wait time between applying vacuum /water and start of test: 5 MIN 5 MIN 5 MIN Test Start Time (Ti): 9:15 AM 9:15 AM 9:15 AM Initial Reading (Rj): 9.00" 9.25" 9.00" Test End Time (TF): 10:15 AM 10:15 AM 10:15 AM Final Reading (RF): 9.00" 9.25" 9.00" Test Duration (TF — Tj): 1 HOUR 1 HOUR 1 HOUR Change in Reading (RF - Ri): 0.00" 0.00" 0.00" Pass /Fail Threshold or Criteria: 0.0625" 0.0625" 0.0625" Test Result: X Pass Fail X Pass Fail X Pass Fail Pass Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I herehy certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: % Date: 01 /31/2012 State laws and regulations do not currently require` aing to be performed by a qualified contractor. However, local requirements may be more stringent. TLS -350 Arco AM PM 2301 F Street Bakersfield, CA 93304 ESO ESO L1 - 91 & 87 Annular, 409 sensor L2 - 91 STP, 208 sensor L3 - 87 STP, 208 sensor L4 - 87 Annular, 409 sensor L5 - 87 STP, 208 sensor L9 - UDC 1 -2, 208 sensor L10 - UDC 3-4, 208 sensor L11 - UDC 5 -6, 208 sensor L12 - UDC 7 -8, 208 sensor L13 - UDC 9 -10, 208 sensor L14 - UDC 11 -12, 208 sensor L15 - UDC 13 -14, 208 sensor L16 - UDC 15 -16, 208 sensor 1 - FX -1V 2 - Mag Probe Regular 10,000 gal. STP L5, 1 STP L3, 1 Regular 20,000 gal. O O2 00 OD D::) ( 2 STP L2, 1 L4 L1