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Home My WebLink AboutFMC 2011MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State ofCalifornia Authority Cited: Chapter 6 7, Health andSafety Code; Chapter l6, 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 ofthis 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 of this date. A. General Information Facility Name: Ramco Express Bldg. No.: _ Site Address: 2222 F Street City: Bakersfield Zip: 93301 Facility Contact Person: Rami Make /Model of Monitoring System: Veeder -Root TLS -350 B. Inventory of Equipment Tested /Certifiedb.— Check the appropriate bo to indicatespedOc equipment impectedhe -iced: Contact Phone No.: 818- 339 -7288 Date of Testing/Servicing: 12/29/2011 Tank ID: 10000 gal. Regular Tank ID: 10000 gal. Plus x] In -Tank Gauging Probe. Model: 847390-107 x] In -Tank Gauging Probe. Model: 847390 -107 Annular Space or Vault Probe. Model: 794390-409 Annular Space or Vault Sensor. Model: 794390 -409 x] Piping Sump / Trench Sensor(s). Model: 794380-208 x] Piping Sump / Trench Sensor(s). Model: 794380 -208 Fill Sump Sensor(s) Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: x_] Electronic Line Leak Detector. Model: PLLD Ll Electronic Line Leak Detector. Model: PLLD L] Tank Overfill / High Level Sensor. Model: OPW -6I -SO X] Tank Overfill / High Leval Sensor. Model: OPW -8I -SO 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: x] 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: Lx] Piping Sump / Trench Sensor(s). Model: 794380-208 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: x] Electronic Line Leak Detector. Model:PLLD Electronic Line Leak Detector. Model: rx] Tank Overfill / High Level Sensor. ModeI:OPW-61-SO 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: Dispenser 112 Dispenser ID: Dispenser 314 Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: x] Shear Valve(s). Lx] Shear Valve(s). L] Dispenser Containment Float(s) and Chain(s). X] 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 varify 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) x0 Syste t -up [x] Alarm hist eport Technician Name (print): Bryan A Self Signature: Certification No: B37501 License No: 804904 Testing Company Name: Confidence UST Services, Inc. Phone No: 800 - 339 -9930 Site Address: 2222 F Street, Bakersfleld,CA 93301 Date of Testing/Servicing: 12/2912011 D. Results ofTesting /Servicing Software Version Installed: 16.02 Complete the following checklist: Lx] Yes No* Is the audible alarm operational? x Yes 0 No* Is the Visual alarm operational? x Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational? x I 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) Hx 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? Sump /Trench Sensors Dispenser Containment Sensors Did you confirm positive shut -down due to leaks and sensor failure /disconnected? [X] Yes; No; Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no U 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 capasity does the alarm trigger? 90 % Yes* U No Was 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* U No Was liquid found inside any secondary containment systems designed as dry systems? Product; Water. If yes, describe causes in Section E, below. x No* Was monitoring system set -up reviewed to ensure proper settings? Attach set -up reports, if applicable. Lx_J 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: X] 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 ofsystem product level readings tested? x Yes No* Was accuracy of system water level readings tested? x Yes No* Were all probes reinstalled properly? Lx] 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: Fx] 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: [X]3 g.p.h.: 0. I 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 Waste testing apparatus properly calibrated? Yes No For machanical LLD's, does the LLD restrict product ow > it detects a leak? gYeN /A x] o* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? N/A Lx] Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is N/A disabled or disconnected? x] Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system N/A malfunction or fails a test? L] Yes No* For electronic LLD's, have all accessible wiring connections been visually inspected? N/A x Yes No 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: F.HNb;O E :PFES, 2222 F STREET BA) :EF. 'FIELD 661-312111- 17 58 12-25 -11 a:36 SYSTEM STATUS REPOPT ALL FUNCTIONS NisRI IHI_ INVENTORY REPORT T I:PLUS VOLUME _ E •13 'aAL UL.LAGE = 7041 90% ULLHl;L'= 6072 GALS TC VOLUME _ 2635 !;rd.S HE I I I•IT - 2'G . 16 1 1417HES WATER VOL n CI GALS wHTER - ii . 00 1 Nl :IU:.: TEMP 64.1 DEC: F T 2:REG VOLUME = E, iE.-A ULLHGE f3F1 GHl_S 90: ULLW.;E= 235'2 C44LS TC VOLUME s 6365 HE I (.'HT = 55.09 INCHES WATER VOL = 13 r_.ALS WATER . 0.76 1 IW;HES TEMP m 59.4 DEC; F T 3:PREM VOLUME o 177E C;ALS' ULLAGE = 7; Ci Ci GHLS 90: ULLi- fi;L:= 693,l GHLS TC VOLUME = 176j GHLS HE I C: HT = 1 . I N1-'HES WATER VOL 13 t,HLS WATEP 0.77 1N -CHES TEMP 64.5 DES: F A R .r, r. e EI'IC1 .: it k x m SOFTWARE REV I s I (-N4 LE'•.: EL VERSION It:..02 SOFTIAIHF'EU 346016 - 100 -G CREATED - 48.05.14.13.04 2- MODULEU ; rl-Thrw c;F_-r1jp T 2:REG T 3: PREMPRODUCTCODEPRODUCTCODE T I :PLUS THERMAL C*OEFF :.00070' -j THERMAL *'OEFF 00u,?00 PR010:1' C*011E THNK DIAMETER 139. OU TANK DIHIIETER 89.00 THERMAL '1',EFF 101.17130 TAN)" PROF I LE FULL Vol. 4 PTS 9684 Ti-MX, PROFILE 4 PTS TANI', Dlf-HETER I-T:i. (DO 6r,. 8 1 NC: t1 VOL 7861 FULL VOL I,6.8 1 NCIA %Y,'.)L 96H 7861Tf4PII: PROF ILE a vrs 14.5 IN,_>i VOL 491-14 44.5 1 NCH VOL 4904FULLVOL22.,_1 1 KcAi voL I sqa 3 1 NCH VOL 169866.8 1 hK'H VOL 4,1. 5 1 1,11-H VOL 1190.1 22.3 IN, H VOL 1898 FLOAT SIZE* 4.0 1 N. 8496 FLOAT SIZE'. 4.0 1 11 - 8496 FLOHT SI2E: I.L1 114. WoTER WARNIMG HIGH WATER LIMIT; 2.0 3.0 WATER WARN I IIG HIGH WATER Eimrr: 3.0 WATER WHRI• 11,113 2.0 IIIAX OR LMBEL VOL: 9684 tli'i,', OR Lrm&EL VOL: cir, Ei4Hl";H WATER LIMIT: 3.0 OVERFILL LIMIT 90% OVERFILL LIMIT 901, Mk,' OR LABEL VOL: q684 HIC.H PRODUCT 8715 951. MGH PROD1,K7 0715 95% OVERFILL L11,11T cig). 1.4199 9199 mc;i-i 95t, DEL I VERY L 1111 T 101. C4 DELIVERY LIMIT 10% 68 968 GEL IVEF`,' LIMIT 101, LOW PRODUCT 675 LOW PPO10"T 075C168LEN); ALARM L IMIT: 99 LEAK Al.viptl LIMIT: y`' LOW f ROL,U-T 675 SUDDEN LOSS LIMIT: 50 SUDDEN LOSS L I H I T : 50 LMAK ALHRT1 Li mrr: 99 Tf4NK T I LT C1.00 TiAN), T I LT 2, • 60 SUDDEN LOSS LIMT: 50 MAN I FOLDED TANKS MANIFOLDED TA14YSTANYTILT3.02 TO: NONE TO: NONE MAN IFOLDED DiNKS TO: NONE LEA*,' MIN PER 10[11 C; 10% LFr41< MIN PERIODIC': I Ij-. 968 LEAK 1-11 N P EP 101, 1 LEt-;K M I N ANNUAL 10'. LEHY 111111 HNNUALu968 968 LEHK III N ANNUml. u % I_.'ER I OD I C: TEST 1`,'PE PERIODIC TEST TYPE STHNDi-;RD STfANDiARr, PER I I C TE6T T"'PE ANNUAL TEST FHIL Aiqfquoii_ TEST Fmit. STf iNflARD F41-FiRM ri I SiiBLF11 ALHRM DISmBLEI, ANfqLL4]- TE*ST FrilL PERIODIC' TE113T FAIL PERIOD 10 TEST FHILf-;L;-iFJI 1118o4bLED W-fiRli DISABLED PERIODIC' TEST Fv,[L ROSS TEST FAIL GROSS TEST FWLALARIIDIE,mHLEL, DISiABLEE, TES-I, FA . ANN TEST tAVERMCONG: OFF ANN TEST 4VERmGING: OFFol.kRM r, I kB 1. E-Z PER TEST AVERmi3I N(,: OFF PER TEST HVERHC I NG: OFF mNN TEST I NG: OFF TANK TEST NOT FY: OFF TANK TEST NOT I FY: OFFPERTESTHVEPH,31 1,16: OFF TANK TEST NQTIFV: OFF TNK TST SIPHON EIPLHI::C)FF 1 TIvY TST SIPHON BREW'.: OFF TW TST SIPHON BI`:b--.K:OFF DEL I VERY E)ELA'•,' : 15 MIN DEL i VERY DELAY 1 5 M 114 1GELIVEF', riELH1,' : 11: 1.11 N LE, -1 I'F.ST 1.11. . Cj i: I-WILLiI)EI.) F 11- L I I'll: I, 1 0 ll I kaUF T 1, LINE IXIJI; . 1-11: lilt 20 1*J'H TF::,'71 P1,iHI.El, L J] 1•4 If 10 G,P1I TI: T MI-I, 1-6 T I T 1:1-01.1 I'Pi'41111 I T I :T•RVYJE OM' I IJ-) i, .':F(IFL "I i%kll L `:FULL 1`4 , RH 11 f E L f I IIj +1 o k'T i-A.r2iYJ,l S::TJ`IkT 7111E T WHIIF- ;',iJ,RI1 TF:A, 0. ;0.0 H : T I'l 1F:H 1, 1 ON LINE I-F-A): T J;PPOHE 0111' I- IoUlli `;KNSOP I I I-Y I- I :FHEL i'O.,iki'll F Y.q:po1•. I I J•11 IOL;*l TIME: Dk. -HIA-Fr; L •I:FUEf. HI—km STuP TIME L I Q:.11, ,Ij,j,l 1. 4 ,,1)T of -vRH L I :SHORT L 4:SHQRT f,Dikll F -1:1."M •P,411-11 T SE] UP L. i:FIIFL L 6:RJEL L CAI'T A4.,} -,H I I L L 1 5,:1111 EP L OUT v,L.Ai-11 Tpi ..:i,,Tl- S I 1,v;l Y I I O.ij F i vi- T','! 1: LI 1 1 r:k;Tl L 4F J"IN I]. 11; JI-It ],)::I HII H, 1. TK, I aTHTE I IL)Jl I I 'I aT L. I: LINLE,L,I:r) U14A T;;TE i-,T! AJR",' * AIM, JL;4, .`:1 'L 7'14 :I - - Ti4TE (:-; I Fl: ,r. 1-) 59 t.'t I'[' E. :;u, F,,, STr- I f,' I I jj* I- R FI.: F,.-.--) I.: I us II Hrilt.rt, IS 04 L F I. LIS t I 1 01 -'ib 8 : Ot-I Tkl :aTATE TY I J,4.' N I PP TE60R'e 07 A jr) I I :,Ir, NE I Ef 6.; Li It.: r it-,j ii i i Rtil TD( -1 IN ]-:i, IF: :I AH 'I').: I TkI it I III T, 411 HL-1-1 I I il :-• [ 'k " )-.1 1 I,, I hLp',RH T 1 T 3: RI'E.11 ETt 1P SETUP F"T, SAMM Yurn InTo INAMM; 137-U_-90 16; I.0 u-, HIGII ATEP M&I Hlijli 1JHTF1.: rL,-;ikH 17-mi 13:26cIj :, I tjj W. .17 1 1 LI.-I 12-20 10 AM: 1,jiil' 1-.F" if I 1 w--OR I , : H 11 IL,',Fhl 1' 20M IbAd 01 00 07 11 A01p17 U! III-, 1_0 9 1 1-2k H 10: L- 12 M 08 1 1 50 L,'-I I i 1`-l 11 1,7 ,L,43 1 LOW Pl', I_IH - 1., 16 CIR-110 ilu I u: Cisu12 -117 -I 1 17:U7 LOIJ cle. 2:, i7: oF 01 SuDDE11 LO .S. OA AE11 I cl- l5- 1 1:1 1 -,: 0 1 I (I I t -I cl ._'1:01 kOH I, 'I f,!.HH I Wj -1 11 IV Mj U7 10. I: _, I H11:;H jD 7 1 b FI 11.1 1 1 .1 L 1 zil CI 7 1 1-07 1 2 n 1NOAAD FM LEVEL 07 PC1 ! ou- -,Fj- I I 14 : 17 I I I o: I S I LAVAL 11) FUEL I.FVEI, Iii ''b I] cj: 08-D9 11 17:1]d 01 -la 11 Ili * 1'.) PME (MT PRM: OUT 12-1 k 10 1 nj' 12: to) 01- MI IrA Y. Ili ' `31 1 1 12-15-tri 8:35 YPAE OuTI'- - U:, 9:30 02-15 Q 15 H11:11 Ilk-0,FY, HIGH WATER INANING 0 01 l 16 w I:i 15: M 01:1 I1I'- Z1, 1.- 12-20-tri 15M MER MMN"; IH-04 ly/ 11:40 12-09 IIIJ 12":' i2-'_-0-07 I! L WIN, NEP i 01 bELIVERY I P- 22 " 1021 I'z -I? -I i 15 : 2 1 pLj 11-12-11 19:09 12-2u4l 11:0 W 11::: 1- ROLIUCT 07-12-1 1 1 1),/ 1 t .: 1 tj 1 Y_ " 11-1 1 -1 1 4-11 J(,T CJ I - Fj I-E(11 wAi-:I,I1N1,.. fI I —.'7 - f-I 9 : ;c. EI,jr) o t ?. x EN1, I . A - 1 - '01 11 i :-; 1 V;) " -: I -n: L I i,Li vwr r4 I ORT 1. 11,11-Dil Cl OUT , ILARI• FUEL AMI 5 FUEL I - I FUEL Al PH J: sMPOP OUT N AM I Z I t.-ti , 8: i. " Fl`llt . • - * , rlj 0-1 FUEL GO; aq L: :1 L I— H,i' a 4JI I IA, " 124 1758 IT r-i bY ODA SO I HS RU AT BMW Sod w PEP +I' NLL FUN-.1 101 G mLL FWCTWNS NOWUL L "MI IK 44LAPI ----- L 531.0: IA d 1. 1 WIWI FUEL W—RI-I 12- 29" 1 9:25 12-2A"l 9:31 SWUR Ansl ---- L Q ;III G: AM :101F 'Ill_} FUHI. "Li431 661-30- W-vq" 1 9:2& 12 L PEA Ti MIP 1 L 6: 1 INI Eil top MAN FIVI. iALHRI-1 12-25-11 9:27, L 2:1L STP Jull ML W"MI 12 - 9 - 11 9: 21 9 PA"70 EX*PRE.--,8 22"" F 2TPEET 121 -'29 --1 1 .; : .,;. 3 SYSTEJ,l ST;iTu:-' PEPOPT HLI- FUW:TIC)Iiq NOP(-"L L I :SlJPEP ANNUI-IiR SPACE FUEL HLiARpi 12-219-11 9:35 2222 F STREET S;A)'EPSF I LLD 661 -32a -1758 1 .2-29-1 1 a:95 SV'SATM FJIPvPT LL FUNCTIONS NC-F.PhLil. PPLSSURE LINE IXA)* iit -Iifll 0 21:SuPER GROS'S LINE FWL 12 -29 -11 9:55 PRE ,SURE LINE t.Ei-d: A[.1,Rfl Cj '-':SlJPER P11D SHUTDOWN W-f4.11*1 12 -29 -II q: 5 PRESSURE I.1 NE LEAV F-11-oRM 0 1 :PLU.cl CROSS LINE FHIL 12-29-11 10:02 PPE-S-D'URE LINE I-DiK f1LiARI-1 Qj I : PLUs PLLD SHUTDOWN oil-ARM 1"'24-11 10:(.12 SENr:*R ALARM ------ L 9' : PLUS mlINULAR E;r.,i.,i-,E SENSOR OUT i-ibAP-1 1?-29-11 lu:uj PRESSURE L) NE I-FiiK :iLiipm 0 3:UNLE,-kriED GROSS LINE FHII- 12-29-11 lCi:rit, PRESSURE LINE I-Ef-W Cl 3: UNLEADED PLLI, SHUTDOWN 1 12 - -;, C"4 - I I I () : 06 ISEI.6u)P, iii.;4.1-1 - - - -- L 3:0MI-DiDED Hflll,IULMP SPACE FUEL ALARH 12-29- 11 1 o: I i SEN,._!DP L I :SUPER ANNULhR SPACE SENSOR OUT 12-29--li 1 o:19 PW(`0 EXPRMS 222.2 F S-rPEM-' BAKERSFIELk 661-324-1758 12-29-11 11:10 SYSTEM STiiTW PEI-14) wr L I :i ENSOR ou'r I.. 3:FUEL ,,,LiAdl L 5 :,SE119uR uUT kiLARM Q I :i3ROSS L 114 FHIL 0 1 :PLLrj 'SHUTIOLM 6 2: (;ROSS L114E Fi-dl- Q -,,:PLLD (Al-i-0*1 a 2,c;koss LINE FHIL Q J:PI-LD SHLj,rLQWN ALI-iPtl PAWO &'PRESS 22"22, F 5TPCE-r DMERSHELD 661-3'--'4 -1 758 1 11 :41 L i .sEisop (.)u,r mLmRM L 3: FUEL i4Li*M L 5:SENSOR OUT fil-,•iRll Q I :t.;R0c3R LINE Fiill.. 0 1 :PI-1-1, SH1.717OWN i.kLt4F.l'T 0 2:C.;P05S LANE Ffill - Fj 2:PLLD SHOTLOWN 0ALJ'iPM 0 3:CROSS LINE FAIL 3,PLLD 2'.HUTL,G-6llq HD-ikll RAIICC, EXPREtid RAMC'U E :F•F:ES.s 2222 F STREET 2222 F STREET BAb:ERSFIELG 'H.?3:tL11 BH}.EP.SFIELD l::i.y.J3ul 661 -724 -1758 661-324 -1750 12-29-11 l2- 29 -11 12:18 SE11SOR ALHRM - R+U1 G L. 3 : UNLEi-ibED 22-22 F STREET HNNULHR SPA,_E BHYERSF I El_CI :A . +:t3 i SEN 10R OUT ril_r,kl 1 661 -32-4 1758 12 -29 -11 1'-:,:19 12 -29 -I1 12 :18 6's' fEM i'fl-,TU(c: RLIKN'T SYST131 5TH'I'11; kEr.c)k "f SYSTEM STATIG REPORT L 1 :SEhrSOR our HLHRtI L i :SENSOP O LIT HI_HRM 6t1- 32.1-1'758ClI :C ;ROSS LINE. F'F11L L 3: FUEL HLhRM L 3: FUEL aiL+-%Rl1 0 I :F'L!_G :.:IiU'fLhJ4J14 HL+ - +FY 1 W 2:GROSS LINE FAIL L 5:SENSOR OUT ALHPM L 5 : SENSOR OUT HI_ARM C+ ^:PLLD :::HU'fGi+.lhl H1 riF.1 °r 0 1: -ROSS LINL• FHIL O 1: C:k05S L I I`!E Fr1 I L L 5: SENSOF: OUT HI.ARt13: PLLD SIIuTfjWPl r~LNRM 0 1 : F'1 -.L.G SHUTDOWN ALA -iRM 0 3 : PLLD 'FUJTDOWN HLF'RI °I 0 1 : PLLD S} IUTEs0WN mi-mki 1 G 2: C;ROSS L 1 l,lE FAIL 1' :':.Rv ^S L I HE FA I L u 3: CROSS L l 1.1E FH I L 4i 2: F•LLD 21•IUTGUWN Al-i43rl SHU1'UOWN H1.HP!•I C+ 3: CROSS L 1 I4E FAIL G 3:CRO13S LINE FAIL 0 3 : PLLD SHUTGOUIN HI_HRM 0 3 : PLLD SHUTDOWN m1 diRi9 SE11SOR ALHRM - R+U1 G L. 3 : UNLEi-ibED 22-22 F STREET HNNULHR SPA,_E BHYERSF I El_CI :A . +:t3 i SEN 10R OUT ril_r,kl 1 661 -32-4 1758 12 -29 -11 1'-:,:19 12 -29 -I1 12 :18 6's' fEM i'fl-,TU(c: RLIKN'T L l :.f1 =ld ClF: OUT AI -"irfl L :3:F'uEL tiLHV21 °t RHh1Ct, L' :!I' >F:1_' 222:.' F STPEE'I' L 5 : SENSOk C,U'f HLHRM 6t1- 32.1-1'758ClI :C ;ROSS LINE. F'F11L 12-29 -11 '12: B 0 I :F'L!_G :.:IiU'fLhJ4J14 HL+ - +FY 1 W 2:GROSS LINE FAIL SYSTEM ST;-OVS- REPORTC+ ^:PLLD :::HU'fGi+.lhl H1 riF.1 °r L I:SENSOR OUT HLHkMQ3:r,ROSy LINE Fill- L 5: SENSOF: OUT HI.ARt13: PLLD SIIuTfjWPl r~LNRM 0 I:i3ROSS LINE FLAIL 0 1 : PLLD S} IUTEs0WN mi-mki 1 G 2'GR05:3 LINE FAIL Cl %:PLLD SHUTDOWN ALHRM u 3: CROSS L l 1.1E FH I L G 3 : F'Lf_D SHUTDOWN HLHRM DjSOR ALARM L I :SUPER FUEL oAL'ARI•I 12-29-11 12;-1? Sc-ti"op L I :SUPER ANNULHP SPACE FUEL ;ALARm 122-29-1 1 12:49 SENSOR AIJ%RM L. I :1-iUPER HNNUL,AR 3Pk4'E FUEL mLj-iRi-i 12-29-11 13:13 RAMCO Er,PRE:;s 2222 F STREET BAKERSFIELD 661-324-1758 12-29-11 1s :15 S"ISTEM .*.:*,Ti-i'I*Ul*a REPORT L 5:SENSOR OUT ALARM iiLmRil - -- L I :13UPER ANNULAR l'o*PA,"E FUEL ALARM 12-29-11 13:32 F.'FV,Y.'O D:PkESS 9227' F STREET BmHRSF I ELD C-1.933u) 661-J24-1758 12-29-11 14:05 SYSTEII STATUS REPORT L I:FUEL. ALARM il SWRCB, January 2006 Spill Bucket Testing Report Form This form is intendedfor use by contractors performing annual testing of UST spill containment structures. The completedform and printouts from tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Ramco Express Date ofTesting: 12/29/2011 Facility Address: 2222 F Street Bakersfield, CA 93301 Facility Contact: Rami I Phone: 818- 339 -7288 Date Local Agency Was Notified of Testing : 12/l/11 Name of Local Agency Inspector (ifpresent during testing): Ernie Medina 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services Technician Conducting Test: Bryan A Self Credentials: 0 CSLB Contractor x ICC Service Tech. x SWRCB Tank Tester Other (Specify) License Number(s): CSLB# 804904 ICC# 8022804 -UT TT# 11 -1756 3. SPILL BUCKET TESTING INFORMATION Test Method Used: Lake x Hydrostatic Vacuum Other Test Equipment Used: Lake Test Equipment Resolution: 0.0625" Identify Spill Bucket (By Tank Number, Stored Product, etc.) 1 Regular 2 Plus 3 Super 4 Bucket Installation Type: 0 Direct Bury Contained in Sump x Direct Bury Contained in Sump x Direct Bury Contained in Sump Direct Bury Contained in Sum Bucket Diameter: 12.00" 12.00" 12.00" Bucket Depth: 10.75" 11.25" 11.25" Wait time between applying vacuum /water and start of test: 5min. 5min. 5min. Test Start Time (Ti): 9:OOam 9:OOam 9:OOam Initial Reading (Rj): 9.75" 10.25" 10.00" Test End Time (TI.):- 9: I Oam 10:00am 10:00am Final Reading (RF): 2.00" 10.25" 10.00" Test Duration (TF — Ti): 10 Min 1 hour 1 hour Change in Reading (RF - Rj): 7.75" 0.00" 0.00" Pass /Fail Threshold or Criteria: 0.0625" 0.0625" 0.0625" Test Result: Pass x Fail x Pass Fail x Pass Fail Pass Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -up forfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the info on contained in this report s-tfr, curate, and infull compliance with legal requirements. Technician's Signature: jji / Date: 12/29/2011 1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. 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