HomeMy WebLinkAboutFMC 2012MONITORING SYSTEM CERTIFICATION
For U.ve By All Jurisdictions Within the State ofCalifornia
Authm ity Cited.- Chapter 6 7, Health and Safet Code; Chapter 16, Division 3, 77tle 23, California Code ofRegulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be
prepared for each monitoring System control panel by the technician who performs the work. A copy 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 9nformation
Facility Name: Shell (Brookside Market) Bldg. No.:
Site Address: 8803 Camino Media Blvd.
Facility Contact Person: Matt Jeffries
Make/Model of Monitoring System: Veeder -Root TLS -350
B. Inventory of Equipment Tested /Certified
Check the appropriate oresio Indicate specific equipment inspectedlsersiced:
City: Bakersfield Zip: 93311
Contact Phone No.: 661 - 496 -7006
Date ofTesting/Servicing 01/17/2012
Tank ID: 20000 gal. Regular Tank ID:_12000 gal. Super
x] In -Tank Gauging Probe. Model: 847390 - 107 x] In -Tank Gauging Probe. Model: 847390 -107
x] Annular Space or Vault Probe. Model: 794380420 X] Annular Space or Vault Sensor. Model: 794380 -420
x] Piping Sump / Trench Sensor(s). Model: 794380 -208 Lx] Piping Sump / Trench Sensor(s). Model: 794380 -208
x] Fill Sump Sensor(s) Model: 794380 -208 X] Fill Sump Sensor(s). Model: 794380 -208
x I Mechanical Line Leak Detector. Model: FX1V x] Mechanical Line Leak Detector. Model: FX1V
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
x] Tank Overfill / High Level Sensor. Model: OPW -6I -SO x] Tank Overfill / High Leval Sensor. Model: OPW -6I -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: 8000 gal. Diesel Tank ID:
x] In -Tank Gauging Probe. Model: 847390-107 in -Tank Gauging Probe. Model:
Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model:
x] Piping Sump / Trench Sensor(s). Model: 794380 -208 Piping Sump / Trench Sensor(s). Model:
rx] Fill Sump Sensors(s). Model: 794380 -208 Fill Sump Sensor(s). Model:
n Mechanical Line Leak Detector. Model: FX1DV Mechanical Line Leak Detector. Model:
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
x] Tank Overfill / High Level Sensor. Model: OPW -6I -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: 112 Dispenser ID: _3/4
n Dispenser Containment Sensor(s). Model: 794380 -208 U Dispenser Containment Sensor(s). Model: 794380 -208
x_1 Shear Valve(s). U Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s)
Dispenser ID: 516 Dispenser ID: 718
Lx] Dispenser Containment Sensor(s). Model: 794380 - 208 x] Dispenser Containment Sensor(s). Model: 794380 -208
rx] Shear Valve(s). U 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 fora. 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, i have attached a copy of the report; (check all that apply) x S Vi Set -up [x]AI4Pm Wstory report
Technician Name (print): Bryan A Self Signature:
Certification No: 837501 License No: 804904
Testing Company Name: Confidence UST Services, Inc. Phone No: 800 - 339 -9930
Site Address: 8803 Camino Media Blvd, Bakersfield, CA 93311 Date of Testing/Servicing: 01/17/2012
D. Results of Testing /Servicing
Software Version installed: 327.04
Complete the following checklist:
x-] Yes No* Is the audible alarm operational'?
Yes No* Is t ie isua a arm operationa '? grx]
Yes No* Were all sensors visually inspected, functionally tested, and confinned operational'?
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)
Lx] 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'? Lx] Sump french Sensors [x] Dispenser Containment Sensors
Did you confirm positive shut -down due to leaks and sensor failure /disconnected? [X] Yes; No;
x] 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 alann visual and audible at
the tank fill point(s) and operating properly'? If so, at what percent of tank capasity does the alarn
trigger'? 90 'X)
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 17 No* Was monitoring system set -up reviewed to ensure proper settings'? Attach set -up reports, if applicable.
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 perfonn leak detection monitoring.
Complete the following checklist:
Ex Yes No* Has all input wiring been inspected for proper enter and tennination,including testing for ground faults'?
1x1 Yes M No* Were all tank guaging probes visually inspected for damage and residue buildup'?
x Yes No* Was accuracy of system product level readings tested'?
x Yes No* Was accuracy of system water level readings tested'?
x Yes No* Were all probes reinstalled properly?
E 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:
x] Yes No* For equip. start-up or annual equipment certification, was a leak simulated to varify LLD perfonnance?
Check all that apply) Simulated leak rate: [x]3 g.p.h.: 0.1 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?
Yes No or mac amca 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
X] N/A malfunction or fails a test?
Yes No* For electronic LLD's, have all accessible wiring connections been visually inspected?
x] N/A
x Yes 0 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:
BR:C!}•:::1C'E ItAF};ET SYSTEM SETUP
yBU3 CHi "l I hlti h1ED 1 H — — — — — — -• — — — —
BAKERSFIELD Ca 5:3 01= JAN 17, 2012 6:15 (AM
JAN 17, 0012 3: 15 hM
SYSTEM UNITS
U.S.
SVSTEr1 I-.r•01GUA1,E
S''1S'CE1 °I ,TATU'S REPORT ENGL I tiH
S"STEM rW'iTE, T I I'1E FORMAT
ALL F! IIJi ::'1' I C;t +)S 11c: >kl I, L HOW DC, ''!';';^ HH : t ^Ir1 : SS >:N
1 11VENTQRV REPOPT BR'_ Oi: =: l DE NWRKET
Kluki C AVIINO MEDIo
1F, SHEEP SF I ELL, CH 93:30'D
1HLS
ULLAt _ 4 1:33 +:;HLS SHIFT TIME 1 2: 00 AI t
9u %;. U LADE- 21 24 GALS SHIFT TIME 2 U 1,
TC %/OLUME = 15931 GAL'S SH I FT T I I °1E :3 D 1 _tiI:IL' L "li
HE l (,HT - 94 .44 1 NCHES 5*11 I FT T 1 ME .1 : DISABLED
WATER +,:OL. - 17 GALS
WATER = 0.81 1 NCHE'S Ti -0,11 PER TST r1EIEI: ED WPM
TEMP = 61 .3 DEG F D 1 SABLED
TAN): ANN "I'ST NEEDED WRI;1
U I SABL.F..0
T 2 : PF,EI'1 I UM
VOLUr1E - I iIi365 r;ALS L1 14E RE- ENABLE 11ETHOD
ULLA E = 19'%6 ALS PA`3S L 1 1'dE TEST
90 U[_LHi;E= 771 ;ALS
Tim iluS 4 i:ALS L NE PEP 7'S'f NEEDED 'WRN
HEIi;HT = 99.33 IPI:HE DISABLED
klATER `•!'`N... _ • U ::ALS LINE ANN TST NEEDED I,,IRN
WATER = 0 .00 ! NC:HES D I SABLED
TEMP = 6u.', DEG F
FR 1 hl'1' 7'C: VOLUhIE:,'
ENABLED
7'
VOLUME = 5066 GALS TEMP C'OMPENSAT I O14
ULLr~GE = 0561 GALS VALUE iDEG F ): 6u.0
90 "i. ULLHGE= 21 5,3 Gtil_ ; S-1' I r :}c HEIGHT 11FF'SET
TC VOLLIr1E = 5CI57 GAL'S D1SABLED
HEIGHT = 76.y1 1 lic.HES ULLHGE: 90%
WATER VOL = U GALS
WATER = 0.00 1 ld!;HE _ H—PROTC >C: iL L'h l'ri FORMAT
TEMP 6:3. 6 DEG F HEIGHT
DF y'L I C;HT SHV I PGs T 11 °IE
ENABLED
EIJL+ - t t i START LATE
APR WEEK 1 SUN
START T I ME
2; 00 AI"1
END PATE
OCT WEEK 6 SUI,t
E14D T I ME
2: uCI HM
PE-DIRECT LOCAL PRINT: :;UT
D I :Sf -iBLED
SvFTI:JAF11 RE',' I ' [ IJfV LE''.!LL E! IRO PROTOCOL PREF L':
VER:' 1ON 327.04
C.FTWAREp '.4h3 '7 -100 -F
CREHTED
5-11ODUL•E {I :330160- UIJJ -a SYSTEM SECURITi
SYSTEr1 FEr;CUF,'FS: CODE : 006000
PER 1 C,D I C IN-TAN); PESTS MAINTENANCE HISTORYAr11110HL1N -TANX TESTS DI SABLED12
PHU
TANK ! ::HART SECURIT`i'
DISABLED
CUST(A"I ALARMS
DISABLED
11AS.S. DENS I TY
D I SABLED
GMMUN I 1 ::A'I- I t:NS SE 111P
PORT SE.TTI Nrc
01111 BOiFiWl'J : I c ED 1 I'1
R'S —''32 'Er:UF.'1'CY
CODE : DISABLED
C"Or f•'I BOAHC! . 2 tRS -2:32)
BAUD RATE : 960
FAR 1 T1' NONE
STOP BIT I STOP
DATA LENGTH: 8 DATH
R5 -2 ECUR I TY
CODE : DISABLED
AUTO TRANSMIT SETT I Ni;ti :
AUTO LEA}: ALHRM LIMIT
DISABLED
AUTO HIGH WATER L 11°1 I T
D I S BLED
AUTO OVERFILL LIMIT
D I SABLED
AUTO LOW PRODUCT
DISABLED
AUTO THEFT LIMIT
DISABLED
AUTO DELIVERY START
DISABLED
AUTO DELIVERY END
U I SHBL.ED
AUTO EXTERNAL INPUT ON
DISABLED
AUTO EXTERNAL INPUT OFF
Lj I SABLED
AUTO SENSC %R FUEL mLi- RI'1
DISABLED
AUTO SENSOR WF;TER AL(4.,r1
DISABLED
AUTO SENSOR OUT A'LHP.M
111 SABLED
RS -232 END OF MEEZik,E
DISABLED
I N —T;40, SETUP
T I : UNLE;iDED
PRODJ+'1' CODE 1
THERHHL .'C:I.F1= :.000700
IY PI}•: I) I ANETER 12'7 , t,0
THNK PROFILE I PT
FULL. VOL. 20082
FLOAT SI?E: 4.0
WATER WARN 11116 2.0
HIGH WATER LIMIT: 3.0
hlAi' OR Li -iBEL VOL: 20092
OVERFILL LIMIT 90 ".
PRODUCT +::OLE
I aur.
HIGH PRODLK. :T 95'
THERMAL +::oEFF :.
1907E+
DEL I V'EI?Y L i PI IT 10 ";
TA1,JK L I Af°IETER :
BOOB
LOW PRODUCT 500
LEAK ALHRI'1 L I M I T: 9
UDL L'hl LOSS L I I °I I "F : 50
TANK TILT 0 . 00
PROBE OFFSET 0.00
SIPHON HAN I FOLDED 'I'AmxS
TO: NONE
LINE MAN I FOLDED 1'wPJ1:5
T#: NONE
LEd1•: MIN PER. I OD I '. I il°•l
2000
LEHL. MIN ANNUAL : I ij,"
2'008
PERIODIC i'1=: T 1lPE
8THNDF,RL1
INNUAL TEST FAIL
HLARI.1 D 1:9ABLED
PER I OI, h-' TENT FH 11_
GRCYSS TEST FA 1 L
AL+;RM DISABLED
ANN TEST oVERt;C.; l NG : OFF
PER TENT AVER+ - +G 1 NG : OFF
THNI' TENT IVOT 1 F(: OFF
TNK TST E:1 PHA: >rl BhEAK :OFF
DEL I VERY DELAY 15 I °1 I N
PUMP THRESHOLD 111.013,:
SIPHc)N MANIFOLDED TANKS
TR: NONE
LINE MANIFOLDED TANKS
To: NOME
LEM): 1-1114 PERIODIC: 10:;
104
LENT: MIIII ANNUAL 1054
1204
PERIL >DIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PER l OD I C: TEST FH I I_
HLHRl'i D I SABLED
aR 2S TEST FAIL
AL-iRl•1 N B,, +BLED
f -0411 TEST AV'ERAG I l`,K; : OFF
PER TEST AVEP.AC I NG : OFF
TNNY: TEST NOTIFY: OFF
TNK TST SIPHON GREMK:OFF
DELIVERY DELAY 15 MIN
PUh1F' THRESH•::ILD 10 -
SIPHON IWAIV 1 F<;-LDEIi 'I'l +f11k::3
TO: NONE
LINE MANIFOLDED TANKS
TO: h:ONE
LEHL: MIN PERIODIC: 10%
802
LL "tiK. hl I bJ ANfVUHL i 0 %:
802
PERIODIC : TEST TYPE
STlaldflr;RL,
APIIVIJAL TES F FH I L
ALHR1.1 D I ,',;BLED
PEFIOD1+:: TENT FF;IL
ALARH DISABLED
GRO °S TEST FAIL
ALARM D 1 SABLED
ANN TEST AVI :RA(; 11•li; : OFF
PER TEST AVERriG I N ; : OFF
TANK TEST NOTIFY: OFF
TPIF; TST :SIPHON BRE+-iY•.:OFF
DEL I VERY DELAY 15 1-1111
PUMP 'CHRESHOLD 10.Uu
LEA)•: TEST OETHOD
TE:_T ANNUALLY: ALL TF011(
DE(: WEE ); 2 WED
START TIME . 2:30 f-iM
TEST RATE :0.20 GAL.--HR
DURATION' : 2 HOURR
TST EoRLY STOP: D I =:1- iBLEF,
LEAK TEST REPORT FORI•Iw't
ENHHNC'ED
T 3:DIESE-L
T 2 : PREM l LlN PRODUCT : :ODE 3
PRODUCT +::OLE THERMHL 1: :OEF'F :.000450
THERMAL +::oEFF :. 001,1700 PHN}t G I AI•IETER 1,27. 50 —
TA1,JK L I Af°IETER : 1 27.50 T;-Oh: PROF I LE 1 PT
TANK PROFILE 1 FT FULL VOL 8027
FULL VOL 12041
FLOAT 51"','E: 4.0 I PI .
FLOAT SIZE: 4.0 1N.
WATER WARN I PIC; 2.0
WATER WARN 1 NG 2 •0 H 1 GI l WR'I'ER L 1 t 1 I T: 3.0
HI,_ :H WATER LIMIT: 3.0
llm,X OR LABEL VOL: 8027
MAX OR LABEL VOL: 12041 OVERFILL LIMIT 90%.
OVERFILL L I I.1 I T 90 %% 4
W837 H I GH PROI +UGT 955.
HIGH PRODUCT 625
114:3':1 DELIVERY LIMIT 10:-.
DELIVERY LIMIT 10 %11• 802
1204
LOW PRODUCT 500
I-Oki PRODUCT 500 LEAK HLf -iRl °1 LIMIT: 99
LEAK ALARM L 11,.11 'F : 99 SUDDEN I-,*)'.;".:'. LIMIT: 50
SUDDEN LOSS L I h1l T : 50 TANK T I LT 0.00
TrMli', TILT 0.00 PROBE OFFSET 0.00
PROBE OFFSET 0.00
SIPHc)N MANIFOLDED TANKS
TR: NONE
LINE MANIFOLDED TANKS
To: NOME
LEM): 1-1114 PERIODIC: 10:;
104
LENT: MIIII ANNUAL 1054
1204
PERIL >DIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PER l OD I C: TEST FH I I_
HLHRl'i D I SABLED
aR 2S TEST FAIL
AL-iRl•1 N B,, +BLED
f -0411 TEST AV'ERAG I l`,K; : OFF
PER TEST AVEP.AC I NG : OFF
TNNY: TEST NOTIFY: OFF
TNK TST SIPHON GREMK:OFF
DELIVERY DELAY 15 MIN
PUh1F' THRESH•::ILD 10 -
SIPHON IWAIV 1 F<;-LDEIi 'I'l +f11k::3
TO: NONE
LINE MANIFOLDED TANKS
TO: h:ONE
LEHL: MIN PERIODIC: 10%
802
LL "tiK. hl I bJ ANfVUHL i 0 %:
802
PERIODIC : TEST TYPE
STlaldflr;RL,
APIIVIJAL TES F FH I L
ALHR1.1 D I ,',;BLED
PEFIOD1+:: TENT FF;IL
ALARH DISABLED
GRO °S TEST FAIL
ALARM D 1 SABLED
ANN TEST AVI :RA(; 11•li; : OFF
PER TEST AVERriG I N ; : OFF
TANK TEST NOTIFY: OFF
TPIF; TST :SIPHON BRE+-iY•.:OFF
DEL I VERY DELAY 15 1-1111
PUMP 'CHRESHOLD 10.Uu
LEA)•: TEST OETHOD
TE:_T ANNUALLY: ALL TF011(
DE(: WEE ); 2 WED
START TIME . 2:30 f-iM
TEST RATE :0.20 GAL.--HR
DURATION' : 2 HOURR
TST EoRLY STOP: D I =:1- iBLEF,
LEAK TEST REPORT FORI•Iw't
ENHHNC'ED
L 11 +U 1 r, 3ENS0P SETUP OUTPUT RELAY SETUP
L 1:87 AIOIULi R R 1 :37 STP
L 4:FUEL ALARM
TP, I -STATE c S I I XE FLOAAT) TYPE:
L 5 : FUEL ALARM
CATEGORY : ANNULAR SPACE STANDARD
L 9:FUEL ALARM
AIR. 'FL",; NETEF
NOWIALLY CLOSED
LIO:FUEL ALARM
CATEGORY
TANK it: 1
L I I : F LIEL ALARM
L 2:87 STP
TR I - STATE + 61 11C,LC FLC1AT >
I -2 L12 :FUEL ALARM
C +tTEGOkY S'!'P SUMP L I WU I U SENSOR ALMS
L l:SENSOR OUT ALARM
L I:FUEL ALARN
D I SPEI,I. ER PHN L 5 : SENSOR OUT ALHRII
L 2 :FUEL HLHRM
L 3:37 FILL L 9 : FLIEL ALARM
TR 1- STIaTC < S f PN :LL FLOAT) L I O: FUEL ALARM
CATEGOP.'r : OTHEFI SENSOF.", L I I : FUEL ALARM
3 -1 L12:SENSOR OUT ALHRII
L12:FUEL ALARM
c S I NGLE FLOAT)
L 1 :SENSOR OUT r- 1LARI -I
ISC4 SITE ALARMS
L 2 : SENSOR OUT AL, -1RII
L 4:91-DIESEL ANNULAR L 9:SENSOR OUT ALARM
TR 1 - STATE (S 1 NC:L.E FLOAT) L 10 : SENSOR. OUT iALHR.M
CATE(30RV : ANNULAP. SPwCE L I I :SEflSOR OUT ALARM
LI':SENSOR OUT ALARN
18D HOSE ALARMS
ISO SITE ALARMS
DISPENSER PAN
L 5:91 STP ISD GROSS PRES FHIL
TR I - *rtr TE (S l IT-4 -E FL1 ?HT) ISD DEGRU PRES FA 11.
CATEC;oRV : STI-1 SUhIP ISD VAPOR LEAK FAIL
TYPE:
ISD HOSE ALARI IS
SINGLE FLOATS
L 6 :91 FILL HLL:GROtr COLLECT FAIL
TRI-STATE (S1NC %LE FLOAT) ALL:DEC;RD COLLECT FAIL
CATEC;ORI` : O'1'HEP SENSORS
TANK 0: 3
R 2:91 STP
TYPE:
STANDARD
L 7 : D 1 ESEL STIR NORh1wLL`I CLOSED
TR 1 -;S'Fi-TE c S I NGLE FL1 (1T 1
CHTE00PI/ : STP SU4, TANY 4:
L 8:11IESEL FILL L12UID SENSOR AL1,18
TRI-STMT£ SINC.'LE FLOAT) L 4:FUEL ALARM
CATS +,0PY OTHER. SENSORS L 5 : FUEL ALARM
s3:1 "1SP5 6F'm
L 9:FUEL ALARM
AIR. 'FL",; NETEF
4:1) 1 SP
LIO:FUEL ALARM
CATEGORY AIR FI.0-i IIETER
L I I : F LIEL ALARM
L 9:D1SP I -2 L12 :FUEL ALARM
TRI-:STATE SINGLE FLOAT) L l:SENSOR OUT ALARM
CHTE1FOR`! D I SPEI,I. ER PHN L 5 : SENSOR OUT ALHRII
L 9:SENSOR, OUT ALARH
L10:SENSOR OUT AL(ARII
LIl :SENSOR OUT ALt-&l
LIiJ:Di%' 3 -1 L12:SENSOR OUT ALHRII
TR I - STATE c S I NGLE FLOAT)
CATEGORV DISPENSER PAN ISC4 SITE ALARMS
ISD GROIK) PRES 17F, I L
ISD DEGRD PRES FAIL
ISD VAPOR L90,' 1-A l L
LII:bISP 5 -6
TR I -STATE. S 1 ItGL.E FLOAT) 18D HOSE ALARMS
CATEGORY DISPENSER PAN ALL :GROSS COLLECT FAIL
HLL : DEC:RD l'OLLEC:T FA I L
R 3 : D I ESEL STF'
1-12:1:11SP 7 -H TYPE:
TRI- STAATE SINGLE FLOATS STANDARD
HTE130R'; DISPENSER PAN NORMALLY CLOSED
TANK 0: 3
1-161.11D SENSOR ALMS
L 4:FUEL ALARM
L 7 : FUEL ALARM
L 12' : FUEL mb-- RM
L :1 : SEN:;OR OU'r F,LAN",I•I
L ']:SENSOR OUT ALARM
112 :SENSOR OUT ALARM
SMARTSEllr$OR : SETUP
1 -2 FI1JHTEGOk`,` A 1 P FLOW METER
3 -A Fl;l
0ATEGOkY AIP FLOW NETEk
s3:1 "1SP5 6F'm
r- ITEGORI' AIR. 'FL",; NETEF
4:1) 1 SP 7 -:3 Ffry
CATEGORY AIR FI.0-i IIETER
5:PRESS I:JENSOR
CmTEGOR'i ri.POP, PRESSURE
ENJP I SD SETUP ALARM HISTORY REPORT Al_i4tl Hl:-:ToRl'j PEI-()P*I'
Sl ' ISTEM ;iLmRPl ----- AL,iRll
EVR T',+E: vi-ICUls-1 ;-i: ;SIST
PiPER 01.1 -
DE4.* 23. 1 1 :39 AN T 2:F'Ral I tPI
VACut•l A,.Slil,-iT TYPE PPI I`rrEF NPOP HIGH WATEP MLIAMHEALY %)HC: DEC 23. 2011 1 :59 ;AM JAN 18• 20 N11
19:
22 'I
PIOZLE A L Rt4PI,:;EZ
57 0. q5 OVERFILL ALARM
JAN 3. 2012 1 '.::J I lilt
VAPOR PRO(-ESSOR Tl,'[.•E DEC; 23. 201 I G:36 f4l
1,10 VAPOR PROLESSOP JuIq 6, ;_oi I q: I I io
HIGH PRODUCT ALAPI•l
ANhLYS I c: T I I,V; jmN 16. 2011 10:52 All
TII-,IE: 10:00 All riEC: '28. 2009 i:37 i-fl•l
DELAY 11111-JUTEP,: I ocT 9, 2oo,'; 'S:02 i-il•
INVALID FUEL LEVEL
AC'CEP'T HIGH 0RVR: JiiN l8. 201 1 9: 10 AN
DISABLED
PPOBE OUT
IUD H012E TABLE JhN 18. 2011 11:37 AM
I C, FP FL HL A;-i RP J#41 IG.. 2011 9: 17 All
01 01 01 02 oll 01.1 H I C' I i 1,,in'T _R WARNING
02 02 02 02 04 ULI Ji-;I,l 18, 2011 9:2 P41-1
03 01 03 02 01 LIU
04 04 04 02 01 UU 4iLp0,l HISTORY REPORT
05 05 05 02 N" UU
06 06 06 02 0; UU
07 07 07 02 on u(i
08 08 08 02 OJ UU T I ! UNLEt)DED
GVERF 11-1. ALHRII
I Sf) mIRFLOW PIETER JHP 16, lloi-2 11:47 r9-1
1 SERlkL NUN L.MBEL JfAll 12, 2(312 6:11:3 fu•;
810, DISP 3-1 F JvW 10. 2012 6:4 5 Alit
1 3,11 3 D I SP 5-6 F
a D ISP 7-0 F L,E,: N. :201 1 •1:29 kt•I
I 81311 DISP 1-2 F uEt." 29, 2• 11 E, : Ia Am
DEC: 23. 2011 6:32 (Al"I
1S FUEL GRmflE HOSE MAP PROBE (.,u,r
1 2 3 4 JUN 29. 2011 5:22 All
Fl- 11HH 111114 fIHH I-IHH AA JLIPI 28. ''011 5:1'9 rt.)
JUN 218 - ;_o 1 1 5:07 MN
01 101 901 201 U U 4
02 102 902 202' U IJ Ll
02 103 903 0f3 Ll u I LOW TE11P WiARI,IIIqr;. ALARM H I s*ror,,v RL-'i>oR'r
0,1 11.14 900 ''l U U0'I I JA01 I B. 201 1 1 1 C40 Filll lbl-TANK ALARM05Io5Dos05uu2
06 1 rib 906 206 U U 2
07 107 907 2107 3 U 3 3: DI ESEL
08 100 908 2013 3 U l
OVERFILL (-iLfiRm
mr.* 4. 201 1 4 PI•I
LABEL TABLE 17E8 E - ?011 1 :06 ph
JUL 22. 20111 9:49 AN
1: UflmSl IGNED
BLEND H1 II PPODIJC "r HLt RPI
I: REGU1.0-%R k X 4 JUL 200.q 1 :25 PI'l
4: MID (.;RtADE
5: PRE(-IIUN PROBE OUT
6: GOLD JAN 18 2u I I It :.10 "1
7: BROICE JAN Is ^011 9:19 W",
8: SILVER
9: BLE1,102
10: BLEND4 LOW TEIIP 04.111 NC;
JAN 18 - 201 1 1 1.: al AN
r. EPIL,
F'•oC'ESSOP CONTROL LEVEL:
NONE
l_HRII Hl :TURI,l pj-p-)p,j- ALARM 1.11STOPy REPORT
Al.iAPM H12TOEV RE) • -P'r
cSUM20p ml-ARM - - ---
L I :87 ;aldttlJL R
SENSOR. OUT f-kL/ARIl3
JHN 16 1f I 1 1 Cj: 45 All
FUEL hLHpr-j
JW1 16, 201 1 10:21 Am
SENSOR OUT ;41_14,11-1
JAN 2e. -:Iolcf 9:29 all
ALAP11 Hl8TORY KlORT
L 2:67 STp
STf
EN n jVP OUT ALHPm
JI-01 is. 2011 10:45 Af-j
FUEL mLARt,)
JHN 16. '?011 1 ID : 31, Api
SEtGuP OUT ALAP11
JH M 218. 201 U 9:29 oul
SEMISOR
L 3:87 FILL
OTHER 8ENSORB
SENSOR OUT ALARM
ITA14 IS. 2011 10:45 Htl
FUEL HI-ARM
Ji4N IS, 201 1 1 Cl::32 k-1
FUEL (41-HRm
JM14 '2`8- 2010 11 :35 i-;ll
A -. '4 ;. END t )t K - -
i-iLmRll 1 t 1!Y1'()F.V YdEjOu
SE1,12OP Hb-01
L 4:91411EFjEl_ ANhnJLhR
hfJNULHP SPACE
SENSOR OUT ml-HIRN
JAN 18, 2011 10:45 HM
FUEL ALARM
JMN Ia. 2,01 1 1 Cl: zoo HM
SEPISSOP OUT ALHRIl
JAM 28. 2010 9:29 F41
SENSOR MbLiKII
L 5:91 STP
M,' SUMP
SENSOR OUT HLRW-1
JAN IS - 2131 1 10: a5 mll
FUEL ALARM
JAN 18. 20 1 1 10:27 HM
SENSOR OUT fiLmRtl
JAN '28. _2010 9:29 rill
ALAPH HISTORY REPORT
S-Evis*R
L 6:91 FILL
OTHER SENSORS
FUEL ALARM
it-&i )Fj. 201 1 12: 28 Pm
FUEL i-tLPiPM
JW1 10. 201 1 1 SI: 16 PH
SENSOR OUT ALARM
miq Ia - 201 1 1 '": 15 pl-1
I
END END
ENEI
Hf.--;TOP',' REPOPT
ALIAR'I'l HISTORY REPORT ALARM HlcTC)R%l REPCIRT
Er.lsxw t;LHRI•I - - ---
L ?:DIESEL .13T P
STP ti;mr'
SENSOR wIT 'ILAPIl
JAN M 1 ) 0:45 H41
FUEL HLARI I
JMN 18 .2LI I I I Am
SEN"A)P Ou'r
JAN 28. 2010 9:29 ml-I
X ENI"I
41_HPM HI:STOPl '
SEI*-;(R mLHF:l-1
L a:C'IESEL FILL
OTHD SEN5juPS
8EN4OR OUT HLriRh
JAM I B. 101 1 1 1 :'ie
SE1,120P OUT i,LmPI1
JAN 16. 2,oil 10:•15 Am
FUEL ;AL Pm
JAN 16
SENSOR ALARM
L 9: D I sp I _12
b I SPENSEP FHN
FUEL ALARM
JAN to. 2011 10.41 1ii•1
SENSOR OUT ALARM
i(IN 28. 2010 9:29 AM
FUEL 4-ARM
JAI,$ 2S. 2010 9:21 i-M-1
jk . p '- X END . A ;4 1,
tAL+iTIM HISTORY REPORT
Dlspr_W"3Ep PAN
FUEL HD4RM
1iii'l Ia. 2.011 111:42 MI °i
SENSOR OUT fALfAF11
JAN 28. 2'010 9:29
FUEL ALARM
2010 9:'_'I AMJAN '7'r3' 4
SE.1,11-DOR
LI I :F'ISP 5-6
DISPENSER PAN
FUEL ALHP11
JNq 18. 21011 10:40 All
SENSOR OUT mLi-iRkI
mN 20o 2010 'J:29 H19
FUEL ALARM
JAJ4 '718. 201Q 9: 23 i-l;•l
A - FN[) ,t -i
HI STOP. Y REPORT
SEm%R
LI-:DISr, 7-8
DISPENSER PAN
FUEL HLriRm
JHN 18.- 2011 10:42 AM
SENSOR OUT (41_ 01
JAN 218, 2010 9:24 P41
FUEL ALARM
JAN 28. 2010 9:22 taV
si . f END o. END
SE0.-,*-OP ;iLi-Rrl ------ SENSOR ALP-01 ----- SENSOR ALIARN
L 2: 87 STI• L t: 87 iiNHOue L I :rjl'3f 5- 1&
STP SUMP ;•NNULAR ST-PCE DISPENSEP PIAN
FUEL FkLfAPI,l FUEL ALARM FUEL ALMPH
Jfil,l 17, 2012 .1 j vill ifIN M 4101 9:t" AmJAN1?. 201 9: 35 P&I
SDISOR AL.PRN
L 7'DIESLL STP
STP Sul%
FUEL AL/If-I I
JAN 17. :IU12, 9: H HI-1
L 5:91 S'T;
STP SUll'
FUEL ALFiPtl
Jmll 17. 2012 'X/ mrl
L 0:blr-.':311 FILL
OTHER,
FUEL fAiLop.,il
JAM i'
ll. -.
1div 9:40 411
I-Jlsi )p
L :yl FILL
OTHER' !3EIqSC, Rl ,.-i
FUE'L Hl.;-ikil
JAN 17. 2012 9:41 AM
L 1:87 FILL
OTHER '.:'
FUEL
SEPJ.'DR ALAKll
L 1 :87 APINUL•R
ANNULHk SPkCE
FUEL FAL;APH
NN 17. 2012 9 *- -13 AM
WR HDAPM - - - --
L. c9l-DIDSEL NINULAR
wil-KIDA, SPi•CE
FOEL ALO-4PI-I
3w01 17. 2012, 9:44 f-411
Bpoo)2, I LIE M-4KET
6002 CAM INO IIIEDIii
8HKERSFIELD Ct4 903OU
J;;m 17, '2101-1 9:45 hil
3'-", STEM STHJUS REPORT
L I TUEL i-4LHRI'l
SE1,20k, ALARM -----
7-8
DISPCHSER Pi4l,l
FUEL ALARM
JHPJ 17. 20112, 9:50 i-Al
SM,GOR ALARM
Ll I :11115P 5-k
DI-PEMSEH, PHN
FUEL hLHRI,l
NAN 17. 201", 9: _5 I W
6
b1SPE1,*',EP Pt-11111
FIJEL i4iLHRI)
J;N 17. 2012" 9:5J
SEICOR
L10:DIS'P 3-4
OISPENSER PAN
FUEL Hl-iAPH
JmN 17, 2012 9:54 f-V.1
BPOMS I DE I•IHPI:E'r
e0l-j i flEPIH
W:,Y,ERSVIELII (A IKI 1013
Jt,ll 17. '201:' 9.56 API
SYSTEM S'I*,4TIlc; REPORT
PALL. FUNCTIONS' 1110PI•INL
SENISOR
L 9:1.'11SP,
DISPENSER, P,41,1
SENSOR OUT ,ALfAPVI
JAN 17. 21012 9'56 MM
SENSOR ALARM ------
MLAP11
JAN 1?. Yljl:? 9:`6 ;Al-1
L I LSCI. I)Nljl ilk
Ji-ill 17,
2F
L ";TP
E t:,.:30p C IJT ALjiPl*l
N 17. 20112 9 : 56 HM
i
I c,: -11 F I [J.
UT HLHP(-1
Ji-&I 17, ?Ql ',
AIT
III ;iLtAPH
N I2CI I --1 ~':56 PH
LNSOP i4l-i-ifill - - - --
L 1 :97 APINUDAP
SENSOR ALIT fAlHIR•
JAP) 17, 2il1 2, 9: 56 till
c'El,lf OP til-hR'l-I
L 8:PIESEL FILL
OTHER SENSORS
BENSON, OUT iLi4PNI
Ji•ilq 17. 2,0121 4:56 All
L 2:67 STP
9TP SLR IF
SENSOR OUT r4l.iiRll
jr pl 17 - .'r) 1
11"
9:1703 -11-1
R ALt:;P.1-1
L FILL
s,qjsyF, OUT AL41.11
JHN I?. 2CII;:f 9: SE. FAM
F3RfAJ`6I[LjL I-ImPEXT
6L-.0 J ('AI'll I NO OED I A
PHKEP: :Flfllj 1-A 4:3-iOG
11-01 17. 2ClI'_l 9:5' ;fl
SYSTDI GTATLI.,' REPORT
iiLL FUf.IC*TIor4S N.,)PI+-;L
SWRCB, January 2006
Spill Bucket Testing Report Form
Thisform is intendedfor use by contractors performing annual testing of USTspill containment structures. The completedform and
printoutsfrom tests (f applicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: Shell Date of Testing: 1/17/2012
Facility Address: Camino Media Blvd.
Facility Contact: Matt Jeffries Phone: 661- 496 -7006
Date Local Agency Was Notified of Testing: Ernie Medina
Name of Local Agency Inspector (fpresent during testing): 12/8/2011
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bryan A Self
Credentials: CSLB Contractor x ICC Service Tech. x SWRCB Tank Tester Other (Specify)
LicenseNumber(s): CSLB# 804904 ICC# 8022804 -UT SWRCB# 11 -1756
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: Z Hydrostatic Vacuum Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (By Tank
Number, Stored Product, etc.)
1 Regular 2 Super 3 Diesel 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" 12.00"
Wait time between applying
vacuum /water and start of test:
5 Min. 5 Min. 5 Min.
Test Start Time (Ti): 9:25am 9:25am 9:25am
Initial Reading (Rj): 9.50" 10.00" 9.50"
Test End Time (TF): 10:25am 10:25am 10:25am
Final Reading (RF): 9.50" 10.00" 9.50"
Test Duration (TF — Tj): 1 Hour 1 Hour I 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 recommerndeclfollow -up forfailed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information ntained in this report is true, accurate, and in full compliance with legal requirements
Technician's Signature: Date: 1/17/2012
State laws and regulations do not currently re ire testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
1. TLS 350
2. 208 Sump Sensor
3. 420 Annuar Sensor
4. Tank ATG
5. Red Jacket FX1V
6. Red Jacket FX1 DV
DI
2.
2.
2.
5.
STP
T2. 0
4.
0
0
2.
6.
STP
2.
0 )
4.
2.
5.
STP
2.04.
0