HomeMy WebLinkAbout2012 FMC RESULTSPass
i MONITORING SYSTEM CERTIFICATION '16 3G s
For Use By All Jurisdictions Within the State ofCalifornia
Authority Cited: Chapter 6.7, Health andSafety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations
This form must be used to document testing and servicing of monitoring equipment. Aaeparate certification or report must be prepared for each
monitoringsystem control panel by the technician who performs the work. A copy ofthis form must be provided to the tank system owner /operator.
The owner /operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date.
A. General Information
Facility Name: SAM'S LIQUOR Bldg. No.:
Site Address: 801 EAST CALIFORNIA AVENUE City: BAKERSFIELD Zip: 93307
Facility Contact Person: SAM Contact Phone No.: (661) 861 -1614
Make/Model of Monitoring System: 1NCON TS 1001- INSP ESTER Date of Testing/Servicing: 5/9/2012
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate s cifie a ui ment inspected/serviced:
Tank ID: REGULAR 87 Tank ID: PREMIUM 91
In -Tank Gauging Probe. Model: MAG in -Tank Gauging Probe. Model: MAG
Annular Space or Vauh Sensor. Model: LS -3 Annular Space or Vault Sensor. Model: LS -3
Piping Sump / Trench Sensor(s). Model: LS-3 Piping Sump / Trench Sensor(s). Model: LS -3
Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model: FX1V Mechanical Line Leak Detector. Model: FX1V
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
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 E on Page 2).
Tank ID: DIESEL Tank ID:
In -Tank Gauging Probe. Model: MAG InTank Gauging Probe. Model:
Annular Space or Vault Sensor. Model: LSD Annular Space or Vault Sensor. Model:
Piping Sump / Trench Sensor(s). Model: LS-3 Piping Sump / Trench Sensor(s). Model:
Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model: FX1DV 0 Mechanical Line Leak Detector. Model:
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
Tank Overfill / High -Level Sensor. Model: FLAPPER Tank Overfill / High -Level Sensor. Model:
Other (specify equipment typeand model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2).
Dispenser ID: 112 Dispenser ID: 314
Dispenser Containment Sensor(s). Model: LS-3 Dispenser Containment Sensor(s). Model: LS -3
Shear Vaive(s). Shear Valve(s).
Dispenser Containment Floats) and Chain(s). Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 516 Dispenser ID: 718
Dispenser Containment Sensor(s). Model: LS -3 Dispenser Containment Sensor(s). Model: LS-3
Shear Valve(s). Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Floats) and Chain(s).
Dispenser 1D: 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).
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) necessary verify that this information is
correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable enerating such reports, I have also
attached a copy ofthe report; (check all that apply): ® System set -up ® Alarm hi report
Technician Name (print): RICH PHILLIPS Signature:
Certification No.: A2908411035169 -UT License. No.: C611D40 809850
Testing Company Name: RICH ENVIRONMENTAL Phone No.: (661) 392 -8687
Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA. 93308 Date of Testing/Servicing: 51912012
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Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed:
Comnlete the following checklist:
Y636 //
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
not interfere with their proper operation?
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? If yes: which sensors initiate
positive shut -down? (Check all that apply) ® Sump/Trench Sensors; ® Dispenser Containment Sensors.
Did you confirm positive shut -down due to leaks and sensor failure/disconnection? ® Yes; No.
Yes No* 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? If yes, identify specific sensors, probes, or other equipment replaced
and list the manufacturer name and model for all replacement parts in Section E, below.
Yes* No 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 No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, if applicable
Yes 1 No* Is all monitoring equipment operational per manufacturer's specifications?
In Section E below, describe how and when these deficiencies were or will be corrected.
E. Comments:
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Monitoring System Certification 7 (0 36fr /1,
F. In -Tank 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 Nos Were all tank gauging probes visually inspected for damage and residue buildup?
Yes No* Was accuracy ofsystem product level readings tested?
Yes No* Was accuracy ofsystem water level readings tested?
Yes No* Were all probes reinstalled properly?
Yes 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): Check this box ifLLDs are not installed.
Cnrnnlete the fnilnwinv rherkliat-
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 F-1 No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
El N/A
Yes No* For electronic LLDs, does the turbine automatically shut off ifthe LLD detects a leak?
N/A
Yes No* For electronic LLDs, does the turbine automatically shut off ifany portion of the monitoring system is disabled
N/A or disconnected?
Yes No* For electronic LLDs, does the turbine automatically shut off ifany portion ofthe monitoring system malfunctions
N/A or fails a test?
Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected?
N/A
Yes 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.
H. Comments:
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Monitoring System Certification
UST Monitoring Site Plan
Site Address: 801 EAST CALIFORNIA AVE. BAKERSFIELD, CA. 93307
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Date map was drawn:
Instructions
if you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring
System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following .
equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill
containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in -tank liquid level probes (if used
for leak detection). In the space provided, note the date this Site Plan was prepared.
UN -036 - 4/4
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www.unidocs.org Rev. 01/17/08
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RICH ENVIRONMENTAL
5643 BROOKS CT. BAKERSFIELD, CA. 93308
OFFICE (661)392 -8687 FAX (661)392 -0621
PRODUCT LINE LEAK DETECTOR TEST
WORK SHEET
W /0 #:
FACILITY NAME: SAM'S LIOUOR
FACILITY ADDRESS: 801 E. CALIFORNIA AVE. BAKERSFIELD
PRODUCT LINE TYPE: PRESSURE
PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS
BELOW P.S.I. OR
SERIAL NUMBER 3 G.P.FI. FAIL
REG87 L/D TYPE : FXIV
YES 10 PASS
SERIAL # 5514
PR, M91 L/D TYPE : FXI V
YES 11 PASS
SERIAL # 5513
DIESEL LID TYPE: FXIDV
YES 11 PASS
SERIAL # 0268
LAD TYPE YES PASS
SERIAL # NO FAIL
I CERTIFY THE ABOVE TESTS WERE CONDUCTED ON THIS DATE ACCORDING TO RED
JACKET PUMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMITATIONS.
THE MECHANICAL LEAK DETECTOR TEST PASS / FAIL IS DETERMINED BY USING A
LOW FLOW THRESHOLD TRIP RATE OF 3 GALLONS PER HOUR OR LESS AT 10 P.S.I. I
ACKNOWLEDGE THAT ALL DATA COLLECTED IS TRUE AND CORRECT TO THE BEST
OF MY KNOWLEDGE.
TECHNICIAN: RICH PHILLIP
SIGNATURE: DATE: 05/09/12
1 3G5 f
SWRCB, January 2006
Spill Bucket Testing Report Form
Thuform is intendedfor use by contractors performing annual testing of USTspill containment structures. The completedform and
printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: SAM'S LIQUOR I Date ofTesting: 5/9/12
Facility Address: 801 E. CALIFORNIA AVE. BAKERSFIELD
Facility Contact: SAM I Phone: (661) 861 -1614
Date Local Agency Was Notified ofTesting: 3/22/32
Name ofLocal Agency Inspector (ifpresent during testing):
2. TESTING CONTRACTOR INFORMATION
Company Name: RICH ENVIRONMENTAL
Technician Conducting Test: RICH ENVIRONMENTAL
Credentials': 0 CSLB Contractor X ICC Service Tech. SWRCB Tank Tester 0 Other (Specify)
License Number(s): 1035169 -UT
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: X Hydrostatic 0 Vacuum Other
Test Equipment Used: VISUAL Equipment Resolution: 0.00
Identify Spill Bucket (By Tank
Number, Stored Product, etc.
l
REG87 -FILL
2
PREM91 -FILL
3
DIESEL FILL
4
Bucket Installation Type: X Direct Bury
0 Contained in Sump
X Direct Bury
0 Contained in Sump
X Direct Bury
0 Contained in Sump
0 Direct Bury
0 Contained in Sum
Bucket Diameter. 12" 12" 12"
Bucket Depth: 12" 12" 12"
Wait time between applying
vacuum/water and start oftest: 30 MIN 30 MIN 30 MIN
Test Start Time (Ti): 9:15 9:15 9:15
Initial Reading (R,): 10" IV 10"
Test End Time (TF): 10:15 10:15 10:15
Final Reading (RF): 10" 10" 10"
Test Duration (TF— T: 1 -HOUR i -HOUR 1 -HOUR
Change in Reading (RF - Rj): 0 0 0
Pass/Fail Threshold or
Criteria: 0.00 0.00 0.00
Test Result: X Pass Fail X Pass Fail X Pass 0 Fail 0 Pass 0 Fail
COmmentS — (include information on repairs made prior to testing, and recommendedfollow -upfor failed tests)
CERTIFICATION OF TECHNI AN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information cons ed in this report is true, accurate, and infull compliance with legal requirements.
Technician's Signature: Date: 5/9/12
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
WWITANKS
SPECIAL 1
NUMBER OF TANKS 3 DIAMETER 111.000
l_FNGTH 288.000
TANK 1 CORRECTION PTS. 0
NAME DIESEL
SAMS iAS 1 TEtIrOR TANK SHAPE HORIZONTAL PROBES
R01 F CALIF AVE TRNK TYPE „PECIAL 1
SAKERSFIELD CA 93307 PROBE PROBE 1 PROBE 1
661- 861 -1614 PRODUCT PRODUCT 1 TYPE STD 125
MANIFOLD NONE GRADIENT 9.08724
PROD'OFFSET 1.000 RATIO 1:1 TIP TO HEAD
05/09/29,12 8: 05. AM WATER OFFSET 1.000 FLOATS 2 FLOATS
DEL THRESHOLD FLOAT TYPE OIL
SYSTEM SETUP REPORT HIGH HIGH LIM 5.000 PROBE 2
HIGH HIGH 0/0 NONE TYPE STD 125
SYSTEM INFO HIGH LIMIT 90.000 GRADIENT 9.08348
HIGH LIMIT 0/0 NONE RATIO 1:1 TIP TO HEAD
SOFTWARE LOW LIMIT 1200.0 FLOATS 2 FLOATS
PART T1P/4 LOW LIMIT 0/0 NONE FLOAT TYPE GASOLINE
UE.RSION 5.000 LOW LOW LIMIT 500.0 PROBE 3
RELEASED 07/05/2006 LOW LOW OIG NONE TYPE STD 125
WATER LIMIT 3.000 GRADIENT 8.99232
SYSTEM ID SEE ABOVE WATER O/G NONE RATIO 1:1 TIP TO HEAD
TANK 2 FLOATS 2 FLOATS
MEASUREMENT UNITS NAME PREMIUM FLOAT TYPE GASOLINE
CORRECTION TEMP 60.0 TANK SHAPE HORIZONTAL
ULAGE PERCENT 95 TANK TYPE SPECIAL 1 PRODUCTS
VOLUME GALLONS PROBE PROBE 2
LEVEL INCHES PRODUCT PRODUCT 2 PRODUCT 1
TEMPERATURE FAHRENHEIT MANIFOLD NONE TAPE PRESSUREPSIPRODOFFSET3.500
DIESEL
WATER OFFSET 1.000 PRODUCT 2
CLOCK/CALENDAR DEL THRESHOLD 200 NAME PROD 91
TIME STYLE 12 HOUR HIGH HIGH LIM 95.000 TYPE UNLEADED SUP
DATE STYLE MM/DD/YY HIGH HIGH 0/0 NONE PRODUCT 3
DAYLIGHT SAV ENABLED HIGH LIMIT 90.000 NAME 87
SET TIME 8:06 AM HIGH LIMIT 0/6 NONE TYPE UNLEADED REG
SR- DATE 05/09/2012 LOW LIMIT 1200.0
LOW LIMIT OrG NONE REPORT SCHEDULES
SENTINEL MODE LOW LOW LIMIT 500.8.
MOVE SCHEDULED LOW-LOW 0/0 NONE INVENTORY
START TIME 1:00 AM WATER LIMIT 4.000 DETAIL
END TIME 3:00 AM WATER O/G NONE SCHEDULE NONE
TANK 3 PRODUCT SUMMARY
REPORT PRINT ENABLES NAME UNL SCHEDULE, NONE
DELIVERIES ENABLED TANK SHAPE HORIZONTAL PRODUCT USAGE DETAIL
ALARMS ENABLED TANK TYPE SPECIAL 1 SCHEDULE NONE
LEAK TESTS ENABLED PROBE PROBE 3 PRODUCT USAGE SUMMARY
PRODUCT PRODUCT 3 SCHEDULE NONE
LIMITS MANIFOLD NONE TANK DETAIL
LEAK LIMIT 2.00 PROD OFFSET 2.500 SCHEDULE SHIFT
LEAK LIMIT 0/0 NONE WATER OFFSET 1.000 TIME 1 5:00 AM
THEFT LIMIT 50.00 DEL THRESHOLD 200 TIME 2 12:00 AM
THEFT LIMIT 0/0 NONE HIGH HIGH LIM 95.000 TIME 3 12 :00 AM
HIGH HIGH 0/0 NONE SEND TO FAX NO
MISCELLANEOUS HIGH LIMIT 90.000 SEND TO PRINTER YES
SYSTEM FAIL ALL GROUPS HIGH LIMIT 0/0 NONE TANK SUMMARY
DELIVERY DELAY 15 LOW LIMIT 1200.0 SCHEDULE NONE
HISTORY LENGTH 50 LOW LIMIT 0/0 NONE RECONCILIATION
PRINT INTERVAL 1 LOW LOW LIMIT 500.0 SCHEDULE 'NONE
BUSY SUPPORTED NO LOW LOW 0/0 NONE DELIVERY
USER THRESHOLD 0 WATER LIMIT 4.000 PRODUCT DETAIL
WATER. 0/0 NONE. SCHEDULE NONE
PRODUCT SUMMARY
SCHEDULE NONE
DELIVERY HISTORY
SCHEDULE NONE
ALARMS
ACTIVE ALARMS
SCHEDULE NONE
CLEARED ALARMS
SCHEDULE NONE
ALARM HISTORY
SCHEDULE NONE
SENSOR STATUS
SCHEDULE NONE
REGULATORY
SCHEDULE NONE
WWI
COMN PGRTS
GOMM PORT 1
MODE
BAUD NATIVE
9600 BAUD NUMBER OF SENSORS .12
DATA BITS 8 BITS
AUXILIARY INPUTS
STOP BITS
PARITY 1 STOP BIT SENSOR 2
RELAY
STD
NO RELAY INPUT i
SECURITY NO PARITY NAME DIESEL STP ACTIVE CLOSED
COMM PORT 2 STD DIG GROUP A NAME AUXILIARY 1
MODE NATIVE SENSOR 2 STD AUX INPUT 0/0 NONE
BAUD 9609 BAUD RELAY NO RELAY INPUT 2
DATA BITS 8 BITS NAME 91 STP ACTIVE CLOSED
NAMESTOPBITS1STOPBITSTD0/c,
SENSOR 3
GROUP B
STD
AUXILIARY 2
AUX INPUT 0/0 NONEPARITY
SECURITY NO PARITY RELAY NO RELAY
ACCESS 1 NAME 87 STP TS -ROM
PHONE I STD 0/13 GROUP C
REDIAL 1 DISABLED SENSOR 4 STD GRACE PERIOD 0
ACCESS 2 RELAY NO RELAY
PHONE 2 NAME SENSOR 4 CHANNEL 1
REDIAL 2 DISABLED STD Oaf NONE OUTPUT GROUPS
ASS 3 SENSOR 5 STD A -P -- YY-- -- - - -- -_
PHONE r RELAY NO RELAY Q -FF ---
REDIAL 3 DISABLED NAME DIESEL ANN CHANNEL 2
ACCESS 4 STD W, GROUP E OUTPUT GROUPS
PHONE 4 SENSOR 6 STD A-P -YYY-
REDIAL 4 DISABLED RELAY NO RELAY Q+F
DIAL DELIU NAME 87 ANN CHANNEL 3
DIAL ALARM STD O/G GROUP E OUTPUT GROUPS
DIA1_ LEAK SENSOR 7 STD A-P Y-- Y--------- ---
RELAY NO RELAY Q-FF ---
LEAK TESTS NAME 91 ANN CHANNEL 4
STD 0/r, GROUP E OUTPUT GROUPS
CONFIDENCE 95.01. SENSOR 8 STD A-P -- -- -
MIN TEST TIME 2 RELAY NO RELAY Q -FF ---- -- --
MAX TEST TIME 4 NAME SENSOR 8 CHANNEL 5
LEAK TEST STD 010 NONE OUTPUT GROUPS
TANK 1 0.20 SENSOR 9 STD A -P -- ---- --
TANK 2 0.20 RELAY RELAY 1 Q -FF - - -----
TANK 3 0'20 NAME DISP 1 -2 CHANNEL 6
TEST SCHEDULES STD O/G GROUP D OUTPUT GROUPS
TANK 1 SENSOR 10 STD A-P
SCHEDULE 28TH DAY RELAY NO RELAY
TTME 1:08 AM NAME DISP 3-4 CHANNEL 7
TANK 2 STD O/G GROUP D OUTPUT GROUPS
SCHEDULE 28TH DAY SENSOR 11 STD A -P --- --
TIME 1;00 AM RELAY NO RELAY Q -FF
TANK 3 NAME DISP 5 -6 CHANNEL 8
SCHEDULE 28TH DAY STD 0/0 GROUP D OUTPUT GROUPS
TIME 1:00 AM SENSOR 12 STD
ALARM ON TEST FAIL NO RELAY NO RELAY Q- FF -
NAME DISP 7 -8
ANNUNCIATORS STD O/G GROUP D
MODULATED ANNUNCIATOR TPI
TIMEOUT 0 ENABLED NO
OUTPUT GROUPS ADDRESS 80
A -P YYYYY—
Q -FF - ---__ __- _____- CATHODIC, PROTECTION
50k TD ANNIJNCIATOR
TIMEOUT 0 ENABLED NO
OUTPUT GROUPS ADDRESS 112
Al-P CURRENT,LIMIT 10.0
O-FF CURRENT OG NONE
RELAYS
RELAY 1
TIMEOUT 15OUTPUTGROUPS
A -P __-
Q- FF ---
RELAY 2
TIMEOUT 15
OUTPUT GROUPS
A-P
Q- FP
y63G-
SAMS GAS LIQUOR
W E CALIF AVE
WERSFIELD CA 93307
661 -561 -1614
05/09/2012 9:26 AM
SENSOR ALARMS
05/09/2312 9:14 AM
STANDARD SENSOR
DISP 7 -8
SENSOR NO. 12
05/09/2012 9:14 AM
STANDARD SENSOR
DTSP 5 -6
SENSOR NO. 11
05/09/2012 9 :13 AM
STANDARD SENSOR
DISP 3 -4
SENSOR NO. 10
05/09/2012 9 :13 AM
STANDARD SENSOR
DISP 1 -2
SENSOR NO. 9
05/09/2012 9:12 AM
STANDARD SENSOR
27 ANN
SENSOR NO. 6
05/09/2012 9:11 AM
STANDARD SENSOR
91 ANN
SENSOR NO. 7
05/09/2012 9:11 AM
STANDARD SENSOR
DIESEL. ANN
SENSOR NO. 5
05/09 /2012 9:09 AM
STANDARD SENSOR
DIESEL ANN
SENSOR 40. 5
05/09/2012 9:09 AM
STANDARD SENSOR
DIESEL STP
SENSOR NO. 1
05/09/2012 9:28 AM
STANDARD SENSOR
9i. STP
SENSOR NO. 2
05/09/2012 9:02 AM
STANDARD SENSOR
7 STP
SENSOR NO. 3
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MONITOR CERT. FAILURE REPORT
SITE NAME : SAM'S LIOUOR DATE: 4,--91 '
THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE
TESTING.
REPAIRS: NONE
LABOR: NONE
PARTS INTALLED : NONE
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.