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Home My WebLink AboutUST-MONIT. SYSTEM 9/7/2011MONITORING 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 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: L Petro Mobil Site Address: 800 34th St Facility Contact Person: Peter Cloven Make /Model of Monitoring System: Veeder -Root TLS 350 B. Inventory of Equipment Tested /Certified Check the appropriate boxes to indicate specificequipment Inspected /serviced: Bldg. No.: City: Bakersfield Zip: 93301 Contact Phone No.: 925 - 673 -5500 Date of Testing/Servicing: 9/7/2011 Tank -ID: 10000 gal. Regular Tank z] ID: 10000 gal. Plus In -Tank Gauging Probe. Model: NoneJIn -Tank Gauging Probe. Model: 847390-107 x] Annular Space or Vault Probe. Model: 794390-409 X] Annular Space or Vault Sensor. Model: 794390 -409 x] Piping Sump / Trench Sensor(s). Model: 794380-208 Piping Sump / Trench Sensor(s). Model: 794380 -208 Fill Sump Sensor(s) Model: Fill Sump Sensor(s). Model: J Mechanical Line Leak Detector. ModeI :FX1V x] Mechanical Line Leak Detector. Model: FX1V Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: U Tank Overfill / High Level Sensor. Model: OPW -6I -SO U 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: 10000 gal. Super Tank ID: x] In -Tank Gauging Probe. Mode1:847390 -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: xx Mechanical Line Leak Decector. Model:FX1DV Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Lx] 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: 1 & 2 Dispenser ID: 3&4 Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: X] Shear Valve(s). U Shear Valve(s). FxI Dispenser Containment Float(s) and Chain(s). x] Dispenser Containment Float(s) and Chain(s) Dispenser ID: 5&6 Dispenser ID: 7 & 8 Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: U Shear Valve(s). U Shear Valve(s). U Dispenser Containment Float(s) and Chains(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 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 - I 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 gene tmg such reports, 1 have attached a copy of the report; (check all that apply) x S s Set -up Alarm re ort Technician Name (print): Bryan A Self Signature: ` Certification No: B37501 License No: 804904 Testing Company Name: Confidence UST Services, Inc. Phone NJ: 800 - 339 -9930 Site Address: 800 34th St Bakersfield, CA 93301 Date of Testing/Servicing: 917/2011 D. Results of Testing /Servicing Software Version Installed: 15.01 Complete the following checklist: Lx] Yes No* Is the audible alarm operational? x Yes No* Is the Visual alarm operational? x I Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational? Ej 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; UYes 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 capasity does the alarm trigger? E9p % Yes* I_ I 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? Product; Water. If yes, describe causes in Section E, below. x I Yes I I I No* Was monitoring system set -up reviewed to ensure proper settings? Attach set -up reports, if applicable. Lx_1 Yes No* I 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. i 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: Cx] Yes No* Has all input wiring been inspected for proper enter and term ination,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? x Yes 7 No* Was accuracy of system water level readings tested? x Yes No* Were all probes reinstalled properly? U 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. G. Line Leak Detectors (LLD): Check this box if LLD's are not installed. Complete the following checklist: Lx] 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.: 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 proper y calibrated? L] Yes For mac amca LLD's, does the LLD restrict product ow if it detects a leak? E7 Yes No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? xj 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? F-1 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? Lx] 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: RS -232 END OF MESSAGE DISABLED SYSTEM SETUP 09 -07 -11 9:32 AM L PETRO MOBIL 8OU 34TH BAKERSFIELD CA 93301 661 - 869 -1974 SYSTEM UNITS U.S. 1N -TANK SETUP 09-07 -11 9:32 AM SYSTEM LANGUAGE ENGLISH SYSTEM DATE /TIME FORMAT T I:SUPER UNLEADED 91 MM -DD -Y HH:MM:SS Al PRODUCT CODE 1 SYSTEM STATUS REPORT THERMAL COEFF :.000070 L PETRO MOBIL TANK DIAMETER 90.85 T 2:PROBE OUT 600 34TH TANK PROFILE 4 PTS BAKERSFIELD CA 93301 FULL VOL 9741 661-869-1974 68.1 INCH VOL 7917 INVENTORY REPORT 45.4 INCH VOL : 4884 SHIFT TIME l 10:00 PM 22.7 INCH VOL 1885 SHIFT TIME 2 6:00 AM T I:SUPER UNLEADED 91 SHIFT TIME 3 DISABLED VOLUME a 1502 GALS SHIFT TIME 4 DISABLED FLOAT SIZE: 4.0 IN. 8496 ULLAE o 8239 GALS 90 ULLACE- 7264 GALS TANK PERIODli:: WARNINGS WATER WARNING 2.0 TC VOLUME o 1499 GALS DISABLED HIGH WATER LIMIT: 3.0 HEIGHT - 19.38 INCHES TANK ANNUAL WARNINGS WATER VOL a 12 BLS DISABLED MAX OR LABEL VOL: 9741 WATER - 0.80 INCHES LINE PERIODIC: WARNING'S OVERFILL LIMIT 9CM TEMP a 86.3 DEC F DISABLED 8766 LINE ANNUAL WARNINGS HIGH PRODUCT 95: DISABLED 9254 T 3:REGULAR UNLEADED 87 DELIVERY] LIMIT 10% VOLUME = 5885 GALS PRINT TC VOLUMES 974 ULLAGE v 3856 GALS ENABLED 90•a ULLAGE= 2881 GALS LOW PRODUCT 500 TC VOLUME a 5871 GALS TEMP COMPENSATION LEAK ALARM LIMIT: 99 HEIGHT o 52.55 1NCHES VALUE (DEG F ): 60.0 SUDDEN LOSS LIMIT: 50 WATER VOL - 23 GALS STICK HEIGHT OFFSET TANK TILT 1.50 WATER o 1.20 INCHES DISABLED TEMP e 92.3 DEC.; F DAYLIGHT SAVING TIME MAN IFOLDED TANKS ENABLED Tit: NONE START DATE 4 x x x A E14D 9wk x x APR WEEK I SUN START TIME LEAK MIN PERIODIC: Ox 2:00 AM 0 END DATE OCT WEEK 6 SUN LEAK MIN ANI4UAL 0% END TIME 0 2:00 AM PERIODIC TEST TYPE SYSTEM SECURITY STANDARD CODE 000000 ANNUAL TEST FAIL SOF- TWARE REVISION LEVEL ALARM DISABLED VERSION 15.01 SOF'TWAREa 346015 -100 -B PERIODIC TEST FAIL CREATED - 9'7.10.23.08.56 ALARM DISABLED ti NO SOFTWARE MODULE GROSS TEST FAIL SYSTEM FEATURES: ALARM DISABLED PERIODIC IN -TANK TESTS ANNUAL IN -TANK TESTS ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF COM11UNICATIONS SETUP TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF PORT SETTINGS: DELIVERY DELAY : 15 MIN NONE FOUND RS-232 SECURITY! CODE : 000000 RS -232 END OF MESSAGE DISABLED T 2:SPECIAL UNLEADED 89 PRODUCT CODE 2 THERMAL COEFF :.000070 TANK DIAMETER 90.85 TANK PROFILE 4 PTS FULL VOL 9741 68.1 INCH VOL 7917 45.4 INCH VOL 4884 22.7 INCH VOL : 1885 MAX OR LABEL VOL: 9741 OVERFILL LIMIT 90% HIGH WATER LIMIT: 8766 HIGH PRODUCT 95y OVERFILL LIMIT 9254 DELIVERY LIMIT 10% HIGH PRODUCT 974 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK. TILT 1.70 MANIFOLDED TANKS 99 TO: NONE 50 LEAF: MIN PERIODIC: 0% 0 LEAF; MIN ANNUAL on 0 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 : 15 MIN T 3:REGULAR UNLEADED 87 PRODUCT CODE 3 THERMAL COEFF :.000070 TANK DIAMETER 90.65 TANK PROFILE 4 PTS FULL VOL 9741 68.1 INCH VOL 7917 45.4 INCH VOL 4884 22.7 INCH VOL 1885 FLOAT SIZE: 4.0 IN. B496 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 9741 OVERFILL LIMIT 90% 8766 HIGH PRODUCT 95%1 9254 DELIVERY LIMIT 10%: 974 LOW PRODUCT 500 LEAF: ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 1.30 MANIFOLDED TANKS TN: NONE LEAK MIN PERIODIC: ox 0 LEAK MIN ANNUAL OX 0 PERIODIC TEST TYPE STANDARD 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 T14K TST SIPHON BREAK :OFF DELIVERY DELAY : 15 MIN LEAK TEST METHOD TEST ON DATE : ALL TANK MAR 26. 1999 START TIME : 2:00 AM TEST RATE :0.20 GAL /HR DURATION : 2 HOURS LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP L 1:91 ANNLLAR TRI -STATE tSINGLE FLOAT) CATEGORY : ANNULAR SPACE L 2:89 ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 3 :87 ANULLAR TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 5:91 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 6:89 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 7:87 STP SUMP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP OUTPUT PELAY SETUP R 1:UNLEDED TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L 3:FUEL ALARM L 4:FUEL ALARM L 7:FUEL ALARM L 3:SENSOR OUT ALARM L 7:SENSOR OUT ALARM R 2:PLu4 TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L 2:FUEL ALARM L 4 :FUEL ALARM L.6:FUEL ALARM L 7:FUEL ALARM L 2:SENSOR OUT ALARM L 6:SENSOR OUT ALARM R 3:PREMIUM TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L 1 : FUEL ALAR14 L 4:FUEL ALARM L 5:FUEL ALARM L I:SENSOR OUT ALARM L 5:SENSOR OU'T ALARM R 4:SONITROL ALARM TYPE: STANDARD NORMALLY OPEN LIQUID SENSOR AU49 ALL :FUEL ALARM ALARM HISTORY REPORT SYSTEM ALARt1 - -- -- PAPER OUT 07 -18-11 10:00 PM PRINTER ERROR 07 -18 -11 10:00 PM BATTERY IS OFF 01 -01 -96 8:00 All CLOCK, IS INCORRECT 10 -29 -00 1:01 All k r R k k END x w X k w ALARM HISTORY REPORT ALARM HISTORY REPORT 114- TANK: ALARM - - - -- IN -TANK ALARM ----- T I:SUPER UNLEADED 91 T 3:REGULAR UNLEADED 87 SETUP DATA WARNING SETUP DATA WARNING 04 -19 -03 9:09 AM 03 -26 -98 8:48 AM 03 -26 -98 8:48 AM MAX PRODUCT ALARM OVERFILL ALARM OVERFILL ALARM 07-10 -10 6:49 AM 02 -12-03 5:24 AM 07 -05 -10 1:11 PM 06 -25 -02 10:17 AM 06-23 -10 10:35 AM 01 -06 -02 12:44 PM LOW PRODUCT ALARM LOW PRODUCT ALARM 04 -03 -06 10:38 AM 16 -11-06 10:15 AM 10 -11-05 12:14 PM 10 -11 -05 11:53 AM HIGH PRODUCT ALARM HIGH PRODUCT ALARM 07 -10 -10 6:51 AM 06 -25 -02 10:18 AM 04 -25 -10 12:30 PM 01 -06-02 12:46 PM 03 -23 -10 3:26 PM 12 -25 -01 7:01 PM INVALID FUEL LEVEL 114VALID FUEL LEVEL 06 -26 -11 4:12 AM 09 -01 -11 9:18 AM 10-04 -10 1:25 PM 07 -19 -11 2:06 PM 03 -01 -09 4:13 AM 01 -12 -07 4•:25 PH PROBE OUT PROBE. OUT 05 -17 -07 12:03 PM 02 -23 -11 1 :07 PM 10 -11 -06 10:46 AM 02 -23 -11 12:55 PM 10 -11 -05 12:14 PM 10 -II -06 10 :16 AM LOW TEMP WARNING 10 -II -05 11:55 AM kxxxx END xrik Pik xxw)x x END xxxxx 1 c DELIVERY NEEDED DELIVERY NEEDED 08 -31-11 9:19 AM 08 -26 -11 5:57 PM 08 -09 -11 1:20 Ptl 08 -04 -11 3:53 PM 07 -17 -11 5:54 PM 07 -12-11 6:27 PM MAX PRODUCT ALARM LOW TEMP WARNING 12 -25 -01 7:03 PM 05 -17 -07 12:12 PM 08 -05 -01 3:22 All 06-16 -01 7:47 PM LOW TEMP WARNING 10 -II -05 11:55 AM kxxxx END xrik Pik xxw)x x END xxxxx 1 c ALARM HISTORY REPORT SENSOR ALARM - - - -- L 1:91 ANULLAR ANNULAR SPACE SENSOR OUT ALARM I1 -19-10 3:10 PM FUEL ALARM I1-19 -10 2:52 PM SETUP DATA WARNING 12 -02 -08 2:51 PM x'xx9 END Am9m E ALARM HISTORY REPORT SENSOR ALARM --- -- L 2:89 ANULLAR ANNULAR SPACE SENSOR OUT ALARM 08 -30 -11 8:50 PM SENSOR OUT ALARM 11-19 -10 3:10 PM FUEL ALARM II -19 -10 2:50 PM ALARM HISTORY REPORT SENSOR ALARM --- L 3:87 ANULLAR ANNULAR SPACE SENSOR OUT ALARM 11 -19 -10 3:10 PM FUEL ALARM 11 -19 -10 2:58 PM FUEL ALARM 11-19 -10 2:55 PM x x x x x END x w x x x ALARM HISTORY REPORT SENSOR ALARM - - - -- L 4:TRENCH LINER OTHER SENSORS SENSOR OUT ALARM 03 -18 -04 9 :29 AM FUEL ALARM 03 -18 -04 9:28 AM SENSOR OUT ALARM 03 -18 -04 9:27 AM ALARM HISTORY REPORT SENSOR ALARM - - --- L 5:91 STP SUMP STP SUMP SENSOR OUT ALARM 11 -19 -10 3:10 PM FUEL ALARM 11 -19 -10 2:47 PM FUEL ALARM tO —I4 -08 1:19 PM A ii x x w END x R x x x ALARM HISTORY REPORT SENSOR ALARM - - --- L 6:89 STP SUMP STP SUMP SENSOR OUT ALARM 11 -19 -10 3:10 PM FUEL ALARM 11 -19 -10 2:43 PM FUEL ALARM 10 -14 -08 1:23 PM x si x x w END x x X x X •0 x x x x END w x i x x w w W x A w END x X A x A ALARM HISTORY REPORT SENSOR ALARM - - - -- L 7:87 STP SUMP STP SUMP SENSOR OUT ALARM 11-19-10 3:10 PM FUEL ALARM 11 -19 -10 2:45 PM FUEL ALARM 10 -14 -08 1:22 PM r x x X END : W. x x SENSOR ALARM -- --- L 6:89 STP SUMP STP SUMP FUEL ALARM 09 -07 -11 10:222 AM SENSOR ALARM - - - -- L 7:87 STP SUMP STP SUMP FUEL ALARM 09 -07 -11 10:23 AM SENSOR ALARM L 5:91 STP SUMP STP SUMP FUEL ALARM 09-07 -11 10:25 MM SENSOR ALARM - - - -- L 7:87 STP SUMP STP SUMP SE14SOR OUT ALARM 09 -07 -11 10:28 AM I SENSOR ALARM - -- -- L 1:91 ANULLAR ANNULAR SPACE SENSOR OUT ALARM 09 -07 -11 10:28 AM SENSOR ALARM - -- -- L 2:89 ANULLAR ANNULAR SPACE SENSOR OUT ALARM 09 -07 -11 10:28 All SENSOR ALARM - - - -- SENSOR ALARM - - - -- L 3:87 ANULLARL3 :87 ANULLAR ANNULAR SPACEANNULARSPACEFUELALARMSENOROUTALARM09 -07 -11 10:48 AM09- 07- 11.10:28 AM SENSOR ALARM - - --- SENSOR ALARM -- - -- L 3:87 ANULLARL5:91 STP SUMP ANNULAR SPACESTPSUMPFUELALARMSENSOROUTALARM09 -07 -11 10:51 AM09-07 -11 10:28 AM SENSOR ALARM - - -- L PETRO MOBIL 800 34THL6:89 STP SUMP BAKERSFIELD CA 93301STPSUMP661 -869 -1974SENSOROUTALARM 09 -07 -11 10:28 AM 09 -07 -11 11:42 AM SYSTEM STATUS REPORT T 2:PROBE OUT X x x x x END o K x x 0 SENSOR ALARM L 2:89 ANULLAR ANNULAR SPACE FUEL ALARM 09 -07 -11 10:39 AM INVENTORY REPORTSENSORALARM - - - -- L 3:87 ANULLAR ANNULAR SPACE T I:SUPER UNLEADED 91FUELALARMVOLUMEa1501GALS 09 -07 -11 10:35 AM ULLAGE a 8240 GALS 90s: ULLAGE- 7265 GALS TC VOLUME o 1498 GALS HEIGHT - 19.37 INCHES WATER VOL - 12 GALS WATER - 0.80 INCHES TEMP - 86.5 DEC F UNLEADED 87 SENSOR ALARM - - - -- • VOLUMEGULAR 5884 GALS L 1:91 ANULLAR ULLAGE -, 3857 GALS ANNULAR SPACE 90% ULLAGE- 2882 GALSFUELTCVOLUME - 5870 GALS 0ALARM 11 10.J7 HM HEIGHT 52.55 INCHES WATER VOL a 23 GALS WATER - 1.20 INCHES TEMP - 92.3 DEG F X x x x x END o K x x 0 SENSOR ALARM L 2:89 ANULLAR ANNULAR SPACE FUEL ALARM 09 -07 -11 10:39 AM SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing of UST spill containment structures. The completedform and printoutsfrom tests (fapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: L Petro Mobil Date ofTesting: 09/07/2011 Facility Address: 800341h St Bakersfield CA 93301 Facility Contact: Peter Cloven Phone: 925- 673 -5500 Date Local Agency Was Notified of Testing: 8/24/2011 Name ofLocal Agency Inspector (cfpresent during testing): Ernie Madina 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. Technician Conducting Test: Bryan A Self Credentials: x CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester Other (Spec) License Number(s): CSLB# 804904 ICC# 8022804 -UT Tank Tester 11 -1756 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 Fill 2 Plus Fill 3 Super Fill 4 Bucket Installation Type: X 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: 13.00" 13.00" 13.00" Wait time between applying vacuum /water and start oftest: 5 Minuets 5 Minuets 5 Minuets Test Start Time (Ti): 9:00 am 9:00 am 9:00 am Initial Reading (Ri): 9.75" 9.50" 9.50" Test End Time (TF): 9:05 am 9:05 am 9.05 am Final Reading (RF): 8.00" 7.00" 8.25" Test Duration (TF — Ti): 5 Minuets 5 Minuets 5 Minuets Change in Reading (RF - Rj): 1.75" 2.50" 1.25" Pass/Fail Threshold or Criteria: 0.0625" 0.0625" 0.0625" Test Result: Pass X Fail Pass X Fail Pass X 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 hereby certify that all the information contained in this report is true, accurate, and infull compliance with legal requirements. Techr Date: 09/07/2011 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing ofUSTspill containment structures. The completedform and printoutsfrom tests (fapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: L Petro Mobil Date of Testing: 09/07/2011 Facility Address: 800 34`h St Bakersfield CA 93301 Facility Contact: Peter Cloven Phone: 925- 673 -5500 Date Local Agency Was Notified of Testing: 8/24/2011 Name of Local Agency Inspector (fpresent during testing): Ernie Madina 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. Technician Conducting Test: Bryan A Self Credentials: 9 CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester Other (Spec) License Number(s): CSLB# 804904 ICC# 8022804 -UT Tank Tester 11 -1756 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.) I Regular Vapor 2 Plus Vapor 3 Super Vapor 4 Bucket Installation Type: X 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: 13.00" 13.00" 13.00" Wait time between applying vacuum /water and start of test: 5 Minuets 5 Minuets 5 Minuets Test Start Time (Ti): 9:00 am 9:00 am 9:00 am Initial Reading (Ri): 9.50" 10.00" 9.50" Test End Time (TF): 10:00 am 9:10 am 10.00 am Final Reading (RF): 9.50" 7.00" 9.50" Test Duration (TF — Ti): 1 Hour 10 Minuets 1 Hour Change in Reading (RF - Ri): 0.00" 3.00" 0.00" Pass/Fail Threshold or Criteria: 0.0625" 0.0625" 0.0625" Test Result: X Pass Fail Pass X Fail X Pass Fail Pass Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -up forjailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and infull compliance with legal requirements Technician's Signature: ZS— \ Date: 09/07/2011 State laws and regulations do not currenfy require testing to be performed by a qualified contractor. However, local requirements may be more stringent. CONFIDENCE UST SERVICES, INC. 417 Montclair Street, Bakersfield, CA 93309 800 - 339.9930 or 661 -631 -3870 FINAL TEST RESULTS: ALERT 1000 / ALERT 1050 / TEI LT -3 CUSTOMER ADDRESS: WORK ORDER:27866 SITE ADDRESS: Pinnacle Environmental Mobil P.O. Box 904 TEST DATE: 9/7/2011 800 34th Street Clayton, CA 904 Bakersfield, CA 93301 SITE CONTACT:Peter Cloven PHONE NUMBER:925- 673 -5500 TECHNICIAN:Kristopher Karns PHONE NUMBER:661- 340 -8602 LICENSE:09 -1743 WATER IN BACKFILL: 0 . 0 0 " DATE 6 TIME OF LAST FUEL DELIVERY:+ 24 Hours TANK INFORMATION: WETTED) PRODUCT TYPE: TOTAL GALLONS: PRODUCT LEVEL: PERCENT FULL: TEST METHOD: WATER IN TANK: TANK MATERIAL: P.S.I.@ BOTTOM: TEST DURATION: FINAL LEAK RATE: TEST RESULT: TANK INFORMATION ULLAGE)U /F ONLY ULLAGE GALLONS: START PRESSURE: END PRESSURE: TEST RESULT: PRODUCT LINES: LINE TYPE: START TINE: END TINE: TEST PRESSURE: FINAL LEAK RATE: TEST RESULT: MECHANICAL LEAK DETECTORS: MODEL: SERIAL NUMBER: CHECK VALVE PSI: BLEED OFF ml: LEAK RATE TESTED: TEST RESULT: TANK 1 TANK 2 TANK 3 TANK 4 Regular Plus Super 10000 10000 10000 ALERT 105OX ALERT 1050X ALERT 1050X ALERT 1050X TEI LT -3 TEI LT -3 TEI LT -3 TEI LT -3 Pressure Pressure Pressure 10:30 A.M. 10:30 A.M. 10:45 A.M. 10:45 A.M. 10:45 A.M. 11:00 A.M. 55 PSI 55 PSI 55 PSI 0.004 0.002 0.002 Pass Pass Pass Red Jacket FXT Red Jacket FXT Red Jacket FXT Red Jacket FXT Fxly Fxly Fxly 15 PSI 16 PSI 15 PSI 33 ML 25 ML 22 ML 3 GPH @ 10 PSI 3 GPH @ 10 PSI 3 GPH @ 10 PSI Pass Pass Pass A) These systems and methods meet or exceed the criteria in USEPA 40CFR parts 280, NFPA 329 -87 and all applicable state codes. B) Any failure listed above may require further action, check with all regulatory agencies. Technicians signature: Date: ManufactureranCderotrification No: yLKristopher Karns q / / Alert:2008011 TEI: LT -098 0 Plus C 76 OT0 Regular C 76 0 VJ0 Super 07 6 I' Sensor Key 1) VeederRoot TLS 350 2) Floats & Chains 3) Veeder Root 409 Senser 4) Emergency Shut Off 5) ATG Probe 6) FX1 V LLD 7) VeederRoot 208 Senser