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Home My WebLink About2014 RESULTSMONITORING SYSTEM CERTIFICATI ON 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, 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 of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: #3366 Chevron (West) B ldg. No.: -----Site Address: 8001 White Lane City: Bakersfield, CA Zip: 93309 ===----Facility Contact Person: _O::...m:..:..:.=e..:....ro=--=G::..::a:..:..rc::...i:.:;a~-----------Contact Phone No.: (800) 339-9930 Make/Model of Monitoring System: -=V--=e::..::e::..::d::..::e..:....r-..:.R..:..:o::...:o::...:t:..._T:...:L::...S=--=3-=5-=0---------Date ofTesting/Servicing: 7/15/2014 B. Inventory of Equipment Tested/Certified Check the aoorooriatc boxes to indicate specific equipment inspected/serviced: Tank ID: 12,000 gal. Regular 1 Tank ID: 12,000 gal. Regular 2 "Siehon" 181 In-Tank Gauging Probe. Model: 847390-107 t8J In-Tank Gauging Probe. Model: 847390-107 181 Annular Space or Vault Sensor. Model: 794390-420 181 Annular Space or Vault Sensor. Model: 794390-420 181 Piping Sump I Trench Sensor(s). Model: 794380-208 181 Piping Sump I Trench Sensor(s). Model: 794380-208 181 Fill Sump Sensor(s). Model: 794380-208 181 Fill Sump Sensor(s). Model: 794380-208 181 Mechanical Line Leak Detector. Model: FX-1V 0 Mechanical Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: 181 Tank Overfill I High-Level Sensor. Model: 847390-107 181 Tank Overfill I High-Level Sensor. Model: 847390-107 0 Other (specify equipment type and model in Section Eon Page 2). 0 Other (specify equipment type and model in Section Eon Page 2). Tank ID: 12,000 gal. Sueer Tank ID: 12,000 gal. Diesel 181 In-Tank Gauging Probe. Model: 847390-107 181 Jn-Tank Gauging Probe. Model: 847390-107 181 Annular Space or Vault Sensor. Model: 794390-420 181 Annular Space or Vault Sensor. Model: 794390-420 181 Piping Sump I Trench Sensor(s). Model: 794380-208 181 Piping Sump I Trench Sensor(s). Model: 794380-208 181 Fill Sump Sensor(s). Model: 794380-208 181 Fill Sump Sensor(s). Model: 794380-208 181 Mechanical Line Leak Detector. Model: FX-1V t8J Mechanical Line Leak Detector. Model: FX-1 DV 0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: 181 Tank Overfill I High-Level Sensor. Model: 847390-107 181 Tank Overfill I High-Level Sensor. Model: 847390-107 0 Other (specify equipment type and model in Section Eon Page 2). 0 Other (specify equipment type and model in Section Eon Page 2). Dispenser ID: 1&2 Dispenser ID: 3&4 181 Dispenser Containment Sensor(s). Model: 794380-208 181 Dispenser Containment Sensor(s). Model: 794380-208 181 Shear Valve(s). t8J Shear Valve(s). 0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5&6 Dispenser ID: 7&8 181 Dispenser Containment Sensor(s). Model: 794380-208 181 Dispenser Containment Sensor(s). Model: 794380-208 181 Shear Valve(s). 181 Shear Valve(s). 0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s). Dispenser ID: 9 & 10 Dispenser ID: 11 & 12 181 Dispenser Containment Sensor(s). Model: 794380-208 181 Dispenser Containment Sensor(s). Model: 794380-208 181 Shear Valve(s). 181 Shear Valve(s). 0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s). . . •If the facility contains more tanks or dispensers, copy th1s form. Include mformat10n for every tank and d1spenser at the fac1hty . 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 to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, 1 have also attached a copy of the report; (clteck all tit at apply): ~ System set-up ~ A m history report Technician Name (print): -=B::.ryz..:a:..:n~A:...:S=..e:..:l:.:...f _______ _ Certification No.: =B:..::3:.:...7..::5..::0..:..1 ____________ _ Testing Company Name: Confidence UST Services Phone Site Address: 8001 White Lane, Bakersfield, CA 93309 Date of Testing/Servicing: 7/15/2014 Page 1 of 3 Monitoring System Certification D. Results ofTesting!Servicing Software Version Installed: ....:::..3:::30~·~0~1 ____________ _ Complete the following checklist: [8:1 Yes 0 No* Is the audible alarm operational? [8:1 Yes 0 No* Is the visual alarm operational? [8:1 Yes 0 No* Were all sensors visually inspected, functionally tested, and confmned operational? [8:1 Yes 0 No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? 0 Yes 0 No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) [8:1 N/A operational? [8:1 Yes 0 No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment 0 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) [8:1 Sumpffrench Sensors; [8:1 Dispenser Containment Sensors. Did you conftrm positive shut-down due to leaks and sensor failure/disconnection? [8:1 Yes; 0 No. [8:1 Yes 0 No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no 0 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? If so, at what percent of tank capacity does the alarm trigger? 90% 0 Yes* [8:1 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. 0 Yes* [8:1 No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) 0 Product; 0 Water. Tfyes, describe causes in Section E, below. [8:1 Yes 0 No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable [8:1 Yes 0 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: Page 2 of 3 Monitoring System Certification F. In-Tank Gauging I SIR Equipment: [8] Check this box if tank gauging is used only for inventory control. D 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: 181 Yes D No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? 181 Yes D No* Were all tank gauging probes visually inspected for damage and residue buildup? 181 Yes D No* Was accuracy of system product level readings tested? 181 Yes D No* Was accuracy of system water level readings tested? 181 Yes D No* Were all probes reinstalled properly? 181 Yes D 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): D Check this box if LLDs are not installed. c h ~ II h kr omplete t e o owmg c ec tst: 181 Yes D No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? D N/A (Check all that apply) Simulated leak rate: [8] 3 g.p.h.; D 0.1 g.p.h ; D 0.2 g.p.h. 181 Yes D No* Were all LLDs confirmed operational and accurate within regulatory requirements? [8] Yes D No* Was the testing apparatus properly calibrated? 181 Yes D No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? D N/A DYes D No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? [8] N/A DYes D No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled 181 N/A or disconnected? DYes D No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions 181 N/A or fails a test? DYes D No* For electronic LLDs, have all accessible wiring connections been visually inspected? 181 N/A 181 Yes D No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe bow and when t hese deficiencies were or will be corrected. H. Comments: Page 3 of 3 FASTRIP ~o6 8001 WHITE Ul BAI:ERSFIELD CA JUL 15. 2014 8:44 AM SYSTEM S'iATtJS REPORT ------------ALL FUt~~JOIIS tiOP.MAL I tNEtfTOP.V REPORT T I :UNLEADED VOLU'1E " 6714 GALS ULLAGE • 5286 GALS 90',; Ull.t\GE• 4086 GALS TC VOLIJNE " 6561 GALS .lElCHT " 65,62 INCHES WATER VOL " 0 GALS WATER " 0. 00 INCitES TEMP " 92.6 DEG F T 2:UULEADED 2 VOLU11E a 7<127 GALS ULLAGE • 4573 GALS 90% ULLACE• 3373 GALS TC VOLU1E • 7267 GALS IIEIGtCT " 71 .28 JtlCHES WATER VOL " 1 0 GALS WATEP. " 0. 78 ltlCHES TEMP • 90.7 DEC F T 3:l'P.EMilli VOLlJIE • 6556 GALS ULLAGE " 5444 GALS 90Y. ULLAGE• 4244 GALS TC VOLUME • 6-112 GALS HEIGHT .. 64.37 ltlCHES WATER VOL " 0 GALS WATER " 0,00 INCHES TEMP • 91.3 OEG F T 4!DIESEL •• ~VOLU1E • 5132 GALS ULLAGE • 6868 GALS 9~; ULLA(;E• 5668 GALS TC VOI.UME • 5041 GALS HEIGHT • 53.17 INCHES WATER VOL • 13 GALS WATER " 0.92 HlCHES TEMP " 99.3 DEC F ~tnFOLDED TAtii:S IINEilTORV TOTALS T I :UNLEADED T 2!UIILEJ\DED 2 VOLUME " 14141 GALS TC VOI.U1E " 13928 GALS SOFn~RE REVISION LEVEL VERSIOtl 330.01 SOFTWARE" 3.16330-100-B 1CREATED-10.07.23.17.25 S·HODULE" 330160·004-o SYSTEM FEATURES: PERIODIC lti-TANK TESTS AriNUAL I U-TANK TESTS lSD S'ISTEM SETUP JUL 15. 2014 S:44 At1 i t.El'l IJHITS u.s. SYSTEM LANCUC\GE EtiGLISH SVSTEI1 DATE/TitlE FORMAT MOll DO ':VYV HH:Ifl:SS l<H FASTRIP 366 8001 WHITE Lt1 BAJ:ERSFIELD CA SHIFT TIHE I : DISABLED SHIFT TIHE 2 : DISABLED SHIFT TIHE 3 : DISABLED SHIFT TIME 4 : DISABLED TAIIK PER TST llEEDED LJRII DISABLED TANK Atltl TST tiEEDED WRtl DISADLED LINE RE-EtiABLE METHOD PASS LitlE TEST Ll tiE PEP. TST IIEEDED WRU DISABLED LINE ANti TST tiEEDED WRtl DISABLED PRitlT TC VOLUI1ES EllA BLED TEMP C0!1PENSATION VALUE <DEC F >: 60.0 STICK IIEIGHT OFFSET DISABLED ULLAGE: 90% H-PROTOCOL DATA FORHAT HEIGHT DA\'LIGICT SAVING TIHE ENABLED START DATE HAR WEE: 2 SUN START TIHE 2:oo AM EtiD DATE · tiOV WEE!: SUtl END TIME 2!00 AN RE-DIRECT LOCAl. PRitfTOUT DISABLED EURO PROTOCOL PREFIX s SYSTEM SEt;URIT'.' CODE : 000000 HAl NTEtlArlCE HISTORY DISABLED TAN" CHART SEC UP. I TY DISABLED Cl.h""TOM ALARMS DISABLED SERVICE t/OTICE DISABLED ISO 3166 COutfTRV CODE: I'IASS,..OEtlSITY DISABLED C0t1NUIHCATIONS SETUP ?ORT SETTWGS: Cot1'1 BOARD : I <EDit1 > RS-232 SECURITY CODE : DISABLED CONN BOARD : 2 <RS-232> BAUD P.ATE : 9600 PARIT\' : tiOtlE STO£' BIT : I STOP ().;TA LENGTH: 8 DATA RS-232 SECURITY j CODE : DISABLED COMH BOARD : 3 <RS-232> BAUD P~T£ : 9600 PARITY tiOtiE STOP BIT I STOP DATA LENGTII: 8 DATA P.S-232 SECtJP.IT'I CODE : DISABLED AUTO TP.AIISMIT SETTINGS: AUTO LEAl: ALARM LINIT DISABLE[• AUTO IIIGH WATER LIMIT DISABLED AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT DISABLED AUTO THEFT LIMIT DISABLED AUTO DELIVERY START DISABLED AUTO DELIVEP.'/ EfiD DISABLED AUTO EXTERNAL I tlPUT ON DISABLED AUTO EXTERNAL INPUT OFF DISABLED AUTO SENSOR FUEL ALARt1 DISABLED AUTO SEIISOR WATER ALAP.N DISABLED AUTO SENSOR OUT ALAP.H DISABLED F:S-232 Ell[l OF 11ESSAGE DISABLED 111-TAIU: SETUP T 1 !UtlLEADED PRODUCT CODE THERMAL COEFF TAttY. DIAMETER TAfiK PROFILE FULL VOL I .000700 120.00 I PT 12000 FLOAT SIZE: 4.0 IN. WATEP. t·IARfHfiG : 2.0 tHCH ~JATER Lit-liT: 3.0 t~~ OR LABEL VOL: 12000 OVERFILL LIMIT 90Y. 10800 HIGH PRODUCT 95Y. 11400 DELIVERY LIHIT ISY. 1800 LOW PRODUI.,""T : 500 LEAl: ALARM L IMIT! 99 SUDDEtl LOSS LIMIT: 99 .TAIIK TILT : 0.00 PROBE OFFSET : 0.00 SIPHOfl HAtHFOLDED TA!IKS TP: 02 LitlE MAIIIFOLDED TAtiKS TP: NONE LEAK Hltl PERIODIC: LEAt: HJU AtiNUAL : t:-: 120 1% 120 PERIODIC TEST T'lf'E STAfiDARD AIINUI'IL TEST FAIL ALARM DISI-IBLEO PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGJfiG: OFF TANK TEST llOTIFY: OFF TN!~ TST SIPHON BREAI::OFF DELIVERY DELAV : I Mltl PIJ1f' THRESHOLD : IO.OOY. T 2:UNLEAt•ED 2 PRODUCT CODE THERMAL COEFF TAN}; DIAMETER TAW: PROFI LE FULL VOL FLOAT SIZE: 2 .000700 120.00 I PT 12000 <1.0 Itl. WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 12000 OVERFILL LIMIT 90Y. 10800 HICII PRODU...."T 95% I 1400 DELIVERY LIMIT 15l; 1800 LOW PRODUCT : 500 LEAK ALARM LIMI T: 99 SUDDEN LOSS LJI11T: 99 TArn: TILT : 0.00 PROBE OFFSET : 0.00 SIPHOU HAtHFOLDED Tfltn:S TP: 01 L I NE HAUIFOLDED TANI:S Til: NONE LEAK HIU PERIODIC: LEAl: Ml N ANNUAL : m 120 1% 120 PERIODIC TEST TYPE STAUDARD ANtiUAL TEST FAIL AlARt1 DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED Atm TEST AVERAGI tiG: OFF PEP. TEST AVERAGING: OFF Tntl~ TE::>t tiOTI FY: OFF THK TST SIPHOil BREAI::OFF DELI VERY DELAY : I 11W PUMP THRESHOLD : !O.OOY. T 3:PP.fJ11UM PRODUCT CODE THERMAL COEFF TANK DIAMETER TAtll: PROFILE FULL VOL FLOAT SIZE: WATER WARNitiG : HIGH WATER Llt11T! HAX OR LABEL VOL: OVERFILL LIMIT : IIIGH PRODUCT DELIVER\' LIMIT LOW PR0Dl):1' : . U:fll' Al.AF.'11 ' I HIT: 3 .000700 120.00 1 PT 12000 4.0 ltl. 2.0 :3.0 12000 90Y. 10800 95}; 11400 ISY. !BOO 500 99 SUDDEN LO"SS"'LIMIT: 99 TAU!: TILT 0.00 PROBE OFFSET o.oo SIPHON t1AIIIFOLDED TANKS Til: !lONE LitlE HAtHFOLDED TANI:S n: tiOrlE LEA~: Mltl PERIODIC: LEAK M I N AtlrlUAL 1., " 120 17. 120 PERIODIC TEST TYPE STANDARD Atllll.IAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED Alltl TEST AVERMGitlC: OFF PER TEST AVERACitiO: OFF TAtlY. TEST NOTIFY: OFF Till\ TST SIPHON BREA.::OFF DELIVERY DELAY : 1 Hill PUI1P THRESHOLD : lO.OOY. T <!:DIESEL PRODUCT CODE THERMAL COEFF TAtn: DIAI1ETER TANK PROFILE FULL VOL FLOAT SIZE: ~JATEP. f..JARIHIIO HIGH WATER l.lt11T: HAX OP. LABEL VOL: OVERFILL LIMIT HIGH PRODUCT DEI.IVERV LIMIT LOU PRODU..."'T . LEAl\ ALARN LIMIT: 4 .000450 120.00 I PT 12000 4.0 Ill. 2.0 :3.0 12000 90Y. !OBOO 9~ 11400 15Y. 1800 500 99 SUDDEN LOSS LIHIT: 99 TAU!\ TILT o.oo PROBE OFFSET o.oo SIPHOil NAtHFOLDEO TAIU~S Til: NONE LitlE HANJFOLDELI TANKS Til: NONE LEAl\ Hill PERIODIC: 17. LEAl\ HI N Atltll.IAL 120 1% 120 PERIODIC TEST TYPE STAUDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARtt DISABLED Atltl TEST AVERAGIIIO: OFF PER TEST AVERAGING: OFF TANK TEST tlOTIFV: OFF Ttl!\ TST SIPHON BREAK:OFF DELIVER'/ DELAY : I Hill PUMP THRESHOLD : I 0. OilY. T~"'T OU DATE : ALL TAtll: JUL 23. 2010 START TIME : DISABLED TEST RATE :0.20 GAL/HR DURATION : 2 HOURS T51' EARL'/ STOP:DISABLED LEAK TEST REPORT FORMAT NORMAL LIQUID SEIISOR SETUP L I :UNL Atlll TRI-STATE <SINGLE FLOAT> CATEGORY : AHNULAR SPACE L 2:UIIL FILL TRI-STATE <SitlGLE FLOAT> CATEGORY : PIPltiG SLt1P L :J:UtlL STP TRI-STHTE <SltiGLE FLOAT> CATEGORY : STP SUMP L 4!UNL 2 Atm TRI-STATE <SI tKlLE FLOAT> CATEGOR\' : AWIULAR SPACE L 5:UilLfJ 2 FILL TRI-STATE <SWGLE FLOAT> CATE•~R\' : PIPWC SLt1P L t>:UtrL 2 STP TRI-STATE <SWGLE FLOAT> CATEGOR'I : STP SU1P L 7:PREI1 AllN TRI-STATE <SINGLE FLOAT> CATEGOR'.' : ANNULAR SPACE L 8!PRE11 FILL TRJ -STATE <SI t.JGLE FLOAT> CATECOR'I : PIPitlG SUMP L 9:PREI1 STP TRI-STATE <SI tlGLE FLOAT> CATEGORY : STP SUMP LIO:DSL AIIN TRI-STATE <SIIlGLE FLOAT> CAlEGOP.\' : AtltiUI..AR SPACE Lll :OSL FILL TRI-STATE <SitiGLE FLOAT> CATEGORY : PIPWI'; SUIIP LJ2:[1SL STP TRI-STATE tSI NGLE FLOAT> CATEGORY : STP SUHP L13:UISP 1-2 TRI-STATE CSI~;LE FLOAT> CATEGORY : DlSPEIC5ER PAU Ll <l!DISP 3 4 TRI-STATE <SINGLE FLOAT> CATEGOR'/ : DISPENSER PAtl LIS:DISP 5-6 TRI-STATE <SINGLE FLOAT> CATEGORY : DISPENSER PAll LIG!DISP 7-8 TRI -STATE <SINGLE FLOAT> CATEr.OR'/ : DISPEIISER PAN LI7:01SP 9-10 TP.I-STATE <SINGLE FI.OAT> CATEGOP.'/ : I>ISPEIISER PAll LIS!DISP 11-12 TRI-STATE <SI NGLE FLOAT> CATEGOR'/ : DISPENSER PAtl OllTPur RELAY SETUP R I :SHllTDOl~ll l"/PE: STAUDAP.D IIOP.t-11\LLY CLOSED TAW: II: LIQUID SEIISOR AU1S L 3: FUEL ALARI1 L 6: FUEL ALARM L 9:FUEJ. ALARI1 Ll2!FUEL ALARM Ll3!FUEL ALARM L14!FUEL iiLARH l.l5!FUEL ALAP.N LIG:FUEL ALARM Ll7!FUEL ALAP.H LH:I!FUEL ALARM L 3:SENSOR OUT ALARM L 6!SEIISOR OUT AlARM L 9:SENSOR OUT ALARM Lt2:SENSOR OUT ALARM Ll3!SEflSOR OUT AlARt1 Ll<l!SENSOR OllT ALARM L15 :SENSOR OUT Al.ARI'1 L16!SENSOR OUT i\LARM L17:SEIISOR our ALARM LIS!SEtlSOP. OUT ALARt1 L :l:SHORT ALARM L 6 :SHORT ALARM L 9 !SHORT ALARM L12:SHORT ALARM LJ3!SHORT AlARM Ll<l!SHORT ALARM LIS:SHOP.T ALARM LIG:SHORT ALARt1 L17:SHORT ALARJ1 LIS!SHORT ALARM ISO SITE ALARMS lSD GROSS PRES FA IL lSD DEGRI> PRES FAlL ISO VAPOR LEAK FAIL ISO VP PRES FAIL ISO VP S'TATUS FAll. ISO HOSE ALARMS ALL!GP.OSS COLLECT FAIL ALL:DEGRD COLLECT FAIL ALL:FLOW COLLECT FAlL R 2:0VERFILL ALARN TYPF.: STAIIDARD NORt1ALLV Of/EN TAIII: II: NOliE IN-TANK ALARMS ALL !OVERFILL ALARM ALL :HIGH PRODUCT Al.ARH ALL :HAX PRODUCT AlAP.tl R 3: IIITERIIAL AlARM TVPE: HOt1EIITARY tiORI'lt!LL'I OPEtl I ti-TAtn: AlARt1S At.L:LEAl: ALARM ALL!HIGH WI-\TER Al.ARM ALL!CVERFILL ALARM ALL:LOW PP.ODUCT ALARM At.L:SUDDEN LOSS ALARM ALL!HIGH PRODUCT ALARM ALL:INVALID FUEL LEVEL ALL!PP.OBE OUT At.L:HIGH L.JATEP. W\RIUNG Al.L!DELIVERV NEEDED At.L:MA.'< PRODUCT AI..I\Rr1 ALL:GROSS TEST FA IL Al.L!PERIODIC TEST FAIL ALL!ANHUAL TEST FAIL ALL :PER TST UEEDED WRtl ALL!Atltl TST NEEDED WRII AtL:PER TST tlEEDED Al.M AlL !AWl TST flEEDED Al.M Al.L!TAtll: TEST ACTIVE Al.L:t-10 CSLD IDLE TINE At.L:TAtll: SIPHOtl BREAt: At.L:LOW TEMP WARNING LIQUID SENSOR ALMS At.L:FUEL AlARM ALL!SEtlSOR OUT ALARt1 All.:SHORT ALARM St1ARTSEtiSOR ALARMS ALL:SETUP DATA WARtlltlG ALL!COt1MUiliCATIOtl AlARM ALL :SEIISOR FAULT ALARM Al.L:FUEL WARNJNr) At.L :FUEL Al.ARH ALL :WATER WAR Ill NG At.L:WATER ALARM ALL!UIGH LIQUID l-JARIHNG ALL:HJGH LIQUID ALARM Al.L!LOW LIQUID WARtlltiG lSD SITE Al.ARHS lSD STAGE I WARil ISO GROSS PRES lJARN lSD GROSS PRES FAIL lSD DEGP.D PRES WAP.fl ISO DEGRD PRES FAIL lSD VAPOR LEAY. WAP.tl lSD VAPOR LEA~ FAIL lSD VP PRES LJAP.ll lSD VP PRES FAlL lSD VP STATUS WARll ISO VP STATUS FAIL MISSING RELAY SETUP t11SSING HOSE SETUP MISSitlG TANK SETUP l11SS VAPOR FLOW HTP. MISS VAPOR PRES SEll HISS triG VP I tlPur lSD SETUP WARN lSD SETUP FAIL ISO SENSOR OUT Wi!Ril lSD SEtlSOR our FAIL SNAP.TSENSOR SETUP s t:PS 11-12 C~TEGORY VAPOR PRESSURE s 2:FN 1-2 CATEGORY AIR FLotJ METER s 3:FM 3-4 CATEGORY AIR FLOW METER s 4!FN 5-6 C'ATEGOP.\' IIIR FLOW METER s 5:FN 7-8 CATEGORY AIR FLOW METER !l 6:Ft1 9-JO CATEGORY AlP. FLOW METER s 7:FN 11.12 CATh~ORY AlP. FLOW METER EVR.r!SD SETUP EVR T'IPE: VMCUUN ASSIST VA~UUH ASSIST TYPE HEAL'/ VAC t102ZLE A/L RAil<::£ .!,~. I ·..!.~ _tll.ti.LJL.9.5_., ., ... - VAPOR PROCESSOR TYPE t10flE AtiAL'/SIS TIMES TIME: 10:00 AM DELAY 111tlUTES: ACCEPT HIGH ORVR: DISABLED ISO HOSE TAeLE ID FP FL HL AA RR ------------------------01 01 01 02 OJ 00 02 02 02 02 01 00 03 03 03 02 02 00 04 04 04 02 02 00 05 05 05 02 03 00 06 06 06 02 03 00 07 07 07 02 04 00 OB OB OB 02 04 00 09 09 09 02 05 00 10 10 10 02 05 00 II 11 II 02 06 00 12 12 12 02 06 00 ISO AIRFLmJ METER 111\'f' ID SERIAL tlUH LABEL ------------------------I 9519 2 950<1 3 8637 4 0593 5 8613 6 859<1 FH 1-2 FH 3-4 FH 5-6 Ft1 7-8 FM 9-JO FM 11.12 lSD FUEL GRADE HOSE HAP I 2 3 4 FP 1111H HHH t-IHII 11HII AA 01 201 301 901 5 tl 1 02 202 302 902 5 II I 03 203 303 903 u u 2 04 20ol 30ol 904 u u 2 05 205 305 905 u u 3 06 206 306 906 u u 3 07 207 307 907 u u 4 08 208 308 908 u u 4 OS 209 309 909 U U 5 10 210 310 SIO U U 5 11 211 311 911 5 tl 6 12 212 312 912 5 tl 6 LABEL TABLE t: UllASSIGilED 2: BLEND3 3: REGULA?. ol: MID GRADE 5: PP.ENIUH 6: GOLD 7: BR0112E 8: SILVER 9: BLEIID2 10: BLEIID4 FI1C SETUP YMC VERSION: 01.03 VAPOR PROCESSOR T'/PE IIOtlE PROCESSOR COtiTROL LEVEL: tiONE At.ARt1 HISTOP.Y REPORT -----SYSTEM I-ILARH -----PAPER OUT JUL 3. 2014 12:13 AH PRINTER ERROR JUL 3. 2014 12!13 AM ALARH HISTORY REPORT ----11~-TANK ALARJ1 ----- T I : UIILEADED OVERFILL ALARM JUL 7. 2014 11:39 AM ~~y 29. 2014 9!38 PM 11AP. 4, 2014 6:32AM LO\.J PRODI.)...""T ALARM JUL tO. 2014 6:08PM HIGH PP.ODI.)...""T ALARM JUL 7. 2014 11!38 AM UNALID FUEL LEVEL JUL 10. 2014 6:36 PM PROBE OUT JUL 7. 2014 11!39 AM JUL 7. 2014 10:18 AH DELIVERY tiEEDED JUL 12. 2014 5:45 PH JUL 11. 2014 2!56 PN JUL 10. 2014 1:21 ~1 ALARM HISTORY REPORT : ----IH-TANJ: ALARM ----- T 2:UULEADED 2 OVERFILL At.AF.N MAP. 4. 2014 6:33 AM HIGH PF.001>-,"'T ALARM JUL 7. 2014 11:41 AM f'ROBE OUT JUL 7, 2014 11!43 AM JUL 7. 2014 10:23 AH DELIVERY NEEDED AH JUL 7. 2014 10!24 MA:: PRODUCT ALARI1 AH JUL 7. 2014 11:41 ALAP.I'l HISTORY REPORT ----lll-TAtll~ ALAP.N ----- T 3:PREMJLt1 OVERFILL ALARM JUL 7. 2014 11:44 AM HIGH PRODUCT ALAR!'! JUL 7. 2014 11!45 AM ItNALID FUEL LEVEL JUL 7, 2014 11!46 AM PROBE OUT JUL 7. 2014 11!45 AM JUL 7. 2014 10!29 AM DELIVER'/ NEEDED JUl. 7. 2014 10!28 Al1 JUII 22. 201<1 9:09 PH APR 6. 2014 6:35 PM ALARH HISTOR'f REPORT ----lfi-TAIH~ ALARM ----- T 4!DIESEL OVERFILL ALARM JUL 7. 2014 11:46 AM LOW PRODUCT ALI\RM JUL 2::1. 2010 9:05 AH HIGH PRODUCT Al.ARH JUL 7. 2014 11:47 AM PROBE OUT JUL 7. 2014 11:<17 AM JUL 7. 2014 10!28 AM DELIVERY tlEEDElJ JUL 23. 2010 8:05 AM LOW TEMP WARN IUC JUL 7. 2014 11:49 AM JUL 7, ~014 10:30 AM Al.AR11 HISTORY REPORT -----SElSOR ALARM -----L I !UtlL AWl A!UlULAR SPACE SElSOR OUT ALARM JUL 7. 2014 11:25 AM SElSOR OUT ALARM JUL 7. 2014 10:57 AM FUEL ALARM JUL 7. 201<1 10:55 AM fllARH HISTORY REPORT -----SEIISOR AlARt1 -----L 2:Utll FILL PIPit.:> SU!1P SEIISOR OUT AlARM JUL 7. 2014 11!25 AM FUEL AlAI\11 JUL 7. 2014 10:50 AM ALAAM HISTORY REPORT -----SEIISOR AlARM -----L :'J:UtiL STP STP SUI1P SENSOR OUT ALARM JliL 7. 2014 11!24 A11 FUEL ALARM JUL 7. 2014 10!37 AM ALAf.l1 IUSTOP.Y REPORT ----SEtiSOR ALARtt -----L .t:miL 2 Allll AfiU UI.IIR SPACE I SENSOR OUT ALARM JUL 7. 2014 11!25 AM FUEL ALARH JUL 7. 2014 10:55 AM AlARM HISTORY REPORT -----SElSOR ALARM -----L 5:UNLD 2 FI Ll. PIPING Slt1P FUEL AlARf1 JUL 7, 2014 1:07 fH SEtSOR OliT AUIRI1 JUL 7. 2014 11 !25 AM FUEL ALARI1 JUL 7. 2014 10!51 AM AlJ\RI-1 HISTORf REPORT -··---SEIISOR ALAI\H -----L 6 !UI~L 2 STP STP St.t1P SE!lSOR OUT ALARM JUL 7, 2014 11:25 AH FUEL ALAI\11 JUL 7, 2014 10!38 AH ~fd1 HI STOR'/ REPORT -----SENSOR ALARtt --·- L 7!PREM AllN ANNULAR SPACE SE!SOP. OliT AlARM JUL 7. 2014 11!25 r~ FUEL fllliRl't JUL 7, 2014 10:56 AM rtlARM HISTORV REPORT -----SENSOR AlARM -----L 8:PREI1 FILL PIPING Sl..t!P SEIISOR OUT ALARM JUL 7. 2014 11:25 AM FUEL AlARI-1 .JUL 7. 2014 10:52 Ar1 11tARH HISTORY REP<iR1' -----SEtiSOR ALAI\11 ----- L 9:PRD1 STP STP Sl.l1P SEtlSOR OUT ALARM JUL ?. 201~ 11:27 AH SEtiSc>R OUT AUIP.I•l JUL 7. 2014 11!24 AM FUEL AlARM JUL 7. 2014 10:46 AN AlARt1 HISTORY REPORT -----SE!lSOR Al..AR/'1 -----L10:DSL ANN AtltlUl.AR SPAt:;E SEtlSOR Our ALARM JUL ?. 2014 11 :27 AM SENSOR Our ALARM JUL 7. 2014 11:24 AM FUEL Alf.IRH JUL 7. 2014 11:09 AM ALARI1 HISTOR\' REPORT -----SEtiSOR AlARM ----- Ll l :DSL FI LL PI Pi tiG SUMP SENSOR Our ALARM JUL ?. 2014 11:25 AH FUEl. AUIRH JUL 7. 2014 11:04 AM ALAP.H lf!STOR\' REPORT -----SEIISOR Al..AR~l -----L12:DSL STP STP SUt1f' £EliSOR 01.11' Al.ARt1 JUL 7. 2014 11 :25 AH FUEL ALARM JUL 7. 2014 10:49 AM AU.RH UISTORV REPORT -----SEIISOR AlARt1 -----Li3:DISP 1-2 [•!SPENSER PAll SENSOR our AlARM JUL 7. 2014 11:~7 AH SEIISOR Our ALARM JUL 7. 2014 11:25 AM FUEL ALARI1 JUL ?. 2014 11:17 ~1 Al.ARt1 HISTORY REPORT -----SEtSOR ALARM ----- LI ~:DISP 3 4 DISPEtlSER PAtl SEtSOR OUT ALARM JIJL 7. 201-1 11 :25 hl1 FUEL ALARI1 JUL 7. 2014 11 : 16 At1 ALARI1 IIISTORY REPORT -----SEtlSOP. ALARM -----LI5:DISP 5-6 lHSPENSEP. PAN SEtSOR OUT ALARM JUL 7. 2014 11:27 At1 SENSOR OUT Al.ARH JUL 7. 2014 11:24 AH FUEL I-ILAI\t1 JUL 7. 2014 11:13 AH I\LARI1 IIISTOFN REPOP.T -----SEtlSOR ALARt1 -----L16:DISP 7-9 DISPENSE?. PAU SEilSOR OUT ALARM JUL 7. 2014 11:27 AH SEtlSOP. OUT ALARM JUL 7. 2014 11:24 At1 FUEL ALARM JUL 7. 2014 11:14 AM ALAP.M HISTO?.Y REPORT -----SEtiSOR Al.AP.H -----Lt7:DISP 9-10 Dl::if-EUSER PAN SENSOR OUT ALARH JUL 7. 2014 11:24 AM FUEL ALARM JUL ?. 2014 11:15 AM ALARH HISTOR\' REPORT -----SENSOR ALAF.N LIS!DISP 11-12 DISPEtlSER PAN SEtSOR OUT AI.ARI1 JUl. 7. 2014 11 :2-1 AM FUEL AV~Rl'l JUL 7. 2014 11:18 ~ ----IN-TAW: ALARt1 -----T I :UtlLEADED HIGH PRODUCT ALARI·l JUL 15. 2014 9:10 AH FASTP.IP 366 8001 WHITE LN BAI:ERSFIELD CA SYl:.IE/1 STATts REPORT ALL FUNCTIONS NORMAL ----I N-TA!ll~ Al.Alll'l -----T 2:UULEADED 2 HIGH PRODUCT ALARtl JUL 15. 2014 9!11 AM --··-IN-TAN~ ALARM -----T :3:PREHilJ'1 IIICH PRODUCT ALARM JUL 15. 2014 9:1:3 At1 ----Ill-TANK ALARt1 -----T 4:DIESEL HIGII PRODUCT ALARM JUl. 15. 2014 9:14AM ,, ------- ----SENSOR ALARM -----L :3: UtiL S'I'f' STP SUHP FUEL. ALARtl JUL 15. 2014 9!17 At1 -----SEUSOR ALARM -----L 6!UNL 2 STP STP SUt1P FUEL ilLARI1 JUL 15. 2014 9:17AM ----SENSOR ilLARM L 9:PREH STP STP Sllt1P FUEL ALARM JUL 15. 2014 9:18 At1 -----SEtSOR ALARt1 -----L12!DSL STP STP SUtiP FUEL ALARM JUL 15. 2014 9:20 At1 -----SEtl.SOR.ALARt1 -----L13!01SP 1-2 DISPENSER PAN FUEL ALARM JUL 15. 2014 9:21 AH -----SENSOR ALARM -----LI4!DISP 3 4 DISPEtSER PAtl FUEL ALARM JUL. 15. 2014 9:21 AM -----SEtiSOR ALARH -----LI5!DISP 5-6 DISPENSER PAll FUEL I'LARt1 JUL 15. 2014 9:22 At1 -----SENSOR ALARM -----1.1 6:D1SP 7-8 DISPE~ISER PAN FUEL ALARM JUL 16. 2014 9:23 At1 -----SEtiSOR AIJ~Rl1 -----L17!DISP 9-10 DISPENSER PAN FUEL ALARM JUL 15. 2014 9:23 ~1 -----SENSOR AUlRt1 -----L1S!DISP 11-12 DISPEtSER PAH FUEL ALAP.M JUL 15. 2014 ~:24 At1 -----SENSOR ALAI\11 -----L10:DSL AtlN AtlUULAP. SPAt;E FUEL ALARM JUL 15. 2014 9:26 ~1 -----SEtS>R ALARI'1 ----L 8:PREM FILL PIPit¥> SUMP FUEL ALARM JUL 15. 2014 9!27 At1 -----SEtlSOP. ALARt1 ----- 1. 'I :PREM 1\NN ANNULAR SPACE FUEL ALARH JUl. 15. 2014 9:28 AH -----SEtiSOR ALARM ---- 1. S!UNLD 2 FILL PIPitlG SUt1P FUEL Al.llRN JUl. 15. 2014 9:28 AN -----SElSOR ALARM -----L 4!UIIL 2 ANII ANNULAR SPACE FUEL ALARI1 JUL 15. 2014 9!29 N1 -----SENSOR ALARI'1 -----L 2!UNL FILL PIPING Sl.t1P FUEL ALARM JUl. IS. 2014 9!30 AM -----SElSOR ALARt1 ----- 1. I :Uti!. AWl AtltiULAR SPACE FUEL f\LAP.H JUL 15. 2014 9:31 ru1 -----SENSOR ALARM -----Lll :DSL FILL PIPII.(; SIJ1P FUEL ALARH JUL 15. 2014 9!33 AH -----SF.tiSOR ALARt1 -----LI'J:IiiSP 9-10 DISPENSER PAll SENSOR OUT ALAJlM JUL 15. 2014 9!35 AM -----SENSOR ALARM ----- L18!DISP 11-12 . Ii1SPEtl:3ER PAU SENSOR OUT ALA?.H JUL 15. 2014 9!35 AM -----SEIISOR ALARH ----L15!DISP 5-6 DISPENSER PAN SENSOR OUT ALARt1 JUL 15. 2014 9!35 AM -----SEt~OR ALARM ----- 1. 9!PREN STP STP SlJIP SEIISOR OUT ALARM JUL 15. 2014 9:35 AH -----SEt~OR ALARt1 ----- L16!DISP 7-B DISPENSER PAll SENSOR OUT ALAJlM JUL 15. 2014 9:35 AM -----SENSOR AtARl1 -----LIO!DSL ANN ArHlULAR SPACE SEt~OR OUT ALARM JUL 15. 2014 9:35 AM -----SENSOR ALARM -----1. 4!UNL 2 ANN AfltllJLAR SPACE SENSOR OUT ALAJlM JUL 15. 2014 9:35 Al·l I -----SEilSOR ALAJlM -----L12!DSL STP STP SUNP SEIISOR OUT ALARM JUL 15. 2014 9!35 Al'l -----SENSOR 1-iLARM -----1. S!UtlLD 2 FILL P1PitlG SUI1P SENSOR OUT ALARM JUL 15. 2014 9:35 N1 -----SEtlSOR ALAR11 ----- LI3!DlSP l-2 DISPENSER PAll SENSOR OUT ALARI'l JUL 15. 2014 9!35 ~1 -----SENSOR ALARII ----- 1. t.:UUL 2 STP STPSUNP SEI~OR our fiLARtl JUl. 15. 2014 9:35 AM -----SEtiSCR AU~RN -----l.I4:DISP 3 4 DISPEt~ER PAN $EliSOR OUT ALARt1 JUL 15. 2014 9:35AM -----SEtGOR ALARH -----l. 7:PREN Atltl t\lltiULAP. SPACE SENSOR OUT-ALARI1 JUL 15. 2014 9:35 AM -----SElSOR ALAKM -----L 1 :UNL AIIU AllfiULAR SPACE SENSOR our ALARM JUL 15. 2014 9:35 AM -----SElSOR ALARt1 L &:PP.EH FILL PIPIII\> Sl.t1P SENSOR Our ALARM JUL 15. 2014 9:35 AH -----SElSOR ALARI1 -----Lil :DSL FILL I> I P IIIG Slt1P SElSOR Our ALARH JUL 15. 2014 9:35 ~1 -----SEtlSOR ALARH -----L 2:UtlL FILL PIP! N\0 SUMP SEtSOP. Otrr ALARH JUL 15. 2014 9:35 AM -----SEtlSOR ALARM L 3:UNL STP STPSUHP SEt/SOP. our ALA'RI1 JUL 15. 2014 9:35 AH SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing ofUSTspill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulat01y agency. 1 FACILITY INFORMATION . Facility Name: #3366 Chevron I Date ofTesting: 7/7/2014 Facility Address: 800 I White Lane, Bakersfield, CA 93309 Facility Contact: Omero Garcia I Phone: 661-393-7000 Date Local Agency Was Notified of Testing: 6/26/2014 Name of Local Agency Inspector (if present during testing): Shane Gardner 2 TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. Technician Conducting Test: Bryan A Self Credentials 1: X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester 0 Other (Specify) License Number(s): CSLB #804904 ICC #8022804-UT TT#11 -1756 3. SPILL BUCKET TESTING INFORMATION Test Method Used: x Hydrostatic 0 Vacuum 0 Other Test Equipment Used: Lake Test Equipment Resolution: 0.0625" Identify Spill Bucket (By Tank 1 Regular #1 2 Regular #2 3 Super 4 Diesel Number, Stored Product, etc.) Bucket Installation Type: 0 Direct Bury 0 Direct Bury 0 Direct Bury 0 Direct Bury x Contained in Sump x Contained in Sump x Contained in Sump x Contained in Sump Bucket Diameter: 12.00" 12.00" 12.00" 12.00" Bucket Depth: 14.00" 15.25" 15 .00" 13.75" Wait time between applying 5 min. 5 min. 5 min. 5 min. vacuum/water and start of test: Test Start Time (T1): 9:10AM 9:10AM 9:10AM 9:10AM Initial Reading (RI): 11.25" 11.25" 11 .25" 11.50" Test End Time (TF): 10:10 AM IO:IOAM lO:lOAM 10:10 AM Final Reading (RF): 11.25" 11.25" 11 .25" 11 .50" Test Duration (T F-T1): 1 hour I hour 1 hour 1 hour Change in Reading (RF-R1): 0.00" f.l.OO" 0.00" 0.00" Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" 0.0625" Criteria: Test Result: ~ Pass 0 Fail ~ Pass O Fail ~Pass 0 Fail ~ Pass 0 Fail Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING ace rate, and in full compliance with legal requirements. 1 State laws and regulations do not current require testing to be performed by a qualified contractor. However, local requirements may be more stringent. 'I r--------------~--IF --I 1 11367 11366 "::::·=----~ ~--------~. I a a I I I I FJR,E EXTINGUISHER I I o I I ~~~~i:TGS : 4 • 12,000 GALLON I !"'" i GOSFORD ROAD #366 LEGEND L1 87·1 ANNULAR L2 87·1 FILL L3 87·1 STP L4 87·2 ANNULAR L5 87·2 FILL L6 87-2 STP #367 LEGEND L 1 87·1 ANNULAR L2 87·1 STP L3 87·1 riLL L.5 87·2 STP L6 87 ·2 ANNULAR L7 87·2 FILL L8 87·2 ANNULAR FILL 1.0 87·2ANNULAR L 10 81 ANNULAR L11 91 STP L12 111 FILL L7 111 ANNULAR L8 91 FILL L9 91 STP L 10 DSL A.tiNULAR L.11 DSL FILL L.12 DSLSTP L13 DSLANNULAR L14 OSL STP L15 OSL PILL L.1G UDC 13 ·14 L17 UOC15·1G L.18 UDC17-18 L19 UDC19·20 L.20 uoc 21.22 L21 UOC 23 • 24 L22 VENTBOX L13 UDC1·2 L14 UDC 3 ·4 L15 UDC5·6 L1G UDC 7 ·8 L17 UCC 9 ·10 L18 UDC 11 ·12 FACILITY LEGEND H HEALY CAS ESO EMERGENCY SHUT·OFF W.S WATER SHUT-OFF@ STREET W·B WATER SHUT·OFF ~BLDG. SITE PLOT PLAN tor: #366 CHEVRON/#367 FASTRIP #640 8001 White Lano Bakersfield, CA 93311 (661) 835-1490 Name: Street: City: Terms: "f\D~+. CJO (\~ ~J.IS~.; ~'~toc'f\0 WI.O WIDi CONfUJENCE• lic.970703 ~lANCE WIDi CONfiDENCE" Lie. 804904 Toll Free#: 1-800-339-9930 Confidence UST 16250 Meacham Road Oakersficld CA 93314 Descnotion of work performed: A-t L-/~<:::7 "ft~'\lr"L) VCJ12..11A.l " TE:.s-1/.U,...., -T_ ( 81-' A~'?_ C1 f\ 7#¥"f!.E Job Order /Invoice#: 3~ -=1-:r~ DateC811ed Time To Whom Site Name: ::t:J::; 33ull i. Jl E11.1i:!lJ..J Street: Be ..,6 1 l ct1tLTE. Lt4N E. City: ~A ~t:.EilSF/eLD State:c-4 Zip: <:j ~~D'T Store No: ?v~ • ~~.5 'J""F/1/) 11A"" N J trJ l!.l ~.)(;. c F--:::rT: ALL Co11-'t PoN~ /;u t"'"n~.n/ /1!!5A.A::E TZ. z;. Or M'.&. r.J A-l._!_ I JI\.J ( FJL.../ CA'O<::::' t...//(S A" i.LJ"' Pc:J ~ 1'.~-#" ::;:: ,.-e>o!uo )r 0., A I{ ?EAJ:=..€ c ... "Ttl& en Vt4.Po~ 012"Y !J!!;."'j~t;.~C.ve,. -c IN\ A IJ A.l.H. Y £'".I .If A /lEO rk&. .T<:?J . A~ J4(_L ~JAJc-rtbJ~ A.)CYfZ.v?t£/ TRAVEL and LABOR (0 5 Hour Monomum Labor Charge) OVERTIME (5:00 PM -7:00AM) Date Techniclan(s) Name Start End Total OT Start OTEnd OTTotal =?-/~IM ~v~ ~ ~-t--Travel Labor ·~ Travel Date Technician(s) Name Start End Total OT Start OTEnd OTTotal Travel Labor Travel Date Technician(s) Name Start End Total OT Start OTEnd OTTotal Travel Labor Travel SUPPLIES-MATERIALS-RENTALS Check One Qty. '1;;. UST Parts Site Parts 'Z., t,pfo4.~ ~ILC f:.A p ~ ( 0 PeA J \ X ' -,/ COMMENTS Store Employee Pnnt Name: Store Employee Signature: Date )ICE-WHITE