HomeMy WebLinkAbout2013 RESULTSMONITORING SYSTEM CERTIFICATION
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 perfonns 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
Facili~Name:_l_nd_e_c_o~~~~~~~~~~~~~~~~~~~~~~~~~~~~-BWg.N~:~~~~
Site Address: 100 South Oswell Street City: Bakersfield Zip: 93307
Facili~ Contact Person:_B_e_n~D_a_s_ht_.!ip_o:....:u_r~~~~~~~~~~~~-Contact Phone No.: -:6::..:6:...1:..._-.::.3.::.66=---=2:.:::5~1...:.1~~~~~-
Make/Model of Monitoring System: Veeder-Root TLS 350 Date ofTesting/Scrvicing: 3/15/2013
Tank ID: 10000 gal. Regular Master Tank 10: 5000 gal. Regula r Slave [~] In-Tank Gauging Probe. Model: 847390-107 [!] In-Tank Gauging Probe. Model: 847390-107
[!] Annular Space or Vault Probe. Model: 794390-420 [!] Annular Space or Vault Sensor. Model: 794390-420
[!] Piping Sump I Trench Sensor(s). Model: 794380-208 [!] Piping Sump I Trench Sensor(s). Model: 794380-208
0 Fill Sump Sensor(s) Model: ~ Fill Sump Sensor(s). Model:
~ Mechanical Line Leak Detector. Model:FX1V 0 Mechanical Line Leak Detector. Model:
0 Electronic Line Leak Detector. Model: D Electronic Line Leak Detector. Model: [!] Tank Overfill I High Level Sensor. Model: OPW-61-SO [!] Tank Overfill I High Leva! Sensor. Model: OPW-61-SO
D Other (specify equip. ~pe and model in Sec. Eon Pg. 2) 0 Other (specify equip. type and model in Sec. Eon Pg. 2)
Tank ID: 5000 gal. S uEer Tank 10: 10000 gal Diesel
[x] In-Tank Gauging Probe. Modef·847390-107 [!] In-Tank Gauging Probe. Model: 847390-107
[!] Annular Space or Vault Sensor. Mode 1 :794390-420 [i] Annular Space or Vault Sensor. Model: 794390-420
~ Piping Sump I Trench Sensor(s). Model: 794380-208 [!] Piping Sump I Trench Sensor(s). Model: 794380-208
0 Fill Sump Sensors(s). Model: 0 Fill Sump Sensor(s). Model:
[X] Mechanical Line Leak Decector. Modef:FX1DV [!] Mechanical Line Leak Detector. Model: FX1 DV
0 Electronic Line Leak Detector. Model: 0 Eleeh·onic Line Leak Detector. Model:
[!] Tank Overfill I High Level Sensor. Modef:OPW-61-SO ~ Tank Overfill I High Level Sensor. Model: OPW-61-SO
0 Other (specify equip. type and model in Sec. Eon Pg. 2) 0 Other (specify equip. ~ps and model in Sec. Eon Pg. 2)
Dispenser ID: 1&2 Dispenser ID: 3&4
[X] Dispenser Containment Sensor(s). Model: 794380-208 [!] Dispenser Containment Sensor(s). Model: 794380-208
[X] Shear Valve(s). ~ Shear Valve(s).
0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s)
Dispenser ID: 5&6 Dispenser 10: 7&8
~ Dispenser Containment Sensor(s). Model: 794380-208 ~ Dispenser Containment Sensor(s). Model: 794380-208
[!] Shear Valve(s). ~ Shear Valve(s).
O Dispenser Containment Float(s) and Chains(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser I D: Dispenser ID:
0 Dispenser Containment Sensor(s). Model: D Dispenser Containment Sensor(s). Model:
0 Shear Valve(s). D Shear Valve(s).
0 Dispenser Containment Float(s) and Chain(s) 0 Dispenser Containment Float(s) and Chain(s).
. . . . *If the fac1hty contams more tanks or d1spensers, copy th1s form. Include mfo1mat10n for evCJy tank and d1spense1 at the fac1h~ .
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 ge ating
such reports, I have attached a copy of the report; (check all that apply) [!] Sx · Set-up [i] Ala m hi o ort
Technician Name (print): Bryan A Self Signature: ~4-~~:...::.....,'fl.<:........:.~----=::....J-~f-~_._-....~~-
Certification No: ..:B:.::3.:.:75:.:0..:..1~~~~~~~~~~~~~~~~
Testing Company Name: Confidence UST Services, Inc.
Site Address: 100 S Oswell St Bakersfield CA, 93307 Date of Testing/Servicing: _3_11_51_2_01....:.3~~~-
D. Results ofTesting/Servicing
Software Version Installed: 123.02
Complete the following checklist:
[i] Yes D No* Is the audible alarm operational?
X Yes f l No* Is the Visual alarm operational? ~X Yes l J No* Were all sensors visually inspected, functionally tested, and confirmed operational?
X Yes D 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?
U Yes td No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem)
N/A operational?
~~Yes 0No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary
ON/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[i] Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? [i] Yes; D No;
0 Yes 0No* 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 till point(s) and operating properly? If so, at what percent of tank capasity does the alarm
trigger? l 90 J %
~ Yes* 0No 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.
D Yes* ~No Was liquid found inside any secondary containment systems designed as dry systems? D Product; D Water. If yes, describe causes in Section E, below. lfx Yr.c; I INo* 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: I had to replace the Veeder-Root 208 Liquid sensor in the 91 STP sump.
F. In-Tank Guaging I SIR Equipment: [x] Check this box if tank guaging is used only for inventory control.
0 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 followine: checklist·
X Yes D No* Has all input wiring been inspected for proper enter and termination, including testing for ground faults?
X Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
X Yes No* Was accuracy 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? r-~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): 0 Check this box if LLD's are not installed.
Complete the following checklist:
[i] Yes 0No* For equip. start-up or annual equipment certification, was a leak simulated to varify LLD performance?
(Check all that apply) Simulated leak rate: ~3 g.p.h.: 00.1 g.p.h.; 00.2 g.p.h.;
l.xJ Yes [ No* Were all LLD's confirmed operational and accurate within regulatory rcquirments?
""'txJ Yes No* Was the testing apparatus properly calibrated?
~Yes No* For machanical LLD's, does the LLD restrict product flow if it detects a leak?
1-N/A
DYes =-= No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak?
[xJ N/A
DYes W 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?
! DYes !:.--JNo* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system
~N/A malfunction or fails a test?
0 Yes h) No* For electronic LLD's, have all accessible wiring connections been visually inspected?
ffiJ Yes
~N/A
[ 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:
OSI.IELL L I ~UOR
100 S.OSWELL
&IKER:.;F I ELD. C1-1
t..l~l-861-9769
I'AR 15, 2013 8:-ttt
8'/STEM STATUS REPORT -
T 4!0EL!VERV NEEDED
INVENTORY REPORT
T I : 87 UtiLEHDED V0Lt;l1!; ~ 5304 C;ALS
Ul LAGE 4848 GALS qo-... ULLAGE• 38:32 GALS TC VOLUf1E 5289 GHLS HEIGHT 49.44 INCHES
WATER VOL 0 GAUJ . l-'ATER D 0 . OLJ I NCHt:;
TEMP = 63.9 DEG F
T 2!87 UNLEADED
VOLUME z 2747 GALS
ULLAGE • 2317 GALS
90'• lJLLAGE ~ I 81 0 GALS
TG VvLlJ1E 2737 GALS
HEIGHT .. 50.9<1 INCHES I.JATER VOL " 0 GALS WATER "' 0. 00 11'.\.~HES
TEtlP ~ 65. 0 DEG F
T ~~: 91 PREM I U'l
VOLlJf·1E I 776 t::~L~ ULLAGE = 3288 GALS
qo~ ULLAGE= 2781 GALS rc ·voLUME. 1767 GALS
HEIGHT :. 36.44 INCHE~>
WATER VOL I 9 GALS
&.lATER I . 64 INCHES
TEMP 66.3 DEG F
T .:~:DIESEL
VOLUME 1541 GALS ULLAGE "' 8611 GALS
90~. ULLAGE• 7595 GALS
TC V01 UME .. 1535 GALS
HEIGHT 19.98 INCHES
WATER VOL • 0 GALS
WATER 0.00 INCHES
TEI·ll:. 68. 2 f•E•3 F
~ :QFTI.oiARE P.E\1! S I 0 N LEVEL
VH'S I OI~ 1 ·'3 .02
~(lfTl~ltREII 346 I 23-1 00-(' ~RERTEll -02. I I . 25. I 5 .. I 7
NO :~<JFTWARE r!ODULE
SVSTEI'l FEATUI<ES : , . , . ~ r•ER 1 Olll C IN-TAN~, 1 EST):) ANNUAL IN-TANK TESTS
SYSTEH SETUJ.>
11AR 15. 2UI ~• 8:48
SVSTEt1 UNITS u.s.
SY:3TEM LANGUAGE
ENGLISH
SYSTEM DATE ,·TIME FORMr;T
MON DD 'IVW HH:1'111!SS
OSWELL LIQUOR
I 00 S . OSl.JELL
BAKERSFIELD.CA 661-861-9769
SHIFT TIME I SHIFT TII'IE '2
SHIFT TI11E 3
SHIFT TIME 4
DISI-\BLED
DISABLE[l DISABLED DISI-IBLED
TANK PER TST NEEDED WRN DISABLED
TAN!\ ANN TST NEEDEO t..IRN DISABLED
L1 NE RE-ENABLE ~1CTHOD
PASS Ll NE TEST
LINE PER TST NEEDED WRN DISABLED
LINE ANN TST III::EDED WRN DISABLED
PRINT TC VOLUMES ENABLED
TErlP COI'IPENSATION
VALUE <DEG F >: 60.0 STICK HEIGHT OFFSET DISABLED
DAYLIGHT SAVING TIME DIShBLED
SVSTEt1 SECURITY CODE : 000000
CUSTOM ALARM LHBELS DISABLED
C~~1UNICATIONS SETUP ---------
PORT SETTINGS:
NONE FOUND
RS-232 END OF t1ESSAGE DISn3LED
IN-TANK SETUP ------
T I : 87 UNLEADED PRODUCT CODE
THERMAL COEFF TANK DIAMETER
TANK PROFILE
FULL VOL
FLOAT SIZE:
WATER WARNING :
HIGH WATER LIMIT:
MAX OR LABEL VOL:
OVERFILL Lll'liT
HIGH PRODLCT
DEL I VERV L! MIT
LOW PRODUCT :
LEAK ALARM LII"II T : SUD[IEN LOSS Ll MIT: TANK TILT
PROBE OFFl:iET
I
:.000700
: 95.50
I PT
10152
~.0 IN.
2.()
3.0
10152
91Y{
9136
95~.
9644
25~.
2538
500
99
99 o.oo o.oo
SIPHON l·l..,f.ll FOLDED TANJ<S Til: NONE
LINE MANIFOLDED TANKS Til: NONE
LEAK /'liN PERIODIC:
LEA~: MIN ANNUAL
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARI'I DISABLE[,
PERIODI C TEST FAIL
ALARI1 DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST ?~VERAGING: OFF
TMN·~ TEST NOTIFY: OFF
TNK TST SIPHON BREt-H: :OFF
DELIVERY DELAY 3 MIN
PU!-IP THRESHOLD : I 0 . 00'•
T 2:87 UNLEADED
PRODUCT CODE
THERMAL COEFF TANK DIAMETER
TANK PROFILE FULL VOL
2
: .000700
95.50
I PT
5064
FLOAT SIZE: 4.0 IN.
~~ATER WARN II'K> 2.0
HIGH WATER Lli"IIT: 3.0
MRX OR LABEL VOL : 5064
OVERFILL Lll"liT 90% 4557
II IGH PRODUCT 95~;
4810 DELIVERY Lll"liT 25~·· 1266
LOW PRODUCT 500 LEAK ALARM LIMIT : 99
SUDDEN LOSS L !11 IT: 99
TANK TILT 0.00 PROBE OFFSET 0.00
SIPHON MANIFOLDED TANKS Til: NONE
L I NE 11AN I FOLDED TANKS Til: NONE
LEAK l"liN PERIODIC :
LEAK MIN ANNUAL
0%
0
0%
0
PERIODIC TEST TYPE STANDARD
ANNUAL TEST FAIL
ALAR~1 D I SABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL ALARM DISABLED
ANN TEST 1\VERAG I NG : OFF PER TEST AIJERAG I NG : OFF
Tr-~t~K TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 3 MIN
PUMP THRESHOLD : I 0. 00%
T 3:91 PREMI Ul"' PRODUCT CODE
THERMAL GOEFF
TANK DIAMETER TANK PROFILE
FULL VOL
3 .000700 '35 .50
I PT 5064
FLOAT SIZE: 4.0 IN.
WATER WARNING 2.0
HIGH WATER LIMIT: 3.0
I"IAX OR LABEL VOL : 5064 OVERFILL Ll 1•11 T : 90% 4557
HIGH PRODUCT 9~/o 4810
DELIVERY LIMIT 25}o
1266
LOW PRODUCT 500 LEAK ~LHRM LIMIT: 99 SUDDEN LOSS LIMIT: 99
TANK TILT : 0.00 PROBE OFFSET 0.00
SIPHON MANIFOLDED TANKS
Til: NONE
LINE MANIFOLDED TANKS
Til: NONE
LEAK MIN PERIODIC:
LEAK 1"1 I N ANNUAL
o~.,
0
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL ALf-IRM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL ALARM DISABLED
ANN TEST AVERAGING: OFF F'ER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREA~~: OFF
DELIVERY DELAY 3 MIN PUMP THRESHOLD : I 0. Octo
T 4:DIESEL PRODUCT CODE
THERMAL COEFF TANK DIAMETER
TANK PROFILE FULL VOL
FLOAT SIZE:
: 4.
; .000450
95.50
1 PT
10152
4.0 IN.
WATER WARNING : 2.0
HIGH WATER LIMIT: 3.0
MAX OR LABEL VOL: 10152
OVERFILL L 111 IT : 90~,
9136
HIGH PRODUCT 95%
'3644
DELI VERY Ll MIT 25%
2538
LOW PRODUCT : 500
LEAK ALARM Lll"ltT: 99
SUDDEN LOSS L 111 I~ : 99
TANK TILT · 0.00
PROBE OFFSET 0.00
SIPHON I'IANIFOLDED TANKS
TU: NONE . L 1 NE 11AN I FOLDED TANKS
Til: NONE
LEAK MIN PERIODIC: 0 •.. ..
0
LEAK 111 N ANNUAL 0
PERIODIC TEST TYPE STANDARD
ANNUAL TEST FAIL ALARM DISABLED
PERIODIC TEST FAIL ALARN DISABLED
GROSS TEST A~k~ D I SABLE[J
ANN TEST AVERAGING : OFF PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 1 MIN PUMP THRESHOLD : 10.00%
_ _.../
LI:.MI\ II:.~T 11ETHOC
TE~T-0~ OATE 7 ALL TA~K-
JAN 1, 1996
START TIME : DISABLED
TEST RATE :0.20 G .... L·HR DuRATION : 2 HOURS
TST EARLY STOP:DISABLED
LEMK TEST REPORT FORMAT
NORM11L
~ i (IU I D SENSOR SETUP
L 1 : 87 ANNULAR
TRI-STATE <SINGLE FLOAT> C~TEGORY : STP SL~P
L 2:91-A7ANNULAR
TRI-STATE <SINGLE FLOI-\T >
CATEGORY : ANNULAR SPACE
L 3:DIESEL ANNULAR TRI-STATE <SINGLE FLOAT >
CATEGORY : ANNULAR SPACE
L 4 : 87 STP SUt1J:>
TRI-STI1TE <SINGLE FLOAT> CATEGORY : STP Sl.t'IP
L 5:87 SVP.SUMP
TRI -STATE <SINGLE FLOAT> CATEGORY : PIPING SUMP
L 6: 91 STP Sll'lP
TRI-ST~TE <SINGLE FLOAT> •~ATEGOR\' : STP SUI"IP
L 7:DJESEL STP
TRI-STATE <SINGLE Fl.OATl CATEGORY : STP SUt1P
L t3 : D I SP . I -2
TRI-STATE <SINGLE FLOAT>
CATEGORY : DIS~ENSER PAN
L '3:DISP .3-4
TRI-STATE <SINGLE FLOAT> CATEGORY : DISF·FNSER PAN
LIO:DISP.5-6
TRI-STHTE 1SJNGLE FLOAT> L'ATEGOR'l : DISPENSER PAl~
Lll :DJSP . 7-8
TRI-ST14TE <SINGLE FLOAT>
l'ATEGORY : DISPENSER PAN
oUTPUT RELAY SETUP
R I : 87 SHUT DOWN TYPE:
STANDARD NORM11LLY CLOSED
LIQUID SENSOR ALMS
L I :FUEL ALI,RI'l L 4 :FUEL Al.ARI·l
L 5 : FUEL ALARt1 L 8: FUEL ALARI1
L '::1: FUEL ALARI"I
Ll 0: FUEL ALARI'l
Lll :FUEL ALAR,.l
L I :SENSOR OUT ALI-\RI1
L 4 :SENSOR OUT ALARI'l L 5:SENSOR OUT ALAR!·! L 8 :SENSOR OUT ALARI"l
L 9:SENSOR OUT ALARM LIO:SENSOR OUT kl.ARM
L 11 :SENSOR OIJf ALARM
R 2: 91 SHUT -DOJ..JN TVPE:
STANDARD
NOR1'1ALL Y CLOSED
LIQUID SENSOR ALI"E
L 6:FUEL ALARM L 8 :FUEL ALAR11
L 9:FUEL ALARM L 1 0 :FUEL ALAR1'1 L I I :FUEL ALARM
L 2:SENSOR OUT ALA~1 L 6:SENSOR OUT ALI-IRI"'
L 8!SENSOR OUT HLARM
L 9:SENSOR OUT ALARM
L I 0 :SENSOR OUT ALARI1 Lll :SENSOR OUT ALARM
R 3:DIESEL SHUT-DOWN TYPE:
STANDARD NORI'IALLY CLOSED
LIQUID SENSOR ALI"'S
L 3: FUEL ALfiRt1
L 7 :FUEL ALARt1 L 9: FUEL ALARM
Lll :FUEL ALAR1'1
L 3:SENSOR OUT ALARM L 7:SENSOR OUT ALAR/'1 L 9:SENSOR OUT ALARM
Lll :SENSOR OUT ALARM
RECONCILIATION SETUP
AUT011ATIC DAILY CLOSING TIME: 2:00AM
PERIODIC RECONCILIATION MODE: MONTHLY
TEMP COMPENSATION
STANDARD
BUS SLOT F IEL Mf:.IER TANK
TANK I"'AP EMPTV
ALARM HISTORY REPORT
-----SYSTCI"l ALARM
PArER OUT FEB 10. 2013 12!5U PRINTER ERF<OR
FEB 10. 2013 12:58
BATTERY IS OFF JAN 1. 1996 8:00
ALARt·1 HI ~-;TORY REPORT
----IN-TANK AL!-1Rtl
T 1 : 87 llNLEIIDE[•
OVEI\'FILL ALARN FEB 14. 2013 5:19
DEC 23. 2012 16:15
DEC I. 2012 6:43
LOW f-ROLIUCT ALAR~!
FEB 7. 2013 7:48
JAN 15. 2013 16:53
JAN 13. 2013 12:03
HIGH l'ROflUCT 1-11..;-.;>H
JUN 2. 2010 2S ::j0 NOV 2. 2006 12:56
SEP 3. 2005 13:54
I NVf.\L I D FUEL LEVEL
FEB 7. 2013 9:20
JA~ 13. 2013 12:12 DEc 16. 2012 17:54
PROBE OUT
t1AY 20. 200'5 8 :55
11AV 20. 20ll5 7 : 48
[•EL I VERY NEEDED
11AI< 13. 201312:48
t~R 8. 2013 II :40
~IAR 5 • 20 1 3 I <1 : J 1
11AX PRODUCT llLARM
SEP 3. 2005 13:5~
APR 21. 2003 13:01
ALARM HI STOR\' REf•ORT
----IN-TANY. ~LARM
T 2:87 UNLEADED
OVERFILL ALARM
OCT 29. 2012 19:46
JUL 3. 2012 17:34 JUN 13. 2012 23:53
LOW PRODUCT ALARN
FEB 6. 2013 19:44
JAN 15. 2013 13:53 JAN 12. 2013 23:29
HIGH PRODUCT ALARM
JUL 3. 2012 17:35
JUN 13. 2012 23:54 JUL 19. 2011 15:44
INVHLID FUEL LEVEL
FEB 7. 2013 9:25
JAN 13. 2013 13 :13 NOV 9. 2012 20:38
PROBE OUT
~~y 20. 2005 8:58
MAY 20. 2005 7:20
DELIVERY NEEDED
MAR 13. 2013 14:43 MAR 8. 2013 13:16
MAR 5. 2013 16:15
ALARM HISTORY REPORT
----IN-TANK ALARM
T 3 : 91 PREt'l I Ul'l
OVERFILL ALARM0 .3?
JUNtO. 2012 2:12
l'\1-\R 24 . 2007 ·
LOW PRODUCT ALARM DEC 20· 2012 15:45
DEC \4. 20\2 \\:41
DEC 5. 2012 a.20
H 1 GH PRODUCT ALARI"I
JUN 10. 2012 o:3~
t'IAR 24 . 2007 2 · \ 3
INVALID FUEL LE~~L
JAN 2. 2009 13:;9 NOV 30. 2008 12:-7 AUG S, 2007 17-04
PROBE OUT a:2B t·'p.' 20, 2005
DELl VER ! NEEDEDB. 25 FEB 12· 2013 · FEB 4. 2013 zo:42 J~N 2B· 20 \3 a.oo
n!..HRI1 HI STORY REPORT
---IN-TANK f\L.,R/"1
T 4:DIESEL
LOW PRODUCT 14U-)Rf1 FEB 25, 2013 8:4~
FEB 15. 2013 15 :06 FEB 12, 2013 22:00
INVALID FUEL LEVEL
FEU 25. 2013 11:21
FEB 15. 2013 lb :06
FEB 12. 2013 23 :28
PROBE OUT
DEC 14, 201~ 14 12
DEC 14, 2012 10 02
DEC 18. 2012 9 58
DELIVER\' NEt.:UED MAR 3. 2013 17 15
FEB 4, 2013 15 04 JAN 4. 2013 21 27
ALARI'1 HI STORY REPORT
-----SENSOR I-ILARt-1
L 1 : 87 ANNULAR STP Sll"1P
FUEL ALARI1 JUN 29 . 2012 13:40
FllEL HLARH
JUN 29. 2012 13:40
FUEL ,.,:.ARI'l
JUN 29, 2012 13:39
ALARM HISTORY REPORT
-----SENSOR HLARH L 2 :9t-87ANNULAR
ANNULAR SPACE FUEL ALARI'l JAN 17. 2013 16 :35
FUEL ALARM
JUN 29. 2012 15:06
SENSOR OUT ALHRI•l
JUN 29, 2012 14:47
ALAR~ I HI STORY REPORT
-----SENSOR ALARM
L 3:DIESEL ANNUL~R ANNULAR SPACE
SENSOR OUT AUIRM
FEB 29. 2012 10:57
FUEL ALARM
FEB 29, 2012 10 :53
SENSOR OUT ALARI'1 DEr 2, 2010 10:32
AL~RM HISTO~( REPORT
-----SENSOR ALAR1'1
L 4 :87 STP SUI'1P
STP SUMP FUEL ALAR11 FEB 29. 201~ 13:09
SENSOR OUT ALARI1 FEB 29. 2012 10:57
FUEL ALARI'l tO:<lb-FEB 29. 2012
ALARI1 H l STORY REPORT
-----SENSOR ALAI<11 -
L 5: 87 SVP . SUI·lP
PIpING Sut1P
FUEL ALARM FEB 29. 2012 12 :05
SENSOR OUT ALARM
FEB 29. 2012 10:57
FUEL ALARI'1 FEB 29. 2012 lJ:45
HLRF<~1 HI STORY REPORT
-----SENSOR ALARM
!. t.:C!I STP SL.tlP STP SUl'1P
SENSOR OUT ALARM
FEB 29 . 2012 10:57
FUEL ALARM
FEB 29. 2012 10:44
SENSOR OUT I-ILRRI-1 DEC 2. 2010 10:32
nLARI1 HISTORY REPORT
-----SENSOR ALARM
L ?:DIESEL STP
STP Sli1P
FUI:L ALI-\RI1
MAR 8. 2013 16:30·
FUEL ALI-\RI"l
FEB 25, 2013 17:05
FUEL ALARM
FEB 21 , 20 I 3 I I : I 7
ALARI"l HISTORY REPORT
-----SENSOR ALARM
L 8 : D I SP . I -2
DISPENSER PAN SENSOR OUT ALARM
FEB 29. 2012 10:57
FUEL ALARM
FEB 29. 2012 10:49
SENSOR OUT RLARt1
DEC 2. 2010 10:32
1-1LARi1 H ll:iTORY REJJORT
-----SENSOR A:....,P.t-1
L 9:DISP.3-4 DISPENSER PAN
FUEL ALARM
DEC 26. 2012 20:39
SENSOR OUT ALARI"l
FEB 29, 2012 10:57
FUEL ALARI"I
FEB 29, 2012 10:50
1-1LI1RM HISTORY REPORT
-----SENSOR ALARI"'
Ll 0 : D I SP . 5 6
DISPENSER PAN SENSOR OUT ALARM
FEB 29. 2012 10:57
FUEL ALARM
FEB 29, 2012 10:48
SENSOR OliT ALARt1 DEC 2. 2010 10 :32
Al.f.IR11 HI STORY J.<EPORT
-----SENSOR ALr'\Rt1
Lll :DISP. 7-8 DISPENSER PAN
FUEL RLARI"' FEB 11. 2013 15:27
SEI.SOR OUT ALARM FEB 29, 2012 10:57
FUEL ALARM
FEB 29. 2012 10:48
I
SYSTEM STATUS REPORT
T 4:DEL!VERY NEEDED
L 7: FUEL ~lLARM
OSWELL LIQUOR
100 S.OSWELL
BAKERSFIELD,CA
661-861-9769
1'1AR 1 5. <!0 13 9 : 24
SYSTEf"l STATUS REPORT ----------
T 4:DELIVERY NEEDED
L 7:FUEL ALARM
-----SENSOR 1-\LARt'l
L 4: 87 STP SU!1P
STP SUMP
FUEL ALARM MAR 15, 2013 9:25
SENSOR ALARI'-1
L 5:87 5'YP .SUI'IP
PIPING SUI1P FUEL ALARI1
!•tAR 15, 2013 9:26
-----SENSOR HLARM
L 6 :91 STP SU11P
STP Sl.ttP FUEL ALARI1
MAR 15. 2013 9 :27
----SENSOR ALARM L I : 87 ANNULAR
STP SUt-lP
FUEL ALARM MAR 15, 2013 9:28
-----SENSOR ALARM
L 2 :91-87ANNULAR
ANNULAR SPACE FUEL ALARM MAR 15, 2013 9 :28
-----SENSOR ALARt·l
L 3:DJESEL ANNULAR
ANNUL1-1R SPACE
FUEL ALARM
MAR 15, 2013 9:28
-----SENSOR ALf.\RM
L 8:DISP.1-2 DISPENSER PAN
FUEL HLARI"l MAR 15. 2013 9 :30
-----SENSOR ALARM
L 9:DJSP.3-4
DISPENSER PAN FUEL ALARM
MAR 15, 2013 9:31
----SENSOR ALARI'1
L10 :DISP.5-6 DISPENSER PAl~
FUEL ALARt-1
MAR 15, 2013 9 :31
-----SENSOR ALARI"l
Lll :DISP . 7-8
DISPENSER PAN
FUEL ALARM f"lf.\R I 5, 20 1 :J 9 : 32
------SENSOR ALARM
L 6:91 STP SUI"IP STP SUMP
SENSOR OUT ALARI"' MAR 15, 2013 9:35
-----SENSOR ALARt•l
L ?:DIESEL STP
STP SUt-IP
SENSOR OUT ALARM
f"'AR 15, 2013 9 :35
-----SENSOR ALARI"I
L 8:DISP .1 -2
DISPENSER PAN
SENSOR OUT ALARf"1
MAR 15, 2013 9:35
-----SE!4SOR 1-\LARI'l
L 9 :DISP.3-4
DISPENSER PAN
SENSOR OUT ALARM MAR 15 , 2013 9 :35
-----SENSOR ALARt1 L10:DISP.5-6
DISPENSER PAN
SENSOR OUT ALARM
MAR 15. 2013 9 :35
-----SENSOR I=ILAR11
Lll :DISP.7-8 DISPENSER PAN 3ENSOR OUT ALARM
MAR 15. 2013 9 :35
-----SENSOR ALARt1
L 1 : 87 ANNULAR
STP SUt1P SENSOR OUT ALARM
1'-lAR 1 5. 20 I 3 '3 : :J5
-----SENSOR ALARM L 2 :91-87ANNULAR
ANNULAR SPACE
SENSOR OUT ALARt1
MAR 15. 2013 9:35
SENSOR 1-\LHT<M L 3 :DIESEL ANNULAR ANNULAR SPACE
SENSOR OUT AL1-1Rt1 MAR 15. 2013 9:35
-----SENSOR ALARM
L 4 : 87 STP SUMF·
S'TP SUI"'P SENSOR OUT ALARt1
MAR 15. 2013 9:35
----SENSOR 1-\LRRM
L 5 : 87 SYP . SU1'1P
PIPING SUMP
SENSOR OUT ALAR~!
t"AR 15. 2013 9::35
-----SENSOR HLARt1
L 6:91 STP Sli'1P STP Sli'1P
SENSOR OUT ALARM
MAR 15. 2013 9:54
-----SENSOR ALARM
L 6:91 STP SUI'"IP STP SUI"'P FUEL ALARM
~~R 15. 2013 10:08
SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and
printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatOty agency.
1 FACILITY INFORMATION .
Facility Name: lndeco I Date of Testing: 3/15/2013
Facility Address: I 00 S Oswell St Bakersfield CA, 93307
Facility Contact: Ben Dashtipour I Phone: 661-366-251 1
Date Local Agency Was Notified ofTesting : 3/5/2013
Name of Local Agency Inspector (if present during testing): Ernie Medin a
2 TESTING CONTRACTOR INFORMATION .
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bryan A Self
Credentials 1: ~ CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester 0 Other (Specify)
License Number(s): CSLB# 804904 ICC# 8022804-UT Tank Tester 11-1756
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: ~ Hydrostatic 0 Vacuum 0 Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (By Tank I Regular UL 2 Regula r Slave UL 3 Super UL 4 Diesel
Number, Stored Product, etc.)
Bucket Installation Type: X Direct Bury X Direct Bury X Direct Bury X Direct Bury
0 Contained in Sump 0 Contained in Sump 0 Contained in Sump 0 Contained in Sump
Bucket Diameter: 12.00" 12.00" 12.00" 12.00"
Bucket Depth: 12.00" 12.00" 13.50" 12 .00"
Wait time between applying 5MTN 5MIN 5 MIN 5MTN vacuum/water and start of test:
Test Start Time {T1): 9:00AM 9:00AM 9:00AM 9:00AM
Initial Reading {R1): 10.00" 10.25" 11.25" 10.00"
Test End Time (Tp): 10:00 AM 10:00 AM 10:00 AM 10:00 AM
Final Reading (Rp): 10.00" 10.25" 11.25" 10.00"
Test Duration (TF-T1): I HOUR I HOUR I I-lOUR I HOUR
Change in Reading (RF-R.): 0.00" 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" 0.0625" Criteria:
Test Result: X Pass 0 Fail X Pass 0 Fail X Pass 0 Fail X 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
I ltereby certify that all tlte information contained in this report is true, ace rate, ami in full compliance witlt legal requirements.
Date:03/ 15/20 13
1 State laws and regulations do not current y require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
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Name:
Street:
City:
Terms:
~fiD~~ ~UsT~
"'.s-~-~'iiuc-t\0
"BUILD WITH CONFIDENCE•
Lic.970703
·coMPLIANCE WITH CONFIDENCE"
Lic.804904
To ll Free#: 1-800-339-9930
Confidence UST
16250 Meacham Road
Bakersfield CA 93312
Descriotion of work oerformed:
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f\tNY~ +~.~+IIWL
7L)P, ( •1LYlA ~ s;:.,.N\. ct., A/ ,\,._ v
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Jo b Order /Invoice #: ·so'fB{
Date Called Time To Whom
Site Name: ..:LiN~"'r ,n_ I (;,o..g r,.,
Street: ltlli _\' (') S't ' ,;::>J \ S.f
City: ~Jip,.rs,:f!,'.,. Jd State:CA Zip: q3'-s'~
Store No:
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,/
TRAVEL and LABOR (0.5 Hour Minimum Labor Charge) OVERTIME (5:00 PM -7:00AM)
Date Technician(s) Name Start End Total OTStart OTEnd OTTotal
I -;Jt~ II~ f\r\/n\11 A ~}-(. Travel
labor .0
Travel
Date Technician(s) Name Start End Total OT Start OTEnd OTTotal
Travel
Labor
Travel
Date Technician(s) Name Start End Total OTStart OTEnd OTTotal
Travel
Labor
Travel
SUPPLIES -MATERIALS -RENTALS Check One
Qty. UST Parts Site Parts
\. \JI"PA..,...rO_r.--A Z.tJP., ( ,:.,e,,. ,A ~-'·~c:;;;...,r ?(
\, Slf' >:"t .IAA 0 t'-.r.._"\ lb.+ )(
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COMMENTS
Store Employee Pnnt Name·