HomeMy WebLinkAboutFMC/Line RESULTS 11-3-16MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of CaliforniaAuthority 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:Bldg. No.:
Site Address:City:Zip:
Facility Contact Person: Contact Phone No.:
Make/Model of Monitoring System:Date of Testing/Servicing:
B.Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced:
Tank ID:Tank ID:
In-Tank Gauging Probe.Model:In-Tank Gauging Probe.Model:
Annular Space or Vault Sensor.Model:Annular Space or Vault Sensor.Model:
Piping Sump / Trench Sensor(s).Model:Piping Sump / Trench Sensor(s).Model:
Fill Sump Sensor(s).Model:Fill Sump Sensor(s).Model:
Mechanical Line Leak Detector.Model:Mechanical Line Leak Detector.Model:
Model:Model:
Tank ID:Tank ID:
In-Tank Gauging Probe.Model:In-Tank Gauging Probe.Model:
Annular Space or Vault Sensor.Model:Annular Space or Vault Sensor.Model:
Piping Sump / TrenchSensor(s).Model:Piping Sump / Trench Sensor(s).Model:
Fill Sump Sensor(s).Model:Fill Sump Sensor(s).Model:
Mechanical Line Leak Detector.Model:Mechanical Line Leak Detector.Model:
Model:Model:
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).
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).
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/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, I have also
attached a copy of the report;(check all that apply):System set-up Alarm history report
Technician Name (print):Signature:
Certification No.:License. No.:804904
Testing Company Name:Confidence UST Services, Inc.Phone No.:(800)339-9930
Site Address:Date of Testing/Servicing:
Page 1 of 3
#1001/WholesaleFuels,Inc.
2200EastBrundageLane
OmeroGarcia
Veeder-RootTLS-350
10,000gal.T-1L-SClearDiesel
847390-107
794390-208
Electronic Line Leak Detector. PLLD
Tank Overfill / High-Level Sensor. Model: 847390-107
Other (specify equipment type and model in Section E on Page 2).
10,000gal.T-2L-SDyedDiesel
847390-107
794390-208
Electronic Line Leak Detector. PLLD
Tank Overfill / High-Level Sensor. Model: 847390-107
Other (specify equipment type and model in Section E on Page 2).
20,000galT-3ClearDiesel
847390-107
794390-208
Electronic Line Leak Detector. PLLD
Tank Overfill / High-Level Sensor. Model: 847390-107
Other (specify equipment type and model in Section E on Page 2).
20,000gal.T-4Unleaded
847390-107
794390-208
Electronic Line Leak Detector. PLLD
Tank Overfill / High-Level Sensor. Model: 847390-107
Other (specify equipment type and model in Section E on Page 2).
T-1L-SClearDiesel
847990-001
T-2L-SDyedDiesel
847990-001
T-3ClearDiesel
847990-001 847990-001
T-4Unleaded
T-5DyedDiesel
847990-001
T-6DyedDiesel
847990-001
2200EastBrundageLane
847990-001
847990-001
847990-001 847990-001
Bakersfield 93307
661-393-7000
11/03/2016
Bradley Seykora
B40738
11/03/2016
X X
, Bakersfield, CA 93307
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of CaliforniaAuthority 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:Bldg. No.:
Site Address:City:Zip:
Facility Contact Person: Contact Phone No.:
Make/Model of Monitoring System:Date of Testing/Servicing:
B.Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced:
Tank ID:Tank ID:
In-Tank Gauging Probe.Model:In-Tank Gauging Probe.Model:
Annular Space or Vault Sensor.Model:Annular Space or Vault Sensor.Model:
Piping Sump / Trench Sensor(s).Model:Piping Sump / Trench Sensor(s).Model:
Fill Sump Sensor(s).Model:Fill Sump Sensor(s).Model:
Mechanical Line Leak Detector.Model:Mechanical Line Leak Detector.Model:
Model:Model:
Tank ID:Tank ID:
In-Tank Gauging Probe.Model:In-Tank Gauging Probe.Model:
Annular Space or Vault Sensor.Model:Annular Space or Vault Sensor.Model:
Piping Sump / TrenchSensor(s).Model:Piping Sump / Trench Sensor(s).Model:
Fill Sump Sensor(s).Model:Fill Sump Sensor(s).Model:
Mechanical Line Leak Detector.Model:Mechanical Line Leak Detector.Model:
Electronic Line Leak Detector.Model:Electronic Line Leak Detector.Model:
Tank Overfill / High-Level Sensor.Model:Tank Overfill / High-Level Sensor.Model:
Other (specify equipment type and model in Section E on Page 2).Other (specify equipment type and model in Section E on Page 2).
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).
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).
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/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, I have also
attached a copy of the report;(check all that apply):System set-up Alarm history report
Technician Name (print):Signature:
Certification No.:License. No.:804904
Testing Company Name:Confidence UST Services, Inc.Phone No.:(800)339-9930
Site Address:Date of Testing/Servicing:
Page 1 of 3
Bakersfield 93307
Veeder-Root TLS-350
20,000gal.T-5L-SDyedDiesel
■847390-107
■794380-208 794380-208
■
■
Electronic Line Leak Detector. PLLD
Tank Overfill / High-Level Sensor. Model: 847390-107
Other (specify equipment type and model in Section E on Page 2).
20,000gal.T-6L-SDyedDiesel
■847390-107
■
■
■
Electronic Line Leak Detector. PLLD
Tank Overfill / High-Level Sensor. Model: 847390-107
Other (specify equipment type and model in Section E on Page 2).
20,000gal.(AST)T-7L-SDyedDiesel
■847390-107 ■
■847390-107
12,000gal.(AST)T-8ClearDiesel
847390-107
■847390-107
B40738
#1001/WholesaleFuels,Inc.
2200EastBrundageLane
OmeroGarcia 661-393-7000
11/03/2016
Bradley Seykora
2200 East Brundage Lane, Bakersfield, CA 93307 11/03/2016
Monitoring System Certification
D.Results of Testing/Servicing
Software Version Installed:
Complete the following checklist:
Yes No*Isthe 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*
N/A
If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem)
operational?
Yes No*
N/A
For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
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*
N/A
For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no
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 oftank capacity does the alarm trigger? %
Yes*NoWas 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*NoWas liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
Product; Water. If yes, 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 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
123.02
90
The veeder-Root 001 standalone sensor in UDC #3 was replaced during testing
Diesel was found and removed from the STP sump for tank #4
Monitoring System Certification
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 No*Were all tank gauging probes visually inspected for damage and residue buildup?
Yes No*Was accuracy of system product level readings tested?
Yes No*Was accuracy of system 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 the Section H, below, describe how and when these deficiencies were or will be corrected.
G.Line Leak Detectors (LLD):Check this box if LLDs are not installed.
Complete the following checklist:
Yes No*
N/A
For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
(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 No*
N/A
For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
Yes No*
N/A
For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
Yes No*
N/A
For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
or disconnected?
Yes No*
N/A
For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions
or fails a test?
Yes No*
N/A
For electronic LLDs, have all accessible wiring connections been visually inspected?
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:
Page 3 of 3
Leak Detector Test Results Sheet
Customer Address: Work Order: Site Address:
Test Date:
Site Contact:
Technician:
Phone: 661-393-7000
Phone: 800-339-9930 ICC No.:
Product Type LLD Type Model Serial No. Check
Valve
Holding
Pressure
Bleed
Off ML.
Leak
Rate
Tested:
Pass/Fail
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
Technician Name: Technician No.:
Signature: Date:
WholesaleFuels,Inc.
POBox82277
Bakersfield,CA93380-2277
37790
L-SClearDSL Electronic PLLD
OmeroGarcia
2200EastBrundageLane
#1001/WholesaleFuels,Inc.
18 PSI135 ml Pass
PLLDElectronicL-SDyedDSL 20 PSI300 ml Pass
PLLDElectronicClearDSL 22 PSI130 ml Pass
PLLDElectronicUnleaded 20 PSI160 ml Pass
PLLDElectronicL-SDyedDSL 27 PSI100 ml Pass
PLLDElectronicL-SDyedDSL 19 PSI210 ml Pass
11/03/2016
Bradley Seykora 8111231-UT
Bradley Seykora
11/03/2016
B40738
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 forsubmittal to the local regulatory agency.
1.FACILITY INFORMATION
Facility Name:Date of Testing:
Facility Address:
Facility Contact:Phone:
Date Local Agency Was Notified of Testing :
Name of Local Agency Inspector (if present during testing):
2.TESTING CONTRACTOR INFORMATION
Company Name:Confidence UST Services, Inc.
Technician Conducting Test:
Credentials1:CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Specify)
License Number(s):CSLB#804904 ICC#
3.SPILL BUCKET TESTING INFORMATION
Test Method Used:Hydrostatic Vacuum Other
Test Equipment Used:Lake Test Equipment Resolution:0.0625”
Identify Spill Bucket (By Tank
Number, Stored Product, etc.)
1234
Bucket Installation Type: Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Bucket Diameter:
Bucket Depth:
Wait time between applying
vacuum/water and start of test:
Test Start Time (TI):
Initial Reading (RI):
Test End Time (TF):
Final Reading (RF):
Test Duration (TF – TI):
Change in Reading (RF -RI):
Pass/Fail Threshold or
Criteria:
Test Result: Pass Fail Pass Fail Pass Fail Pass 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 hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician’s Signature:________________________________________________ Date:_________
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
#1001/WholesaleFuels,Inc.
2200EastBrundageLane
OmeroGarcia
T-1L-SClearDiesel
12.00"
14.25"
5min.
8:30 am
9.50"
9:30 am
9.50"
1hour
0.00"
0.0625"
T-2L-SDyedDiesel
12.00"
13.75"
5min.
8:30 am
10.00"
8:50 am
8.00"
20 min.
2.00"
0.0625"0.0625"
T-3ClearDiesel
12.00"
13.75"
5min.
8:30 am
9.50"
9:30 am
9.50"
1hour
0.00"
T-4Unleaded
12.00"
14.00"
5min.
8:30 am
9.50"
9:30 am
9.50"
1hour
0.00"
0.0625"
11/03/2016
, Bakersfield, CA 93307
(661)393-7000
10/27/2016
Kristopher Karns
Bradley Seykora
X
8111231-UT
X
11/03/2016
X
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 forsubmittal to the local regulatory agency.
1.FACILITY INFORMATION
Facility Name:Date of Testing:
Facility Address:
Facility Contact:Phone:
Date Local Agency Was Notified of Testing :
Name of Local Agency Inspector (if present during testing):
2.TESTING CONTRACTOR INFORMATION
Company Name:Confidence UST Services, Inc.
Technician Conducting Test:
Credentials1:CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Specify)
License Number(s):CSLB#804904 ICC#
3.SPILL BUCKET TESTING INFORMATION
Test Method Used:Hydrostatic Vacuum Other
Test Equipment Used:Lake Test Equipment Resolution:0.0625”
Identify Spill Bucket (By Tank
Number, Stored Product, etc.)
1234
Bucket Installation Type: Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Bucket Diameter:
Bucket Depth:
Wait time between applying
vacuum/water and start of test:
Test Start Time (TI):
Initial Reading (RI):
Test End Time (TF):
Final Reading (RF):
Test Duration (TF – TI):
Change in Reading (RF -RI):
Pass/Fail Threshold or
Criteria:
Test Result: Pass Fail Pass Fail Pass Fail Pass 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 hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician’s Signature:________________________________________________ Date:_________
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
#1001/WholesaleFuels,Inc.11/03/2016
2200EastBrundageLane
OmeroGarcia (661)393-7000
10/27/2016
Kristopher Karns
Bradley Seykora
8111231-UT
T-5L-SDyedDiesel
12.00"
14.00"
5min.
8:30 am
9.75"
9:30 am
9.75"
1hour
0.00"
0.0625"
T-6L-SDyedDiesel
12.00"
14.25"
5min.
8:30 am
9.75"
9:30 am
9.75"
1hour
0.00"
0.0625"
11/03/2016
, Bakersfield, CA 93307
X
T-2 L-S Dyed Diesel(Re-Test)
X
12.00"
13.75"
5 min.
10:00 am
9.75"
11:00 am
9.75"
1 hour
0.00"
0.0625"
X
T-2 L-S Dyed Diesel original Spill Bucket failed. Replaced and retested with a new Spill Bucket , passed.
Confidence UST Services, Inc.
16250 Meacham Road, Bakersfield, CA 93314 800-339-9930 or 661-631-3870
FINAL TEST RESULTS
ALERT 1000 / ALERT 1050 / TEI LT-3 / VMI LDT-890
CUSTOMER ADDRESS:WORK ORDER: SITE ADDRESS:
TEST DATE:
SITE CONTACT: PHONE:
TECHNICIAN: PHONE: LICENSE:
WATER IN BACKFILL: DATE & TIME OF LAST FUELDELIVERY:
____________________________________________________________________________
TANK INFORMATION:
(WETTED) TANK 1 TANK 2 TANK 3 TANK 4
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
ALERT 1050XALERT 1050X ALERT 1050X ALERT 1050X
ULLAGE GALLONS:
START PRESSURE:
END PRESSURE:
TEST RESULT:
PRODUCT LINES:TEI LT-3TEI LT-3TEI LT-3 TEI LT-3
LINE TYPE:
START TIME:
END TIME:
TEST PRESSURE:
FINAL LEAK RATE:
TEST RESULT:
MECHNICAL LINE
LEAK DETECTORS:VMI LDT-890VMI LDT-890VMI LDT-890 VMI LDT-890
MODEL:
SERIAL NUMBER:
CHECK VALVE PSI:
BLEED OFF ml:
LEAK RATE TESTED:
TEST RESULT:
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.
TECHNICIAN SIGNATURE:DATE:MANUFACTURER CERTIFICATION NO:
WholesaleFuels,Inc.
P.O.Box82277
Bakersfield,CA93380-2277
37790
#1001/WholesaleFuels,Inc.
2200EastBrundageLane
OmeroGarcia
(800)339-9930 15-1763
L-SClearDiesel L-SDyedDiesel ClearDiesel 87Unleaded
Pressure
1:45 pm
2:00 pm
82 PSI
0 ml
Pass
Pressure
1:45 pm
2:00 pm
82 PSI
0 ml
Pass
Pressure
2:30 pm
2:45 pm
65 PSI
0 ml
Pass
Pressure
3:00 pm
3:15 pm
65 PSI
0 ml
Pass
TMI-156
11/03/2016 Bakersfield, CA 93307
(661)393-7000
Bradley Seykora
11/03/2016
Confidence UST Services, Inc.
16250 Meacham Road, Bakersfield, CA 93314 800-339-9930 or 661-631-3870
FINAL TEST RESULTS
ALERT 1000 / ALERT 1050 / TEI LT-3 / VMI LDT-890
CUSTOMER ADDRESS:WORK ORDER: SITE ADDRESS:
TEST DATE:
SITE CONTACT: PHONE:
TECHNICIAN: PHONE: LICENSE:
WATER IN BACKFILL: DATE & TIME OF LAST FUELDELIVERY:
____________________________________________________________________________
TANK INFORMATION:
(WETTED) TANK 1 TANK 2 TANK 3 TANK 4
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
ALERT 1050XALERT 1050X ALERT 1050X ALERT 1050X
ULLAGE GALLONS:
START PRESSURE:
END PRESSURE:
TEST RESULT:
PRODUCT LINES:TEI LT-3TEI LT-3TEI LT-3 TEI LT-3
LINE TYPE:
START TIME:
END TIME:
TEST PRESSURE:
FINAL LEAK RATE:
TEST RESULT:
MECHNICAL LINE
LEAK DETECTORS:VMI LDT-890VMI LDT-890VMI LDT-890 VMI LDT-890
MODEL:
SERIAL NUMBER:
CHECK VALVE PSI:
BLEED OFF ml:
LEAK RATE TESTED:
TEST RESULT:
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.
TECHNICIAN SIGNATURE:DATE:MANUFACTURER CERTIFICATION NO:
WholesaleFuels,Inc.
P.O.Box82277
Bakersfield,CA93380-2277
37790
#1001/WholesaleFuels,Inc.
2200EastBrundageLane
OmeroGarcia
(800)339-9930 15-1763
L-SDyedDiesel L-SDyedDiesel
PressurePressure
4:15 pm
4:30 pm
65 PSI
0 ml
Pass
TMI-156
11/03/2016 Bakersfield, CA 93307
Bradley Seykora
(661)393-7000
11/03/2016