HomeMy WebLinkAbout2600 WHITE LANE FMC 2013q'.02t Q k
HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No.
File Number: 3 . 7 7 7
Date Received: 2'-6, --
Address:
Permit No. Permit No. Permit No.
0
Business Name: :!fs ke-C._
T.-) -
SYSTEM: E BUILDING SQUARE FEET:
New Mod.
Commercial Hood System Building Sq. Feet:
Fire Alarm System Calculation Bldg. Sq. Ft: 1.
Fire Sprinkler System 2.
Spray FWsh System 3.
Aboveground Storage Tank 4.
Underground Storage Tank
minor
modification Underground Storage Tank
removal Underground Storage Tank
tY Other.
INSPECTION LOG
Date Time
S
Signature
Comments: -TEd.
SCG:9 5,299X5-2 Exe-
VR 836 Fra-o exe
MONITORING SYSTEM CERTIFICATION
For Use ByAll Jurisdictions Within the State ofCalifornia
Authority Cited: Chapter 6 7, Health andSafety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each
monit9drig system control aenel 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 ofthis form to the local agency regulating UST systems within 30 days of test date.
A. General Information
Facility Name: WHITE LN SHELL
Site Address: 2600 WHITE LN City: BAKERSFIELD
Bldg. No.:
Zip:
Facility Contact Person: LOUNG CHAO Contact Phone No.: ( )
Make/Model of Monitoring System: TLS -350 Date of Testing/Servicing: 8/21/2013
B. Inventory of Equipment Tested/Cerdfled
Check the anorooriate boxes to indicate soecitic eauioment iasnected /serviced:
Tank ID: UNL87 Tank ID: PREM91
Z In -Tank Gauging Probe. Model: MAGI Z In -Tank Gauging Probe. Model: MAGI
Annular Space or Vault Sensor. Model: 303 Annular Space or Vault Sensor. Model: 303
Z Piping Sump / Trench Sensor(s). Model: 208 Z Piping Sump/ Trench Sensor(s). Model: 208
Fill Sump Sensor(s). Model: 208 Z Fill Sump Sensor(s). Model: 208
Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model:
Z Electronic Line Leak Detector. Model: VEEDER -ROOT Z Electronic Line Leak Detector. Model: VEEDER -ROOT
Z Tank Overfill / High -Level Sensor. Model: BALL FLOAT IS Tank Overfill / High -Level Sensor, Model: BALL FLOAT
Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2).
Tank ID: DIESEL Tank ID:
Z in -Tank Gauging Probe. Model: MAGI In -Tank Gauging Probe. Model:
Annular Space or Vault Sensor. Model: 303 Annular Space or Vault Sensor. Model:
Z Piping Sump / Trench Sensor(s). Model: 208 Piping Sump / Trench Sensor(s). Model:
Fill Sump Sensor(s). Model: 208 El Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model:
Electronic line LeakDetector. Model: VEEDER -ROOT Electronic Line Leak Detector. Model:
Z Tank Overfill / High -Level Sensor. Model: BALL FLOAT 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: 1 -2 Dispenser ID: 3-4
Z Dispenser Containment Sensor(s). Model: 208 Dispenser Containment Sensor(s). Model: 208
Z Shear Valve(s). Z Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 5-6 Dispenser ID: 7.8
Dispenser Containment Sensor(s). Model: 208 • Dispenser Containment Sensor(s). Model: 208
ShearValve(s). Z Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 9 -10 Dispenser ID:
Z Dispenser Containment Sensor(s). Model: 208 Dispenser Containment Sensor(s). Model:
Z Shear Valve(s). Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s).
Ifthe facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility.
C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers'
guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary 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 ofthe report; (check all that apply): ® System set -up ® Alarm history report
Technician Name (print): RICHARD MASON Signature:
Certification No.: 63688015297857 -UT License. No.: C611 D40 809850
Testing Company Name: RICH ENVIRONMENTAL Phone No.: (661) 392 -8687
Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date ofTesting/Servicing: 821113
Page 1 of 4
UN- 036 —1/4 www.unidoes.org Rev. 01/17/08
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed: 327.04
Complete the follo ing checklist:
Yes No* Is the audible alarm operational?
Yes No* Is the visual alarm operational?
Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational?
Yes No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their proper operation?
Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem)
N/A operational?
Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? Ifyes: which sensors initiate
positive shut -down? (Check all that apply) ® Sump/Trench Sensors; ® Dispenser Containment Sensors.
Did you confirm positive shut -down due to leaks and sensor failure /disconnection? ® Yes; No.
Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no
N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank
fill point(s) and operating properly? Ifso, at what percent oftank capacity does the alarm trigger? %
Yes* No Was any monitoring equipment replaced? Ifyes, identify specific sensors, probes, or other equipment replaced
and list the manufacturer name and model for all replacement parts in Section E, below.
Yes* No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
Product; Water. Ifyes, describe causes in Section E, below.
Yes No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, ifapplicable
Yes 1 No* 1 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 4
UN- 036 — 2/4 www.unidotLorg Rev. 01 /17/08
Monitoring System Certification
F. In -Tank Gauging / SIR Equipment: Check this box iftank gauging is used only for inventory control.
Check this box ifno 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 ofsystem 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 Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD):
Cmmnlete the follnwing checklist:
Check this box if LLDs are not installed.
Yes No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
N/A Check all that apply) Simulated leak rate: ® 3 g.p.h.; [10. 1 g.p.h ; [10.2 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* For mechanical LLDs, does the LLD restrict product flow ifit detects a leak?
NIA
Yes No* For electronic LLDs, does the turbine automatically shut off ifthe LLD detects a leak?
N/A
Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
N/A or disconnected?
Yes No* For electronic LLDs, does the turbine automatically shut off ifany portion ofthe monitoring system malfunctions
N/A or fails a test?
Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected?
N/A
Yes I No* I Were all items on the equipment manufacturer's maintenance checklist completed?
In Section M below, describe how and when these deficiencies were or will be corrected.
H. Comments:
UN -036 — 3/4
Page 3 of 4
www.unidocs.org Rev. olm/os
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RICH ENVIRONMENTAL
5643 BROOKS CT. BAKERSFIELD, CA. 93308
OFFICE (661)392 -8687 FAX (661)392 -0621
PRODUCT LINE LEAK DETECTOR TEST
WORK SHEET
W /0 #:
FACILITY NAME: WHITE LANE SHELL
FACILITY ADDRESS: 2600 WHITE LANE, BAKERSFIELD
PRODUCT LINE TYPE: PRESSURE
PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS
BELOW P.S.I. OR
SERIAL NUMBER 3 G.P.H. FAIL
UNL87 L/D TYPE: ELECTRONIC
YES 11 PASS
SERIAL # VEEDER -ROOT
PREM91 L/D TYPE: ELECTRONIC
YES 11 PASS
SERIAL # VEEDER -ROOT
DIESEL L/D TYPE: ELECTRONIC
YES it PASS
SERIAL # VEEDER -ROOT
L/D TYPE YES PASS
SERIAL # NO FAIL
I CERTIFY THE ABOVE TESTS WERE CONDUCTED ON THIS DATE ACCORDING TO RED
JACKET PUMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMITATIONS.
THE MECHANICAL LEAK DETECTOR TEST PASS / FAIL IS DETERMINED BY USING A
LOW FLOW THRESHOLD TRIP RATE OF 3 GALLONS PER HOUR OR LESS AT 10 P.S.I. I
ACKNOWLEDGE THAT ALL DATA COLLECTED IS TRUE AND CORRECT TO THE BEST
OF MY KNOWLEDGE.
TECHNICIAN: RICHARD MASON
SIGNATURE: t ( V r
DATE: 8/21/13
0• t ,j
SWRCB, January 2006
Spill Bucket Testing Report Form
Thisform is intendedfor use by contractorsperforming annual testing ofUSTspill containment structures. The completedform and
printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: WHITE LN SHELL Date of Testing: 8/21/13
Facility Address: 2600 WHITE LANE, BAKERFIELD
Facility Contact: I Phone:
Date Local Agency Was Notified ofTesting: 8/1/13
Name ofLocal Agency Inspector (ifpresent during testing): ERNIE MEDINA
2_ TFSTiNG CONTRArTnR iNFnRMATinN
Company Name: RICH ENVIRONMENTAL
Technician Conducting Test: RICHARD MASON
Credentials': CSLB Contractor X ICC Service Tech. SWRCB Tank Tester 0 Other (Spec)
License Number(s): 5297857 -UT
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: X Hydrostatic Vacuum Other
Test Equipment Used: VISUAL Equipment Resolution: 0.00
Identify Spill Bucket (By Tank
Number, Stored Product, etc.
t UNL87 2 PREM91 3 DIESEL 4
Bucket Installation Type: Direct Bury
X Contained in Sump
Direct Bury
X Contained in Sump
Direct Bury
X Contained in Sump
Direct Bury
Contained in Sum
Bucket Diameter: 12" 12" 12"
Bucket Depth: 16" 16" 16"
Wait time between applying
vacuum/water and start oftest: 30MIN 30MIN 30MIN
Test Start Time (TO: 1:45 1:45 1:45
Initial Reading (Rj): 16" 16" 16"
Test End Time (TF): 2:45 2 :45 2:45
Final Reading (RF): 16" 16" I6"
Test Duration (TF — TO: 60MIN 60MIN 60MIN
Change in Reading (RF - Rj): 0 0 0
Pass/Fail Threshold or
Criteria: 0 0 0
Test Result: X Pass Fail X Pass Fail X Pass []Fail 0 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.
Technician's Signature: / — Date: 8/21/13
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
SYSTEM SETUP
AUG 21, 2013 1:14 PM
CUSTOM ALARMS
DISABLED
MASS /DENSITY
n r OAOT nn
SYSTEM UNITS
U.S.
IN -TANK SETUP COMMUNICATIONS SETUP SYSTEM LANGUAGE
ENGLISH
SYSTEM DATE /TIME FORMAT
T 1 :UNL MON DD YYYY HH :MM:SS xM
PRODUCT CODE 1 PORT SETTINGS:
THERMAL COEFF :.000700 WHITE LANE SHELL
TANK DIAMETER : 92.00 COMM BOARD 1 <EDIM ) COM232 2600 WHITE LANE
TANK PROFILE : 4 PTS SECURITY BAKERSFIELD
FULL VOL 9728 CODE DISABLED
69.0 INCH VOL : 7910
46.0 INCH VOL 4864 COMM BOARD 2 (RS -232) SHIFT TIME 1 DISABLED
23.0 INCH VOL 1818 BAUDBAUD RATEBR : 1200 SHIFT TIME 2 DISABLED
ODD SHIFT TIME 3 DISABLED
STOP BIT 1 STOPI SHIFT TIME 4 DISABLED
FLOAT SIZE: 4.0 IN. DATA LENGTH: DATA
RS -232 SECURITY TANK PER TST NEEDED WRN
WATER WARNING 2.0 CODE : DISABLED DISABLED
HIGH WATER LIMIT: 3.0 TANK TST NEEDED WRNCOMMHOARD3 {FXMOD)
MAX OR LABEL VOL: 9728 BAUD RATE : 2400
OVERFILL LIMIT METHOD
8755 STOP BIT I STOP PASS
LINEN
TEST
HIGH PRODUCT 95% DATA LENGTH: 7 DATA
9241 RS -232 SECURITY LINE PER TST NEEDED WRN
DELIVERY LIMIT 10% CODE : DISABLED DISABLED
972 DIAL TYPE : TONE LINE ANN TST NEEDED WRN
ANSWER ON : 1 RING DISABLED
LOW PRODUCT 500 MODEM SETUP STRING
LEAK ALARM LIMIT: 99 PRINT TC VOLUMES
SUDDEN LOSS LIMIT: 200 DIAL TONE INTERVAL: 32 ENABLED
TANK TILT 0.00
PROBE OFFSET 0,00 C
AUTO TRANSMIT SETTINGS: VALUE
EGNFAT:
60.0
STICK HEIGHT OFFSET
SIPHON MANIFOLDED TANKS AUTO LEAK ALARM LIMIT DISABLED
Tit: NONE DISABLED ULLAGE: 90%
LINE MANIFOLDED TANKS AUTO HIGH WATER LIMIT
T #: NONE DISABLED H- PROTOCOL DATA FORMATAUTOOVERFILLLIMITHEIGHTDISABLEDPRECISIONTESTDURATION
LEAK MIN PERIODIC: 10% AUTO LOW PRODUCT HOURS: 12
972 DISABLED DAYLIGHT SAVING TIME
AUTO THEFT LIMIT ENABLED
LEAK MIN ANNUAL 10% DISABLED START DATE
942 AUTO DELIVERY START APR WEEK 1 SUNDISABLEDSTARTTIMEAUTODELIVERYEND2:00 AM
PERIODIC TEST TYPE DISABLED END DATE
STANDARD AUTO EXTERNAL INPUT ON OCT WEEK 6 SUN
DISABLED END TIME
ANNUAL TEST FAIL AUTO EXTERNAL INPUT OFF 2:00 AM
ALARM DISABLED DISABLED
AUTO SENSOR FUEL ALARM RE- DIRECT LOCAL PRINTOUT
PERIODIC TEST FAIL DISABLED DISABLED
ALARM DISABLED AUTO SENSOR WATER ALARM
DISABLED EURO PROTOCOL PREFIX
GROSS TEST FAIL AUTO SENSOR OUT ALARM S
ALARM DISABLED DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF SYSTEM SECURITY
CODE : 000000
TANK TEST NOTIFY: OFF
RECEIVER SETUP: MAINTENANCE HISTORY
TNK TST SIPHON BREAK:OFF DISABLED
NONE
DELIVERY DELAY : 15 MIN
PUMP THRESHOLD : 10.00% TANK CHART SECURITY
DISABLED
CUSTOM ALARMS
DISABLED
MASS /DENSITY
n r OAOT nn
LEAK TEST METHOD
TEST ON DATE : ALL TANK
FEB 6, 2007
START TIME :.DISABLED
TEST RATE :0.20 GAL/HR
DURATION : 2 HOURS
TST EARLY STOP:DISABLED
LEAK TEST REPORT FORMAT
NORMAL
PRESSURE LINE LEAK SETUP
A 1:87 STP
TYP:2.0i3,0IN FIBERGLASS
2.0IN DIA LEN: 150 FEET
3.0IN DIA LEN: 0 FEET
SHUTDOWN RATE: 3.0 GPH
LOW PRESSURE SHUTOFF:NO
LOW PRESSURE : 0 PSI
T 1:UNL
DISPENSE MODE:
STANDARD
SENSOR: NON— VENTED
PRESSURE OFFSET: O.OPSI
8 2:91 STP
TYP:2.0i3.0IN FIBERGLASS
2.0IN DIA LEN: 150 FEET
3.0IN DIA LEN: 0 FEET
SHUTDOWN RATE: 3.0 GPH
LOW PRESSURE SHUTOFF:NO
LOW PRESSURE 0 PSI
T 2:PREM
DISPENSE MODE:
STANDARD
SENSOR: NON— VENTED
PRESSURE OFFSET: O.OPSI
T 3:DIESEL ' T'2:PREM
PRODUCT CODE 3 PRODUCT CODE 2
THERMAL COEFF 000450 THERMAL COEFF 000700
TANK DIAMETER 92.00 TANK DIAMETER 92.00
TANK PROFILE 4 PTS TANK PROFILE 4 PTS
FULL VOL 9728 FULL VOL 9728
69.0 INCH VOL 7910 69.0 INCH VOL 7910
46.0 INCH VOL 4864 46.0 INCH VOL 4864
23.0 INCH VOL 1818 23.0 INCH VOL 1818
FLOAT SIZE:
WATER WARNING
HIGH WATER LIMIT:
MAX OR LABEL VOL:
OVERFILL LIMIT :
HIGH PRODUCT
DELIVERY LIMIT
4.0 IN.
2.0
3.0
LOW PRODUCT
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT
PROBE OFFSET
9728
92%
8949
97%
9436
109
972
500
99
200
0.00
0.00
SIPHON MANIFOLDED TANKS
T#: NONE
LINE MANIFOLDED TANKS
T #: NONE
LEAK MIN PERIODIC: 10%
972
LEAK MIN ANNUAL 10%
972
FLOAT SIZE:
WATER WARNING
HIGH WATER LIMIT:
MAX OR LABEL VOL:
OVERFILL LIMIT :
HIGH PRODUCT .
DELIVERY LIMIT
4.0 IN.
2.0
3.0
LOW PRODUCT
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT
PROBE OFFSET
9728
90%
8755
959
9241
1046
972
500
99
220
0.00
0.00
SIPHON MANIFOLDED TANKS
T #: NONE
LINE MANIFOLDED TANKS
T #: NONE
LEAK MIN PERIODIC: 10:
972
LEAK MIN ANNUAL 10s:
972
PERIODIC TEST TYPE PERIODIC TEST TYPE
STANDARD 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
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 15 MIN
PUMP THRESHOLD : 10.0
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
PUMP THRESHOLD 10.009
PLLD LINE DISABLE SETUP
Q 1:87 STP
LIQUID SENSOR ALMS
L 3:FUEL ALARM
L 4:FUEL ALARM
L 5:FUEL ALARM
L 6:FUEL ALARM
L 7:FUEL ALARM
L 9:FUEL ALARM
ISD SITE ALARMS
ISD GROSS PRES FAIL
ISD DEGRD PRES FAIL
ISD VAPOR LEAK FAIL
ISD VP PRES FAIL
ISD HOSE ALARMS
ALL:GROSS COLLECT FAIL
ALL:DEGRD COLLECT FAIL
ALL:FLOW COLLECT FAIL
Q 2:91 STP
LIQUID SENSOR ALMS
L 3:FUEL ALARM
L 4:FUEL ALARM
L 5:FUEL ALARM
L 6:FUEL ALARM
L 7:FUEL ALARM
L12:FUEL ALARM
L 3:SENSOR OUT ALARM
L 4 :SENSOR OUT ALARM
L 5:SENSUR (flit rtl,r,RM
L 6:SENSOR otrr ALt xvi
L 7:SENSOR OUT HLARM
ISD SITE ALARMS
ISD GROSS PRES FAIL
ISD DEGRD PRES FAIL
ISD VAPOR LEAK FAIL
ISD HOSE ALARMS
ALL:GROSS COLLECT FAIL
ALL:DEGRD COLLECT FAIL
ALL :FLOW COLLECT FAIL
Q 3 :DIESEL STP
LIQUID SENSOR ALMS
L 6:FUEL ALARM
L 7 :FUEL ALARM
L15:FUEL ALARM
L 6:SENSOR OUT ALARM
L 7:SENSOR OUT ALARM
L15:SENSOR OUT ALARM
LIQUID SENSOR SETUP
L 1:DSL
TRI -STATE (SINGLE FLOAT)
CATEGORY : PIPING SUMP
L 2:VENT
TRI -STATE (SINGLE FLOAT)
CATEGORY : OTHER SENSORS
L 3:DISP 1 -2
TRI -STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L 4:DIS 3 -4
TRI -STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
i
L 5:DIS 5 -6
TRI -STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L 6:DIS 7 -8
TRI -STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L 7:DIS 9 -10
TRI -STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L 9:87 STP
TRI -STATE (SINGLE FLOAT)
CATEGORY : STP SUMP
L10:87 ANN
DUAL POINT HYDROSTATIC
CATEGORY : ANNULAR SPACE
L11:87 FIL
TRI -STATE (SINGLE FLOAT)
CATEGORY : PIPING SUMP
L12:91 STP
TRI -STATE (SINGLE FLOAT)
CATEGORY : STP SUMP
L13:91 ANN
DUAL POINT HYDROSTATIC
CATEGORY : ANNULAR SPACE
L14:91, FIL
TRI -STATE (SINGLE FLOAT)
CATEGORY : PIPING SUMP
L15:DSL STP
TRI -STATE (SINGLE FLOAT)
CATEGORY : STP SUMP
L16:DSL ANN
DUAL POINT HYDROSTATIC
CATEGORY : ANNULAR SPACE
Q 3 :DIESEL STP '
TYP :2.0/3.OIN FIBERGLASS
2.0IN DIA LEN: 150 FEET
3.01N DIA LEN: 0 FEET
SHUTDOWN RATE: 3.0 GPH
LOW PRESSURE SHUTOFF:NO
LOW PRESSURE : 0 PSI
T 3:DIESEL
DISPENSE MODE:
STANDARD
SENSOR: NON- VENTED
PRESSURE OFFSET: 0.OPSI
LINE LEAK LOCKOUT SETUP
LOCKOUT SCHEDULE
DAILY
START TIME: DISABLED
STOP TIME : DISABLED
SOFTWARE REVISION LEVEL
VERSION 327.04
SOFTWARE# 346327 -100 -E
CREATED - 07.02.06.10.28
S- MODULE# 330160 -004-a
SYSTEM FEATURES:
PERIODIC IN -TANK TESTS
ANNUAL IN -TANK TESTS
ISD
PMC
ALARM HI6 TUXY klrl OKI n r izu,i n tA i vx Y xarvx 1
SENSOR ALARM - - - -- SENSOR ALARM - - - --
L 4:DIS 3-4 L 1 :DSL
OTHER SENSORS
DISPENSER PAN PIPING SUMP
AUG 21, 2013 2:55 PM
SENSOR OUT ALARM SENSOR OUT ALARM
AUG 21, 2013 2 :55 PM AUG 21, 2013 2:54 PM
SENSOR OUT ALARM SENSOR OUT ALARM
AUG 21. 2013 2:51 PM AUG 21. 2013 2:50 PM
FUEL ALARM FUEL ALARM
AUG 21. 2013 2:48 PM AUG 21. 2013 2:35 PM
xxxx9 END xxxxx x0xxx END xxxxx
ALARM HISTORY REPORT ALARM HISTORY REPORT
SENSOR ALARM - - - -- SENSOR ALARM - - - --
L S:DIS 5 -6 L 2:VENT
DISPENSER PAN OTHER SENSORS
SENSOR OUT ALARM FUEL ALARM
AUG 21, 2013 2:55 PM AUG 21. 2013 3:50 PM
SENSOR OUT ALARM SETUP DATA WARNING
AUG 21, 2013 2:50 PM AUG 21, 2013 3:50 PM
FUEL ALARM FUEL ALARM
AUG 21. 2013 2:47 PM AUG 21. 2013 3:16 PM
xxxxx END xxxxx xxxxx END xxxxx
ALARM HISTORY REPORT ALARM HISTORY REPORT
SENSOR ALARM - - - -- SENSOR ALARM - - - --
L 6:DIS 778 L 3:DISP 1 -2
DISPENSER PAN DISPENSER PAN
SENSOR OUT ALARM SENSOR OUT ALARM
AUG 21, 2013 2:55 PM AUG 21, 2013 2:55 PM
SENSOR OUT ALARM SENSOR OUT ALARM
AUG 21. 2013 2:50 PM AUG 21, 2013 2:51 PM
FUEL ALARM FUEL ALARM
AUG 21, 2013 2:46 PM AUG 21, 2013 2 :49 PM
SMARTSENSOR SETUP
s 1 :DIS 1 -2 AFM
CATEGORY AIR FLOW METER
s 2:DIS 3 -4 AFM
CATEGORY AIR FLOW METER
s 3:DIS 5 -6 AFM
CATEGORY AIR FLOW METER
s 4:DIS 7 -8 AFM
CATEGORY AIR FLOW METER
s 5:DIS 9 -10 AFM
CATEGORY AIR FLOW METER
s 6 :PRES SENS
CATEGORY VAPOR PRESSURE
s B:ATM
CATEGORY ATM P SENSOR
EVR /ISD SETUP
EVR TYPE: VACUUM AS81ST
VACUUM ASSIST r,'PE
HEALY VAC
J% v J
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L13:91 ANN
ANNULAR SPACE
LOW LIQUID ALARM
AUG 21. 2013 2:56 PM
SENSOR OUT ALAN(
AUG 21. 2013 2:54 PM
LOW LIQUID ALARM
AUG 21, 2013 2:52 PM
x % X END Wxxxx
ALARM HISTORY REPORT
SENSOR ALARM --
L14:91 FIL
PIPING SUMP
SENSOR OUT ALARM
AUG 21, 2013 2:55 PM
SENSOR OUT ALARM
AUG 21. 2013 2:51 PM
FUEL ALARM
AUG 21, 2013 2 :34 PM
X X m x X END m* X m X
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L15:DSL STP
STP SUMP
SENSOR OUT ALARM
AUG 21. 2013 2:55 PM
SENSOR OUT ALARM
AUG 21, 2013 2:51 PM
FUEL ALARM
AUG 21, 2013 2:43 PM
ALARM HISTORY REPORT
SENSOR ALARM - - - --
1.10:87 ANN
ANNULAR SPACE
LOW LIQUID ALARM
AUG 21. 2013 2:56 PM
SENSOR OUT ALARM
AUG 21. 2013 2:55 PM
LOW LIQUID ALARM
AUG 21. 2013 2:52 PM
x X x x X END X x* x x
ALARM HISTORY REPORT
SENSOR ALARM - - - --
1.11:87 FIL
PIPING SUMP
SENSOR OUT ALARM
AUG 21. 2013 2:55 PM
SENSOR OUT ALARM
AUG 21. 2013 2:61 PM
FUEL ALARM
AUG 21, 2013 2:31 PM
xxxxX END ***X*
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L12:91 STP
STP SUMP
SENSOR OUT ALARM
AUG 21. 2013 2:55 PM
SENSOR OUT ALARM
AUG 21, 2013 2:51 PM
FUEL ALARM
AUG 21, 2013 2:32 PM
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L 7:DIS 9 -10
DISPENSER PAN
SENSOR OUT ALARM
AUG 21. 2013 2:55 PM
SENSOR OUT ALARM
AUG 21,, 2013 2:50 PM
FUEL ALARM
AUG 21. 2013 2:46 PM
x x x x x END X X x x x
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L 8:
OTHER SENSORS
x x x x x END x X x x X
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L 9:87 STP
STP SUMP
SENSOR OUT ALARM
AUG 21. 2013 2:54 PM
SENSOR OUT ALARM
AUG 21, 2013 2:51 PM
FUEL ALARM
AUG 21. 2013 2:30 PM
i%t
ALARM HISTORY REPORT
SENSOR ALARM - - - --
Q 2 :91 STP
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:55 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:50 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:49 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:48 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:47 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:46 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:46 PM
PLLD SHUTDOWN ALARM
AUG 21. 2013 2:44 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:44 PM
LLD SHUTDOWN ALARM
4UG 21, 2013 2:32 PM
PLLD SHUTDOWN ALARM
AUG 21. 2013 2:49 PM
PLLD SHUTDOWN ALARM
AUG 21. 2013 2:48 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2 :47 PM
PLLD SHUTDOWN ALARM
AUG 21. 2013 2:46 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:46 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:44 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:44 PM
PLLD SHUTDOWN ALARM
AUG 21. 2013 2:30 PM
PLLD SHUTDOWN ALARM
MAR 2, 2013 10:01 AM
ALARM HISTORY REPORT
b
SENSOR ALARM - - - --
3> '0
L16:DSL ANN
d
ANNULAR SPACE
ALARM HISTORY REPORT LOW LIQUID ALARM
AUG 21, 2013 2:56 PM
SENSOR ALARM - - - --
Q 1:87 STP SENSOR OUT ALARM
PLLD SHUTDOWN ALARM AUG 21. 2013 2:54 PM
AUG 21. 2013 2:54 PM
0
ca Z
LOW LIQUID ALARM
W
AUG 21. 2013 2 :52 PM
PLLD SHUTDOWN ALARM
AUG 21. 2013 2:49 PM
PLLD SHUTDOWN ALARM
AUG 21. 2013 2:48 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2 :47 PM
PLLD SHUTDOWN ALARM
AUG 21. 2013 2:46 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:46 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:44 PM
PLLD SHUTDOWN ALARM
AUG 21, 2013 2:44 PM
PLLD SHUTDOWN ALARM
AUG 21. 2013 2:30 PM
PLLD SHUTDOWN ALARM
MAR 2, 2013 10:01 AM
xxxxx END xxxxx
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L 1:DSL
PIPING SUMP
SENSOR OUT ALARM
AUG 21. 2013 2:54 PM
SENSOR OUT ALARM
AUG 21. 2013 2:50 PM
FUEL ALARM
AUG 21, 2013 2:35 PM
b 0 9D t
irr. 3> '0
C7
m
d b
tV til r iSi
to to
to
aQ O, GQ pr0 0
ca ZW aNN N G1i N 2>
m a`
Ct3> to
t
t
w+
xxxxx END xxxxx
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L 1:DSL
PIPING SUMP
SENSOR OUT ALARM
AUG 21. 2013 2:54 PM
SENSOR OUT ALARM
AUG 21. 2013 2:50 PM
FUEL ALARM
AUG 21, 2013 2:35 PM
b 0 9D t
irr.
C7
m
d b N b t
5 v
3
N0
to
aQ O,
G7
pr0 0
caZ b j
N 2>
m a`
3 t
t
MONITOR CERT. FAILURE REPORT
SITE NAME: WHITE LANE SHELL DATE: 8/21/13
ADDRESS: 2600 WHITE LANE TECHNICIAN: RICHARD MASON
CITY: BAKERSFIELD SIGNATURE: ! V
REPAIRS: NONE
PARTS INSTALLED: NONE
THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING
THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR
THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR
ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF
ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE.
A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR
CONVIENENCE.
BAKERSFIELD CITY FIRE DEPARTMENT - INSPECTION RECORD
Post this Card at the Job Site and DO NOT Remove for Duration of Work
Inspection Request Phone No. (661) 326 -3979
UST NEW INSTALL
DESCRIPTION DATE SIGNATURE
BACKFILL
PRIMARY PIPE
SECONDARY PIPE
SECONDARY CONTAINMENT
SENSORS
AUTHORIZATION FOR FUEL
ELECTRICAL SEAK -OFF
C- -- TANK TESTING __ - - _ _ t
G
UST REMOVAL
DESCRIPTION DATE SIGNATURE
AST NEW INSTALL
DESCRIPTION DATE SIGNATURE
MODIFICATIONS MINOR / MAJOR
AST REMOVAL
DESCRIPTION DATE SIGNATURE
EVR UPGRADE
PIRM TO OPERATION_OF ANY SYSTEM,
BALL UST AND /OR AST SYSTEMS SHALL BE
INSTALLCOMPLETE AND ACCEPTED BY
MISC. ACTIVITY THE BAKERSFIELD CITY FIRE DEPARTMENT.,
FIRE DEPARTMENT (FINAL)
REMARKS:
BUILDING ADDRESS: c2Cc00 77777 LK
JOB DESCRIPTION: t= iA,& L OCCUPANCY TYPE:
OWNER: ke L PERMIT NO. 1,3 -
CONTRACTOR: c L PHONE # S 2 - 9f7
FD 1743
BILLING & PERMIT STATEMENT
FPERIMIT NO.:
B 1A B R S P I D
4 FIRE
ARrAr r
BAKERSFIELD FIRE DEPT.
Prevention Services
1600 Truxtun Ave Ste 401
Bakersfield CA 93301
Tel.: (661) 326 -3979 • Fax: (661) 852 -2171
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT.
Alarms - New & Modifications - (Minimum Charge) $280.00 ,
SITE INFORMATION
LOCATION OF PROJEC PROPERTY OWNER
Ck
STARTING DATE QM ION DATE NAME
PROJECTNAME , ,
l
ADDRESS PHONE NO.
PROJECTADDRESS CnY STATE ZIPCODE
CONTRACTOR INFORMATION
CONTRACTOR NAME CA LICENSE NO. TYPE OF LICENSE. EXPIRATION DATEJFYY13'cS R C tt O SO t 1>40AHA 3c 20l
PHONE NO.
g 2 -8
CONTRACTOR COMPANY NAME
IG r )V
FAX NO.
Oo
ADDRESS CITY ZlPwut
9:6
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT.
Alarms - New & Modifications - (Minimum Charge) $280.00 ,
98
Over 10,000 Sq. Ft. Sq. Ft x.028 = Permit fee 84
98
Sprinklers - New & Modifications - (Minimum Charge) 280.00 84
98
Over 10,000 Sq. Ft Sq. Ft x.028 = Permit fee 84
98
Minor Sprinkler Modifications (< 10 heads) 96.00 [Inspection Only] 84
98
Commercial Hoods - New & Modifications 470.00 84
98
Additional Hoods 58.00 84
98
Spray Booths - New & Modifications 470.00 84
98
Aboveground Storage Tanks (Installation/Insp.-1 0 Time) 180.00 82
Additional Tanks 96.00 82
Aboveground Storage Tanks (RemovaUlnspection) 109.00 82
Underground Storage Tanks (Installation. /Inspection) 878.00 (per tank) 82
Underground Storage Tanks (Modification) 878.00 (persite) 82
Underground Storage Tanks (Minor Modification) 167.00 82
Underground Storage Tanks (Removao 573.00 (per tank) 84
Oilwell (Installation) 96.00 84
Mandated Leak Detection (Testing) / Fu Monit. rt/SB989.
Note: $96.00 for each type of test / per site heduled
at the same dme)
C) n „ /1 82
Tents 96.00 (per tend 84
Pyrotechnic - (Per event, Plus Insp. Fee @ $96 per hour) 96.00 + (5 hrs. min. standby fee /Inspection) -- $576..00 84
After hours inspection flee 121.00 84
RE- INSPEC77ON(S) / FOLLOW -UP INSPECTION(S) 96.00 (per hour) 84
Portable LPG (Propane): NO. OF CAGES? _ 96.00 84
Explosive Storage 266.00 84
Copying & File Research (File Research Fee $50.00 per hr) 250 per page 84
Miscellaneous 84
FD 2021 (Rev. 06/07)
1 •ORIGINAL WHrTE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer)
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
Please note that these are separate
Individual tests and will be charged per
separate type test accordingly.)
PERMIT #
ARA Aftsp I np
wfiBi
Asrmr r
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Q10 k E-t 5 -mF-ET
Bakerstield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
ENHANCED LEAK DETECTION SB -989 SECONDARY CONTAINMENT
TANK TIGHTNESS 1 f EL MONITORING CERTIFICATIO
SIT
FACILITY NAME ® PHONE 9 OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE #
OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES NO
TANK a# VOLUME CONTENTS
I
a
15
TANK:TESTING:COMPANY;_ .
TESTING COMPANY NAME $ PHONE it OF CONTACT PERSON
MAILING ADDRESS
5tn -13 t3C oo c5 CrT. - F.PrK+R.SF 1E.t -D C °13308
NAME & PHONE # OF TESV OR SPECIAL INSP CT CERTIFICATION S
1809 GSo
DATE & TIME TEST TO BE C CTS ^
C1• \
Y l
ICC 3 TEST METHOD
APPLICANT SIGNATUR DATE
YHIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 03/08)