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HomeMy WebLinkAbout4815 PANAMA LANE FMC 2013vl 7-:2-'2> HOODS ALARMS SPRINKLER SYSTEMS SPAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. 3 - /OCR 33 / File Number: j' 3q7 7 Address: Bakersfield, CA 933 Date Received: 7 - r - /3 Business Name: S C L SYSTEM: BUILDING SQUARE FEET: INSPECTION LOG New Mod. Commercial Hood System Fire Alarm System Fire Sprinkler System Spvay FWsh Systern Aboveground Storage Tank Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank CY Other. =mil <— Building Sq. Feet: Calculation Bldg. Sq. Ft: 1. a. 3. 4. Date Time Signature MONITORING SYSTEM CERTIFICATION For Use ByAll Jurisdictions Within the State ofCaliforniaAuthorityCited. Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each monitoring system control Rand by the technician who performs the work. A copy ofthis 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 oftest date. A. General Information Facility Name: PANAMA LANE SHELL Bldg. No.: Site Address: 4815 PANAMA LANE City: BAKERSFIELD Zip: Facility Contact Person: LOUNG CHAO Contact Phone No.: ( ) Make/Model of Monitoring System: VEEDER -ROOT TLS -350 Date ofTesting/Servicing: 7/23/2013 B. Inventory of Equipment Tested/Certified Check the annroariate taxes to indicate sneeiic equipment insoected/serviced: Tank ID: UNL87 inTank Gauging Probe. Model: MAG PLUS D Annular Space or Vault Sensor. Model: 420 Piping Sump / Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: 208 Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: PLLD Tank Overfill / High -Level Sensor, Model: MAG PLUS Other (specify equipment type and model in Section E on Page 2). Tank ID: DIESEL InTank Gauging Probe, Model: MAG PLUS Annular Space or Vault Sensor. Model: 420 Piping Sump / Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: 208 Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: PLLD Tank Overfill / High -Level Sensor. Model: MAG PLUS Other (specify equipment type and model in Section E on Page 2). Tank ID: PREM -91 Tank ID: In -Tank Gauging Probe. Model: MAG PLUS In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: Piping Sump/ Trench Sensor(s). Model: 208 Piping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: PLLD Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: MAG PLUS 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: 718 Dispenser Containment Sensor(s). Model: 208 Dispenser Containment Sensor(s). Model: 208 Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: 3/4 Dispenser ID: 9110 Dispenser Containment Sensor(s). Model: 208 Dispenser Containment Sensor(s). Model: 208 Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: 516 Dispenser ID: 11112 Dispenser Containment Sensor(s). Model: 208 Dispenser Containment Sensor(s). Model: 208 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 a utpment. For any equipment capable ofgenerating 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: - k\`-, Certification No.: 5297857 -UT / B36880 License. No.: C6 D40 809850 Testing Company Name: RICH ENVIRONMENTAL Phone No.; (661) 392 -8687 Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date of Testing/Servicing: 7/2312013 Page 1 of 5 UN- 036 -1/4 www.unidoes.org Rev. 01/17/08 swtv Monitoring System Certification D. Results of Testing/Serviciing Software Version Installed: 329.02 Complete the folio 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 ofsecondary 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 failureldisconnection? ® 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? If so, at what percent of tank capacity does the alarm trigger? 90% Yes* No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. Yes* No Was liquid found inside any secondary containment systems designed as dry systems? (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 No* I 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 5 UN- 036 — 2/4 www.unidocs.org Rev. 02/PM Monitoring System Certification F. In -Tank Gauging / SIR Equipment: VtAku f 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 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 Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Cmmnlete the fnllowino 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.; 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* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut off if the 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 offifany 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/ALOYesNo* 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. H. Comments: UN-036 — 3/4 Page 3 of 5 www.unidocs.org Rev. 01/17/08 Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors I. Results of Vacuum/Pressure Monitoring Equipment Testing J I `9 %%-" r This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of this form must be included with the Monitoring System Certification Form, which must be provided to the tank system owner /operator. The owner /operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Manufacturer: VEEDER -ROOT Model: System Type: Pressure; ® Vacuum Sensor ID S:18 Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail Component(s) Monitored by this Sensor. UNL87 ANNULAR S:13 S:1 1 Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail Component(s) Monitored by this Sensor: PREM91 ANNULAR S:14 Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail Component(s) Monitored by this Sensor: DIESEL ANNULAR S:17 Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result. ® Pass; Fail Component(s) Monitored by this Sensor: UNL87 PRODUCT LINE S:9 Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail Component(s) Monitored by this Sensor. PREM91 PRODUCT LINE 8:12 Sensor Functionalitv Test Result: M Pass. M Fail Interstitial Communication Test Result: 5a Pass. n Fail S:10 Component(s) Monitored by this Sensor: VAPOR RETURN LINE Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail S:15 Component(s) Monitored by this Sensor: DIESEL VENT LINE Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail How was interstitial communication verified? Leak Introduced at Far End of Interstitial Space;' ® Gauge; Visual Inspection; Other (Describe in Sec. J, below, Was vacuum/pressure restored to operating levels in all interstitial spaces? ® Yes No (Ifno, describe in Sec. J, below) J. Comments: N/A Page 4 of 5 If the sensor successfully detects a simulated vacuum/pressure Ieak introduced in the interstitial space at the furthest point from thesensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice. UN -036A - 1/1 www.unidomorg Rev. 01/26/06 Component(s) Monitored by this Sensor: DIESEL PRODUCT LINE S:18 Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail Component(s) Monitored by this Sensor: 87 -91 VENT LINE S:13 Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail S:10 Component(s) Monitored by this Sensor: VAPOR RETURN LINE Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail S:15 Component(s) Monitored by this Sensor: DIESEL VENT LINE Sensor Functionality Test Result: ® Pass; Fail Interstitial Communication Test Result: ® Pass; Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass; Fail Interstitial Communication Test Result: Pass; Fail How was interstitial communication verified? Leak Introduced at Far End of Interstitial Space;' ® Gauge; Visual Inspection; Other (Describe in Sec. J, below, Was vacuum/pressure restored to operating levels in all interstitial spaces? ® Yes No (Ifno, describe in Sec. J, below) J. Comments: N/A Page 4 of 5 If the sensor successfully detects a simulated vacuum/pressure Ieak introduced in the interstitial space at the furthest point from thesensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice. UN -036A - 1/1 www.unidomorg Rev. 01/26/06 7:) tyw Moott"Ing System Ce:rtlfication UST Monitoring Site Plan Site Address: 431 S Ply A ?„ ......... n Yt :.S L ; a ::: .... . 0 ............. ....... .,....t .... .... 4 glt ........ I........... p .. . . . . .... .. ..... . .. ... . t —k • Date mapwas d=awn: ' / • //o Ifyou Wrc* have a diagraat diet sbows all required ia%=9on, you tray i it, ra;}fr rhea this Pegg, with your MoaitoriggSystemCerdfication. On your site Plan, show the ab=al layout of tanks and PIPID& Clearly identify locations of the following egWp=t, if installed: monitoring syskm control Manaus; 'SOaBOns mont10or1ng drone aoratlar spates, cps+ dispaw Pte• *U cmtughers, or other secondary conuaimaent aneg deal or ele*a * line leak detectors; and in"tank liquid level probes (ifused for leak detoation). Inthe spew provided, riots thedaft this SitePlea was prepared P9V 4 of .4 L74 -M -414 awW:eawonM - ea: mn ro8 3VA w SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing ofUST spill containment structures. The completedform and printoutsfrom tests (ifapplicable), should beprovided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: PANAMA LANE SHELL Date of Testing: 7/23/13 Facility Address: 4815 PANAMA LANE, BAKERSFIELD Facility Contact: LOUNG CHAD Phone: Date Local Agency Was Notified of Testing: 719/13 Name of Local Agency Inspector (fpresent during testing): ESTHER 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RICHARD MASON Credentials': 0 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 0 Vacuum 0 Other Test Equipment Used: INCON Equipment Resolution: VISUAL Identify Spill Bucket (By Tank Number, StoredProduct, etc. ) 1 L87 Z PREM91 3 DIESEL 4 Bucket Installation Type: 0 Direct Bury X Contained in Sump 0 Direct Bury X Contained in Sump 0 Direct Bury X Contained in Sump 0 Direct Bury 0 Contained in Sum Bucket Diameter. 12" 12" 12" Bucket Depth: 12" 12" 12" Wait time between applying vacuum/water and start of test: 30MIN 30MIN 30MIN Test Start Time (TO: 9:00 9:00 9:00 Initial Reading (Rj): 10" 10" 10" Test End Time (TF): 10:00 10:00 10:00 Final Reading (RF): to" 10" 10" Test Duration (TF — TO: 60MIN 60MIN 60MIN Change in Reading (RI, - Rj): 0 0 0 Pass/Fail Threshold or Criteria: 0.00 0.00 0.00 Test Result: X Pass 0 Fail X Pass Fail X Pass Fail Pass Fail Comments —(include information on repairs made prior to testing, andrecommendedfollow -upforfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby cert(fy that all the Information contained In this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: ' `/ Date: 7/23/13 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. RICH ENVIRONMENTAL 5643 BROOKS CT. BAKERSFIELD, CA. 93308 OFFICE (661)392 -8687 FAX (661)392 -0621 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET W /O#: FACILITY NAME: PANAMA LANE SHELL FACILITY ADDRESS: 4815 PANAMA 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 LID TYPE: PLLD YES 0 PASS SERIAL # PREM91 WD TYPE: PLLD YES 0 PASS SERIAL # DIESEL L/D TYPE: PLLD YES 0 PASS SERIAL # 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: DATE: 7/23/13 IN -TANK SETUP T I:UNL -87 PRODUCT CODE 1 THERMAL COEFF 000700 TANK DIAMETER 113.75 TANK PROFILE 4 PTS FULL VOL 15022 B5.3 INCH VOL 12104 56.9 INCH VOL 7545' 28.4 INCH VOL 2965 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 15022 OVERFILL LIMIT 90%6 13519 HIGH PRODUCT 9564 14271 DELIVERY LIMIT 106 1502 LOW PRODUCT 1000 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 0.00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS Tit: NONE LINE MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 0% 0 LEAK MIN ANNUAL 096 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY . 1 MIN PUMP THRESHOLD : 10.00% SOFTWARE REVISION LEVEL VERSION 329.02 SOFTWARE# 346329 -100 -C CREATED - 09.07.01.16.29 S- MODULE# 330160 -004 -a SYSTEM FEATURES: PERIODIC IN -TANK TESTS ANNUAL IN -TANK TESTS ISD COMMUNICATIONS SETUP PORT SETTINGS: COMM BOARD : 1 IEDIM ) RS-232 SECURITY CODE : DISABLED COMM BOARD : 2 (RS -232) BAUD RATE : 9600 PARITY : ODD STOP BIT : 1 STOP DATA LENGTH: 7 DATA RS -232 SECURITY CODE : DISABLED COMM BOARD 3 (RS -232) BAUD PATE 1200 PARITY ODD STOP BIT 1 STOP DATA LENGTH: 7 DATA RS -232 SECURITY CODE : DISABLED AUTO TRANSMIT SETTINGS: AUTO LEAK ALARM LIMIT DISABLED AUTO HIGH WATER LIMIT DISABLED AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT DISABLED AUTO THEFT LIMIT DISABLED AUTO DELIVERY START DISABLED AUTO DELIVERY END DISABLED AUTO EXTERNAL INPUT ON DISABLED AUTO EXTERNAL IIVPUT OFF DISABLED AUTO SENSOR FUEL ALARM DISABLED AUTO SENSOR WATER ALARM DISABLED AUTO SENSOR OUT ALARM DISABLED JUL 23, 2013 8:58 AM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE /TIME FORMAT MON DD YYYY HH:MM:SS xM PANAMA LANE SHELL 4815 PANAMA LANE BAKERSFIELD CA 93313 SHIFT TIME I : 6:00 AM SHIFT TIME 2 : DISABLED SHIFT TIME 3 : DISABLED SHIFT TIME 4 : DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE RE- ENABLE METHOD PASS LINE TEST LINE PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET DISABLED ULLAGE: 90% H- PROTOCOL DATA FORMAT HEIGHT PRECISION TEST DURATION HOURS: 12 DAYLIGHT SAVING TIME DISABLED RE- DIRECT LOCAL PRINTOUT DISABLED EURO PROTOCOL PREFIX S SYSTEM SECURITY CODE : 000000 MAINTENANCE HISTORY DISABLED TANK CHART SECURITY DISABLED CUSTOM ALARMS DISABLED SERVICE NOTICE DISABLED ISO 3166 COUNTRY CODE: MASS /DENSITY DISABLED LEAK TEST METHOD TEST ON DATE : ALL TANK JUL 1. 2009 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 0 1:UNL -87 TYP:2.0i3.0IN FIBERGLASS 2.0IN DIA LEN: 250 FEET 3.0IN DIA LEN: 0 FEET SHUTDOWN RATE: NONE LOW PRESSURE SHUTOFF:NO LOW PRESSURE 0 PSI T 1 :UNL -87 DISPENSE MODE: STANDARD SENSOR: NON- VENTED PRESSURE OFFSET: O.OPSI MECHANICAL BLENDER: NO S 2:PREM -91 TYP:2.0/3.0IN FIBERGLASS 2.0IN DIA LEN: 250 FEET 3.0IN DIA LEN: 0 FEET SHUTDOWN RATE: 3.0 GPH LOW PRESSURE SHUTOFF:NO LOW PRESSURE 0 PSI T 2:PREM -91 DISPENSE MODE: STANDARD SENSOR: NON- VENTED PRESSURE OFFSET: O.OPSI MECHANICAL BLENDER: NO T 3:DIESEL 2.0 PRODUCT CODE 3 THERMAL COEFF 000450 TANK DIAMETER 95.75 TANK PROFILE 4 PTS FULL VOL 8021 71.8 INCH VOL 6464 47.9 INCH VOL 4030 23.9 INCH VOL 1585 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 8021 OVERFILL LIMIT 90% 7218 HIGH PRODUCT 95% 7620 DELIVERY LIMIT : 1016 802 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS Tit: NONE LINE MANIFOLDED TANKS T #: NONE LEAK MIN PERIODIC: 0%G 0 LEAK MIN ANNUAL W. 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : I MIN PUMP THRESHOLD : 10.00% JX%MV T 2:PREM -91 PRODUCT CODE 2 THERMAL COEFF :.000700 TANK, DIAMETER : 95.75 TANK PROFILE : 4 PTS FULL VOL : 8021 71.8 INCH VOL 6464 47.9 INCH VOL 4030 23.9 INCH VOL 1585 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 8021 OVERFILL LIMIT 90% 7210 HIGH PRODUCT 95% 7620 DELIVERY LIMIT 10% 802 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS T#: NONE LINE MANIFOLDED TANKS T #: NONE LEAK MIN PERIODIC: 0%, 0 LEAK MIN ANNUAL 0% 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 1 MIN PUMP THRESHOLD : 10.00% h 510 EVR /ISD SETUP EVR TYPE: BALANCE 13ALANCE NOZZLE TYPE VST LIQUID SENSOR SETUP L13:87 FILL SUMP VAPOR PROCESSOR TYPE TRI -STATE (SINGLE FLOAT) VEEDER -ROOT POLISHER CATEGORY : PIPING SUMP L 1:DISP 1 -2 PAN TRI -STATE SINGLE FLOAT) CATEGORY DISPENSER PAN ANALYSIS TIMES L14:87 FILL SUMP BRIN£ TIME: 10:00 AM TRI -STATE (SINGLE FLOAT) DELAY MINUTES: 1 CATEGORY : PIPING SUMP L 2:DISP 1-2 BRINE TRI -STATE SINGLE FLOAT) ACCEPT HIGH ORVR: L15:87 STP SUMP CATEGORY DISPENSER PAN ENABLED TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP ISD HOSE TABLE ID FP FL HL AA RR L 3:DISP 3 -4 PAN L16:87 STP SUMP BRINE ATE SINGLE FLOAT) 01 01 01 02 01 UU TRI -STATE (SINGLE FLOAT) CATEGORYRYCATEGO DISPENSER PAN 02 02 02 02 01 UU CATEGORY : STP SUMP 03 03 03 02 02 UU 04 04 04 02 02 UU 05 05 05 02 03 UU L17:91 FILL SUMP L 4:DISP 3 -4 BRINE 06 06 06 02 03 UU TRI -STATE (SINGLE FLOAT) TRI -STATE SINGLE FLOAT) 07 07 07 02 04 UU CATEGORY : PIPING SUMP CATEGORY DISPENSER PAN 08 08 08 02 04 UU 09 09 09 02 05 UU 10 16 10 02 05 UU L18:91 FILL SUMP BRINE 11 17 11 02 06 UU TRI -STATE (SINGLE FLOAT) L 5:DISP 5 -6 PAN 12 1.8 12 02 06 UU CATEGORY : PIPING SUMP TRI -STATE SINGLE FLOAT) CATEGORY DISPENSER PAN ISD AIRFLOW METER MAP L19:91 STP SUMP ID SERIAL NUM LABEL TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 6:DISP 5 -6 BRINE 1 41847 1 2 FLOW M TRI -STATE SINGLE FLOAT) 2 38916 3 -4 FLOW M CATEGORY DISPENSER PAN 3 40334 5 -6 FLOW M L20:91 STP SUMP BRINE 4 38945 7 -8 FLOW M TRI -STATE (SINGLE FLOAT) 5 36574 9 -10 FLOW CATEGORY : STP SUMP 6 41840 11 12 FLOW L 7:DISP 7-8 BRINE TRI -STATE SINGLE FLOAT) L21:DSL FILL SUMP CATEGORY DISPENSER PAN ISD FUEL GRADE HOSE MAP TRI -STATE (SINGLE FLOAT) 1 2 3 4 ' CATEGORY : PIPING SUMP FP MHH MHH MHH MHH AA L 8:DISP 7 -8 PAN 01 201 101 901 U U 1 L22:DSL FILL SUMP BRINE TRI -STATE SINGLE FLOAT) 02 202 902 102 U U 1 TRI -STATE (SINGLE FLOAT) CATEGORY DISPENSER PAN 03 203 103 903 U U 2 CATEGORY : PIPING SUMP 04 204 104 904 U U 2 05 205 105 905 U U 3 06 206 106 906 U U 3 L23:DSL STP SUMP L 9:DISP 9 -10 PAN 07 207 107 907 3 U 4 TRI -STATE (SINGLE FLOAT) TRI -STATE SINGLE FLOAT) 08 208 106 908 3 U 4 CATEGORY : STP SUMP CATEGORY DISPENSER PAN 09 209 109 909 3 U 5 16 210 110 910 3 U 5 17 211 111 911 U U 6 L24:DSL STP SUMP BRINE 18 212 112 912 U U 6 TRI -STATE (SINGLE FLOAT) L10:DISP 9 -10 BRINECATEGORY : STP SUMP TRI -STATE SINGLE FLOAT) CATEGORY DISPENSER PAN LABEL TABLE L25:VENT BOX PAN 1: UNASSIGNED TRI -STATE (SINGLE FLOAT) 2: BLEND3 CATEGORY : OTHER SENSORS L11:DISP 11 -12 PAN 3: REGULAR TRI -STATE SINGLE FLOAT) 4: MID GRADE CATEGORY DISPENSER PAN 5: PREMIUM 6: GOLD L26 :VENT BOX BRINE 7: BRONZE TRI -STATE (SINGLE FLOAT) 8: SILVER CATEGORY : OTHER SENSORS L12:DISP 11 -12 BRINE 9: BLEND2 TRI -STATE SINGLE FLOAT) 10: BLEND4 CATEGORY DISPENSER PAN s 3:5 -6 FLOW METER CATEGORY AIR FLOW METER s 4:7 -8 FLOW METER CATEGORY AIR FLOW METER s 5:9 -10 FLOW METER CATEGORY AIR FLOW METER s 6:11 -12 FLOW METER CATEGORY AIR FLOW METER s 7.:PRESSURE SENSOR 5 -6 CATEGORY VAPOR PRESSURE s 8: ATM CATEGORY ATM P SENSOR s 9:87 PRODUCT LINE CATEGORY VAC SENSOR PUMP #I. Q 1:UNL -87 VOLUME: 200.0 GALLONS RELIEF VALVE: : NO s10:87 VAPOR LINE CATEGORY VAC SENSOR PUMP 0: Q 1:UNL -87 VOLUME: 300.0 GALLONS RELIEF VALVE: : NO s11:87 ANNULAR CATEGORY VAC SENSOR PUMP 0: Q 1 :UNL -87 VOLUME: 50.0 GALLONS RELIEF VALVE: : NO x12:91 PRODUCT LINE CATEGORY VAC SENSOR PUMP #: Q 2:PREM-91 VOLUME: 200.0 GALLONS RELIEF VALVE: : NO s13:91 -87 VENT LINE CATEGORY VAC SENSOR PUMP #I Q 2:PREM -91 VOLUME: 100.0 GALLONS RELIEF VALVE: : NO x14:91 ANNULAR CATEGORY VAC SENSOR PUMP a: Q 2:PREM -91 VOLUME: 45.0 GALLONS RELIEF VALVE: : NO s15:DSL VENT LINE CATEGORY VAC SENSOR PUMP #: 0 3:DIESEL VOLUME: 100.0 GALLONS RELIEF VALVE: : NO s16:DSL PRODUCT LINE CATEGORY VAC SENSOR PUMP #: Q 3:DIESEL VOLUME: 60.0 GALLONS RELIEF VALVE: : NO s17:DSL ANNULAR CATEGORY VAC SENSOR PUMP 0: Q 3:DIESEL VOLUME: 45.0 GALLONS RELIEF VALVE: : NO s18:POLISHER CATFnORY VAPOR VALVE Q 2:PR£ -91M LIQUID SENSOR ALMS L I:FUEL ALARM L 3:FUEL ALARM L 5:FUEL ALARM L 8:FUEL ALARM L 9:FUEL ALARM LII:FUEL ALARM L17:FUEL ALARM L19:FUEL ALARM L25:FUEL ALARM L 1:SENSOR OUT ALARM L 3:SENSOR OUT ALARM L 5:SENSOR OUT ALARM L 8:SENSOR OUT ALARM L 9 :SENSOR. OUT ALARM L11:SENSOR OUT ALARM L17:SENSOR OUT ALARM L19:SENSOR OUT ALARM L25:SENSOR OUT ALARM L I:SHORT ALARM L 3:SHORT ALARM L 5:SHORT ALARM L B:SHORT ALARM L 9:SHORT ALARM LII:SHORT ALARM L17:SHORT ALARM L19:SHORT ALARM L25:SHORT ALARM SMARTSENSOR ALARMS s12:FUEL ALARM s13:FUEL ALARM s14:FUEL ALARM ALL:HIGH LIQUID ALARM ISD SITE ALARMS ISD GROSS PRES FAIL ISD DEGRD PRES FAIL ISD VAPOR LEAK FAIL ISD VP PRES FAIL ISD VP STATUS FAIL MISSING RELAY SETUP ISD HOSE ALARMS ALL:GROSS COLLECT FAIL ALL:DEGRD COLLECT FAIL ALL :FLOW COLLECT FAIL Q 3:DIESEL LIQUID SENSOR ALMS L 8:FUEL ALARM L 9:FUEL ALARM L21:FUEL ALARM L23:FUEL ALARM L25:FUEL ALARM L 8 :SENSOR OUT ALARM L 9:SENSOR OUT ALARM L21 :SENSOR OUT ALARM L23 :SENSOR OUT ALARM L25 :SENSOR OUT ALARM L 8:SHORT ALARM L 9:SHORT ALARM L21:SHORT ALARM L23:SHORT ALARM L25:SHORT ALARM SMARTSENSOR ALARMS s15:FUEL ALARM s16:FUEL ALARM s17:FUEL ALARM ALL:HIGH LIQUID ALARM PLLD LINE DISABLE SETUP Q 1 :UNL -87 LIQUID SENSOR ALMS L 1:FUEL ALARM L 3:FUEL ALARM L 5:FUEL ALARM L 8:FUEL ALARM L 9:FUEL ALARM L11:FUEL ALARM L13:FUEL ALARM 1.15:FUEL ALARM L25:FUEL ALARM L 1:SENSOR OUT ALARM L 3:SENSOR OUT ALARM L 5:SENSOR OUT ALARM L 8:SENSOR OUT ALARM L 9:SENSOR OUT ALARM L11 :SENSOR OUT ALARM L13:SENSOR OUT ALARM L15:SENSOR OUT ALARM L25:SENSOR OUT ALARM L 1:SHORT ALARM L 3-SHORT ALARM L 5:SHORT ALARM L 8:SHORT ALARM L 9:SHORT ALARM L11:SHORT ALARM L13:SHORT ALARM L15:SHORT ALARM L25:SHORT ALARM SMARTSENSOR ALARMS s 9:FUEL ALARM s10:FUEL ALARM sit :FUEL ALARM ALL:HIGH LIQUID ALARM ISD SITE ALARMS ISD GROSS PRES FAIL ISD DEGRD PRES FAIL ISD VAPOR LEAK FAIL ISD VP PRES FAIL ISD VP STATUS FAIL MISSING RELAY SETUP ISD SENSOR OUT FAIL ISD HOSE ALARMS ALL:GROSS COLLECT FAIL ALL :DEGRD COLLECT FAIL ALL:FLOW COLLECT FAIL PMC ALARMS VP EMISSIONS FAIL VP PRESSURE FAIL VP DUTY CYCLE FAIL ALARM HISTORY REPORT SENSOR ALARM - - - -- L 7:DISP 7 -8 BRINE DISPENSER PAN FUEL ALARM JUL 23, 2013 10:41 AM SENSOR OUT ALARM JUL 23. 2013 10:35 AM x * END *9*** ALARM HISTORY REPORT SENSOR ALARM -- L 8:DISP 7 -8 PAN DISPENSER PAN SENSOR OUT ALARM JUL 23, 2013 10:35 AM FUEL ALARM JUL 23, 2013 10:32 AM END * * * * * ALARM HISTORY REPORT SENSOR ALARM - - - -- L 9:DISP 9 -10 PAN DISPENSER PAN SENSOR OUT ALARM JUL 23, 2013 10:35 AM FUEL ALARM JUL 23, 2013 10:30 AM ALARM HISTORY REPORT SENSOR ALARM - ---- L 4:DISP 3 -4 BRINE DISPENSER PAN FUEL ALARM JUL 23, 2013 10:40 AM END * A * * * ALARM HISTORY REPORT SENSOR ALARM L 5:DISP 5 -6 PAN DISPENSER PAN SENSOR OUT ALARM JUL 23, 2013 10:35 AM FUEL ALARM JUL 23. 2013 10:28 AM END * * * * * ALARM HISTORY REPORT SENSOR ALARM - - - -- L 6:DISP 5-6 BRINE DISPENSER PAN FUEL ALARM JUL 23, 2013 10:40 AM SENSOR OUT ALARM JUL 23, 2013 10:35 AM 5tgp ALARM HISTORY REPURi SENSOR ALARM - - -- L 1:DISP 1 -2 PAN DISPENSER PAN FUEL ALARM JUL 23, 2013 10:23 AM X*** * END * **** ALARM HISTORY REPORT SENSOR ALARM - -- -- L 2:DISP 1 -2 BRINE DISPENSER PAN FUEL ALARM JUL 23, 2013 10:40 AM END X X * * * ALARM HISTORY REPORT SENSOR ALARM L 3:DISP 3 -4 PAN DISPENSER PAN FUEL ALARM JUL 23, 2013 10:26 AM 0 ALARM HISTORY REPORT SMARTSENSOR ALARM -- s 9:87 PRODUCT LINEHIGHLIQUIDALARMJUL23, 2013 11:11 AM NO VACUM ALJUL23- U 20113A11:10 AM xxxxx END xxxxx ALARM HISTORY REPORT SMARTSENSOR ALARM -- 510:87 VAPOR LINEHIGH JUL 23102013A11 AM NO VACUUM ALARMJUL23, 2013 11:10 AM x 0 x x x END x x x x x LARM HISTORY REPORT SMARTSENSOR ALARM -- 11:87 ANNULARDVACUUMALARMJL23. 2013 11:11 AM ALARM HISTORY REPORT SENSOR ALARM - - -- L22:DSL FILL SUMP BRINE PIPING SUMP FUEL ALARM JUL 23. 2013 10:38 AM SENSOR OUT ALARM JUL 23, 2013 10:34 AM xxxxx END xxxxx ALARM HISTORY REPORT SENSOR ALARM - - - -- L23:DSL STP SUMP STP SUMP SENSOR OUT ALARM JUL 23. 2013 10:35 AM FUEL ALARM JUL 23, 2013 10:21 AM FUEL ALARM JUL 23, 2013 10:21 AM x x x x x END x x x x x ALARM HISTORY REPORT SENSOR ALARM L24:DSL STP SUMP BRINE STP SUMP FUEL ALARM JUL 23, 2013 10:39 AM SENSOR OUT ALARM JUL 23. 20`13 10:34 AM ALARM HISTOR`! REPORT SENSOR ALARM - - - -- L19:91 STP SUMP STP SUMP SENSOR OUT ALARM JUL 23, 2013 10:34 AM FUEL ALARM JUL 23, 2013 10:15 AM FUEL ALARM JUL 23, 2013 10:15 AM xxx END xxxxx ALARM HISTORY REPORT SENSOR ALARM - - - -- L20:91 STP SUMP BRINE STP SUMP FUEL ALARM JUL 23, 2013 10:39 AM SENSOR OUT ALARM JUL 23. 2013 10:34 AM xxXxx END *xxxx ALARM HISTORY REPORT SENSOR ALARM - - - -- L21:DSL FILL SUMP PIPING SUMP SENSOR OUT ALARM JUL 23, 2013 10:34 AM FUEL ALARM JUL 23, 2013 10:20 AM 5 i cty ALARM HISTORY REPORT SENSOR ALARM - - - -- L16:87 STP SUMP BRINE STP SUMP FUEL ALARM JUL 23, 2013 10:39 AM SENSOR OUT ALARM JUL 23, 2013 10:35 AM xwx%% END xxxxx ALARM HISTORY REPORT SENSOR ALARM - - - -- L17:91 FILL SUMP PIPING SUMP SENSOR OUT ALARM JUL 23, 2013 10:34 AM FUEL ALARM JUL 23. 2013 10:20 AM x x x x END X ALARM HISTOR`! REPORT SENSOR ALARM - - --- L18:91 FILL SUMP BRINE PIPING SUMP FUEL ALARM JUL 23, 2013 10:38 AM SENSOR OUT ALARM JUL 23, 2013 10:34 AM ALARM HISTORY REPORT SENSOR ALARM - - - -- L13:87 FILL SUMP PIPING SUMP SENSOR OUT ALARM JUL 23, 2013 10:34 AM FUEL ALARM JUL 23, 2013 10:19 AM xxxxx END xxx*x ALARM HISTORY REPORT SENSOR ALARM - - - -- L14:87 FILL SUMP BRINE PIPING SUMP FUEL ALARM JUL 23, 2013 10:38 AM SENSOR OUT ALARM JUL 23, 2013 10:35 AM X x x x x END x x x x x ALARM HISTORY REPORT SENSOR ALARM - - - -- L15:87 STP SUMP STP SUMP SENSOR OUT ALARM JUL 23, 2013 10:35 AM FUEL ALARM JUL 23, 2013 10:18 AM ALARM HISTORY REPORT SENSOR ALARM - -- -- L10:DISP 9 -10 BRINE DISPENSER PAN FUEL ALARM JUL 23, 2013 10:41 AM SENSOR OUT ALARM JUL 23. 2013 10:35 AM A x x x x END x x x x x ALARM HISTORY REPORT SENSOR ALARM - - - -- L11:DISP 11 -12 PAN DISPENSER PAN SENSOR OUT ALARM JUL 23. 2013 10:34 AM FUEL ALARM JUL 23, 2013 10:29 AM x x x x x END * x x x x ALARM HISTORY REPORT SENSOR ALARM - - - -- L12:DISP 11 -12 BRINE DISPENSER PAN FUEL ALARM JUL 23. 2013 10:41 AM SENSOR OUT ALARM JUL 23, 2013 10:34 AM J `'lLV m/ ALARM HISTORY REPORT SENSOR ALARM - -- -- L25:VENT BOX PAN OTHER SENSORS FUEL ALARM JUL 23, 2013 10:42 AM SENSOR OUT ALARM JUL 23. 2013 10:34 AM END * * * ri * ALARM HISTORY REPORT SENSOR ALARM - - - -- L26:VENT BOX BRINE OTHER SENSORS FUEL ALARM JUL 23, 2013 10:42 AM SENSOR OUT ALARM JUL 23, 2013 10:34 AM OUTPUT RELAY SETUP - - R 1:OVERFILL ALARM TYPE: STANDARD NORMALLY OPEN TANK 0: NONE IN -TANK ALARMS ALL:OVERFILL ALARM ALARM HISTORY REPORT SMARTSENSOR ALARM -- s15:DSL VENT LINE HIGH LIQUID ALARM JUL 23. 2013 11:19 AM X*** * END ** *X* ALARM HISTORY REPORT SMARTSENSOR ALARM -- s16:DSL PRODUCT LINE HIGH LIQUID ALARM JUL 23, 2013 11:19 AM NO VACUUM ALARM JUL 23, 2013 11:18 AM END ***x* ALARM HISTORY REPORT BMARTSENSOR ALARM -- s17:DSL ANNULAR NO VACUUM ALARM JUL 23. 2013 11:18 AM ALARM HISTORY REPORT SMARTSENSOR ALARM -- 12:91 PRODUCT LINE NO VACUUM ALARM JUL 23. 2013 11:15 AM VACUUM WARNING JUN 27, 2013 4:10 PM NO VACUUM ALARM JUN 27, 2013 3:34 PM END * * * * * ALARM HISTORY REPORT SMARTSENSOR ALARM -- s13:91 -87 VENT LINE NO VACUUM ALARM JUL 23. 2013 11:14 AM END * * * * * ALARM HISTORY REPORT SMARTSENSOR ALARM -- s14:91 ANNULAR NO VACUUM ALARM JUL 23. 2013 11:15 AM Stop ALARM HISTORY REPORT SENSOR ALARM - - - -- ALARM HISTORY REPORT ALARM HISTORY REPORT Q 3:DIESEL GROSS LINE FAIL SENSOR ALARM - - - -- SENSOR ALARM - - - -- QJUL23, 2013 11:45 AM Q 2:PREM-91 1:UNL -87 GROSS LINE FOILILPLLDSHUTDOWNALARM JUL 23. 2013 11:50 AM JUL 23, 2013 AM PLLD SHUTDOWN ALARM z zN C JUL 23. 2013 11 :19 AM GROSS LINE FAIL PLLD SHUTDOWN ALARM JUL 23, 2013 11:50 AM JUL 23. 2013 11:19 AM PLLD SHUTDOWN ALARM JUL 23, 2013 11:11 AM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM Fa m JUL 23, 2013 11:19 AM JUL 23. 2013 11:11 AM PLLD SHUTDOWN ALARM tnt r m JUL 23. 2013 10:42 AM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM JUL 23, 2013 11:11 AM UL 23, 2013 10:42 AMJ PLLD SHUTDOWN ALARM d JUL 23. 2013 10:34 AM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM C3 JUL 23, 2013 10:42 AM UL 23. 2013 10:34 AMJ PLLD SHUTDOWN ALARM b JUL 23. 2013 10:32 AM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM z 0 w JUL 23, 2013 10:34 AM JUL 23, 2013 10:32 AM PLLD SHUTDOWN ALARM JUL 23, 2013 10:30 AM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM JUL 23, 2013 10:32 AM JUL 23, 2013 10:30 AM PLLD SHUTDOWN ALARM JUL 23. 2013 10:21 AM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM JUL 23, 2013 10:30 AM UL 23, 2013 10:29 AMJ PLLD SHUTDOWN ALARM JUL 23, 2013 10:21 AM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM JUL 23. 2013 10:29 AM UL 23, 2013 10:28 AMJ PLLD SHUTDOWN ALARM JUL 23. 2013 10:20 AM PLLD SHUTDOWN ALARM PLLD SHUTDOWN ALARM JUL 23, 2013 10:28 AM JUL 23, 2013 10 :26 AM EotoDpr i r m h.j rprz ca oNrC' x m NCO I n 3i n7ztatncy io[nH 7•• O C 92 m am z zN C I MjWzwo00Z6M nzm Fa m o c I x tnt r m zz jtvd D M i c z to d omGC7IH C3 ooz a '"n o i bC r s 1 10 z 0 w OH rrl T, MONITOR CERT. FAILURE REPORT SITE NAME: PANAMA LANE SHELL DATE : 7/23/13 ADDRESS: 4815 PANAMA LANE TECHNICIAN: RICHARD MASON THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS; NONE LABOR; NONE PARTS INSTALLED: NONE NAME: TITLE: SIGNATURE: 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. BILLING & PERMIT STATEMENT FPERMIT NO.: A B 9. S P D FIRE ARrm r BMERSFIELD FIRE DEPT. Prevention Services 1600 Truxtun Ave Ste 401 Bakersfield CA 93301 Tel.: (661) 326 -3979 • Fax: (661) 852 -2171 FD 2021 (Rev. 06/07) 1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer) SITE INFORMATION LOCATION OF PROJECT PROPERTY OWNER STARTING DATE COMPLETIONN DATE NAME l V PROTECT NAME PROJECT ADDRESS q z ADDRESS` {, , „ A SIITAATTE lX PHONE NO. CITY', , ZIP CODE CONTRACTOR CONTRACTOR NAME CA LICENSE NO. J CM 4r C tt O O INFORMATION TYPE OF LICENSE. EXPIRATION DATE 1 c gHA 30 20( PHONE NO. g 2 —$ CONTRACTOR COMPANY NAME FAXNn. 2 - S6 ADDRESS CRY ZlPwue All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. Alarms - New & Modffications - (Minimum Charge) $280.00 ® 84 98 Over 10,000 Sq. Fit Sq. Ft x. 84 98 Sprinklers - New & Modifications - (Minimum Charge) 280.00 84 98 Over 10,000 Sq. Ft x .028 = Permit f 98 Minor Sprinkler Modifications (< 10 heads) 96.00 [Inspectio 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.-1s Time) 180.00 82 Additional Tanks 96.00 82 Aboveground Storage Tanks (Remova#lnspection) 109.00 82 Underground Storage Tanks (Instal/adon 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 (Removal) 573.00 (per tank) 84 Oilwell (Installation) 96.00 84 Mandated Leak Detection (Testing) Fuel onit. ert/SB989. Note: $96.00 for each type oftest /per ' e even ' heduled at the same time) 8 86 (persiteZ 1 , n 82 Tents 96.00 (per tens 84 Pyrotechnic - (Per event, Plus insp. Fee @T $96 per hour) 96.00 + (5 hrs. min. standby fee /Ins)edon)- 76..00 84 After hours inspection flee 121.00 84 RE4NSPEC7ION(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 $50.00 per hr) 250 per page 84 Miscellaneous 84 FD 2021 (Rev. 06/07) 1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer) 4 t. r i rr {.,' ,'k . . f. - w.r. BAKERSFIELD CITY FIRE DEPARTMENT — INSPECTION RECORD Post this Card at the Job Site and DO NOT Remove for Duration of Work Inspection Request Phone No. (661) 326 -3979 UST NEW INSTALL DESCRIPTION DATE SIGNATURE BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF i C-- - _ -- -- TANK- TESTING - -- - - - -- UST REMOVAL DESCRIPTION DATE SIGNATURE AST NEW INSTALL DESCRIPTION DATE SIGNATURE MODIFICATIONS MINOR / MAJOR I AST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE PRIOR TO.OPERATION OF ANY_ -SYSTEM , BALLUSTAND /OR AST SYSTEMS SHALL BED INSTALL COMPLETE AND ACCEPTED 6Y, MISC. ACTIVITY THE_BAKERSFIELD-CITY FIRE DEPARTMENT. rL.FIRE- DEPARTMENT (FINAL) REMARKS: BUILDING ADDRESS: </$ / 5 L KJ . JOB DESCRIPTION: , kZ4 L OCCUPANCY TYPE: .L3 OWNER: PERMIT NO. - 14:)60 331 CONTRACTOR: PHONE # 2- 9Z.1 j FD 1743 BILLING & PERMIT STATEMENT PERMIT NO.: BAKERSFIELD FIRE DEPT. a 3 p Prevention Services FIRE AR1Y 1600 Truxtun Ave Ste 401 Itu 1 Bakersfield CA 93301 Tel (6611 326 -3979 • Fax: (6611852-2171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. I Alarms - New & Modifications - (Minimum Charge) 1$280.00 1 84 1 98 Undergroun d SITE INFORMATION LOCATION OF PROJECT 0 PROPERTY OWNER STARTING DATE COMPLETION DATE NAME 1 PROJECT NAME - L/ oil PROJECT ADDRESS — k J P ADDRESS n v V 82 CITY1 / STATE ZIP CODE CONTRACTOR CONTRACTOR NAME CA LICENSE NO. JpmIES - C_ ti SCE INFORMATION TYPEOFLICENSE. EXPIRATION DATE tD40.4N 1 3 > 20Iq PHONE NO 3q,2 -8 a7 CONTRACTOR COMPANY NAME 1 G > JV FAX NO. 80 ADDRESS 6U CITY ZIP wuc 9 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. I Alarms - New & Modifications - (Minimum Charge) 1$280.00 1 84 1 98 Undergroun d a Underground Storage Tanks (Modification) 878.00 (per site) 82 Underground Storage Tanks (Minor Modification) 167.00 82 Underground Storage Tanks (Removaq 573.00 (per tank) 84 Oilwell (Installation) 96.00 64 6 Mandated Leak Detection (Testing) Fuel onit. erVSf3989. Note. $9S. ADforeach typeof test /per a even heduled at the same time) 98 9@ (peFSite,L 9 0 O d 82 Tents 96.00 (per tend 84 Pyrotechnic - (Per event, Plus Insp. Fee @ $96 per hour) 96.00 + (5 hrs. min. standby feeAnspection)a$576..00 84 After hours inspection fee 121.00 84 RE- INSPECTION(S) /FOLLOW -UP INSPECTIONS) 96.00 (per hour) 84 Portable LPG (Propane): NO. OF CAGES? _ 96.00 Explosive Storage 266.00 e4 Copying & File Research (File Research Fee $50.00 per hr) 250 per page 84 Miscellaneous 84 1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer) FD 2021 (Rev. 08/07) 1 i lip- t f 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 # A_ 11r ! BAKERSFIELD FIRE DEPARTMENT Prevention Services Q O L k-t 5-MEET Bakerstield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 Page 1 of 1 ENHANCED LEAK DETECTION LINE TE SB-989 SECONDARY CONTAINMENT TANK TIGHTNESS FUEL MONITORING CE N SIrm FACILITY e- I— NAME & PHONE # 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 # VOLUME CONTENTS Q' I I I U a alc\ V 2. 9/P lam l I 1 wl _ 9 1 APPLICANT SIG ` DA G _l JD THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY DATE Je- 7 -,3 FD2095 (Rev 03/08) r r '