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HomeMy WebLinkAbout5401 STOCKDALE HWY FMC 2013F - -0')7 q0 HOODS ALARMS SPRINKLER SYSTEMS FIR 1, R Co CURIFF,, AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. 1,3- /DO©O 33c(- File Number: %/ Date Received: — — 13 Address: Bakersfield, CA 933 ' Business Name: %IAP. (o L Comments: --r-L Z(:( 1. 2. 3. 4. NSPECTBOtd Date Time S gnature Signature I c C- :tt- 5-;Z,9 ? 85"7 ev. ///0//5- VA # $3&' 8b'o 6W- 9 12-&/ly VHi # 21 Itr EAP• `Y12 11S SYSTEM: BUILDING SQUARE FEET: New Mod. Commercial Hood System Building Sq. Feet: Fire Alarm System Calculation Bldg. Sq. Ft: Fire Sprinkler System sit - , . Firr-,i„ Aboveground Storage Tank Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank her C-- Comments: --r-L Z(:( 1. 2. 3. 4. NSPECTBOtd Date Time S gnature Signature I c C- :tt- 5-;Z,9 ? 85"7 ev. ///0//5- VA # $3&' 8b'o 6W- 9 12-&/ly VHi # 21 Itr EAP• `Y12 11S 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 ndividual tests and will be charged per separate type test accordingly.) PERMIT # F/BI IR rmA T BAKERSFIELD FIRE DEPARTMENT Prevention Services Q10( Nk SZREET Bakerstield, CA 93301 Phone: 661-326-3979 • Fax: 661 - 852 -2171 Page 1 of 1 ENHANCED LEAK DETECTION LINE TESTING SB -989 SECONDARY CONTAINMENT TANK TIGHTNESS 13'1 UEL MONITORING CERTIFICATION SITE INFORMATION FACILITY 1 NAME & PHON F CONTACT PERSON ADDRESS OWNER NAME OPERATOR NAME PERMITTO OPERATE # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES NO TANK # VOLUME CONTENTS 2 TANK TESTING COMPANY TESTING COMPANY NAME & PHONE OF CONTACT PERSON LOPULA MAILING ADDRESS F3Pr1GE+R.SF1E. -O C F °3308 to a NAME & PHONE # O TESTER OR SPECIAL INSPECTOR _, R_( ^ T_MnSM 7 CERTIFICATION # ^ 0 7 U DATE & TIME TEST t0 BE CONDUCIED ICC A TEST METHOD APPLICANT SIGNA DATE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY DATE FD2095 (Rev 03/08) 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 ANKTESTI UST REMOVAL DESCRIPTION DATE SIGNATURE AST NEW INSTALL DESCRIPTION DATE SIGNATURE MODIFICATIONS MINOR / MAJOR AST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE PRIORI PERATION OF AN_Y_SYSTEM,) ALL_U.ST AND /OR_AST SYSTEMS SHALL BEI INSTALL -, -COMPLETE AND ACCEPTED BY MISC. ACTIVITY T;HE- BAKERSFIELD -CITY FIRE-DEPARTMENT7 FIRE DEPARTMENT (FINAL) REMARKS: BUILDING ADDRESS: 5qd 6c- (< JOB DESCRIPTION: v!/l C OCCUPANCY TYPE: OWNER: ')/I/l 6 to t' PERMIT NO. - 166CO CONTRACTOR: , ' Ly PHONE # 2 - % FD 1743 BILLING & PERMIT STATEMENT PERMIT NO.: MRS A D 4 FIRE AATN' T 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. R SITE INFORMATION LOCATION OF PROJECT _ ^ 1 PROPERTY ER STARTING DATE Q COMPLETION DA 0 NAME ' PROJECT NAME Q L ADDRESS PHONE NO. fECTADDRESS CITY STATE ZIP CODE CONTRACTOR CONTRACTOR NAME CA LICENSE NO. TYPE OF LICENSE. EXPIRATION DATE J'1 c- S Ct- O SO f 4c gHA 30 201 PHONE NO. 9'2-8(pa7 CONTRACTOR COMPANY NAME FAX NO- If ADDRESS CITY ZIP wuc All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. R PERMIT TYPE Alarms - New & Modifications - (Minimum Charge) FEE CALCULATION 280.00 TOTAI TREASURY DUE ACCT NO 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 98 Additional Hoods 58.00 84 98 Spray Booths - New & Modifications 470.00 84 98 Aboveground Storage Tanks (Installadon/Insp. -t" Time) 180.00 82 Additional Tanks 96.00 82 Aboveground Storage Tanks (RemovaNnspection) 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 (Removal) 573.00 (pertank) 84 Oilwell (Installation) 96.00 84 Mandated Leak Detection (Testing) / uel MDnit. ert/SB989. Note. $96.00 foreach type of test 1per s scheduled at the same time) 98:66-(peFSite,L Ca , O r 82 Tents 96.00 (per tent) r 84 Pyrotechnic - (Per event, Plus Insp. Fee 0 $96 per hour) 96.00 + (5 hrs. min. standby fee /inspection)--$576..00 84 After hours inspection fee 121.00 84 RE- INSPECTION(S) /FOLLOW- UPINSPECTION(S) 96.00 (per hour) 84 Portable LPG (Propane): NO. OF CAGES? _ 96.00 84 Explosive Storage 266.00 84 Copying & File Research (Fie 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) w RICH ENVIRONMENTAL SERVICE STATION SERVICES 90- 7162/3222 4245 LIC. #809850 5643 BROOKS CT. BAKERSFIELD, CA 93308 -3708 DATE 661) 392 -8687 t AYTOTHE 1'D 1 — — i J Tllgen Chase Bank, N.A. Bakersfieldi CA 93308 FOR * • • — q ' ,_ 7+'h,. ' { "' ,. C'OF ?NIS., _ ( t' NT'. y40M I1R13_A'= 8`HNSIT'IYFa:F1G ' T( Tl1CM OR.•` H, B' l f'. Nt( OE b' 1V1' L '61ti''BPF Rj1N1}r„T,Ht!T 7 i..:'.•"'. ^' +;T I'•P.yY-'yjw^F '~ ito. • •a??+.sl.tu;.. tr. ry .r ,... ,.,,..u r. v+a 'A.iKair: r...:rs.... x", -..w;r .:: u:3, yati-(. rl i r h.?..:..:... r v. J'.• ",yiy. gin? , v..0 ..r - .t .,:. _. . Ftile, PI( 13 t- /sa -w MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State ofCali ornia 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 Monitoring as= control panel 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 of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: MOBIL STATION Site Address: 5401 STOCKDALE HWY Facility Contact Person: FONG Make/Model of Monitoring System: TLS -350 B. Inventory of Equipment Tested /Certified Check the appropriate boxes to indicate specific equipment inspected /serviced: Bldg. No.: City: BAKERSFIELD Zip: Contact Phone No.: ( ) Date of Testing/Servicing: 8/27/2013 Tank ID: UNL87 Tank ID: PREM91 In -Tank Gauging Probe. Model: MAG In -Tank Gauging Probe. Model: MAG Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: 420 Piping Sump / Trench Sensor(s). Model: 208 Piping Sump / Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: RED JACKET Mechanical Line Leak Detector. Model: FE PETRO Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: FLAPPER Tank Overfill / High -Level Sensor. Model: FLAPPER 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: In -Tank Gauging Probe. Model: MAG 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: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: FE PETRO Mechanical Line Leal: Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: FLAPPER 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: 112 Dispenser ID: 314 DispenserContainment Sensor(s). Model: 001 Dispenser Containment Sensor(s). Model: 001 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: 718 Dispenser Containment Sensor(s), Model: 001 Dispenser Containment Sensor(s). Model: 001 Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: 9110 Dispenser ID: Dispenser Containment Sensor(s). Model: 001 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 -1 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): RICHARD MASON Signature: r Certification No.: 5297857 -UT 1 B36880 License. No.: C6 1 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: 8127/2013 Page 1 of 5 UN -036 — V4 www.unidoes.org Rev. 01/17/08 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed; 329.01 Comolete the following 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? 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* For tank systems that utilize the monitoring system as the primacy 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. 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 5 UN -036 — 2/4 www.unidGes.org Rev. 01 /17/08 Monitoring System Certification F. In -Tank Gauging / SIR Equipment: J% ,u4.- 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 Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Cmmnlete the Mllnwino rherklict! Check this box ifLLDs 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 ; 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 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 of the 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 No* I 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. 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R 'f .y t 6 / a y • f t ,, !. •, j- i -p, • s 1 1 r"i t; -! 4, / i • 7k ! 1 i i 11• ( J• f• / I M .F 1 1 t' a y -• 4 a t ,- 1• 1 t •a Y t• •f f l r a! a •• • '1 ,•• 1 ai/ 1 1 i . : t; 1 4 1 :F A• r• J• r ,. l/! f 1 q ' 1 1 1 '7. • a. 411ta • t , r t , "1. i ti r • I "i'R i , , i • • •. • , 'j-'s -x , • Y'.: • a , . . • 6 1 1 • 1 a 1 f (' .a 1 ! 1 1 •. / ; a . 1 1 . 1 •, . • 1 f, i • :-! , . : / , , 1 I J i r r IAQ I J i r d t6u — RICH ENVIRONMENTAL 3305 BRITTAN ST. BAKERSFIELD, CA. 93308 OFFICE (661)326 -8402 FAX (661)326 -8934 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET W /0#: FACILITY NAME: MOBIL STATION FACILITY ADDRESS: 5401 STOCKDALE HWY, 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: RED JACKET YES 10 PASS SERIAL # 8097 PREM91 L/D TYPE: FE PETRO YES 10 PASS SERIAL # MECHANICAL DIESEL L/D TYPE: JE PETRO YES 11 PASS SERIAL # MECHANICAL 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: L DATE: 8/27/13 Jl L "Jv SWRCB, January 2006 Spill Bucket Testing Report Form This form is intendedfor use by contractors performing annual testing ofUST spill 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: MOBIL STATION I Date of Testing: 8127113 Facility Address: 5401 STOCKDALE HWY, BAKERSFIELD Facility Contact: Phone: Date Local Agency Was Notified ofTesting: 7/9/13 Name of Local Agency Inspector (fpresent during testing): ERNIE MADENA 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RICHARD MASON Credentials: 0 CSLB Contractor X [CC Service Tech. 0 SWRCB Tank Tester 0 Other (Spec) License Number(s): 5297857 -UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic 0 Vacuum Other Test Equipment Used: VISUAL Equipment Resolution: 0 Identify Spill Bucket (By Tank Number, Stored Product, etc. I REG 87 -FILL 2 PREM 91 -FILL 3 DIESEL FILL 4 Bucket Installation Type: X Direct Bury Contained in Sump X Direct Bury D Contained in Sump X Direct Bury 0 Contained in Sump Direct Bury 0 Contained in Sum Bucket Diameter: 12" 12" 12" Bucket Depth: 14" 14" 14" Wait time between applying vacuum/water and start oftest: 30MYN 30MIN 30MIN Test Start Time (Tj): 1:30 1:30 1:30 Initial Reading (111): 14" 14" 14" Test End Time (TF): 2:30 2:30 2:30 Final Reading (RF): 14" 14" 14" Test Duration (TF — T,): 60MIN 60MIN 60MIN Change in Reading (RF - Rj): 0 0 0 Pass/Fail Threshold or Criteria: 0 0 0 Test Result: X Pass 0 Fail X Pass 0 Fail X Pass 0 Fail Pass 0 Fail Comments — (include information on repairs made prior to testing, andrecommendedfollow -upforfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby cerdfy that all the information contained in this report is true, accurate, and infull compliance with legal requirements. Technician's Signature: Date: 8/27/1 t 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 08 -27 -13 12:21 PM MASSiDENSITY T) T RAPT T=n SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH IN —TANK SETUP — _ _ _ _ SYSTEM DATE/TIME FORMAT MM —DD —YY HH:MM:SS xM COMMUNICATIONS SETUP T I- REGULAR 87 1 STOCKDALE MOBIL PRODUCT CODE ;.000700 5401 STOCKDALE HWY THERMAL COEFF 96.00 BAKERSFIELD.CA TANK DIAMETER PORT SETTINGS: 661.833 -2726 TANK PROFILE 12245 COMM BOARD : 1 (EDIM ) SHIFT TIME 1 11:00 PM RS -232 SECURITY SHIFT TIME 2 4:29 AM 4.0 IN. CODE : DISABLED SHIFT TIME 3 4 :29 AM FLOAT SIZE: SHIFT TIME 4 4:29 AM WATER WARNING 3.0 3'0 COMM BOARD : 2 (RS -232) BAUD RATE : 1200 TANK PER TST NEEDED WRNHIGHWATERLIMIT' PARITY : ODD DISABLED LABEL VOL: 12245 STOP BIT : i STOP TANK ANN TST NEEDED WRN MAX OR LIMIT 90% DATA LENGTH: 7 DATA DISABLED OVERFILL 11020 RS -232 SECURITY CODE : DISABLED LINE RE— ENABLE METHOD HIGH PRODUCT 11632 PASS LINE TEST DELIVERY LIMIT 15% 1836 AUTO TRANSMIT SETTINGS: LINE PER TST NEEDED WRN DISABLED 800 AUTO LEAK ALARM LIMIT LINE ANN TST NEEDED WRN LOW PRODUCT : LIMIT: 99 DISABLED DISABLED LEAK ALARMLOSS LIMIT: 50 AUTO HIGH WATER LIMIT SUDDEN 3'37 DISABLED PRINT TC VOLUMES TANK TILT 0'00 AA TO LVERFILL LIMIT ENABLED PROBE OFFSET AUTO LOW PRODUCT TEMP COMPENSATION TANKS DISABLED VALUE (DEG F ): 60.0 SIPHON MANIFOLDED AUTO THEFT LIMIT STICK HEIGHT OFFSET Tat: NONE TANKS DISABLED DISABLED LINE MANIFOLDED AUTO DELIVERY START ULLAGE: 90% To: NONE DISABLED AUTO DELIVERY END H— PROTOCOL DATA FORMAT LEAK MIN PERIODIC: 0% 0 DISABLED AUTO EXTERNAL INPUT ON HEIGHT DAYLIGHT SAVING TIME DISABLED DISABLED 0% AUTO EXTERNAL INPUT OFF RE— DIRECT LOCAL PRINTOUT LEAK MIN ANNUAL 0 DISABLED DISABLED AUTO SENSOR FUEL ALARM DISABLED EURO PROTOCOL PREFIX TEST TYPE AUTO SENSOR WATER ALARM S PERIODIC STANDARD SENSORAUTO OUT ALARM TEST FAILANNUALALARMDISABLED DISABLED SYSTEM SECURITY CODE : 000000 PERIODIC TALARAIL MAINTENANCE HISTORY DISABLED GROSS TESTAFAAIL DISABLED TANK CHART SECURITY TEST AVERAGING: OFF RS -232 END OF MESSAGE DISABLED ANN PER TEST AVERAGING: OFF DISABLED TANK TEST NOTIFY: OFF CUSTOM ALARMS DISABLED TNK TST SIPHON BREAK-OFF DELAY 15 MIN SERVICE NOTICE DELIVERY PUMP THRESHOLD 10.00% DISABLED ISO 3166 COUNTRY CODE: MASSiDENSITY T) T RAPT T=n LEAK TEST METHOD TEST ON DATE : ALL TANK JAN 29, 2009 START TIME : DISABLED TEST RATE :0.20 GAL/HR DURATION : 2 HOURS TST EARLY STOP :DISABLED LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP L 1:UNL 87 STP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 2:DIESEL ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 3:DIESEL STP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 4:91 ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 5:PREMIUM 91 STP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 6:UNL 87 ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE Dl L -D '' T 3 :DIESEL T 2:PREMIUM 91 PRODUCT CODE 3 PRODUCT CODE 2 THERMAL COEFF :.000450 THERMAL COEFF :.000700 TANK DIAMETER 96.00 TANK DIAMETER 96.00 TANK PROFILE 1 PT TANK PROFILE 1 PT FULL VOL 5000 FULL VOL 12245 FLOAT SIZE: 4.0 IN. FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 HIGH WATER LIMIT: 3.0 MAX'OR LABEL VOL: 5000 MAX OR LABEL VOL: 12245 OVERFILL LIMIT : 90% OVERFILL LIMIT : 90% 4500 11020 HIGH PRODUCT 95% HIGH PRODUCT 95% 4750 11632 DELIVERY LIMIT 16% DELIVERY LIMIT 15% 800 1836 LOW PRODUCT 500 LOW PRODUCT 800 LEAK ALARM LIMIT: 99 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 SUDDEN LOSS LIMIT: 50 TANK TILT 0.00 TANK TILT 0.00 PROBE OFFSET 0.00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TO: NONE LINE MANIFOLDED TANKS Tit: NONE LEAK MIN PERIODIC: 16% 800 LEAK MIN ANNUAL : 161/0 800 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 15 MIN PUMP THRESHOLD 10.00% SIPHON MANIFOLDED TANKS TO: NONE LINE MANIFOLDED TANKS TO: NONE LEAK MIN PERIODIC: 0% 0 LEAK MIN ANNUAL 016 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 : 15 MIN PUMP THRESHOLD : 10.00% t cJ ALARM HISTORY REPORT SENSOR ALARM - - - -- L 1:UNL 87 STP EVRiISD SETUP STP SUMP SENSOR OUT ALARM 08 -27 -13 1:31 PM EVR TYPE: BALANCE FUEL ALARM 08 -27 -13 1:05 PM BALANCE NOZZLE TYPE VST FUEL ALARM 03 -14 -13 12:45 PM VAPOR PROCESSOR TYPE VEEDER —ROOT POLISHER ANALYSIS TIMES OUTPUT RELAY SETUP TIM£: 10:00 AM DELAY MINUTES: 1 R 1:87 RELAY TYPE ACCEPT HIGH ORVR: STANDARDDISABLEDNORMALLYCLOSED END ISD HOSE TABLE TANK #: 1 ID FP FL HL AA RR 01 01 01 02 01 02 LIQUID SENSOR ALMS 02 02 02 02 01 02 ALL:FUEL ALARM030303020202ALL :SENSOR OUT ALARM040404020202 05 05 05 02 03 02 ISD SITE ALARMS 06 06 06 02 03 02 ISD GROSS PRES FAIL070707020402ISDDEGRDPRESFAIL 08 08 08 02 04 02 ISD VAPOR LEAK FAIL ALARM HISTORY REPORT 09 09 09 02 05 02 ISD VP PRES FAIL101610020502ISDVPSTATUSFAIL SENSOR ALARM - - - -- L 2:DIESEL ANNULAR ISD HOSE ALARMS ANNULAR SPACE ISD AIRFLOW METER MAP ALL:GROSS COLLECT FAIL SENSOR OUT ALARM ID SERIAL NUM LABEL ALL :FLOW COLLECT FAIL 08 -27 -13 I :31 PM 1 40036 DISP 1 -2 R 2:PREMIUM FUEL ALARM 2 39497 DISP 3 -4 TYPE: 08 -27 -13 1:16 PM 3 40049 DISP 5 -6 STANDARD440031DISP7--8 NORMALLY CLOSED541522DISP9 -10 TANK #: 2 ISD FUEL GRADE HOSE MAP 1 2 3 4 LIQUID SENSOR ALMS FP MHH MHH MHH MHH AA ALL:FUEL ALARM ALL:SENSOR OUT ALARM01101201901UU1 02 102 202 902 U U I ISD SITE ALARMS END * * 03 103 203 903 U U 2 ISD GROSS PRES FAIL04104204904UU2ISDDEGRDPRESFAIL 05 105 205 905 U U 3 ISD VAPOR LEAK FAIL06106206906UU3ISDVPPRESFAIL071072079073U4ISDVPSTATUSFAIL 08 108 208 908 3 U 4 09 109 209 909 3 U 5 ISD HOSE ALARMS 16 110 210 910 3 U 5 ALL :GROSS COLLECT FAIL ALL:FLOW COLLECT FAIL LABEL TABLE R 3:DIESEL TYPE: ALARM HISTORY REPORT 1: UNASSIGNED STANDARD2: BLEND3 NORMALLY CLOSED SENSOR ALARM - - - -- 3: REGULAR L 3:DIESEL STP 4: MID GRADE TANK #: 3 STP SUMP 5: PREMIUM SENSOR OUT ALARM 6: GOLD 08 -27 -13 1:31 PM 7: BRONZE LIQUID SENSOR ALMS8: SILVER ALL:FUEL ALARM FUEL ALARM 9: BLEND2 ALL:SENSOR OUT ALARM 08 -27 -13 1:06 PM 10: BL.END4 r16 v ALARM HISTORY REPORT SENSOR ALARM L 4:91 ANNULAR ANNULAR SPACE SENSOR OUT ALARM 08 -27 -13 1:31 PM FUEL ALARM 08 -27 -13 1:04 PM PMC SETUP PMC VERSION: 01.03 VAPOR PROCESSOR TYPE * * * END VEEDER -ROOT POLISHER SOFTWARE REVISION LEVELVERSION330.01SOFTWARE# 346330 -100 -BCREATED - 10.07.23.17.25 S- MODULE# 330160 -004 -aSYSTEMFEATURES: PERIODIC IN -TANK TESTSANNUALIN -TANK TESTS ALARM HISTORY REPORT SENSOR ALARM -- L 5:PREMIUM 91 STP STP SUMP SENSOR OUT ALARM 08 -27 -13 1:31 PM FUEL ALARM 08 -27 -13 1:04 PM SMARTSENSOR SETUP- CANISTORNVAPORVALVE CATEGORY x X END x x x x x VAPOR PRESSURERVACATEGORY s 3:DISP 1 -2AIR FLOW METERCATEGORY CATEGORY 3AIR FLOW DIETER s 5:DISP 5-6R FLOW TER CATEGORY ALARM HISTORY REPORT CATEGORY 7AIR FLOW METER SENSOR ALARM - - - -- L 6:UNL 87 ANNULAR s 7:DI5P 9 -10 CATECARY AIR FLOW METER ANNULAR SPACE SENSOR OUT ALARM 08 -27 -13 1:31 PM s B:ATM ATM P SENSORCATEGORY FUEL ALARM 08 -27 -13 1:05 PM MONITOR CERT. FAILURE REPORT SITE NAME: MOBIL STATION DATE: 8/27/13 ADDRESS: 5401 STOCKDALE HWY 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.