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HomeMy WebLinkAbout4200 ASHE ROAD (10)QLS ffcr61b MONITORING SYSTEM CERTIFICATION For Use By All JW1sdldfons Within the State ofCalifornia Authority Cited: Chapter 6.7; Health acidSafety Code; Chapter 16, Division 3, Tale 23, California Code ofRegulations This form must be used to document testing and servicing ofmonitoring equipment. A gong gotification or art mast be Rrmgmd for each ttmnitorina system controlpanel by the technician who performs the work. A copy of this form must be provided to the tank system owner /operator. The owns /operator must submit a copy ofthis tbrm to the local agency regulating UST systems within 30 days oftest date. A. General Information Facility Name: PANAMA BUENA VISTA U.S.D. Bldg. No.: Site Address: 4200 ASHE RD. City: BAKERSFIELD Zip: 93313 Facility Contact Person: VICKI STALNAKER Contact Phone No.: i } Make/Model ofMonitoring System: TLS-= INSP.- ESTER AND ERNIE Date ofTestiiig/Servicing: 3/4/2011 B. Inventory of Equipment Tested/Certified Cheek the anmmnrlate hmen toindieate anedfic eaornment htwmetedhwPvlred: l Tank ID: REGULAR 87 Tank ID: DIESEL 1n -Tank Ganging Probe. Model: 1AAG In -TankGaugingProbe. 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(,). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: FX1V Mechanical Line Leak Detector. Model: FX1 DV Electronic Line Leak Detector. Model: Electronic Line LeakDetector. Model: Tank Overfill / High -Level Scum. Model: MAGI E.OA Tank Overtill / High-Level Sensor. Model: MAGI E.OA Other (specify equipmenttype and model in Section E on Pagg2). Other (specify equipment type and model in Section Eon Page 2). Tank ID: WASTE OIL Tank ID: In -Tank Gauging Probe. Model: NM In-TankGauging Probe. Model: Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: Piping Sump / Trench Sensor(s). Model: Piping Sump / Trench Seosar(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Lace Leak Detector. Model: Mechanical Line Leak Detector. Model: ElectronicLine Leak Detector. Model: Electronic Line Leek Detector. Model: Tank Overfill / High -Level Sensor. Model: WA Tank Overfill / High -Level Sensor. Model: Other (specify equipment type and model in Section E on Page 2). Other (speedy equipmenttype and model in Section E on Page 2). Dispenser ID: 112 Dispenser ID: 314 Dispenser Containment Sensor(s). Model: 208 Dispenser Containment Sessor(s). Model• 208 Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) andChain(s). Dispenser Containment Float(s) andChain(s). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: DispenserContainment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) andChain(s). Dispenser ID: Dispenser ED: Dispenser Containment Sensor(s). Model• Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Vahro(s). Dispenser Containment Float(s) and Cham(s). Dispenser Containment Float(s) andChain(s). If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification - I certify that the equipment identified in this document was inspected/serviced In accordance with the manufacturers' guldelines. Attacbed 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 ulpmettt. For any equipment capable of generating such reports, I have also attached a copy of the report; (chwk aQ that apply): System set -up ® Alarm history report Technician Name (prim): STEVEN OBERT Signature: Certification No.: A28531 t8029880-UT License. No.: CM11 D40 809850 Testing Company Name: RICH ENVIRONMENTAL Phone No.: (661) 326-W2 Testing Company Address: 3305 BRITTAN RD. BAKERSFIELD, CA. 93308 Date of Testing/servicing: 31412011 Page 1 of 5 UN4% -1 /4 www.unldocs.org Rev. 01n7M 43w Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: 329.01 Comnlete the followina 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 'on? 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 lgId sensor f Ldureldisconnection? ® 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? 90% 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* IM 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 IS Yes No* Is all monitoring operational M manufacturer's specifications? In Section E below, describe how and when these deffelencies were or will be corrected. E. Comments: Page 2 of 5 UN-M-2/4 w".unldomorg Rev. OV17/08 Monitoring System Certification yObi b F. In -Tank Ganging / SIR Equipment: ® Check this box if tank 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 ofsystem 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): C'mmnlete the fnllmvtna eharklkt- Check this box ifI I are not installed Yes No* For equipment start -up or annual equipment certification, was a leak 'simulated to verify LLD performance? NIA Check all that apply) Simulated leak rate: ® 3 g.p h.; 0.1 g.p.h ; 02 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? 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 ifany portion of the monitoring system is disabled tg N/A or disconnected? Yes No* For electronic LLDs, does the turbine automatically shut off ifany portion of the monitoring system malfimctions N/A or fails a test? Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? N/A 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. FL Comments: L'N -036 - 3/4 Page 3 of b www.enldomorg Rev. NAM$ Monitoring System Certification Form: Addendum for Vacuum /Pressure Interstitial Sensors I. Results of Vacuum/Pressure Monitoring Equipment Testing 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 ofthe Monitoring System Certification Form to the local agency regulating UST systems within 30 days oftest date. Manufacturer. N/A Model: System Type: Pressure; Vacuum Sensor 1D Component(s) Monitored by this Sensor. 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 Components) Monitored by this Sensor: 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 Component(s) Monitored by this Sensor. 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 Component(s) Monitored by this Sensor: 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 Component(s) Monitored by this Sensor. Sensor Functionality Test Result Pass; Fail Interstitial Communication Test Result: Pass; Fail Component(s) Monitored by this Sensor: Sensor Fumctionality Test Result: Pass; Fail Interstitial Communication Test Result Pass; Fail How was interstitial communication verified? Leak Introduced at Far End ofInterstitial S ;1 G ; Visual 'on; Other (Describe in Sea J, below) Was vacuum/pressure restored to operating levels in all interstitial spaces? Yes No ffno, describe in Sec. J, below) J. Comments: NONE OF THESE SENSORS ARE PRESENT AT THIS SITE. Page 4 of 5 If the sensor sugcessfidly detects a simulated tev cupmfpressure le *mtrod d m the interstitial space at the furthest point from the sensor, unto sure has been demoastr$ W be commumi throughout the interstice. UN-WA -1/1 wwwmddemorg Rev. 01!16/06 AVW m Or JI 10 Mk BINH 5, w 6t t. A IM. t, V, f, 'r q :A.e P%: Y. 11 t 14 Af :i 4! ;(1 -J: litit. il f Qv 21 U, -4, hi ;1 4 4 A 0 i, v -Z .;i i-v 11 m '7 '41% tr. fit -.S. ti -f V It .4; 1? T^ it. .';I .A! 1, VV T. . Ik :1 4. 4i •4 f, :w I M M '41 .4 t, K ly 4 M1 IL 't V , e x.. it, 71 v I v i: A It itF' i, It ri. I. it 7t ;1 :1 t T. z W I 1f N 40'A :X' - w I 't 1 17l7lw. al `1.- 11 5, I fio ;4 t 'A It T. f fr V Y, Z: It 74 -A f:. -f %F !-ta t- iz -,r; 'k -v iA ihle7-: r- . 4 mot. LL 7e ok, 'A is -1(5 i4 t, m. it V o. j, !Z! N 14 fe t, 1; l, A r4 i Y 4 T 71 k,. w • .6 k. R1, -.W 4 a; J,: j. I: WAN RICH ENMONMENTAL 3305 BRTTTAN ST. BAKERSFIELD, CA. 93308 OFFICE (661)326 -8402 FAX (661)326 -8934 PRODUCT LINE LEAK DETECTOR TEST 1: 1 4 " l W/0#: FACILITY NAME: PANAMA BUENA VISTA SCHOOL DISTRICT FACILITY ADDRESS: 4200 ASHE RD. BAKERSFIELD, CA. PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL UNL&7 L/D TYPE: 'FXIV YES 10 P.S.I. PASSSERIAL # _3 DIESEL L/D TYPE FX1DV YES 10 P.S.L PASS SERIAL # 7 q IJD TYPE: _ PASS YES SERIAL # FAEL L/D TYPE: PASS YES SERIAL. # FAEL I CERTIFY THE ABOVE TESTS WERE CONDUCTED ON THOS DATE ACCORDING TO RED JACKET PUMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMLTATIONS. 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 PAL I ACKNOWLEDGE THATALL DATA COLLECTED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. TECHNICIAN: STEVEN OBERT SIGNATURE: DATE: 3/4611 SWRCB, January 2006 / N ` Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing ofUSTspill containment structures. The completedform and printoutsfrom tests (tf `applicable), shouldbe provided to thefacility owner /operatorfor submittal to the local regulatory agency. is FACILITY INFORMATION Facili Name: PANAMA BUENA VISTA U.S.D. Date ofT 3/4/2011 Facility Address: 4200 ASHE RD. BAKERSFIELD, CA. 93313 Facility Contact: VICKI STALNAKER Phone: Date Local Agency Was Notified ofTesting : 1 /27 /2011 Name ofLocal Agency Inspector Wpresent during testing): ERNM AND ESTER 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: STEVEN OBERT Credcnfials': CSLB Contractor X ICC Service Tech: SWRCB Tank Tester ' Other ecify) License Number(s): 8029980 -UT 3. SPILL BUCKET ,TESTING INFORMATION Comments — ('include i* mation on repairs madeprior to testing, andrecommendedfoll w -upforfailed tests) WASTE OIL BUCKET IS TORN AND LEAKING WILL NEED TO BE REPLACED. CERTIFICATION OF TECEMICIAN RESPONSIBLE FOR CONDUCTING TSIS TESTING I hereby ceA j+ that aQ the infonnadon contabted In this report h true, accurate, and Inf fi covVWwece with legalrequhwnentL Technician's Signature: Co ` = Date: 3/4/11,,.. State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. T I:DIESEL 2.0 PRODUCT CODE 1THERMALCOEFF000450TANKDIAMETER95.00TANKPROFILE20PTS DELIVERY LIMIT FUL VOL 1215390.3 INCH VOL 1192885.5 INCH VOL 11520 80.8 INCH VOL 11016 76.0 INCH VOL 1042371.2 INCH VOL 977066.5 INCH VOL 908761.7 INCH VOL 835557.0 INCH VOL 7614 52.2 INCH VOL 684147.5 INCH VOL 607642.7 INCH VOL 5295 38.0 INCH VOL 4539 28.5 INCH VOL 3066 23.7 INCH VOL 2368 19.0 INCH VOL 173014.2 INCH VOL 1136' 9.5 INCH VOL 633 4.7 INCH VOL 224 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0HIGHWATERLIMIT: 3.0 MAX OR LABEL VOL: 12153OVERFILLLIMIT90% HIGH PRODUCT 1095% DELIVERY LIMIT 1504X5 1215 LOW PRODUCT 1000LEAKALARMLIMIT: 50SUDDENLOSSLIMIT: 50TANKTILT0.25PROBEOFFSET0.00 SIPHON MANIFOLDED TANKSTit: NONE LINE MANIFOLDED TANKST#: NONE LEAK MIN PERIODIC: 43.3% LEAK MIN ANNUAL 5O 6076. PERIODIC TEST TYPE STANRARD ANNUAL WT FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFFPERTESTAVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERYRESHHOOLD i 10. DO% COMMUNICATIONS SETUP - y PORT SETTINGS: COMM BOARD : 5 (RS -485) BAUD RATE :..2400 PARITY : EVEN STOP BIT : 1 STOP DATA LENGTH: 7 DATA RS -232 SECURITY CODE : DISABLED COMM BOARD : 6 (RS -232) BAUD RATE : 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 D I.SABLED AUTO THEFT LIMIT DISABLED AUTO DELIVERY START DISABLED AUTO DELIVERY END DISABLED AUTO EXTERNAL INPUT ON DISABLED AUTO EXTERNAL INPUT OFF DISABLED AUTO SENSOR FUEL ALARM DISABLED AUTO SENSOR WATER ALARM DISABLED AUTO SENSOR OUT ALARM DISABLED RS -232 END OF MESSAGE DISABLED SYSTEM SETUP - l+Vrt, [ MAR -4. 2011 10:57 AM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYYY HH:MM:SS xM PANAMA BUENA VISTA 4200 ASHE RD BAKERSFIELD CA SHIFT TIME 1 : 1:00 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 PRINTTO VOLUMES TEMP COMPENSATION VALUE (DEG F ): 60.0 STICK DIGHT OFFSET ULLAGE : 90%t H- PROTOCOL DATA FORMAT HEIGHT DAYLIGHT SAVING TIME ENABLED START DATE MAR WEEK 2 SUN START TIME 2:00 AM END DATE NOV WEEK I SUN END TIME 2:00 AM 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 c • uivicn• - CODE 5.0 JERMAL 5.0 000700 aNK DIAMETER OVERFILL LIMIT 95.00 3NK PROFILE 20 PTS FULL VOL 12153 90.3 INCH VOL 11928 85.5 INCH VOL 11520 80.8 INCH VOL 11016 76.0 INCH VOL 10423 71.2 INCH VOL 9770 66.5 INCH VOL 9087 61.7 INCH VOL 8355 57.0 INCH VOL 7614 52.2 INCH VOL 6841 47.5 INCH VOL 6076 42.7 INCH VOL 5295 38.0 INCH VOL 4539 33.2 INCH.VOL 3782 28.5 INCH VOL 3066 23.7 INCH VOL 2368 19.0 INCH VOL 1730 14.2 INCH VOL 1136 9.5 INCH VOL 633 4.7 INCH VOL 224 LOAT SIZE: 4.0 IN. ATER WARNING 2.0 IGH WATER LIMIT: 3.0 AX OR LABEL VOL: 12153 VERFILL LIMIT, : 90% 10937 IGH PRODUCT 956 11545 ELI VERY LIMIT : 10% 1215 OW PRODUCT 1000 EAK ALARM LIMIT: 50 UDDEN LOSS LIMIT: 50 ANK TILT 1.25 ROBE OFFSET 0.00 IPHON MANIFOLDED TANKS 0: NONE INE MANIFOLDED TANKS NONE EAK MIN PERIODIC: 33% 4010 EAK MIN ANNUAL 50% 6076 ERIODIC TEST TYPE STANDARD NNUAL TEST FAIL ALARM DISABLED ERIODIC TEST FAIL ALARM DISABLED ROSS TEST FAIL ALARM DISABLED NN TEST AVERAGING: OFF ER TEST AVERAGING: OFF ANK TEST NOTIFY: OFF NK TST SIPHON BREAK:OFF SLIVERY DELAY : 3 MIN UMP THRESHOLD : 10.00% 1 J;wm 11r V1L THERM COEFF :.010470 TANK DIAMETER 46.00 TANK PROFILE I PT FULL VOL `550 FLOAT SIZE: 4.0 IN. WATER WARNING 5.0 HIGH WATER LIMIT: 5.0 MAX OR LABEL VOL: 550 OVERFILL LIMIT 90% r HIGH 40DUCT 495 5 DELIV AY LIMIT 1% 5 LOW PRODUCT 1 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TO: NONE LINE MANIFOLDED TANKS TO: 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: OFFPERTESTAVERAGING: OFF TAW TEErZ NOTIFY : OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 1 MIN PUMP THRESHOLD : 10.00% ALARM HISTORY REPORT SENSOR ALARM - - - -- L 3:DIESEL ANNULAR ANNULAR SPACE SENSOR OUT ALARMMAR4, 2011 9:22 AM FUEL ALARM MAR 4, 2011 9:10 AM FUEL ALARM MAR 4. 2011 9:10 AM x x x x x END x x x x x F ALARM HISTORY REPORT SENSOR ALARM - - - -- L 4:DIESEL STP SUMP STP SUMP SENSOR OUT ALARMMAR4. 2011 9:22 AM FUEL ALARM MAR 4, 2011 9:17 AM SENSOR OUT ALARMMAR18: 2010 9:32 AM i x x x END x x x x x ALARM HISTORY REPORT SENSOR ALARM - - - -- L S:DISPENSER 1 2 DISPENSER PAN SENSOR OUT ALARM MAR 4. 2011 9:22 AM FUEL ALARM MAR 4. 2011 9:21 AM SENSOR OUT ALARM MAR 18, 2010 9:32 AM LARM HISTORY REPORT SENSOR ALARMf 6:DISPENSER 3 4 ISPENSER PAN TENSOR OUT ALARM IAR 4, 2011 9:22 AM UEL ALARM 1AR 4. 2011 9:20 AM SENSOR OUT ALARM IAR 18, 2010 9:32 AM xxxx9 END xxxx HISTORY REPORT SENSOR ALARM - -- L 7:WASTE OIL OTHER SENSORS. FUEL ALARM MAR 4, 2011 10:59 AM SENSOR OUT ALARM MAR 4. 2011 9:22 AM SENSOR OUT ALARM MAR 18. 2010 9:32 AM xxxxx END xxxx ALARM HISTORY REPORT SENSOR ALARM - -- OTHER SENSORS xxxxxENDxxxx EAK TEST METHOD EST ON DATE : ALL TANK iN 29. 2009 CART TIME : DISABLED EST RATE :0.20 GAL/HR JRATION : 2 HOURS 3T EARLY STOP:DISABLED FAK TEST REPORT FORMAT NORMAL IAUID SENSOR SETUP 1:UNLEADED ANNULAR RI -STATE (SINGLE FLOAT) 4TEGORY : ANNULAR SPACE 2 :UNLEADED STP SUMP RI -STATE (SINGLE FLOAT) 4TEGORY : STP SUMP 3:DIEBEL ANNULAR RI -STATE (SINGLE FLOAT) ATEGORY : ANNULAR SPACE 4:DIESEL STP SUMP ` RI -STATE (SINGLE FLOAT) ATEGORY : STP SUMP 5:DISPENSER 1 2 AT : (DISPENSPAN b: RI- 0 SHUTDOWN 00- 7--'f-tb?L HISTORY REPORT 1;.44 - - -- IN -TANK ALARM - T 2:UNLEADED TES HIGH PRODUCT ALARMESTSMAR4. 2011 9:08 AM MAR 18. 2010 9:20 AM PROBE OUT MAR 4, 2011 9:09 AM MAR 4. 2011 9:08 AM DELIVERY NEEDED MAY 24, 2010 4:09 PM MAX PRODUCT ALARM MAR 4. 2011 9:08 AM MAR 18. 2010 9:20 AM x x x x x END x x x x x xxxxx END xxxx ALARM HISTORY REPORT SENSOR ALARM -- L I:UNLEADED ANNULAR ANNULAR SPACE SENSOR OUT ALARM MAR 4. 2011 9:22 AM FUEL ALARM MAR 4. 2011 9 :07 AM SENSOR OUT ALARM MAR 18. 2010 9 :32 AM xxxxx END xxxx ALARM HISTORY REPORT SENSOR ALARM -- L 2:UNLEADED STP SUMP STP SUMP SENSOR OUT ALARM MAR 4. 2011 9:22 AM FUEL ALARM MAR 4. 2011 9:18 AM SENSOR OUT ALARM MAR 18, 2010 9:32 W MONITOR CERT. FAILURE REPORT ADDRESS : 4,200 ASHE RD. TECHNICIAN: STEVEN OBERT THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED.TO COMPLETE TESTING. REP : D WASTE OIL BUCKET TORN NEEDS TO BE REPLACED. . 1! a M no 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 ENVIRONMENTAL 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.