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Home My WebLink About1418 GOLDEN STATEPass Appendix VI Copies of Monitoring System Certification form and UST MonitodN Plot Plan available at hftp://www.waterboacds.ca,gov) MONITORING SYSTEM CERTIFICATION For Use ByAllJtmWlc tons Wlfhln the Stele ofdalifomla AuthoNry Cfted: Chapter 5. 7, Health and Safety Code, Chapter 18, Division 3, Title 23, Caifomle Code of Regulations This form must be used to document testing and servicing of monitoring equipment A separate certification or report must be prepared for each monitoring system control penal 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 syste na within 30 days, of test date. A. General Information Facility Name: Qn le Dell Bldg. No.: SRe Address: 1418 Golden StWe City: Bekemffokl Zip: Facility Contact Penn: Contact Phone No.: Make(Model of Monitoring System InconTS -1000 Data ofTeaWg/3eMclrg: x /12/ 2010 B. Inventory of EquipmentTested /Certifled rh.ek thw annn Anha hn.— M 1-11 srtn .norm{- —.d—nt I.wno'fnA /mrvirarl Tank iV: 67 UL Tank iD: In -Tank Gauging Probe. Model: TW-4a to -TankGaugkrg Robe. Model: AnnularSpace or Vault Sensor. Model: Annular Space orVault Sensor. Model: 0 Piping Sump / Trench Sensor(s). Model: TSP--JLS Piping Sump / Trench Serraor(s). Model: 0 Fig SumpSensor(s). Modek.. FinSump Sermor(a). Model: 0 Mechanical Line Leak Detector. Model: PW 0 Mechanics! Line Leak Detector. Model: Electronic Lire Leak Detector. Mods: Electronic Une Leak Detector. Model: D Tank OverMI / High -Level Sensor. Model: D Tank Overfill / High-Level Sensor. Model: Other ent aand model In Section Eon Pace . Other (spectfy equipment type and model In Section EonPa TankID: 911& Teak ID: D In -Tank Gauging Probe. Model: TSPUR D IrrTar* Gauging Probe. Model: AnnularSpace or Vault Sensor. Model: 0 AnnularSpace or Vaud Sensor. Model: D Piping Sump / Trench Sensor(s). Model: TSP -ULS Piping Sump / Trench Sensor(s). Modal: D F-dl Sump Sensor(s). Model: 0 F61 Sump Sensor(s). Model: Mechanical Lhre Leak Detector. Model: _PLO 0 Mechanical Lune Leak Detector. Model: Electronic Una Leak Detector. Model: 0 Electronic Une Leak Detector. Model: 0 Tank Overfill I High-level Sensor. Model-. Tank Overfill / HWk evel Sensor. Model: Other (specify equiornent toe and model in Section Eon Paw 2). Other equipment type and model In Section E on Pane 21. Dlsportw IM 1-2 Dlaportaw ID, Disperser Containment Sersor(s). Model: Beaudreau 0 Dispenser Containment Sensor(s). Model: 0 Shear VeWs), D ShearVahre(s). DispenserContainment s andChain(s). Dls rxraerContainment s andCho s . Dtapensw ID: 34 Dlsporwor ID: 0 DisperserContainment Sensor(s). Modet: Beaudmau D DisperserContainment Sensor(s). Model: 0 Shaarvalve(e). ShearVaN*a). Dispenser Containment Fb s and Chal s . Dispenser Containment Flo s and Chaln s . Dispenser 11): 34 OlspenwID: DispenserContainment Sensor(s). Modek Beaudreau D Disperser Carmimnerd Seneon(s). I Model: ShearVatve(s). 0 gearVaW s). serContainment Float(s) and Chet s RtMser ContainmentFloats and Chain(s). nme TeenycwMns more wnnw or Ugxmaers, copyTns Tome. mcuoaanommuon Tor everywnK aria =parser a< areremay. C. CertlBcation. - 1 cer try that the equipment iderrtiflad In this document was InspechKWeMced in accordance with the manufaftrers' guldelines. Attached to thle Certification Is Urtommdon (e.g. manufacbmers' checklists) necessary to verily that lids Irrfomratlon is correct anda PlotPlan showing the Woutof monitoringequipment Forany equipment capableof generatingsuch reports, I ham also allwhad a copy ofthe report; (check act thatapply): X System setup X Alarm history report c TeeMidan Name (priory: Omoa W. Mass Sitprahne: Lv CeNRwtion No-, 223813791 License. No.: 9217M Testing Company Name: CeWaltev Eauimmerit Phone No. :(6811327.9341 Testing Company Address: &'f00 GGmore Ave. Bakerefleld. Ca 83308 Date of Testbg/Servicing: 12 / 13 12010 Monitoring System Certl(kwUon Page 1 of4 19107 1 2/21/07 D. Results ofTeating0micing Software Version Installed: Complete the foltowirm checklist. T Yes 0 No Is the audble alarm operational? X Yes No' Is the hdatlai alarm operational? X Yes No' Were all sensors visually inspected, functionally tested, and confirmedoperational? Yes No' Were all sensors tnstalled.st lowest point ofsecondary containment and positioned so that other equipmentwill not Interfere with their proper rstlon? 0 Yea 0 No' It alarms are relayed toaremote monitoring station, isall corwnunkaWns equipment (e.g. modem) operational? X WA Yes No* For pressurized piping systems, does the turbine eutometicaly, shut down ifthe piping secondary containment monitoring system 0 N!A detectsa leak, iamb to operate. or Is electricallydisconnected? Nyes: which sensors intliele positive strut -down? (Check all that apply) Sumprrrarudr Sensors, 04enser Containment Sensors. W you confirm positive shut -down due to leaks gp¢ sensor fallumJdisconnection? XYes• No. Yea No' For tank systems that utilize the monitoring system as the primary tank overfill warring device (i.e. no mechanical overfill prevention X NIA valve is Installed), isthe overfill warning alarm visible and audible at the tank fill points) and operating property? If so,, at what percent oftank capacity does thealarm r? I % 0 Yes' X No Was any monflafing equipment replaced? If yes, identify spedflc sensors, probes, or other equipment replaced and tiat the manufacturer name and model forall replaosmient parts in Section below, Yes' X No Was liquid found inside any seoxWary containment systems designed as dry systems? (Check affthat apply) 0 Product 0 Water. If describe causes in Section E, below. Yea No' Wasmonitoring system self revievred to ensure proper selfts? Attach set up reports, if applicable X Yes No' Is all mordtodng equipment operational per manufacureesspedtkations? In Section E below, describe how and when these deflclenGaswere orwill be corrected. E Comments: Performed Product line testing. Monitoring System Certification Page 2 OfAl 12107 2 2/21/07 CAL - VALLEY EQUIPMENT 3500 Gilmore Avenue AES PLT — 100R Bakersfield, CA 93308 Ph #661- 327 -9341 Fax#661- 325 -2529 NAME: Circle Deli LINE #1: 91 UL TECHNICIAN: Bruce W. Hinsle ADDRESS: 1416 Golden State LINE #2: 87 UL1 LICENSE #: 90 -1069 CITY/ ST.: Bakersfield, Ca. LINE #3: 0.009 TEST DATE: 12113/2010 THE CONVERSION CONSTANT IS FOUND BY: (60 MIN/HR) / (3790 /MIUGAL) = 0.0158311 (MIN /HOUR (GAUMIN) Divide the volume differential by the test time (15 minutes) and multiply by 0.0158311, which will convert the volume differential from milliliters per minute to gallons per hour. The conversion constant causes the millimeters and minutes to cancel out PRODUCT TIME PSI START VOL ml END VOL ml TEST VOL DIFF. ml GPH GAIN/LOSS (ml) PASS FAIL 91 UL 10:15 50 222 213 9 0.009 X 10:30 50 213 205 8 0.008 X COMMENTS: PRODUCT TIME PSI START VOL ml END VOL ml TEST VOL DIFF. ml GPH GAINILOSS (ml) PASS FAIL 87 UL 11:10 50 210 198 12 0.012 X 11:25 50 198 187 11 0.011 X COMMENTS: PRODUCT TIME PSI START VOL ml END VOL ml TEST VOL DIFF. ml GPH GAIN /LOSS (ml) PASS FAIL COMMENTS: I declare underpenalty of perjury that I am a licensed tank tester in the State of California and that the information in this report is true and correct to the best ofmy knowledee. X Z L, A.: r SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractorsperforming annual testing ofUSTspill containment structures. The completedform and printoutsfrom tests (7fapplicable), should beprovidedto thefacility owner/operatorforsubmittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Circle Deli Date ofT 12113/2010 Facility Address: 1416 Golden State Bakersfield, Ca. Facility Contact: Phone: DateLocal Agency Was Notified of Testing Name ofLocal Agency Inspector (ifpresent daring testing): 2_ TF.CTING (nNTRA( TOR INFORMATION Compan Name: Cal - Valley Equipment Technician Conducting Test: Bruce W. Hinsley Credentials': X CSLB Contractor ICC Service Tech. 0 SWRCB Tank Tester Other (Specify) License Number(s): 921733A i_ Cprr.r. RrTCKF.T TF.CTING PWORMATMN Test Method Used: X Hydrostatic 0 Vacuum Other Test Equipment Used: Visual Equipment Resolution: Identify Spill Bucket (By Tank Number Stored Product, eta 1 87 UL 2 91 UL 3 4 Bucket Installation Type: X Direct Bury Contained in Sump X Direct Bury Contained in Sump 17 Direct Bury Contained in Sump 0 DirectBury Contained in Sum Bucket Diameter: 11" 11" Bucket Depth: I1" I1" Wait time between applying vacuum/water and start oftest: 10 thin. 10 min. Test Start Time (T): 09:45 09:45 Initial Reading (Pi): 9.25" 9.25" Test End Time (TF): 10:45 10:45 Final Reading (Rp): 9.25" 925" Test Duration (TF — T): 1 fir. 1 Hr. Change in Reading (RF - N: 0.0" 0.0" Pass/Fail Threshold or Criteria: 025" 0.25" TeatResult: 7yC Pass C Fail, Pass `_ Fatl , 0. OFaQ ,, 0 Pass ; .O Fail , Comments —(include information on repairs made prior to testing: and recommendedfollow -upforfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING Ihereby certify that all the it1Jormadan contained In this report is true, accurate, and infall compliance with legal requiremma. Technician's Signature: ;Vft c Date: 12/13/2010 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may hA mn p. ct.inaA t cu. Cal- Valley Equipment 3500 Gilmore Ave. Bakersfield CA 93308 661 - 327 -9341 FAX# 661 -325 -2529 VAPORLESS MANUFACTURING, INC. LDT-M Leak Detector Teat Reenni Contractor: Cal-Valley Equipment Customer: Circle Deli Date: 12/13/2010 Location: 1416 Golden State Bakersfield, Ca. Product: 91 UL Technician: Bruce W. Hinsley Submersible Pump Identification Manufacturer: RedJacket Model No.: Serial No.: Notes: i.eak Detector identification Manufacturer. Red'acket Description: Diaphragm-type: Piston- : PLD Tamper -proof seal installed: Other Style Leak Detector: Notes: eak Detector in Cnhmermihle Pumn '1'ewt nt 13innenmer Operating.Pump.Pressure (psi): 26 para. 15 Gallons per hour rate: 3.0 22 Linepressure with pump shut off (psi): 14 23 Bleed -back Test with pump off (ml): 60 ara. 2 Step-through time to full flow (sees): 3 ara. 30 Leak detector stays in leak search position (Yes/No): Yes para. 42 en Detectnr'1'ect Pass / Fail Notes: Pass Complete thermal expansion lest beforefailing leak detector DIAL LEAK THEFT OFF DIAL ALARM SYSFAIL OFF DIAL DELIV LEAK LIM OFF REDIAL 4 DISABLED WATER LIM OFF PHONE 4 LOw LOW OFF ACCFSS.4 H16H HIGH OFF REDIAL 3 DISABLED LOW LIM HIGH LIM OFF OFF PHONE 3 l ACCESS 3 SYSTEM SETUP REPURT TIMEOUT 0 i REDIAL 2 DISABLED 12/13/1910 12:,1 PM RELAY PHONE 2 ACCESS 2 SITE # 00001 THEFT OFF REDIAL I DISABLED SAKERSFIELD> CA 93304 SYSFAIL OFF PHONE 1 1416 GOLDENSTATE Hwy LEAK LIM OFF ACCESS i CIRCLE DELOART WATER LIM OFF SECURITY i LUIS LOW OFF PARITY 1 HONE HIGH HIGH OFF STOP BITS i LOW LIM OFF DATA BITS 8 HIGH Lin OFF BAUD CHAN i 1:euld SUP SUMP TIMEOUT 0 f MODE CHAN 1 NATIVE 10:i6 Am ALARM PRINT INTERVAL 10.00 ALARM REPORi TANK 2 12:00 AM NO. OF ALARMS 10 12/13/1910 10-16 Art TANK 1 12:00 Am REPORT TESTS ENABLED 1TIMETESTREPORTALRMSYES SITE # 00001 TANK 2 NONE REPORT DELIV YES BAKERSFIELD, CA 93304 TANK I 7TH DAY DELIQ DELAY 15 1416 GOLDENSTATE HWY SCHD TEST END SNTNL 12;90 Am CIRCLE DELIMART LEAK TEST 0.10 j START SNTNL 12:80 AN CONFIDENCE 99.0% SNTNL MODE OFF DELIV LIMIT 200.00 TIMES ALST 12:00 Am THEFT LIMIT 10 00 TIME2 ALST 12:00 AM LEAK LIMIT 2:00 UNL SUMP TIMEi ALST 12:00 AM NO. TANKS 2 12/13/1916 i0: 14 AM SCHD ALST NONE TIME3 ACTAL 12:00 AM SET DATE 12/0/010 d ALARM REPORT TIME2 ACTAL 12:00 An SET TIME 12.32 PM j:: 12/2/1916 10;14 Am TIME1 ACTAL 12:00 AN DAYLIGHT SAO ENABLED I SCHD ACT AL NONE DATE STYLE MM/DD/YY SITE # 00001 TIMES ALHST 12:00 AN TIME STYLE 12 HOUR BAKERSFIELD, CA 93'04 TIME2 ALHST 12:00 Am TEMP UNITS FAHRENHEIT 4LL; RGOLDEt T-%HWY TIMEI ALHST 12:06 AM LEVEL UNITS INCHES SCHD ALHST NONE VOL UNITS GALLONS TIME3 DLHST 12:00 AM TIME2 DLHST 12:60 AM SITE # U600 I TIME! DLHST 12i80 Am ZIP CODE 93304 SCHD DLHST NONE STATE CA TIMES INORC 12:00 An CITY 2 TIME2 INVRC 12:00 AM CITY I BAKERSFIELD TIMEi INURC 12:00 AM STREET 2 STATE HWY SCHD lmVRC NONE STREET 1 1416 GOLDEN TIME3 lNQTR 12:00 AM LOCATION 2 MART TIME2 lmoR 12:0e Ail LOCATION i CIRCLE DELI TIME! imvTR 12:00 AM SCHD INUTRY NONE SOFTWARE VERSION 0.91 HOURLY DATA LOW 2 HONE LOW 1 NONE I END WATER 0,086 IN I HOURLY DATA LOW LOm 2 NONE ` END WATER 0.0 GAL I i i LOW LOW i NONE END TEMP 85.733 F END WATER 01008 IN i GRACE PERIOD 6ENDLEVEL47.383 IN END WATER d.8 GAL CONTROL OUTPUTENDNET581I.2 GAL END TEMP 72.668 FENDGROSS5918.8 GAL f'.: END LEVEL 38.330 IN MODE 24 STDENDDATE0912411987fnUYET44415.9 GAL MOUE 23 STDENDTIME2:27 PM I END GROSS 4484.3 GAL MODE 22 STDBEGINWATER6.064 IN END DATE 12/87/1516 MODE 21 STDBEGINWATER0,0 GAL END TIME 7:59 AM MODE 20 STDBEGINTEMP85.302 F BEGIN WATER d.A80 'tH MODE 19 STDBEGINLEVEL52.428 IN BEGIN WATER 0.0 GAL NODE :8 STDBEGINNET6662.8 GAL 6EGIN GROSS BEGIN TEMP 72.777 F MODE 17 STD6722.9 GAL BEGIN LEVEL 38.332 IN MODE 16 STDGROSSCAPACITY55.86 BEGIN NE,T. 44.48,.9., GAL GR MODE 15 STDLASTDELIVERY09/20/1907 BEGIN GROSS 4484.6 "' i MODE 14 STULASTDELIVERY14:12 AM I GROSS CAPACITY 37.26 NODE 13 STUTESTSTARTED09/24/1907 LAST DELIVERY 11/20/1910 MOUE 12 STDfTESTSTARTED6:27 AM f DELIVERY 12:26 PM MDvl 11 STDlCONFIDENCELEVEL99.0: f [,-, LAST STARTED 12/07/1910 MODE 10 STDjLEAKTHRESHOLD6.050 G/H I. TEST STARTED 12:00 AM MODE 9 STDLEAKTEST0.180 fi/N CONFIDENCE LEVEL 99.8 %. MODE 8 STU LEAK THRESHOLD 0.050 G/H j MODE r STUUNLEADEDkEG i LEAK TEST 0.100 G/H MODE 6 STDTANKNO. 2 12000 GAL GAL i MOUE 5 STD UNLEADED SUP NODE 4 STDiLEAKTESTREPORTTANKNO. 1 12000 GAL GAL MODE 3 STD12/13/1910 12:37 PM MODE 2 STD LEAK. "TEST REPORT MODE 1 STDSITE800061112/13/1918 12:36 PM SENSOR TYPEBAKERSFIELD, CA 93304 414166ULDENSTATEHWYj SITE R 00081 ALARM 8 STD 8ICIRCLEUELIMARTBAKERSFIELD, CA 93304 ALARM 7 STD 7i1416GOLDENSTATEHWYALARM6STD6ICIRCLEDELINAR'i ALARM 5 STD 5 ALARM 4 STD 4 LEAK RATE ALARM 3 STU 3 SLOPE EQUALS CALCULATED ALARM 2 ALARM i UHL SUMP SUP SUMPTESTRESULTSPASSEDSTD8NONESTD f SLOPE HIGH 0.01 GAL/RR STD 7 NONEjSLOPELOW0.01 GAL/HR STU 6 NONE ALARM 8 OFF Jj SLOPE 0.01 GAL /HR STU 5 NONE ALARM 7 OFF STD 4 NONE RLRkM 6 OFF7:59 AN 72.660 4448.89 STD 3 NONE ALARM 5 OFF6:59 AN 72.675 4445ALARM 57D 2 NONE ALARM 4 OFF5:59 AM 72.689 4449.08i I STU 1 NONE ALARM 3 OFF I 4:59 AN 72.703 4448.93 J ALARM 2 ON3:59 AM 72.714 4446.96 j SYSTEs1 FAIL NONE j ALARM 1 ON2:59 AM 72.730 4448.84 I j STD "RELAY1:59 AM 72.748 4448.73 SlGH NIGH 2 NONEj12:59 AM 72.760 4446.85 HIGH HIGH I NONE ALARM S OFF7IMEDEGFGALALARM7OFF HIGH 2 NONE ALARM 6 OFF HIGH 1 NONE ALARM 5 OFF ALARM 4 OFF HIGH WTR 2 NONE ALARM 3 OFF HIGH WTR i NONE ALARM 2 ON ALARM 1 On j STD ALARM T i 90.600 11.721.3' .! 60.666 6716.6 i 70.608 9401.5 00.606 7912.4 56.006 633ti.3 46.066 4746.3 36.066 3213.0 20.000 1816.4 10.066 665.0 1.000 0.0 INCHES GALLONS STRAPPING DATA RTD LOG 5 77.19 RTD LOG 4 60.47 RTD LOG 3 45.81 RTD LOC 2 36.93 RTD LOC 1 11.49 NO. RTDS 5 ALPHA 320.00 API GRAVITY 63.56 TEMP COMP API 68/54B CATER LIMIT 4.00 LOW LOW 315.00 HIGH HIGH 90.60 LOW LIMIT 480.00 HIGH LIMIT 85.60 SENSOR LENGTH 161 GRADIENT 8.8657 FLOAT TYPE GASOLINE FLOATS PM PROBE STU 181 MANIFOLD NONE OFFSET W 5.50 OFFSET P 0.00 PRODUCT UNLEADED REG LEhu -H 384.60 D:H E;L i 96.00 iArvK 8hHPE CYLINDER IRN-, b.tc 12666 GAL yhR 3 8 n 32 hivF, Y't STcEL 1 Uhr_cAJt) kEG nh+4 hG. 2 1260- GAL GAL I i Hhlf St i Ur' Kth'UK i lo 12:41 ","i SITE 4 uOO6i BAKERSFIELD, CA `1,531)4 1416 GULDENSTATE HWY CIRCLE DELIMART 46.860 11721.3 86.006 i0716.0 70.800 9401.5 60.000 7912.4 50.000 6336.3 40.000 4746.3 38.000 3213.0 20.008 1816.4 16.000 665.0 0.000 0.0 INCHES GALLONS STRAPPING DATA RTD LOC 5 77.19 RTD LOG 4 60.47 RTD LOG 3 45.81 RTD LOC 2 38.93 RTD LOG 1 11.49 NO. RTDS 5 ALPHA 320.00 API GRAVITY 51.30 TEMP COMP API 68/548 WATER LIMIT 4.00 LOW LOW 315.00 HIGH HIGH 90.60 LOW LIMIT 480.00 HIGH LIMIT 85.00 SENSOR LENGTH 101 I GRADIENT 9.0661 FLOAT TYPE GASOLINE FLOATS 2 PROBE STD 101 MANIFOLD NONE OFFSET W -4.25 OFFSET P 0.00 PRODUCT UNLEADED SUP LENGTH 384.60 DIAMETER 96.80 TANK SHAPE CYLINDER TANK SIZE 12000 GAL TANK DIMS 8 X 32 TANK TYPE STEEL UNLEADED SUP TANK. NO. 1 12000 GAL GAL TANK SETUP REPORT 12/13/1916 12 :40 PM SITE # 0080i BAKERSFIELD, CA 93304- 1416 GOLDENSTATE HWY w CIRCLE DELIMART SUP SUMP 12/13/1910 10:16 AM UNL SUMP 12/13/1910 10:14 AM WD TIMEOU'i 4/26/1910 06:38 AM SUP SUMP 1/19/1910 12:46 PM UHL SUMP 1/4/1918 16:40 PM UNL SUMP 12/7/1909 02:21 PM TANK NO, 2 LOW LOW 11/7/1969 08:41 Ain TANK NO. Y. LOW LIMIT 11/6/1909 84:09 PN SUP SUMP 10/27/1909 08:27 AM UNL SUMP 16/27/1909 I 08:27 AM ALARM HISTORY REPORT I 12/13/1910 12:38 PM l SITE iF 00001 BAKERSFIELD, CA 93364 1416 GOLDENSTATE HWY CIRCLE DELIMART LEAK RATE SLOPE EQUALS CALCULATED TEST RESULTS FAILED SLOPE HIGH -94.82 GAL /HR SLOPE LOW -96.81 GALIHR SLOPE -95.82 GAL /HR 2:27 PM 85.733 5811.22 1:27 PM 85.683 5856.38 12:27 PM 85.644 5909..06 11:27 AM 85.629 5979.74 10:27 AM 85.595 5996.17 9:27 AM 85.540 6160.33 8 :27 AM 885.467 6246.05 7:27 AN 85.366 6504.50 TIME DEG F GAL