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HomeMy WebLinkAbout1700 MT. VERNON AVENUEMONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State ofCalifornia Authority Cited: Chapter 6 7, Health andSafety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner /operator. The owner /operator must submit a copy ofthis form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: KERN MEDICAL CENTER Site Address: 1700 MT VERNON AVENUE -k Facility Contact Person: Make /Model of Monitoring System: TLS -350 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected /serviced: City: BAKERSFIELD Bldg. No.: Zip: Contact Phone No.: ( ) Date of Testing/Servicing: 1/9/2012 Tank ID: TK -1 1500 DIESEL AGT Tank ID: TK -2 10K DIESEL In -Tank Gauging Probe, Model: N/A In -Tank Gauging Probe. Model: BMAG -1 Annular Space or Vault Sensor. Model: 208 Annular Space or Vault Sensor. Model: 208 Piping Sump / Trench Sensor(s). Model: Piping Sump / Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical LineLeak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: 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). Tank ID: TK-3 2K DIESEL AGT Tank 1D: TK-41 K DIESEL AGT In -Tank Gauging Probe, Model: MAG -1 In -Tank Gauging Probe. Model. Annular Space or Vault Sensor. Model: 208 Annular Space or Vault Sensor. Model: Piping Sump / Trench Sensor(s). Model: Piping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: Tank Overfill / High -Level Sensor. Model: Other (specify equipmenttypeand model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2), Dispenser 111): Dispenser ID: Dispenser Containment Sensor(s). Model: 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). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: 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). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: 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). Ifthe 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 ofthe report; (check all that apply): ® System set -up ® Alarm ory report Technician Name (print): RICH PHILLIPS Signature: Certification No.: A2908411036169 -UT License. No.: _ 611 D40 809850 Testing Company Name: RICH ENVIRONMENTAL Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 UN -036 — I/4 Page 1 of 5 www.unidoes.org Phone No.: (661) 392 -8687 Date ofTesting/Servicing: 11912012 Rev. 01 /17/08 Ni Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: 324.03 6n fn11n rinn n1.nn41icH Yes No* Is the audible alarm operational? Yes No* Is the visual alarm operational? Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational? Yes No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) N/A operational? Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? ifyes: which sensors initiate positive shut -down? (Check all that apply) Sump/Trench Sensors; Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks Wo sensor failure /disconnection? Yes; No. Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? 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. 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* 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. El Comments: SUMP SYSTEM IS SUCTION 208 SENSOR I I I M Page 2 of 5 UN -036 — 2/4 www.uaidomorg Rev. 01/17 /08 Monitoring System Certification Lk53iz A` 4 F. In -Tank Gauging / SIR Equipment: Check this box iftank 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): Check this box if LLDs are not installed. Cmmnlete the fallnwinu checklist- El 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 ; [10.2 g.p.h. Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? Ej 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 off if any portion ofthe monitoring system malfunctions N/A or fails a test? p Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? N/A p 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. IL Comments: SUCTION SYSTEM -NO LEAK DETECTORS VN -036 — 3/4 Page 3 of 5 www.unidm.org Rev. OIA7 /08 u 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 of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Manufacturer: NONE Model: System Type: Pressure; ® Vacuum Sensor 1D A kWSS n: • ' ,_ s.., -, 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 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 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: NONE OF THESE SENSORS ARE PRESENT AT THIS SITE. Page 4 of 5 If the sensor successful) detects a simulated vacuum/pressure le i e sensor, vacuum/pressurehas been demonstrated to be communicating, throughout the intetrstice. space at the furthest point from th UN -036A -1/1 www.unidoes.org Rev. 01126/06 SWRCB, January 2006 Spill Bucket Testing Report Form This form is intendedfor use by contractors performing annual testing ofUSTspill containment structures. The completedform and printoutsfrom tests (fapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: KERN MEDICAL CENTER I Date of Testing: 1/9/12 Facility Address: 1700 MT VERNON AVENUE, BAKERSFIELD Facility Contact: Phone: Date Local Agency Was Notified of Testing: 10/31/11 Name ofLocal Agency Inspector (fpresent during testing): ERNIE 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RICH PHILLIPS Credentials: CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other (Specify) License Number(s): 1035169 -UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic Vacuum Other Test Equipment Used. VISUAL Equipment Resolution: 0 Identify Spill Bucket (By Tank Number, Stored Product, etc. l DIESEL 10K 2 3 4 Bucket Installation TType: Direct Bury X Contained in Sump Direct Bury Contained in Sump Direct Bury Contained in Sump 11 Direct Bury Contained in Sum Bucket Diameter: 12" Bucket Depth: 14" Wait time between applying vacuum/water and start oftest: 30 MIN Test Start Time (Ti): 9:45 Initial Reading (Rj): 14" Test End Time (TF); 10:45 Final Reading (RF): 14" Test Duration (TF — Tj): 1 -HOUR Change in Reading (RF - Rj): 0 Pass/Fail Threshold or Criteria: 0.00 Test Result: X Pass Fail Pass Fail Pass Fail Pass Fail COMMent3 — (include information on repairs made prior to testing, andrecommendedfollow -upfor failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the Informado, ntained In this report is true, accurate, and infull compliance with legal requirements. Technician's Signature: Date: 1/9/12 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. ys3t1.' RICH ENVIRONMENTAL 5643 BROOKS CT. BAKERSFIELD, CA. 93308 OFFICE (661)392 -8687 FAX (661)392 -0621 PRODUCT LINE LEAD DETECTOR TEST WORK SHEET FACILITY NAME: KERN MEDICAL CENTER FACILITY ADDRESS: 1700 MT VERNON AVENUE, BAKERSFIELD PRODUCT LINE TYPE: SUCTION SYSTEM PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL l L/D TYPE:_ SERIAL #_ YES NO PASS FAIT. L/D TYPE: _ YES PASS SERIAL # _ NO FAIL L/D TYPE: _ YES PASS SERIAL # _ NO FAIL 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: RICH PHIL SIGNATURE: DATE: 1/9/12 f" SOFTWARE REVISION LEVEL VERSION 324.03 SOFTWARE# 346324 -100 -D CREATED - 05.06.06.15.41 NO SOFTWARE MODULE SYSTEM FEATURES: PERIODIC IN -TANK TESTS ANNUAL IN -TANK TESTS f, SYSTEM SETUP JAN 9. 2012 9:01 AM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYYY HH:MM:SS xM KERN MEDICAL CENTER 1.830 FLOWER ST. BAKERSFIELD.CA 93305 661- 326 -2482 SHIFT TIME I DISABLED 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 ALARM ACKNOWLEDGE LINE PER TST NEEDED WRN DISABLED L 114E ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F ?: 60.0 STICK HEIGHT OFFSET DISABLED DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK 1 SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM 0 SYSTEM SECURITY CODE : 000000 CUSTOM ALARM LABELS DISABLED COI °1MUNICATIONS SETUP PORT SETTINGS: NONE FOUND RS -232 END OF MESSAGE DISABLED IN-TANK SETUP- T 1:DIESEL PRODUCT, CODE 1 THERMAL COEFF :.000450 TANK DIAMETER 36.00 TANK PROFILE 1 PT FULL VOL 1502 FLOAT SIZE: 4.0'IN. WATER WARNING 2.5 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 1502 OVERFILL LIMIT 909 1351 HIGH PRODUCT 95% 1426 DELIVERY LIMIT 50% 751 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 1.70 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TG: NONE LINE MANIFOLDED TANKS TO: NONE LEAK MIN PERIODIC: 0% 0 LEAK MIN AN14UAL 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 I MIN PUMP THRESHOLD 10.00`%. N exuoUCT CODE 2 THERMAL COEFF :.000450 TANK DIAMETER 96.00 TANK PROFILE 4 PTS FULL VOL 9726 72.0 INCH VOL 8246, 48.0 INCH VOL 5149 24.0 INCH VOL 1935 FLOAT SIZE: 4.0 IN, T 3:2000 DIESEL PRODUCT CODE 3 THERMAL COEFF 000450 TANK DIAMETER 60.00 TANK PROFILE 4 PTO FULL VOL 2000 45.0 INCH VOL 1500 30.0 INCH VOL 1000 15.0 1N0- WIT. 500 WATER WARNING 2.5 FLOAT S1"F: 4.0 IN. HIGH WATER,, LIMIT: 3.0 WATER WARNING 2.0 MAX QR LABEL VOL: 9728 HIGH WATER LIMIT: 3.0 OVERFILL LIMIT 90% 8755 MAX OR LABEL VOL: 2000 HIGH PRODUCT 95% OVERFILL LIMIT : 90% 9241 1800 DELIVERY LIMIT 25% HIGH PRODUCT 950% 2432 1900 DELIVERY LIMIT 25% LOW PRODUCT 1000 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 LOW PRODUCT 500 TANK TILT 0.00 LEAK ALARM LIMIT: 99 PROBE OFFSET 0.00 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS T#' NONE LINE MANIFOLDED '. NYS SIPHON MANIFOLDED TANKS TO*. NONE TO: NONE LINE MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 0% 0.' LEAK MIN PERIODIC: 0% LEAK MIN ANNUAL 0% 0 0 LEAK MIN ANNUAL : 0% 0 PERIODIC TEST TYPE STANDARD PERIODIC TEST TYPE ANNUAL TEST FAIL STANDARD ALARM DISABLED ANNUAL TEST FAIL PERIODIC TEST FAIL ALARM DISABLED ALARM DISABLED PERIODIC TEST FAIL GROSS TEST FAIL. ALARM DISABLED ALARM DISABLED GROSS TEST FAIL ANN TEST AVERAGING: OFF ALARM DISABLED PER TEST AVERAGING: OFF ANN TEST AVERAGING: OFF TANK TEST NOTIFY: OFF PER TEST AVERAGING: OFF TNK TOT SIPHON BREAK:OFF TANK TEST NOTIFY: OFF DELIVERY DELAY I MIN TNK TOT SIPHON BREAK:OFF PUII1V THRESHOLD 10.004 DELIVERY DELAY I MIN PUMP THRESHOLD 10.00% q6-vl-- t Z, LEAK TEST METHOD TEST MONTHLY : ALL TANK WEEK. 1 MON START TIME : 2:00 AM TEST RATE :0.20 GAL/HR DURATION : 2 HOURS TOT EARLY STOP:DISABLED LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP L 1 :TANK 1 ANNULAR SPACE NORMALLY CLOSED CATEGORY : ANNULAR SPACE L 2:FILL SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : OTHER SENSORS L 3:MID SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : OTHER SENSORS L 4:END SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : OTHER SENSORS L 5:2000 ANNULAR SPACE NORMALLY CLOSED CATEGORY : ANNULAR SPACE L 7 :DT 100 TRI -STATE (SINGLE FLOAT) CATEGORY : OTHER SENSORS REPORTALARMHISTORY OUTPUT RELAY SETUP ALARM HISTORY REPORT SENSOR ALARM L 4:END SUMPMPSENSORALARM -- OTHER SENSORSL1:TANK I ANNULAR SPACE FUEL ALARMR1:T3 2000 DIESEL ANNULAR SPACE JAN 9, 2012 9:42 AMTYPE: FUEL ALARM STANDARD JAN S. 2012 9:07 AM FUEL ALARMNORMALLYOPENJAN9, 2012 9:39 AMFUELALARM IN -TANK ALARMS NOV 2. 2010 8:57 AM FUEL ALARM ALL:OVERFILL ALARM FUEL ALARM NOV 2. 2010 8:48 AM ALL:LOW PRODUCT ALARM JUL 29..2010 10:58 AM ALL:HIGH PRODUCT ALARM LIQUID OENSOR ALMS L 5:FUtL ALARM R 2:10.000 HORN ALARM HISTOR`! REPORT TYPE: STANDARD SENSOR ALARM - - - -- NORMALLY OPEN ALARM HISTOR'. REPORT 5 :2000 ANNULAR SPACELSPACE 1N -TANK ALARMS SENSOR ALARM - - - -- L 2:FILL SUMP FUEL ALARMFUE 9, 2012 9:08 AM ALL:OVERFILL ALARM OTHER SENSORS JAN ALL:LOW PRODUCT ALARM FUEL ALARM FUEL ALARMALL:HIGH PRODUCT ALARM JAN 9. 2012 9:47 AM NOV 2. 2010 9:02 AM R 3:T1 FUEL ALARM Fes, ALARMTYPE: JAN 9, 2012 9:47 AM JUL 30, 2010 6:19 AM STANDARD NORMALLY OPEN FUEL ALARM SEP 10, 2011 6:04 Pt -1 IN -TANK ALARMS III I ALL:OVERFILL ALARM ALL:LOW PRODUCT ALARM ALL:HIGH PRODUCT ALARM T 1 :MAX PRODUCT ALARM ALARM HISTORY REPORT LIQUID SENSOR ALMS SENSOR ALARM - - - -- L 1:FUEL ALARM ALARM HISTORY REPORT r L 6:DT 325 OTHER SENSORSR4:DAY TANK 100 TYPE: ALARM - - - -- SENSOR OUT ALARM STANDARD L 3:MIDES mp DEC 28. 2011 10 :27 AM NORMALLY CLOSED OTHER SENSORS FUEL ALARM SENSOR OUT ALARM NO ALARM ASSIGNMENTS - JAN 9. 2012 9:45 AM DEC 1. 2011 12:44 PM FUEL ALARM SENSOR OUT ALARM NOV 2, 2010 8 :50 AM DEC 1, 2011 12:42 PM FUEL ALARM AUG 12. 2009 8:30 AM HISTORY REPORT ALARM SENSOR ALARM _' - -- Lr? : DT X100 OTHER SENSORS - NOV ALARM 8:4? AM 2010 SENSOR OUT LARM31 JUL 30• SENSOR OUT ALARM 30 AM JUL .3 2010 MONITOR CERT. FAILURE REPORT SITE NAME: /n iccL G[/ DATE:— S -J -- ADDRESS: 17o D M 7' A1-4:r TECHNICIAN: RICHIE PHILLIPS CITY: .6A 1666 -Lj /'`'` / yA SIGNATURE: REPAIRS: NONE PARTSINSTALLED: NONE THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMENTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON- COMPLYANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE.