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HomeMy WebLinkAbout2612 BUCK OWENS BOULEVARD (4)po,55 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State ofCalifornia Authority Cited: 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 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: JOHNNYS ARCO Site Address: 2612 BUCK OWENS BLVD Facility Contact Person: JOHNNY Make/Model ofMonitoring System: TLS -350 B. Inventory of Equipment Tested/Certified Checktheanorouriate boxes to indicate saecific equipment inspected /serviced: City: BAKERSFIELD Bldg. No.: Zip: Contact Phone No.: ( ) Date of Testing/Servicing: 11/30/2011 Tank ID: UNL87 Tank ID: UNL 87 SIPHON InTank Gauging Probe. Model: MAG In -Tank Gauging Probe. Model: MAG Annular Space or Vault Sensor. Model: 409 Annular Space or Vault Sensor. Model: 409 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 DIAPHRAM Mechanical Line Leak 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: 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: PREM 91 Tank ID: In -Tank Gauging Probe. Model: MAG In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: 409 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: RED JACKET Mechanical Line Leak 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: 1 -2 Dispenser ID: 3-4 Dispenser Containment Sensor(s), Model: 406 Dispenser Containment Sensor(s). Model: 406 Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). El Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5-6 Dispenser ID: 7-8 Dispenser Containment Sensor(s). Model: 406 Dispenser Containment Sensor(s). Model: 406 IR 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). 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' 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 grating such reports, I have also attached a copy of the report; (check all that apply): ® System set -up ® Alarm hilt report Technician Name (print): RICH PHILLIPS Signature: Certification No.: A2908411035169 -UT License. No.: 1/ D40 809850 Testing Company Name: RICH ENVIRONMENTAL Phone No.: (661) 392 -8687 Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date ofTesting/Servicing: 11130/2011 Page 1 of 5 UN -036 —1/4 www.unidoes.org Rev. 01/17/08 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: 329.01 Complete 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 gDA 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? 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. Ifyes, 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 1 No* Is all monitoring equipment operational per manufacturer's ecifications? 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.unidomorg Rev. 01/17/08 Monitoring System Certification F. In -Tank Gauging / SIR Equipment: 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? a Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Complete the following 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 ; 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 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 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* 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 ` 1 ` 1. 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 ID Components) Monitored by this Sensor: Sensor Functionality Test Result: El [3 Fail Interstitial Communication Test Result: Pass; Fail Components) 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 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 6 If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice. UN -036A - t/1 www.unidoes.org Rev. 01/26/06 Monitoring System Certification UST Monitoring Site Plan Site Address: LV? BUCA OWENS BLVD. BAKERSFIELD, CA. 9330$ 6 u C 0. date map was drawn- ;: 1:2019. 111tstruc6s.m. If you already have a diagran:::,at shoe u: wd "r-nation, vn,, m- ! -0- it, rather than this page. with your Monitoring System Certtficc.ion. On your site plan, snow the gene ai layou-' u` tanks .u, n }. Clearly identify Ic;atiuns nl thr Wu-wing equipment, if it :.,fled: nivahuring system control :acts; sensors r ovi.,;6 annular spaces, stu,ips, dispenser pans, spill containers, or other secondary containment areas: [mechanical or electronic li le leak detectors; and in -tank liquid level probes (if used for leak detection). ,„ ; ?.; space provided, note the date this Site Plan was prepai , 1. pape 4 of 4 l;\ -036 -3/i www.anidoch.j-,; Rev. WP/(iit COO SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractorsperforming annual testing ofUSTspill containment structures. The completedform and printoutsfrom tests (rfapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: JOHNNY'S ARCO Date of Testing: 11/30/11 Facility Address: 2612 BUCK OWENS BLVD, BAKERSFIELD Facility Contact: JOHNNY Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (fpresent during testing): ERNIE MEDINA 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RICH PHILLIPS Credentials: CSLB Contractor X ICC Service Tech. 0 SWRCB Tank Tester 0 Other (Specify) License Number(s): 1035169 -UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic 0 Vacuum 0 Other Test Equipment Used: VISUAL Equipment Resolution: 0 Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 REG87 -FILL 2 UNL87 SIPHON -FILL 3 PREM91 -FILL 4 Bucket Installation Type: X Direct Bury Contained in Sump X Direct Bury 0 Contained in Sump X Direct Bury 0 Contained in Sump 0 Direct Bury Contained in Sum Bucket Diameter: 12" 12" 12" Bucket Depth: 14" 14" 14" Wait time between applying vacuum/water and start oftest: 30 MIN 30 MIN 30 M1N Test Start Time M: 9:30 9:30 9:30 Initial Reading (RD: 10" 10" 10" Test End Time (TF): 10:30 10:30 10:30 Final Reading (RF): 9" 9" 9" Test Duration (TF -TO: 1 -14OUR 1 -HOUR 1 -HOUR Change in Reading (RF - 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 0 Fail Pass 0 Fail Comments— (include information on repairs made prior to testing, and recommendedfollow -up forfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby cen* that all the information coast ' din this report is true, accurate, and in fullcompliance with legal requirements. Technician's Signature: Date: 11/30/11 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. RICHENVIRONMENTAL 5643 BROOKS CT. BAKERSFIELD, CA. 93308 OFFICE (661)392 -8687 FAX (661)392 -0621 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET Wro #: FACILITY NAME: JOHNNY'S ARCO FACILITY ADDRESS: 2612 BUCK OWENS BLVD, BAKERSFIELD PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL 87 LID TYPE: RED JACKET YES 11 PASS SERIAL # 6776 91 L/D TYPE: RED JACKET YES 10 PASS SERIAL # 3486 L/D TYPE: PASS YES SERIAL # FAIL L/D TYPE: PASS YES SERIAL # 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 PHILL SIGNATURE: DATE: 11/30/11 ISO 3166 COUNTRY CODE: MASS /DENSITY SYSTEM SETUP DISABLED NOV 30, 2011 8:35 AM Lf"l —T l RECEIVER SETUP: "' NONE AUTO DIAL TIME SETUP: NONE SYSTEM UNITS SYSTEM SECURITY CODE : 000000 U.S. MAINTENANCE HISTORY 30FTWARE REVISION LEVEL DISABLED ERSION 330.01 3OFTWARE4 346330 -100 -H TREATED - 10.07.23.17.25 TANK CHART SECURITY ENGLISH DISABLED MODULE# 330160 -004-'a SYSTEM DATE/TIME FORMAT 3YSTEM FEATURES: PERIODIC IN -TANK TESTS CUSTOM ALARMS ANNUAL IN -TANK TESTS DISABLED ISD SERVICE NOTICE COMMUNICATIONS SETUP DISABLED ISO 3166 COUNTRY CODE: MASS /DENSITY SYSTEM SETUP DISABLED NOV 30, 2011 8:35 AM Lf"l —T l RECEIVER SETUP: "' NONE AUTO DIAL TIME SETUP: NONE SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH RS -232 END OF MESSAGE SYSTEM DATE/TIME FORMAT DISABLED MON DD YYYY HH:MM:SS XM COMMUNICATIONS SETUP AUTO DIAL ALARM SETUP ARCO81360 2612 Huck Owens Blvd Bakersfield CA 93308 PORT SETTINGS: SHIFT TIME 1 10:00 PM COMMCOMM BOARD 1 (EDIMSHIFTTIME2DISABLED232SECURITYSHIFTTIME3DISABLEDCODEDISABLEDSHIFTTIME4DISABLED TANK PER TST NEEDED WRN COMM HOARD 2 (RS -232) bISABLED BAUD RATE 1200 TANK ANN TST NEEDED WRN PARITY ODD STOP BIT 1. STOP N- TAtdfC SETUP DISABLED DATA LENGTH: 7 DATA LINE RE- ENABLE METHOD RS -232 SECURITY CODE : DISABLED T 1:U R PASS LINE TEST PRODUCTCT CODECODE 1 THERMAL COEFF :.000700 LINE PER TST NEEDED WRN AUTO TRANSMIT SETTINGS: TANK DIAMETER 92.00 DISABLED TANK PROFILE 4 PTS LINE ANN TST NEEDED WRN AUTO LEAK ALARM LIMIT FULL VOL 11627 DISABLED DISABLED 69.0 INCH VOL 9438 PRINT TC VOLUMES AUTO HIGH WATER LIMIT 46.0 INCH VOL 23.0 INCH VOL 5814 2190 ENABLED DISABLED AUTO OVERFILL LIMIT ITEMP COMPENSATION DISABLED AUTO LOW PRODUCT FLOAT SIZE: 3.0 IN. VALUE (DEC F ): 60.0 DISABLEDSTICKHEIGHTOFFSETAUTOTOTHEFT LIMIT WATER WARI4I NG 2.0 DISABLED DISABLED NIGH WATER LIMIT: 3.0 ULLAGE: 90% AUTO DELIVERY START MAX OR LABEL VOL: 11627 H- PROTOCOL DATA FORMAT AUTOAUTO DELIVERY END OVERFILL LIMIT 90% HEIGHT DISABLED 10464 SAVING TIME AUTO EXTERNAL INPUT ON HIGH PRODUCT DIYYLIGHT DISABLED 11045 RE- DIRECT LOCAL PRINTOUT AUTO EXTERNAL INPUT OFF DELIVERY LIMIT 10% DISABLED DISABLED 1162 EURO PROTOCOL PREFIX AUTO SENSOR FUEL ALARM DISABLED LOW PRODUCT 500 S AUTO SENSOR WATER ALARM LEAK ALARM LIMIT: 99 DISABLED SUDDEN LOSS LIMIT: 50 AUTO SENSOR OUT ALARM TANK TILT PROBE OFFSET 0.00 0.00DISABLED G VAPOR PROCESSOR TYPE SMARTSENSOR SETUP L3 :91 STP VEEDER -ROOT POLISHER TRI -STATE SINGLE FLOAT) s 1:VAPOR PRESSURECATEGORY : STP SUMP CATEGORY VAPOR PRESSURE L 4:87 ANN I s 2:CANISTER CATEGORY VAPOR VALVE TRI -STATE SINGLE FLOAT) 3 42039 CATEGORY : ANNULAR SPACE s 3:DISP 1 -2 ISD GROSS PRES FAIL s 6:DISP CATEGORY CATEGORY AIR FLOW METER OUTPUT RELAY SETUP R 1:87 STP EVR!ISD SETUP TYPE'. STANDARD NORMALLY CLOSED EVR TYPE: BALANCE TANK #: NONE BALANCE NOZZLE TYPE VST LIQUID SENSOR ALMS VAPOR PROCESSOR TYPE s 4:DISP 3 -4 VEEDER -ROOT POLISHER L 5:87 ANN 2 CATEGORY AIR FLOW METER TRI -STATE SINGLE FLOAT) 1 42020 L 2:8ENSOR OUT ALARM CATEGORY : ANNULAR SPACE s 5:DISP 5 -6 TIME: 11:59 PM 3 42039 CATEGORY AIR FLOW METER L 6:91 ANN ISD GROSS PRES FAIL s 6:DISP CATEGORY 7 -8 AIR FLOW METERTRI -STATE SINGLE FLOAT) ISD VAPOR LEAK FAIL CATEGORY : ANNULAR SPACE s B:ATM . ENABLED ALL:FLOW COLLECT FAIL ISD VP STATUS FAIL CATEGORY ATM P SENSOR OUTPUT RELAY SETUP R 1:87 STP EVR!ISD SETUP TYPE'. STANDARD NORMALLY CLOSED EVR TYPE: BALANCE TANK #: NONE BALANCE NOZZLE TYPE VST LIQUID SENSOR ALMS VAPOR PROCESSOR TYPE 1 L 1:FUEL ALARM VEEDER -ROOT POLISHER ISD L 2:FUEL ALARM L 3:SENSOR OUT ALARM ID SERIAL L 1:SENSOR OUT ALARM ISD SITE ALARMS 1 42020 L 2:8ENSOR OUT ALARM ANALYSIS TIMES 2 42045 DISP 3 -4 TIME: 11:59 PM 3 42039 ISD SITE ALARMS DELAY MINUTES: 1 42018 ISD GROSS PRES FAIL ISD VP PRES FAIL ISD DEGRD PRES FAIL ISD VP STATUS FAIL ISD VAPOR LEAK FAIL ACCEPT HIGH ORVR: ISD VP PRES FAIL ENABLED ALL:FLOW COLLECT FAIL ISD VP STATUS FAIL ISD HOSE TABLEISDHOSEALARMSI- FL AA RR ALL:FLOW COLLECT FAIL FP -- 01 01 01 02 01 02R2:91 STP 02 02 02 02 01 02 TYPE: 03 03 03 02 02 02 STANDARD 04 04 04 02 02 02 NORMALLY CLOSED 05 05 05 02 03 02 06 06 06 02 03 02 TANK #: 3 07 07 07 02 04 02 08 08 08 02 04 02 LIQUID SENSOR ALMS UNASSIGNED 1 2 3 N L 3:FUEL ALARM ISD AIRFLOW METER MAPL3:SENSOR OUT ALARM ID SERIAL NUM LABEL ISD SITE ALARMS 1 42020 DISP 1 -2 ISD GROSS PRES FAIL 2 42045 DISP 3 -4 ISD DEGRD PRES FAIL 3 42039 DISP 5 -6ISDVAPORLEAKFAIL442018DISP7 -8ISDVPPRESFAIL ISD VP STATUS FAIL ISD HOSE ALARMS ALL:FLOW COLLECT FAIL q'i - 14L ISD FUEL GRADE HOSE MAP UNASSIGNED 1 2 3 N FP MHH MHH MHH MHH AA - -- 01 - 101 501 901 U U 1 102 03 102 103 502 902 U U 503 303 U U 2 04 104 504 304 U U 2 U 305105505905U306106506906UU07107507307UU4 0S l0a 508 308 U U 4 LABEL TABLE 1: UNASSIGNED 2: BLEND3 3: REGULAR 4: MID GRADE 5: PREMIUM 6: GOLD 7: BRONZE 8: SILVER 9: BLEND2 10: BLEND4 PMC SETUP pMC VERSION: 01.03 VAPOR PROCEOR TYPE VEEDER -ROOTPOLISHER SIPHON PIANIFOLDED TANKSTO: NONE LINE MANIFOLDED TANKST#: NONE LEAK MIN PERIODIC: 10% 1162 LEAK MIN ANNUAL IQ9 1162 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM• D I SABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFFPERTESTAVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 15 MINPUMPTHRESHOLD : 10.003; LEAK MIN PER I Ob I C: 10% 1162 LEAK MIN PERIODIC: 10% 1162 ' LEAK. MIN ANNUAL : 10% 1162 LEAK MIN A14NUAL 10% 1162 PERIODIC TEST TYPE STANDARD 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% ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED AN14 TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 15 MIN PUMP THRESHOLD 10.00% LEAK TEST METHOD TEST 014 DATE : ALL TANK JAN 29. 2009 START TIME : 12:00 AM TEST RATE :0.20 GAL/HR DURATION : 2 HOURS TST EARLY STOP:DISABLED LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP L 1:67 1 TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 2:87 2 TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP T 3: UL PREMIUM PRODUCT CODE 3 THERMAL COEFF :.000700 TANK DIAMETER 92.00 TANK PROFILE 4 PTS T 2:UNLEADED R FULL VOL 11627 PRODUCT CODE 1 69.0 INCH VOL 9438 THERMAL COEFF :.000700 46.0 INCH VOL 5814 TANK DIAMETER 92.00 23.0 INCH VOL 1170 TANK PROFILE 4 PTS FULL VOL 69.0 INCH VOL 11627 9438 FLOAT SIZE: 3.0 1N, 46.0 INCH VOL 23.0 INCH VOL 5814 2190 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 FLOAT SIZE: 3,0 IN. MAX OR LABEL VOL: 11627 OVERFILL LIMIT 90% WATER WARNING 2,Q 10464 HIGH WATER LIMIT: 3.0 HIGH PRODUCT 9 110455 MAX OR LABEL VOL: 11627 DELIVERY LIMIT 10% OVERFILL LIMIT : 90% 1162 HIGH PRODUCT 10464 95% LOW PRODUCT 500 LEAK ALARM LIMIT: 99 DELIVERY LIMIT 11045 SUDDEN LOSS LIMIT: 50 1162 TANK TILT 3.50 PROBE OFFSET 0.00 LOW PRODUCT 500LEAKALARMLIMIT: SUDDEN LOSS LIMIT: 99 SIPHON MANIFOLDED TANKS TANK TILT PROBE OFFSET 50 4.50 T#: NONE LINE MANIFOLDED TANKS0.00 Tit: NONE SIPHON MANIFOLDED TANKST#: NONE LINE MANIFOLDED TANKST#: NONE ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED AN14 TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 15 MIN PUMP THRESHOLD 10.00% LEAK TEST METHOD TEST 014 DATE : ALL TANK JAN 29. 2009 START TIME : 12:00 AM TEST RATE :0.20 GAL/HR DURATION : 2 HOURS TST EARLY STOP:DISABLED LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP L 1:67 1 TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 2:87 2 TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP SENSOR ALARM -- - -- T, 1:8? 1 STP sump FUEL ALARM 1:11 PMNOV30 SENSOR OUT ALARM Pd•1 NOV 30. 2011 FUEL ALARM 9:31 AMNOV30, 2011 ALARM HISTORY REPORT SENSOR ALARM - -- L 2:87 2 STP SUMP SENSOR OUT ALARM NOV 30. 2011 9:46 AM FUEL ALARM NOV 30. 2011 9:31 AM ALARM HISTORY . RI:pO r .. L 3 1 STSENOR ALARMSTPgI' -- SENSORONOV30. 011. 9:46 AMFUELALANOV30, 011 9:30 AM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 4:87 ANN 1 ANNULAR SPACE SENSOR OUT ALARM NOV 30. 2011 9:46 AM FUEL ALARM NOV 30. 2011 9:36 AM FUEL ALARM NOV 30, 2011 9:35 AM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 5:87 ANN 2 ANNULAR SPACE SENSOR OUT ALARM NOV 30. 2011 9:46 AM FUEL ALARM NOV 30, 2011 9:37 AM FUEL ALARM NOV 30. 2011 9:37 AM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 6:91 ANN ANNULAR SPACE SENSOR OUT ALARM NOV 30. 2011 9:46 AM FUEL ALARM NOV 30. 2011 9:38 AM FUEL ALARM NOV 30. 2011 9:38 AM MONITOR CERT. FAILURE REPORT S6N"'1 SITE NAME: DATE: 130 -1 ADDRESS: 9-- %Y `' 4ra J TECHNICIAN: RIME PWLLIPS CITY: 1k1 J, REPAIRS: NONE PARTS INSTALLED: J NONE SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBII ITY 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.