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HomeMy WebLinkAbout3605 ROSEDALE HWY (4)P-1155 zt -cry MONITORING 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 certifle4on.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 of this form to the local agency regulating UST systems within 30 days oftest date. A. General Information Facility Name: C&M SHELL STATION Bldg. No.: Site Address: 3605 ROSEDALE HWY. City: BAKERSFIELD Zip: 93308 Facility Contact. Person: CHOY Contact Phone No.: (661) 304 -7747 Make /Model.of Monitoring System: TLS -350 INSP.- ESTHER Date of TestinWServicing: 511812011 . B. Inventory of Equipment Tested /Certified Check the appropriate boxes to indicate specific equipment inspected /serviced: Tank iD: REGULAR 87 Tank ID: PREMIUM 91 In -Tank Gauging Probe, Model: MAG In -Tank Gauging Probe: Model: MAG Annular Space or Vault Sensor. Model: 301 Annular Space or Vault Sensor. Model: 302 Piping Sump./ Trench Sensor(s). Model: 208 Piping Sump /Trench Sensor(s). Model: 268 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: FX1V Mechanical Line Leak Detector. Model: FX1V 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 onPage2). Other (specify equipment type and model'in Section E on Page 2). Tank ID: DIESEL Tank ID: VENT BOX In -Tank Gauging Probe. Model: MAG In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: 302 Annular Space or Vault Sensor. Model: Piping Sump/ Trench Sensor(s). Model: 362 PipingSump/ Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: FX1DV Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: El 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 (specifyequipment type and model in Section E on Page 2). Dispenser ID: 112 Dispenser ID: 314 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). Dispenser Containment Float(s) and Chain(s). Dispenser ID: 516 Dispenser ID: 718 Dispenser Containmenf Sensor(s). Model: 351. Dispenser Containment Sensor(s). Model: 351 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: 11112" Dispenser Containment Sensor(s). Model: 406 DispenserContainment Sensor(s). Model: 406 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 equi ment capable of generating such reports, I have.also attached a copy of the report; (check aU that apply): ® System set -up term 'story report Technician Name (print): RYAN MASON Signature: CertificationNo.: A273671 8029371 -UT License. No.: V611 D 0 809850 Testing Company Name: RICH ENVIRONMENTAL Phone No.: 661) 326 -8402 Testing Company Address: 5643 BROOKS CT. BAKERS FIELD, CA 93308 Date of Testing/Servicing: 511812011 Page 1 of 5 UN- 036 —1/4 www.unidoes.org Rev. 01117/08 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: 330.01 Complete the followine checklist: q24 r 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 p 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 shutdown due to leaks and sensor failure /disconnection? 10 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? % 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 replacementparts 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, ifapplicable 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 wwwxoidoeaorg Rev. 01/17/08 Monitoring System Certification 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): Cmmnlete the fnllnwino checklist! p 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.; 0.1 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 ifit detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Z. 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 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 wereor will be corrected. H. Comments: Page 3 of 5 UN-036 — 3/4 www.nnidocs:org Rev. 01/17 /08 Sii,: ildress. t -A 6:3W 00 _133W IC 4L dj 11"voij 91117'L6tiv have a:diagrarh that shows al :1 ,r;c 8qijrc8.. ritefti&', it'.:ratho IhAn piga. with:ypyr ar y. Ss;,4611 uitmcatioh. : N yvar.... 'laypuv6ff_fik_s :4ti& C46 I identify, Iix ations -of [lie f0p0m: 014h,:O the mineral: Odiobeft.* il' in§tjllc& qpk*;: dispenser parts: —,pi(Iwwr% mont ns. ivi1hr. MMOenI- kd' and in -tank liquid. I" N.s 6fv-sed for le;k, det&ti6n). th:th6 aic N Olt Odd- UN;O36 - 414 Ps ww.w;ijrtidk-Lorg tIkAs/fIN19 I/ q,ZA59 t 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: C &M SHELL STATION FACILITY ADDRESS: 3605 ROSEDALE HWY. BAKERSFIELD, CA.93308 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: FX1V YES 10 P.S.I. PASS SERIAL # 9838 PREM91 L/D TYPE: FX1V YES 10 P.S.I. PASS SERIAL # 0874 DIESEL L/D TYPE: FX1DV YES 10.P.S.I. PASS SERIAL # 4746' 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: RYAN MASON SIGNATURE: DATE: 5/18/11 L4 z,451 SWRCB, January 2006 Spill Bucket Testing Report Form Thuform is intendedfor use by contractors performing annual testing of USTspill 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: C&M SHELL STATION Date ofTesting: 5/13/10 Facility Address: 3605 ROSEDALE HWY. BAKERSFIELD, CA. 93308 Facility Contact: CHOY Phone: (661) 304 -7747 Date Local Agency Was Notified ofTesting: 4/28/10 Name of Local Agency Inspector (fpresent during testing): ERNIE MEDINA 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RYAN MASON Credentials: CSLB Contractor X ICC Service Tech. "SWRCB Tank Tester Other (Spec) License Number(s): 8029371 =UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic Vacuum Other Test Equipment Used: VISUAL Equipment Resolution: 0 YA Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 REGULAR 87 -FILL 2 PREMIIUM 91- FILL 3 DIESEL FILL 4 Bucket Installation Type: X Direct Bury Contained in Sump X Direct Bury Contained in Sump X Direct Bury O Contained in Sum 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 MIN Test Start Time (T,): 0900 0900 0900 Initial Reading (R,): 12" 12" 12" Test End Time (TF): 1000 1000 1000 Final Reading (RF): 12" 12" 12" Test Duration (TF -- Ti): 1 -HOUR HOUR 1 -HOUR Change in Reading (RF - Rj): 0 0 0 Pass/Fail Threshold or Criteria: 0.00 0.00 0.00 UK • N91, i Comments — (include information on repairs made.prior to testing, and recommendedfollow -upforfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certj& that all the information contained in dtls report Is true,. accurate, and infull compliance with legal requirements. Technician's Signature: Date: 1 5118/11 1 State laws and regulations do not currently require testing to beperformed by a,qualified contractor. However, local requirements may be more stringent. 1 SOFTWARE REVISION LEVELVERSIOIV330 .'01 SOFTWAREO 346330 -100 -BCREATED - 10,07,23,17.25 S- MODULE;! 330160 -004 -eSYSTEMFEATURES: PERIODIC IN -TANK TESTSANNUAL•IN -TANK TI?STSISD SYSTEM SETUP T - - - - MAY 18, 2011' 2:10 F'M SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE /TIME FORMATMONDDYYYVHH :MM:SS M SHELL 3605 ROSEDALE HWYBAKERSFIELDCA SHIFT TIME 1 12:00 AMSHIFTTIME24:00 AMSHIFTTIME3.: DISABLEDSHIFTTIME4DISABLED TANK PER TST NEEDED WRNDISABLED TANK ANN TST NEEDED WRNDISABLED. LINE RE- ENABLE METHODPASSLINETEST LINE PER TST NEEDED WRNDISABLED LINE ANN TST NEEDED WRNDISABLED PRINT TC VOLUMESENABLED TEMP COMPENSATIONVALUE (DEG F ): 60.0 STICK HEIGHT OFFSETDISABLED ULLAGE: 90% H- PROTOCOL DATA FORMATHEIGHT DAYLIGHT SAVING TIME. DISABLED RE- DIRECT LOCAL PRINTOUTDISABLED EURO PROTOCOL PREFIXS COMMUNICATIONS SETUP IN -TANK SETUP PORT SETTINGS: COMM.BOARD : I (EDIM S T 1:87 RS -232 SECURITY PRODUCT CODE l CODE : DISABLED THERMAL COEFF :.000700 TANK DIAMETER 92.00 COMM BOARD 2 (RS -232) TANK PROFILE I PT BAUD RATE 1200 FULL VOL 972B PARITY ODD STOP BIT 1 STOP DATA LENGTH: 7 DATA FLOAT SIZE: 4.0 IN. RS -232 SECURITY CODE *. DISABLED WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 COMM BOARD 3 (FXMOD) BAUD RATE : 2400 MAX OR.LABEL VOL: 9728. PARITY ODD OVERFILL LIMIT 90% STOP BIT 1 STOP 8755 DATA LENGTH: 7 DATA HIGH PRODUCT 95i RS -232 SECURITY 9241 CODE : DISABLED DELIVERY LIMIT 5% DI AL .TY? : 496BONE ...,._:._.:..., ANSWER MODEM SETUP STRING LOW PRODUCT 500 LEAK ALARM LIMIT: 3 DIAL TONE INTERVAL: 32' SUDDEN LOSS LIMIT: 50 TANK TILT 2.20 PROBE OFFSET 0.00 AUTO TRANSMIT SETTINGS: AUTO LEAK ALARM LIMIT SIPHON MANIFOLDED TANKS DISABLED TO: NONE AUTO HIGH WATER LIMIT LINE MANI.FOLDED TANKS DISABLED TO: NONE AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT LEAK MIN PERIODIC: 0% DISABLED 0 AUTO THEFT LIMIT DISABLED LEAK MIN ANNUAL : 0% AUTO DELIVERY START 0 DISABLED AUTO DELIVERY END DISABLED PERIODIC TEST TYPE AUTO EXTERNAL INPUT ON STANDARD DISABLED AUTO EXTERNAL INPUT OFF ANNUAL TEST FAIL DISABLED ALARM DISABLED AUTO SENSOR FUEL ALARM DISABLED PERIODJC TEST FAIL AUTO SENSOR WATER ALARM ALARM DISABLED DISABLED AUTO SENSOR OUT ALARM GROSS TEST FAIL DISABLED ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF RECEIVER SETUP: TNK.TST SIPHON BREAK:OFF NONE DELI VERY . DELAY 5 KINN PUMP THRESHOLD 10.00 AUTO DIAL TIME SETUP: NONE T 3:91T2:DIEBEL PRODUCT CODE 3 LEAK TEST METHODPRODUCTCODE2THERMALCOEFF :.000700 — — — — — — — THERMAL•COEFF :.000450 TANK DIAMETER 92.00 TEST ON DATE : ALL TANKTANKDIAMETER92.00 TANK PROFILE 1 PT JAN 29, 2009TANKPROFILE1PT" FULL VOL 9728 START 'TIME : DISABLEDFULLVOL9728TESTRATE :0.20 GAL /HR FLOAT SIZE: 4.0 IN. FLOAT SIZE: 4.0 IN. DURATION : 2 HOURS WATER WARNING 2 p WATER WARNING 2.0 TST EARLY. STOP :DISABLED HIGH WATER LIMIT: 3,0 HIGH WATER LIMIT: 3.0 LEAK TEST REPORT FORMAT MAX OR LABEL VOL: 9728 MAX LABEL 9.728 NORMAL OVERFILL LIMIT' 90% OVERFILL LIMIT 90% 9755 8755 HIGH PRODUCT 95% HIGH PRODUCT 95% 9241 9241 DELIVERY LIMIT 10% DELIVERY LIMIT 144: 972 1361 LOW PRODUCT 500 LOW PRODUCT 500 LEAK ALARM LIMIT' 3 LEAK ALARM LIMIT: 3 SUDDEN LOSS LIMIT: 50 SUDDEN LOSS LIMIT: 50 TANK TILT 1.45 TANK TILT 2.44 LIQUID SENSOR SETUP PROBE OFFSET 1.45 PROBE OFFSET 0100 _ — — _ _ _ _ — — — — L 1 :87 STP SIPHON MANIFOLDED TANKS SIPHON MANIFOLDED TANKS TRI —STATE (SINGLE FLOAT) TO: NONE, Tat: NONE CATEGORY : STP SUMP LINE MANIFOLDED TANKSLINEMANIFOLDEDTANKSTO: NONENONE L 2:DIESEL STP. DUAL FLT. HIGH VAPOR LEAK MIN PERIODIC: 0% LEAK MI14 PERIODIC: CATEGORY : STP SUMP 0 LEAK MIN ANNUAL Ogg LEAK MIN ANNUAL 00 L 3 :91 STP 0 TRI—STATE (SINGLE FLOAT) CATEGORY : STP SUMP PERIODIC TEST TYPE PERIODIC TEST TYPE STANDARD STANDARD L 4:87 ANN NORMALLY CLOSED ANNUAL TEST FAIL ANNUAL TESALARMLDISA,BLED CATEGORY ANNULAR SPACE ALARM DISABLED PERIODIC TEST FAIL PERIODIC TEST FAIL ALARM-DISABLED ALARM DISABLED L.5:DIESEL ANN DUAL POINT HYDROSTATIC GROSS TEST FAIL GROSS TEST FAIL CATEGORY : ANNULAR SPACE ALARM DISABLED ALARM DISABLED ANN TEST AVERAGING: OFF ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF PER TEST AVERAGING: OFF L 6:91 ANN DUAL,POINT HYDROSTATIC TANK TEST NOTIFY: OFF TANK TEST NOTIFY: OFF CATEGORY ANNULAR SPACE TNK TST SIPHON BREAK:OFF ?NK TST SIPHON BREAK ":OFF DELIVERY DELAY 5"MIN DELIVERY DELAY • 5 MIN L 7 :VENT BOX PUMP THRESHOLD 10.00% PUMP THRESHOLD 10.00% TRI —STATE (SI.NGLE FLOAT) CATEGORY : OTHER.SENSORS L e: NONE NORMALLY CLOSED CATEGORY I OTHER SENSORS EVR /ISD SETUP SMARTSEN$OR SETUP OUTPUT .RELAY SETUP 5 1:VAPOR PRESSURE EVR TYPE: BALANCE R 1:87 CATEGORY VAPOR PRESSURE TYPE: BALANCE NOZZLE TYPE STANDARD s 2:CANISTER VST NORMALLY CLOSED CATEGORY VAPOR VALVE VAPOR PROCESSOR TYPE TANK 4:. 1 s 8' :ATM VEEDER -ROOT POLISHER CATEGORY ATM P SENSOR LIQUID SENSOR ALMS s 9;DISP 1 -2 ANALYSIS TIMES L 1 :FUEL ALARM CATEGORY AIR FLOW METER TIME: 10 :00 AM L 3:FUEL ALARM DELAY MINUTES: I L 1:SENSOR OUT ALARM 510 :DISP 3 -4 L 3 :SENSOR OUT ALARM CATEGORY AIR FLOW METER L 3:WATER ALARM ACCEPT HIGH ORVR: L 1:HIGH LIQUID ALARM 511 :DISP 5 -6 ENABLED L 3:LIQUID WARNING CATEGORY AIR FLOW METER ISD HOSE TABLE ISD SITE ALARMS 512:D1SP 7 -8 ID FP FL HL AA RR ISD GROSS PRES .FAIL CATEGORY AIR FLOW METERISDDEGRDPRESFAIL 01 01 O1. 02 01 03 ISD VAPOR LEAK FAIL sl3.:DISP 9 -10 02 02 02 02 01 03 ISD VP PRES FAIL CATEGORY AIR FLOW METER 03 00 03 02 02 03 ISD VP STATUS FAIL 04 04 04 02 02 03 sl4:DISP 11 -12 05 05 05 02 03 03 ISD HOSE ALARMS CATEGORY AIR FLOW METER 06 06 06 02 03 03 ALL :FLOW COLLECT FAIL 07 '07, 07 02 04 03 08 08 08 02 04 03 R 2:DIESEL. 09 09 09 02 05 03 TYPE: 10 16 10 02 05 03 STANDARD 11 17' 11 02 06 03 NORMALLY CLOSED 12 16 12 02 06 03 TANK 0: 2 ISD AIRFLOW METER MAP ID SERIAL NUM LABEL LIQUID SENSOR ALMS L 2:FUEL ALARM 134514 DISP 1 -2 L 2:SENSOR OUT ALARM 2 39498 DISP 3 -4 L 2 :HIGH LIQUID ALARM 3 38972 DISP 5 -6 4 37267 DISP 7 -8 R 3:91 5 36516 DISP 9 -10 TYPE:' 6 34444 DISP 11 -12 STANDARD NORMALLY CLOSED ISD FUEL GRADE HOSE MAP TANK 4: 3 1 2 3 4 FP MHH MHH MHH MHH AA LIQUID SENSOR ALMS 01101.30I 201 U U 1 L 3:FUEL ALARM 02 102 302 202 U'U 1. L 3:SENSOR OUT ALARM 03 103 303 203 U U 2 04 104 304 204 U U 2 ISD SITE ALARMS PMG GETUP 05 105 305 205 U U 3 ISD GROSS PRES FAIL 06 106 306 206 U U 3 ISD DEGRD PRES FAIL C VERSION: ISD VAPOR LEAK FAIL 01,03 08 108.308 208 4 U 4 ISD VP PRES FAIL VAPOR PROCE 09 109 309 209 U U 5 ISD VP STATUS FAIL VEEDER-ROOT POLI 110 5ER17 .1.10 9110. 3 U ISD HOSE ALARMS 18 212 112 912 3 U 6 ALL:FLOW COLLECT FAIL LABEL TABLE 1: UNASSIGNED 2 :' BLEND3 3: REGULAR 4: MID GRADE 5: PREMIUM 6: GOLD 7: BRONZE B: SILVER 9: BLEND2, 10: BLEND4 ALARM HISTORY. REPORT ALARM HISTORY REPORT - SYSTEM ALARM - - - -- - - -- IN -TANK ALARM - - - -- PAPER OUT ALARM HISTORY REPORT MAY 18, 2011 2:10 PM T 3:91 - - - -- SENSOR ALARM - - - -- PRINTER ERROR L 3:91 STPMAY18, 2011 2:10 PM STP SUMP SENSOR OUT ALARM MAY 18. 2011 12:45 PM FUEL ALARM MAY 18, 2011 12:19 .PM FUEL ALARM DEC 10. 2010 2:16 P11 SEND * * ** x+ xxEN.D x * * END END ALARM HISTORY REPORT REPORT ALARM HISTORY REPORT 1N -TANK ALARM - - --- SENSOR ALARM - - - -- IN -TANK ALARM. - - - -- L, 1:87 STP MAY 18, 2011 12:45 PM STP SUMP T 1:87 SENSOR OUT ALARM MAY 18, 2011 12:45 PM OVERFILL ALARM MAY iB. 2011 12:19 PM ALARM HISTORY REPORT MAR 13, 2011 2 :57 PM FUEL ALARM FUEL ALARM JAN 6, 2011 4:53 AM 5 : 09 All MAY 18, 2011 12:20 PM ALARM HISTORY REPORTIAN4, 201.1 SENSOR ALARM - - - -- MAY 5, 2011 HIGH PRODUCT ALARM FUEL ALARM DEC 10. 2010 11:13 AM SENSOR ALARM - - - -- NOV 8. 2014 9:22 AM L 4:87 ANN OCT 27., 2010 3:35 AM ANNULAR SPACE SENSOR OUT ALARM FUEL ALARM MAY 18. 2011 1:12 PM LOW LIQUID ALARM LOW LIQUID ALARM MAY 18. 2011 12:45 PH MAY 18. 2011 12:27 PM SENSOR OUT ALARM MAY 1.8, 2011 12:44 PM END * ** x x x END * .. ...' x * * END ALARM HISTORY REPORT ALARM'H1STORY REPORT SENSOR ALARM - - - -,- L 2:DIESEL STP 1N -TANK ALARM - - --- STP SUMP SENSOR OUT ALARM MAY 18, 2011 12:45 PM T 2:DIESEL FUEL.ALARM. DELIVERY NEEDED MAY iB. 2011 12:19 PM ALARM HISTORY REPORT MAY 13, 2011 9:34 AM FUEL ALARM MAY 6, 2011 8:55 AM DEC 10. 2010 1:1:11 AM SENSOR ALARM - - - -- MAY 5, 2011 6:34 AM L 5:DIESEL ANN ANNULAR'SPACE SENSOR OUT ALARM MAY 18, 2011 12:45,PM LOW LIQUID ALARM MAY 18. 2011 12:27 PM HIGH LIQUID ALARM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 6:91 ANN E ANNULAR SPACE SENSOR OUT ALARM ALARM HISTORY REPORT MAY 18, 2011 12.45 PM SENSOR ALARM - - - -- LOW LIQUID ALARM L 8:NQNE MAY 18, 2011 12:28 PM OTHER SENSORS FUEL ALARM HIGH LIQUID ALARM MAY 18. 2011 12:45 PM MAY 18, 2011 12:24 PM x * x x, * END ***xx ALARM HISTORY REPORT SENSOR ALARM - - - -- L 7:VENT BOX OTHER SENSORS FUEL ALARM MAY 18. 2011 12:53 PM SENSOR OUT ALARM MAY 18, 2011 12:45 PM FUEL ALARM DEC 21. 2010 12:37 PM x x x x x END x x x x x x x x x x END x x x ** ALARM HISTORY REPORT SENSOR ALARM - ---- e 1 OTHER SENSORS x x x x x END x x x X x MONITOR CERT. FAILURE REPORT SITE NAM: C &M SHELL STATION DATE: 5/18/11 THE FOLLOWING COMPONENTS WERE REPLACED/REPAVED W. COMPLETE TESTING. REPAIRS; NONE LABOR: NONE PARTS INTALLED : 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 O.CCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE.