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HomeMy WebLinkAbout3605 ROSEDALE HWY (5)2il MONITORING SYSTEM CERTIFICATION %361 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 of Regulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or reportgtust be prepared for each monitoring system control panel by the technician who performs the worlc 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 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 Date ofTesting/Servicing: B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment insnected/serviced: Tsnk ID: REG87 Tank ID: PREM91 In -Tank Gauging Probe. Model: MAG In -Tank Gauging Probe. Model: MAG Annular Space or Vault Sensor. Model: 302 Annular Space or Vault Sensor. Model: 302 Piping Sump / Trench Sensor(s). Model: 206 Piping Sump / Trench Sensor(s). Model: 208 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 on Page 2). 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: 352 Piping Sump / Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line leak Detector. Model: FX1 DV 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: 112 Dispenser ID: 314 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 Floats) and Chain(s). Dispenser ID: 516 Dispenser ID: 7/8 Dispenser Containment 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 1D: 11/12 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). If the 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 capaery nerating such reports, I have also attached a copy ofthe report; (check aU that apply): ® System set -up ® Alarnt eport Technician Name (print): RICH PHILLIPS Signature: Certification No.: A2908411035169 -UT License. No.: C611 D40 809850 Testing Company Name: RICH ENVIRONMENTAL Phone No.: (661) 392 -8687 Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date of Testing/Servicing: 518/2012 Page 1 of 5 UN -036 1/4 www.unidoes.org Rev. 01/17/08 Monitoring System Certification A Results of Testing/Servicing Software Version Installed: 330.01 Comnlete the following checklist: yG38¢ . 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 and 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? % Yes* E 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* E 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. E Yes No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, ifapplicable 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. E. Comments: REPLACED STAND ALONE SENSOR DISP 9/10 (BEAUDREAU 406) AND RE- TESTED Page 2 of 6 UN -036 — 2/4 www.unidocs.org Rev. 01/17/08 Monitoring System Certification F. In -Tank Gauging / SIR Equipment: y 394 Z 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 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): rmmnlete the fnllnwina ehecklict- 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: g 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? g Yes No* Was the testing apparatus properly calibrated? ER 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 offifthe LLD detects a leak? g N/A Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled g N/A or disconnected? Yes No* For electronic LLDs, does the turbine automatically shut offif any portion of the monitoring system malfunctions g N/A or fails a test? Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? N/A L11 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. UN -036 - 3/4 Page 3 of 5 www.unidoes.org Rev. 01/17/08 Monitoring System Certificaifon UST Monitoring Site Plan Site Address: 3605 ROSEDALE HWY. BAKERSFiELD, CA. 93308 l6 3$9 f/ I .. . . . . . . . . . . . . . 1cc3C.0AA.t3b-. ._,... . . . . . . . . ... . . . . . , • f . . . . . . . . . . . . . . . . . t QA1>; w 4e•.t.d*,r„j c` . . . . . . fn %7 W!'l1 $t . ....... . Qr. elizi E::::....::: Date map was drawn: 5,'1_3`10. InAructiOns If you already have a diagram ihat shows ali requirod information, you may include it, rather than this page. with your Monitoring Sy tem Certification. On your:site plan, show the general layout of tanks and.piping. Clearly' idcmify locations, of the follmving equipment; if installed: monitoring system control panels; scissors monitoring tank annular spaces, sumps, dispenser pans. spill containers. or iother secondary containment areas; mechanical or electronic lute leak detectors; and in -tank liquid level probe~ (if used for seal: demlion). M the space provided, note the datethis Site Flan was prepared. Page 3 of ' 5 l :N-M - 4A www.unidoes.org Rev. 0 1if71118 Y 3$1 RICH ENVIRONMENTAL 5643 BROOKS CT. BAKERSFIELD, CA. 93308 OFFICE (661)392 -8687 FAX (661)392 -0621 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET FACILITY NAME: C &M SHELL STATION FACILITY ADDRESS: 3605 ROSEDALE HWY, BAKERSFIELD PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL UNL87 L/D TYPE: FX1V NO FAIL SERIAL # 9838 PREM91 LID TYPE: FX1V NO FAIL SERIAL # 0874 LID TYPE: FX1DV DSL YES 10 PASS SERIAL # 4746 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 PHZIPS SIGNATURE: DATE: 5/8/12 43 f SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing of UST spill containment structures. The completedform and printouts from 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: 5/8/I2 Facility Address: 3605 ROSEDALE HWY, BAKERSFIELD Facility Contact: I Phone: Date Local Agency Was Notified of Testing: 3/28/12 Name ofLocal Agency Inspector (fpresent during testing): 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 El Other Test Equipment Used: VISUAL Equipment Resolution: 0 Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 REG87 FILL 2 PREM91 FILL 3 DIESEL FILL 4 Bucket Installation Type: X Direct Bury Contained in Sump X Direct Bury Contained in Sump X Direct Bury Contained in Sump 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 (Tj): 9:00 9:00 9:00 Initial Reading (RO: 12" 12" 12" Test End Time (TF): 10 :00 10:00 10:00 Final Reading (RF): 12" 12" 12" Test Duration (TF — T,): 1 -HOUR i -HOUR 1 -HOUR Change in Reading (RF- R,): 0 0 0 Pass/Fail Threshold or Criteria: 0.00 0.00 0.00 Test Result: X Pass Fail X Pass Fail X Pass Fail Pass Fail Comments — (include information on repairs made prior to testing andrecommendedfollow -upforfailed tests) CERTIFICATION OF TE NICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the informatio retainedin this report is true, accurate, and infull compliance witlt legal requirements. Technician's Signature: Date: 5/8/12 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. SOFTWARE REVISION LEVEL TANK CHART SECURITY DISABLED VERSION 330.01 PARITY ODD SOFTWARE0 346330 -100 -B STOP BIT 1 STOP DATA LENGTH: 7 DATA CREATED - 10.07.23.17.25 CUSTOM ALARl -tS S- MODULE# 330160 -004 -a DISABLED SYSTEM FEATURES: PORT SETTINGS: PERIODIC IN -TANK TESTS TESTS SERVICE NOTICE ANNUAL IN -TANK. DISABLED ISD RS -232 SECURITY ISO 3166 COUNTRY CODE: MASS /DENSITY DISABLED SYSTEM SETUP MAY 6, 2012 7:05 AM SYSTEM UNITS COMM BOARD 3 (FXMOD) BAUD RATE 2400 U.S. PARITY ODD SYSTEM LANGUAGE STOP BIT 1 STOP DATA LENGTH: 7 DATA ENGLISH SYSTEM DATE /TIME FORMAT COMMUNICATIONS SETUP MON DD YYYY HH:MM:SS xM CODE : CODE DISABLED SHELL PORT SETTINGS: 3605 ROSEDALE HWY ANSWER ON 1 RING MODEM SETUP STRING BAKERSFIELD CA COMM BOARD : 1 (ED IM ) TEMP COMPENSATION RS -232 SECURITY SHIFT TIME 1 12:00 AM CODE : DISABLED SHIFT TIME 2 4:00 AM SHIFT TIME 3 : DISABLED COMM BOARD 2 (RS -232) SHIFT TIME 4 DISABLED BAUD RATE 1200 PARITY ODD TANK PER TST NEEDED WRN STOP BIT l STOP DATA LENGTH: 7 DATA DISABLED RS -232 SECURITYTANKANNTSTNEEDEDWRNCODE : DISABLED DISABLED DISABLED LINE RE-ENABLE METHOD COMM BOARD 3 (FXMOD) BAUD RATE 2400PASSLINETESTPARITYODD LAVE PER TST NEEDED WRN STOP BIT 1 STOP DATA LENGTH: 7 DATADISABLEDSECURITYLINEANNTSTNEEDEDWRNCODE : CODE DISABLEDDISABLEDDIALTYPETONE PRINT TC VOLUMES ANSWER ON 1 RING MODEM SETUP STRINGENABLED TEMP COMPENSATION DIAL TONE INTERVAL: 32 VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET AUTO TRANSMIT SETTINGS: DISABLED ULLAGE: 90% AUTO LEAK ALARM LIMIT DISABLEDH- PROTOCOL DATA FORMAT AUTO HIGH WATER LIMITHEIGHTDISABLEDDAYLIGHTSAVINGTIMEAUTOOVERFILLLIMITDISABLEDDISABLEDRE- DIRECT LOCAL PRINTOUT AUTO PRODUCTDISABLEDLOW DISABLED EURO PROTOCOL PREFIX AUTO THEFT LIMIT DISABLEDSAUTODELIVERY START DISABLED AUTO DELIVERY END DISABLEDSYSTEMSECURITYAUTOEXTERNAL I tip UT ONCODE : 000000 nTQORT -ED MAINTENANCE HISTORY DISABLED AUTO EXTERNAL INPUT OFF / DISABLED qb ( il' AUTO SENSOR FUEL ALARM DISABLED AUTO ;SENSOR WATER ALARM DISABLED AUTO SENSOR OUT ALARM DISABLED RECEIVER SETUP: NONE AUTO DIAL TIME SETUP: NONE RS -232 END OF MESSAGE DISABLED AUTO DIAL ALARM SETUP 46illA tt,lUY 1:97 ODUCT CODE 1 ERMAL COEFF :.000700 NK DIAMETER 92.00 IVK PROFILE 1 PT FULL VOL 9728 OAT SIZF-: TER WARNING GH WATER LIMIT X OR LABEL VQL ERFILL LIMIT GH PRODUCT LIVERY LIMIT 4.0 IN. 2.0 3.0 9728 909 8755 95i 9241 5% 486 W PRODUCT 500 AK ALARM LIMIT : 3 DDEN LOSS LIMIT: 50 NX TILT 2.20 OBE OFFSET 0.00 PHON MANIFOLDED TANKS N014E NE MANIFOLDED TANKS NONE AK MIN PERIODIC: 0% 0 AK III N ANNUAL 0yo 0 RIODIC TEST TYPE STANDARD NUAL TEST FAIL ALARM DISABLED RIODIC TEST FAIL ALARM DISABLED OSS TEST FAIL ALARM DISABLED N TEST AVERAGING: OFF R TEST AVERAGING: OFF NK TEST NOTIFY: OFF K TST SIPHON BREAK:OFF LIVERY DELAY 5 MIN MP THRESHOLD 10.00° Lr -hlt. 1 ttt 1 1"IJr1• HUU TEST ON DATE : ALL TANK JAN 29, 2009 START TIME : DISABLED TEST RATE :0.20 GAL /HR DURATIOIV : 2 HOURS TST EARL`; STOP :DISABLED LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP L 1:87 STP TRI —STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 2:DIESEL STP DUAL FLT. HIGH VAPOR CATEGORY : STP SUMP L 3:91 STP TRI —STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 4:87 ANN NORMALLY CLOSED CATEGORY : ANNULAR SPACE L 5 :DIESEL ANN DUAL POINT HYDROSTATIC CATEGORY : ANNULAR SPACE L 6:91 ANN DUAL POINT HYDROSTATIC CATEGORY : ANNULAR SPACE L 7:VENT BOX TRI —STATE (SINGLE FLOAT) CATEGORY : OTHER SENSORS L 8:NONE NORMALLY CLOSED CATEGORY : OTHER SENSORS OUTPUT RELAY SETUP R 1:87 TYPE: STANDARD NORMALLY CLOSED TANK 0: LIQUID SENSOR ALMS L 1 :FUEL ALARM L 3:FUEL ALARM L I:SEI+SOR OUT ALARM L 3:SENSOR OUT ALARM L 3:WATER ALARM L I :HIGH LIQUID ALARM L 3:LIQUID WARNING ISD SITE ALARMS ISD GROSS PRES FAIL ISD DEGRD PRES FAIL ISD VAPOR LEAK FAIL ISD VP PRES FAIL ISD VP STATUS FAIL ISD HOSE ALARMS ALL :FLOW COLLECT FAIL R 2:DIESEL TYPE: STANDARD NORMALLY CLOSED TA14K #: 2 LIQUID SENSOR ALMS L 2:FUEL ALARM L 2:SENSOR OUT ALARM L 2:HIGH LIQUID ALARM R 3:91 TYPE: STANDARD NORMALLY CLOSED TANK 0: 3 LIQUID SENSOR ALMS L 3:FUEL ALARM L 3 :SENSOR OUT ALARM ISD SITE ALARMS ISD GROSS PRES FAIL ISD DEGRD PRES FAIL ISD VAPOR LEAK FAIL ISD VP PRES FAIL ISD VP STATUS FAIL ISD HOSE ALARMS ALL :FLOW COLLECT FAIL Y63$9 SMARTSENSOR SETUP s 1 :VAPOR PRESSURE CATEGORY VAPOR PRESSURE s 2:CANISTER CATEGORY VAPOR VALVE s S:ATM CATEGORY ATM P SENSOR s 9:DISP 1 -2 CATEGORY AIR FLOW METER 510:DISP 3 -4 CATEGORY A.IR FLOW METER sll:DISP 5 -6 CATEGORY AIR FLOW PIETER sl2:DISP 7 -8 CATEGORY AIR FLOW METER sl3:DISP 9 -10 CATEGORY AIR FLOW METER 514:DISP 11 -12 CATEGORY AIR FLOW METER EVR /ISD SETUP E %JR TYPE: BALANCE BALANCE NOZZLE TYPE VST VAPOR PROCESSOR TYPE VEEDER-ROOT POLISHER ANALYSIS TIMES TIME: 10:00 All DELAY MINUTES: 1 ACCEPT HIGH ORVR: ENABLED ISD HOSE TABLE ID FP FL HL AA RR 01 01 01 02 01 03 02 02 02 02 O1 03 03 03 03 02 02 03 04 04 04 02 02 03 05 05 05 02 03 03 06 06 06 02 03 03 07 07 07 02 04' 03 08 08 08 02 04 03 09 09 09 02 05 03 10 16 10 02 05 03 11 17 11 02 06 03 12 18 12 02 06 03 ISD AIRFLOW METER MAR ID SERIAL NUM LABEL 1 34514 DISP 1 -2 2 39498 DISP 3 -4 3 36972 DISP 5 -6 4 37267 DISP 7 -8 5 36516 DISP 9 -10 6 34444 DISP 11 -12 ISD FUEL GRADE HOSE MAP 1 2 3 4 FP MHH MHH MHH MHH AA O1 101 301 201 U U 1 02 102 302 202 U U 1 03 103 303 203 U U 2 04 104 304 204 U U 2 05 105 305 205 U U 3 06 106 306 206 U U 3 07 107 307 207 4 U 4 08 108 308 208 4 U 4 09 109 309 209 U U 5 16 110 310 210 U U 5 17 211 111 911 3 U 6 18 212 112 912 3 U 6 LABEL TABLE 1: U14ASSIGNED 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 PROCESSOR TYPE VEEDER -ROOT POLISHER. ALARM HISTORY REPORT SEI4SOR ALARM - - - -- L 1:87 STP STP SUMP SEI'ISOR OUT ALARMIlAY8- 2012 10:08 AM FUEL ALARMMAY8, 2012 9:53 AM SENSOR OUT ALARMMAY18, 2011 12:45 PM HLMXI'i H 1;:i- J UK Y Xr-FUX 1 SENSOR ALARM L 2:DIESEL STP STP SUMP SENSOR OUT ALARM MAY S. 2012 10:09 AM FUEL ALARM MAY 8, 2012 9:51 AM SENSOR OUT ALARM MAY 18, 2011 12:45 PM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 3:91 STP STP SUMP SENSOR OUT ALARM MAY 8, 2012 10:09 AM FUEL ALARr l MAY 9. 2012 9:50 AM SENSOR OUT ALARM MAY 18, 2011 12 :45 PM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 4:87 ANN ANNULAR SPACEFUELALARM MAY 8, 2012 2:47 PM FUEL ALARM MAY 8, 2012 1:17 PM FUEL ALARM PIAV 8, 2012 11:13 AM r ALARM HISTUR*f REPORT - SEflEOR ALARM - L S:DI SEL ANN ANNULAR EPAALARM ENS. O'Z OI,GI2 10:08 Arl LOW LIQUID ALARMLQ129:52 PJ4 UrF t'Sg aQ1flLA"!45 PM ALARM HISTORY REPORT SENSOR ALARM - - - -- L 6:91 ANN ANNULAR SPACE SENSOR OUT ALARM MAY 8. 2012 10:09 All LOW LIQUID ALARM MAY 8, 2012 9:50 All LOW LIQUID ALARM NOV 28, 2011 12:11 All y63Xt A x x x X END X X x x X ALARM HISTORY REPORT SENSOR ALARM - -- -- L 7:VENT BOX OTHER SENSORS FUEL ALARM MAY B. 2012 3:34 PM FUEL ALARM MAY 8, 2012 11:11 AM SENSOR OUT ALARM MAY 8, 2012 10:09 AM 0 zllG3` 4/384 MONITOR CERT. FAILURE REPORT SITE NAME: C &M SHELL STATION DATE: 5/8/12 ADDRESS: 3605 ROSEDALE HWY TECHNICIAN: RICHIE MILLIPS CITY: BAKERSFIELD SIGNATURE: 'go/ REPAIRS: REPLACED TWO RED JACKET LEAK DETECTORS FX1V REPLACED ONE BEAUDREAU 406 STAND ALONE SENSOR ON DISP 49/10 PARTS INSTALLED: LEAK DETECTORS - OWNER SUPPLIED 1- BEAUDREAU 406 STAND ALONE SENSOR 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 OCCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE.