HomeMy WebLinkAbout2018 FMC2/21/07 1
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of California
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 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 of test date.
$General Information
Facility Name: ________________________________________________________________________ Bldg. No.:___________________
Site Address: ________________________________________________ City: ________________________ Zip: ____________________
Facility Contact Person: ___________________________________________ Contact Phone No.: _________________________________
Make/Model of Monitoring System: ________________________________________ Date of Testing/Servicing: ___________________
%Inventory of Equipment Tested/CertifiedCheck the appropriate boxes to indicate specific equipment inspected/serviced:
Tank ID: ____________________________________________
2/21/072
D. Results of Testing/Servicing
Software Version Installed: _____________________________________
Complete the following checklist:
2/21/073
F. In-Tank Gauging / SIR Equipment:
Leak Detector Test Results Sheet
&ĂĐŝůŝƚLJEĂŵĞ͗Site Address:
Test Date:
TechnicianŽŶĚƵĐƚŝŶŐdĞƐƚ: ICC No.:
Product Type LLD Type Model Serial No. Check
Valve
Holding
Pressure
Bleed
Off ML.
Leak
Rate
Tested:
Pass/Fail
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
3 gph @
10 psi
TechnicianSignature: Date:
Unleaded Electronic WPLLD 13 psi 25 mls Pass
Unleaded 2 Electronic WPLLD 14 psi 50mls Pass
Premium Electronic WPLLD 13 psi 25 mls Pass
Diesel Electronic WPLLD 12psi 25 mls Pass
09/05/2018
Jaco #33351 Howard's Mini Mart #4 09/05/2018 3200 Panama Ln
Timothy Capehart 8414476
Howards panama
SETUP BEFORE AND AFTER
SETUP
Responses Received: 200 HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 SEP 5, 2018 8:36 AM TANK PRODUCT GALLONS INCHES WATER DEG F ULLAGE 1 PNL 2812 27.31 0.0 92.2 9188 2 UNL 1 5833 46.95 0.0 91.7 6167 3 DSL 3208 30.03 1.0 91.5 8792 4 UNL 2 6036 48.23 0.8 91.2 5964
I90500 SEP 5, 2018 8:36 AM SOFTWARE REVISION LEVEL VERSION 327.04 SOFTWARE# 346327-100-E CREATED - 07.02.06.10.28 S-MODULE# 330160-066-a SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS CSLD ISD PMC PLLD 0.10 AUTO 0.20 REPETITIV WPLLD 0.10 AUTO 0.20 REPETITIV I50500 SEP 5, 2018 8:36 AM
SYSTEM TYPE AND LANGUAGE FLAG SYSTEM UNITS U.S.
SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYYY HH:MM:SS xM I50201 SEP 5, 2018 8:36 AM SHIFT TIME 1 : 6:00 AM I50202 SEP 5, 2018 8:36 AM SHIFT TIME 2 : DISABLED I50203 SEP 5, 2018 8:36 AM SHIFT TIME 3 : DISABLED I50204 SEP 5, 2018 8:36 AM SHIFT TIME 4 : DISABLED I54600 SEP 5, 2018 8:36 AM TANK PER TST NEEDED WRN: DISABLED I54900 SEP 5, 2018 8:36 AM TANK ANN TST NEEDED WRN: DISABLED I55300 SEP 5, 2018 8:36 AM LINE RE-ENABLE METHOD PASS LINE TEST I55600 SEP 5, 2018 8:36 AM LINE PER TST NEEDED WRN: DISABLED
I55900 SEP 5, 2018 8:36 AM LINE ANN TST NEEDED WRN: DISABLED I50D00 SEP 5, 2018 8:36 AM PRINT TC VOLUMES ENABLED I50E00 SEP 5, 2018 8:36 AM TEMP COMPENSATION VALUE (DEG F ): 60.0 I60B00 SEP 5, 2018 8:36 AM STICK HEIGHT OFFSET ENABLE STATUS DISABLED I51400 SEP 5, 2018 8:36 AM H-PROTOCOL DATA FORMAT HEIGHT I51A01 SEP 5, 2018 8:36 AM DAYLIGHT SAVING TIME ENABLED ON I51B00 SEP 5, 2018 8:36 AM DAYLIGHT SAVING TIME START DATE MAR WEEK 2 SUN 12:00 AM END DATE NOV WEEK 1 SUN 12:00 AM I51600 SEP 5, 2018 8:36 AM RE-DIRECT LOCAL PRINTOUT
DISABLED I50400 SEP 5, 2018 8:36 AM 232 SECURITY CODE PORT SECURITY CODE STATUS 1 000000 DISABLED 2 000000 DISABLED 3 000000 DISABLED 4 000000 DISABLED 5 000000 DISABLED 6 000000 DISABLED I21900 SEP 5, 2018 8:36 AM TANK CHART SECURITY DISABLED I5BD00 SEP 5, 2018 8:36 AM CUSTOM ALARM LABELS DISABLED I56000 SEP 5, 2018 8:36 AM MASS/DENSITY DISABLED I88101 SEP 5, 2018 8:36 AM PORT SETTINGS: COMM BOARD : 1 (EDIM ) RS-232 SECURITY CODE : DISABLED I88102 SEP 5, 2018 8:36 AM PORT SETTINGS: COMM BOARD : 2 (RS-232)
BAUD RATE : 9600 PARITY : NONE STOP BIT : 1 STOP DATA LENGTH: 8 DATA RS-232 SECURITY CODE : DISABLED I88103 SEP 5, 2018 8:36 AM I88104 SEP 5, 2018 8:36 AM I88105 SEP 5, 2018 8:36 AM PORT SETTINGS: COMM BOARD : 5 (RS-485) BAUD RATE : 9600 PARITY : NONE STOP BIT : 1 STOP DATA LENGTH: 8 DATA RS-232 SECURITY CODE : DISABLED I88106 SEP 5, 2018 8:36 AM PORT SETTINGS: COMM BOARD : 6 (RS-232) BAUD RATE : 9600 PARITY : NONE STOP BIT : 1 STOP DATA LENGTH: 8 DATA RS-232 SECURITY CODE : DISABLED I52000 SEP 5, 2018 8:36 AM RECEIVER AUTO DIAL TYPE & START TIME RCVR LOCATION LABEL DIAL TYPE START TIME 1 ON DATE FEB 17, 2012 DISABLED 2 ON DATE FEB 17, 2012 DISABLED 3 ON DATE FEB 17, 2012 DISABLED 4 ON DATE FEB 17, 2012 DISABLED 5 ON DATE FEB 17, 2012 DISABLED 6 ON DATE FEB 17, 2012 DISABLED 7 ON DATE FEB 17, 2012 DISABLED 8 ON DATE FEB 17, 2012 DISABLED
I60100 SEP 5, 2018 8:36 AM TANK CONFIGURATION DEVICE LABEL CONFIGURED 1 PNL ON 2 UNL 1 ON 3 DSL ON 4 UNL 2 ON I60200 SEP 5, 2018 8:36 AM TANK PRODUCT LABEL TANK PRODUCT LABEL 1 PNL 2 UNL 1 3 DSL 4 UNL 2 I60300 SEP 5, 2018 8:36 AM TANK PRODUCT CODE TANK PRODUCT LABEL 1 PNL 1 2 UNL 1 2 3 DSL 3 4 UNL 2 4 I60900 SEP 5, 2018 8:36 AM TANK THERMAL COEFFICIENT TANK PRODUCT LABEL 1 PNL 0.000070 2 UNL 1 0.000700 3 DSL 0.000450 4 UNL 2 0.000700 I60700 SEP 5, 2018 8:36 AM TANK DIAMETER TANK PRODUCT LABEL INCHES 1 PNL 96.00 2 UNL 1 96.00 3 DSL 96.00 4 UNL 2 96.00 I60A00 SEP 5, 2018 8:36 AM
TANK FULL VOLUME TANK PRODUCT LABEL TANK PROFILE GALLONS 1 PNL 1 PT 12000 2 UNL 1 1 PT 12000 3 DSL 1 PT 12000 4 UNL 2 1 PT 12000 I60400 SEP 5, 2018 8:36 AM TANK FULL VOLUME TANK PRODUCT LABEL GALLONS 1 PNL 12000 2 UNL 1 12000 3 DSL 12000 4 UNL 2 12000 I60500 SEP 5, 2018 8:36 AM TANK 4 POINT VOLUMES TANK PRODUCT LABEL GALLONS 1 PNL 12000 0 0 0 2 UNL 1 12000 0 0 0 3 DSL 12000 0 0 0 4 UNL 2 12000 0 0 0 I60600 SEP 5, 2018 8:36 AM TANK 20 POINT VOLUMES TANK PRODUCT LABEL GALLONS 1 PNL 12000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 UNL 1 12000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 DSL 12000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 UNL 2 12000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 I61500
SEP 5, 2018 8:36 AM TANK PRODUCT LABEL METER DATA 1 PNL NO 2 UNL 1 NO 3 DSL NO 4 UNL 2 NO I62F00 SEP 5, 2018 8:36 AM MAG PROBE FLOAT SIZE TANK PRODUCT LABEL FLOAT SIZE: 1 PNL 3.0 INCHES 2 UNL 1 4.0 INCHES 3 DSL 4.0 INCHES 4 UNL 2 4.0 INCHES I62700 SEP 5, 2018 8:36 AM TANK HIGH WATER WARNING LIMIT TANK PRODUCT LABEL INCHES 1 PNL 2.0 2 UNL 1 2.0 3 DSL 2.0 4 UNL 2 2.0 9999FF1B I62400 SEP 5, 2018 8:36 AM TANK HIGH WATER LEVEL LIMIT TANK PRODUCT LABEL INCHES 1 PNL 3.0 2 UNL 1 3.0 3 DSL 3.0 4 UNL 2 3.0 I62800 SEP 5, 2018 8:36 AM TANK MAXIMUM VOLUME LIMIT TANK PRODUCT LABEL GALLONS 1 PNL 12000 2 UNL 1 12000 3 DSL 12000 4 UNL 2 12000 I62300 SEP 5, 2018 8:36 AM
TANK OVERFILL LEVEL LIMIT TANK PRODUCT LABEL GALLONS 1 PNL 10800 2 UNL 1 10800 3 DSL 10800 4 UNL 2 10800 I62200 SEP 5, 2018 8:36 AM TANK HIGH PRODUCT LIMIT TANK PRODUCT LABEL GALLONS 1 PNL 11400 2 UNL 1 11400 3 DSL 11400 4 UNL 2 11400 I62900 SEP 5, 2018 8:36 AM TANK DELIVERY REQUIRED LIMIT TANK PRODUCT LABEL GALLONS 1 PNL 1200 2 UNL 1 1200 3 DSL 1200 4 UNL 2 1200 I62100 SEP 5, 2018 8:36 AM TANK LOW PRODUCT LIMIT TANK PRODUCT LABEL GALLONS 1 PNL 600 2 UNL 1 600 3 DSL 600 4 UNL 2 600 I62600 SEP 5, 2018 8:36 AM TANK LEAK ALARM LIMIT TANK PRODUCT LABEL GALLONS 1 PNL 99 2 UNL 1 99 3 DSL 99 4 UNL 2 99 I62500 SEP 5, 2018 8:36 AM TANK SUDDEN LOSS LIMIT TANK PRODUCT LABEL GALLONS
1 PNL 99 2 UNL 1 99 3 DSL 99 4 UNL 2 99 I60800 SEP 5, 2018 8:36 AM TANK TILT TANK PRODUCT LABEL INCHES 1 PNL 2.71 2 UNL 1 2.16 3 DSL 2.54 4 UNL 2 2.58 I60B00 SEP 5, 2018 8:36 AM STICK HEIGHT OFFSET ENABLE STATUS DISABLED I60C00 SEP 5, 2018 8:36 AM TANK STICK HEIGHT OFFSET TANK PRODUCT LABEL INCHES 1 PNL 0.00 2 UNL 1 0.00 3 DSL 0.00 4 UNL 2 0.00 I61200 SEP 5, 2018 8:36 AM TANK MANIFOLDED PARTNERS TANK PRODUCT LABEL SIPHON MANIFOLDED TANKS LINE MANIFOLDED TANKS 1 PNL NONE NONE 2 UNL 1 NONE NONE 3 DSL NONE NONE 4 UNL 2 NONE NONE I63600 SEP 5, 2018 8:36 AM PERIODIC LEAK TEST MIN VOLUME TANK PRODUCT LABEL GALLONS 1 PNL 120 2 UNL 1 120 3 DSL 120 4 UNL 2 120 I62A00 SEP 5, 2018 8:36 AM
ANNUAL LEAK TEST MIN VOLUME TANK PRODUCT LABEL GALLONS 1 PNL 120 2 UNL 1 120 3 DSL 120 4 UNL 2 120 I62C00 SEP 5, 2018 8:36 AM TANK PERIODIC TEST TYPE TANK PRODUCT LABEL PERIODIC TEST TYPE 1 PNL STANDARD 2 UNL 1 STANDARD 3 DSL STANDARD 4 UNL 2 STANDARD I62D00 SEP 5, 2018 8:36 AM TANK LEAK TEST FAIL ALARMS TANK PRODUCT LABEL 1 PNL GROSS TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED ANNUAL TEST FAIL ALARM DISABLED 2 UNL 1 GROSS TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED ANNUAL TEST FAIL ALARM DISABLED 3 DSL GROSS TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED ANNUAL TEST FAIL ALARM DISABLED 4 UNL 2 GROSS TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED ANNUAL TEST FAIL ALARM DISABLED I63100 SEP 5, 2018 8:37 AM TANK LEAK TEST AVERAGING TANK PRODUCT LABEL ANNUAL PERIODIC 1 PNL OFF OFF 2 UNL 1 OFF OFF 3 DSL OFF OFF 4 UNL 2 OFF OFF I63000 SEP 5, 2018 8:37 AM
IN-TANK LEAK TEST NOTIFY TANK PRODUCT LABEL TANK TEST NOTIFY: 1 PNL OFF 2 UNL 1 OFF 3 DSL OFF 4 UNL 2 OFF I63200 SEP 5, 2018 8:37 AM TANK TEST SIPHON BREAK TANK PRODUCT LABEL SIPHON BREAK 1 PNL OFF 2 UNL 1 OFF 3 DSL OFF 4 UNL 2 OFF I61000 SEP 5, 2018 8:37 AM TANK DELIVERY DELAY TANK PRODUCT LABEL 1 PNL 1 2 UNL 1 1 3 DSL 1 4 UNL 2 1 I63A00 SEP 5, 2018 8:37 AM LOW LEVEL PUMP THRESHOLD FOR SEQUENTIAL LINE MANIFOLD TANK PRODUCT LABEL PUMP THRESHOLD 1 PNL 10.00% 2 UNL 1 10.00% 3 DSL 10.00% 4 UNL 2 10.00% I61100 SEP 5, 2018 8:37 AM LEAK TEST METHOD - - - - - - - - - - - - TEST CSLD : ALL TANK Pd = 95% CLIMATE FACTOR:MODERATE GROSS TEST AUTO-CONFIRM: DISABLED REPORT ONLY: END OF MONTH
TST EARLY STOP:DISABLED I61300 SEP 5, 2018 8:37 AM CSLD PROBABLITY OF DETECTION T 1:PNL : Pd = 95% T 2:UNL 1 : Pd = 95% T 3:DSL : Pd = 95% T 4:UNL 2 : Pd = 95% I61400 SEP 5, 2018 8:37 AM CSLD CLIMATE FACTOR T 1:PNL : MODERATE T 2:UNL 1 : MODERATE T 3:DSL : MODERATE T 4:UNL 2 : MODERATE I61600 SEP 5, 2018 8:37 AM TANK PRODUCT LABEL CAL UPDATE 1 PNL IMMEDIATE 2 UNL 1 IMMEDIATE 3 DSL IMMEDIATE 4 UNL 2 IMMEDIATE I61A00 SEP 5, 2018 8:37 AM IN-TANK LEAK TEST EARLY STOP TANK PRODUCT LABEL TST EARLY STOP: 1 PNL DISABLED 2 UNL 1 DISABLED 3 DSL DISABLED 4 UNL 2 DISABLED I61B00 SEP 5, 2018 8:37 AM IN-TANK LEAK GROSS TEST AUTO-CONFIRM TANK PRODUCT LABEL AUTO-CONFIRM 1 PNL DISABLED 2 UNL 1 DISABLED 3 DSL DISABLED 4 UNL 2 DISABLED I61C00
SEP 5, 2018 8:37 AM CSLD REPORT ONLY TANK PRODUCT LABEL CSLD REPORT ONLY 1 PNL END OF MONTH 2 UNL 1 END OF MONTH 3 DSL END OF MONTH 4 UNL 2 END OF MONTH I62B00 SEP 5, 2018 8:37 AM TANK LAST ANNUAL TEST TANK PRODUCT LABEL DATE 1 PNL ??? 0, 0 2 UNL 1 ??? 0, 0 3 DSL ??? 0, 0 4 UNL 2 ??? 0, 0 I63300 SEP 5, 2018 8:37 AM LEAK TEST REPORT FORMAT: NORMAL I63400 SEP 5, 2018 8:37 AM RECONCILIATION WARNING LIMIT TANK PRODUCT LABEL GALLONS 1 PNL 0 2 UNL 1 0 3 DSL 0 4 UNL 2 0 I63500 SEP 5, 2018 8:37 AM RECONCILIATION ALARM LIMIT TANK PRODUCT LABEL GALLONS 1 PNL 1 2 UNL 1 1 3 DSL 1 4 UNL 2 1 I63900 SEP 5, 2018 8:37 AM ACCU CHART END SHAPE FACTOR TANK PRODUCT LABEL 1 PNL END FACTOR: NONE
2 UNL 1 END FACTOR: NONE 3 DSL END FACTOR: NONE 4 UNL 2 END FACTOR: NONE I78000 SEP 5, 2018 8:37 AM I77700 SEP 5, 2018 8:37 AM I77800 SEP 5, 2018 8:37 AM I78C00 SEP 5, 2018 8:37 AM I78300 SEP 5, 2018 8:37 AM I78F00 SEP 5, 2018 8:37 AM I78700 SEP 5, 2018 8:37 AM I70200 SEP 5, 2018 8:37 AM LIQUID LABEL DEVICE LABEL 1 DISP 1-2 2 DISP 3-4 3 DISP 5-6 4 DISP 7-8 5
6 7 8 I70300 SEP 5, 2018 8:37 AM LIQUID TYPE SENSOR LOCATION TYPE 1 DISP 1-2 TRI-STATE (SINGLE FLOAT) 2 DISP 3-4 TRI-STATE (SINGLE FLOAT) 3 DISP 5-6 TRI-STATE (SINGLE FLOAT) 4 DISP 7-8 TRI-STATE (SINGLE FLOAT) 5 TRI-STATE (SINGLE FLOAT) 6 TRI-STATE (SINGLE FLOAT) 7 TRI-STATE (SINGLE FLOAT) 8 TRI-STATE (SINGLE FLOAT) I70400 SEP 5, 2018 8:37 AM LIQUID CATEGORY SENSOR LOCATION CATEGORY 1 DISP 1-2 DISPENSER PAN 2 DISP 3-4 DISPENSER PAN 3 DISP 5-6 DISPENSER PAN 4 DISP 7-8 DISPENSER PAN 5 OTHER SENSORS 6 OTHER SENSORS 7 OTHER SENSORS 8 OTHER SENSORS I74200 SEP 5, 2018 8:37 AM I74300 SEP 5, 2018 8:37 AM I74400 SEP 5, 2018 8:37 AM I74700 SEP 5, 2018 8:37 AM I74800 SEP 5, 2018 8:37 AM
I74900 SEP 5, 2018 8:37 AM I7BC00 SEP 5, 2018 8:37 AM I80200 SEP 5, 2018 8:37 AM I80300 SEP 5, 2018 8:37 AM I80400 SEP 5, 2018 8:37 AM I80700 SEP 5, 2018 8:37 AM RELAY LABEL DEVICE LABEL 1 OVERFILL ALARM 2 3 4 I80900 SEP 5, 2018 8:37 AM RELAY ORIENTATION RELAY DESIGNATION ORIENTATION 1 OVERFILL ALARM NORMALLY OPEN 2 NORMALLY OPEN 3 NORMALLY OPEN 4 NORMALLY OPEN I80B00 SEP 5, 2018 8:37 AM RELAY TANK ASSIGNMENT RELAY DESIGNATION TANK 1 OVERFILL ALARM NONE 2 NONE 3 NONE 4 NONE
I80A00 SEP 5, 2018 8:37 AM RELAY TYPE RELAY DESIGNATION TYPE 1 OVERFILL ALARM STANDARD 2 STANDARD 3 STANDARD 4 STANDARD I80C00 SEP 5, 2018 8:37 AM I80800 SEP 5, 2018 8:37 AM RELAY SETUP REPORT R 1:OVERFILL ALARM TYPE: STANDARD NORMALLY OPEN TANK #: NONE IN-TANK ALARMS ALL:OVERFILL ALARM ALL:HIGH PRODUCT ALARM ALL:MAX PRODUCT ALARM R 2: TYPE: STANDARD NORMALLY OPEN TANK #: NONE - NO ALARM ASSIGNMENTS - R 3: TYPE: STANDARD NORMALLY OPEN TANK #: NONE - NO ALARM ASSIGNMENTS - R 4: TYPE: STANDARD NORMALLY OPEN
TANK #: NONE - NO ALARM ASSIGNMENTS - I79000 SEP 5, 2018 8:37 AM EDIM:1 VR:349634-003-C TD:06.05.11.11.15 I79100 SEP 5, 2018 8:37 AM I72300 SEP 5, 2018 8:37 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 SMARTSENSOR ASSIGNMENT DEVICE LABEL CATEGORY 01 PS 1-2 VAPOR PRESSURE 02 FM 1-2 AIR FLOW METER 03 FM 3-4 AIR FLOW METER 04 FM 5-6 AIR FLOW METER 05 FM 7-8 AIR FLOW METER 06 UNKNOWN 07 UNKNOWN 08 UNKNOWN 09 UNKNOWN 10 UNKNOWN 11 UNKNOWN 12 UNKNOWN 13 UNKNOWN 14 UNKNOWN 15 UNKNOWN 16 UNKNOWN 17 UNKNOWN 18 UNKNOWN 19 UNKNOWN 20 UNKNOWN 21 UNKNOWN 22 UNKNOWN 23 UNKNOWN 24 UNKNOWN 25 UNKNOWN 26 UNKNOWN 27 UNKNOWN 28 UNKNOWN 29 UNKNOWN 30 UNKNOWN 31 UNKNOWN 32 UNKNOWN
33 UNKNOWN 34 UNKNOWN 35 UNKNOWN 36 UNKNOWN 37 UNKNOWN 38 UNKNOWN 39 UNKNOWN 40 UNKNOWN IV4E00 SEP 5, 2018 8:37 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 EVR/ISD SETUP TYPE: VACUUM ASSIST VACUUM ASSIST TYPE: HEALY VAC IV4F00 SEP 5, 2018 8:37 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 NOZZLE A/L RANGE A/L RATIO: 0.95 - 1.15 IV4000 SEP 5, 2018 8:37 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 VAPOR PROCESSOR TYPE NO VAPOR PROCESSOR IV4700 SEP 5, 2018 8:37 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 ASSESSMENT TIME START TIME: 10:00 AM TIME DELAY MINUTES: 1
IV5200 SEP 5, 2018 8:37 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 ACCEPT HIGH ORVR: YES IV4A00 SEP 5, 2018 8:37 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 ISD HOSE TABLE HOSE FP FP AFM HOSE ID ID LABEL ID LABEL 01 01 01 01 BLEND3 02 02 02 01 BLEND3 03 03 03 02 BLEND3 04 04 04 02 BLEND3 05 05 05 03 BLEND3 06 06 06 03 BLEND3 07 07 07 04 BLEND3 08 08 08 04 BLEND3 IV4B00 SEP 5, 2018 8:37 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 PRODUCT/HOSE MAP TABLE FP AFID M1/H1 M2/H2 M3/H3 M4/H4 01 01 02/01 03/01 09/01 xx/xx 02 01 02/02 03/02 09/02 xx/xx 03 02 02/03 03/03 09/03 xx/xx 04 02 02/04 03/04 09/04 xx/xx 05 03 02/05 03/05 09/05 xx/xx 06 03 02/06 03/06 09/06 xx/xx 07 04 02/07 03/07 09/07 xx/xx 08 04 02/08 03/08 09/08 xx/xx IV4900 SEP 5, 2018 8:37 AM HOWARDS MINI MART 3200 PANAMA
BAKERSFIELD 93312 LABEL TABLE ID LABEL 01 UNASSIGNED 02 BLEND3 03 REGULAR 04 MID GRADE 05 PREMIUM 06 GOLD 07 BRONZE 08 SILVER 09 BLEND2 10 BLEND4 IV1000 SEP 5, 2018 8:37 AM ISD VERSION: 01.01 BEFORE
Responses Received: I10200 SEP 5, 2018 8:38 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 SYSTEM CONFIGURATION SLOT BOARD TYPE POWER ON RESET CURRENT 1 8SMARTSENSOR BD 39273 39269 2 4 PROBE / G.T. 162789 163025 3 INTERSTITIAL BD 200210 200530 4 UNUSED 4746087 4813472 5 UNUSED 4742381 4808534 6 UNUSED 4738903 4811612 7 UNUSED 4738965 4806407 8 UNUSED 4742029 4806179 9 WPLLD POWER BD 201795 201933 10 WPLLD POWER BD 200557 200677 11 AC INTERFACE BD 163722 163848 12 RELAY BOARD 14951 14965 13 UNUSED 4739676 4809494 14 UNUSED 4738869 4809247 15 UNUSED 4738289 4809019 16 UNUSED 4738434 4808689 COMM 1 ELEC DISP INT. 100769 100840 COMM 2 RS232 SERIAL BD 14826 14819 COMM 3 WPLLD COMM BD 200940 201103 COMM 4 UNUSED 4740856 4809350 COMM 5 RS485 SERIAL BD 68190 68326
COMM 6 RS232 SERIAL BD 14847 14840 I90200 SEP 5, 2018 8:38 AM SOFTWARE REVISION LEVEL VERSION 327.04 SOFTWARE# 346327-100-E CREATED - 07.02.06.10.28 S-MODULE# 330160-066-a SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS CSLD ISD PMC PLLD 0.10 AUTO 0.20 REPETITIV WPLLD 0.10 AUTO 0.20 REPETITIV I11100 SEP 5, 2018 8:38 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 PRIORITY ALARM HISTORY ID CATEGORY DESCRIPTION ALARM TYPE STATE DATE TIME W 4 OTHER UNL 2 WPLLD SHUTDOWN ALM CLEAR 8-29-18 12:00PM W 3 OTHER DSL WPLLD SHUTDOWN ALM CLEAR 8-29-18 12:00PM W 2 OTHER UNL 1 WPLLD SHUTDOWN ALM CLEAR 8-29-18 12:00PM W 1 OTHER PNL WPLLD SHUTDOWN ALM CLEAR 8-29-18 12:00PM L 4 DISP PAN DISP 7-8 SENSOR OUT ALARM CLEAR 8-29-18 12:00PM L 3 DISP PAN DISP 5-6 SENSOR OUT ALARM CLEAR 8-29-18 12:00PM L 2 DISP PAN DISP 3-4 SENSOR OUT ALARM CLEAR 8-29-18 12:00PM L 1 DISP PAN DISP 1-2 SENSOR OUT ALARM CLEAR 8-29-18 12:00PM L 4 DISP PAN DISP 7-8 SENSOR OUT ALARM ALARM 8-29-18 12:00PM L 2 DISP PAN DISP 3-4 SENSOR OUT ALARM ALARM 8-29-18 12:00PM L 3 DISP PAN DISP 5-6 SENSOR OUT ALARM ALARM 8-29-18 12:00PM L 1 DISP PAN DISP 1-2 SENSOR OUT ALARM ALARM 8-29-18 12:00PM W 4 OTHER UNL 2 WPLLD SHUTDOWN ALM ALARM 8-29-18 12:00PM W 3 OTHER DSL WPLLD SHUTDOWN ALM ALARM 8-29-18 12:00PM W 2 OTHER UNL 1 WPLLD SHUTDOWN ALM ALARM 8-29-18 12:00PM W 1 OTHER PNL WPLLD SHUTDOWN ALM ALARM 8-29-18 12:00PM W 3 OTHER DSL WPLLD SHUTDOWN ALM CLEAR 8-29-18 11:58AM W 3 OTHER DSL GROSS LINE FAIL CLEAR 8-29-18 11:58AM W 2 OTHER UNL 1 WPLLD SHUTDOWN ALM CLEAR 8-29-18 11:58AM W 2 OTHER UNL 1 GROSS LINE FAIL CLEAR 8-29-18 11:58AM W 1 OTHER PNL WPLLD SHUTDOWN ALM CLEAR 8-29-18 11:58AM W 1 OTHER PNL GROSS LINE FAIL CLEAR 8-29-18 11:58AM W 4 OTHER UNL 2 WPLLD SHUTDOWN ALM CLEAR 8-29-18 11:58AM W 4 OTHER UNL 2 GROSS LINE FAIL CLEAR 8-29-18 11:58AM W 1 OTHER PNL WPLLD SHUTDOWN ALM ALARM 8-29-18 11:00AM W 1 OTHER PNL GROSS LINE FAIL ALARM 8-29-18 11:00AM
W 4 OTHER UNL 2 WPLLD SHUTDOWN ALM ALARM 8-29-18 10:54AM W 4 OTHER UNL 2 GROSS LINE FAIL ALARM 8-29-18 10:54AM W 2 OTHER UNL 1 WPLLD SHUTDOWN ALM ALARM 8-29-18 10:39AM W 2 OTHER UNL 1 GROSS LINE FAIL ALARM 8-29-18 10:39AM W 3 OTHER DSL WPLLD SHUTDOWN ALM ALARM 8-29-18 10:29AM W 3 OTHER DSL GROSS LINE FAIL ALARM 8-29-18 10:29AM T 2 TANK UNL 1 PROBE OUT CLEAR 8-29-18 10:14AM T 2 TANK UNL 1 PROBE OUT ALARM 8-29-18 10:14AM T 2 TANK UNL 1 PROBE OUT CLEAR 8-29-18 10:13AM T 4 TANK UNL 2 PROBE OUT CLEAR 8-29-18 10:07AM T 4 TANK UNL 2 PROBE OUT ALARM 8-29-18 10:07AM T 3 TANK DSL PROBE OUT CLEAR 8-29-18 10:06AM T 3 TANK DSL OVERFILL ALARM CLEAR 8-29-18 10:05AM T 3 TANK DSL PROBE OUT ALARM 8-29-18 10:05AM T 3 TANK DSL OVERFILL ALARM ALARM 8-29-18 10:05AM T 2 TANK UNL 1 PROBE OUT ALARM 8-29-18 10:04AM T 2 TANK UNL 1 PROBE OUT CLEAR 8-29-18 10:04AM T 2 TANK UNL 1 PROBE OUT ALARM 8-29-18 10:04AM T 1 TANK PNL LOW PRODUCT ALARM CLEAR 8-29-18 10:03AM T 1 TANK PNL LOW PRODUCT ALARM ALARM 8-29-18 10:03AM T 1 TANK PNL PROBE OUT CLEAR 8-29-18 10:02AM T 1 TANK PNL PROBE OUT ALARM 8-29-18 10:02AM W 4 OTHER UNL 2 WPLLD SHUTDOWN ALM CLEAR 8-29-18 9:58AM W 3 OTHER DSL WPLLD SHUTDOWN ALM CLEAR 8-29-18 9:58AM I11200 SEP 5, 2018 8:38 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 NON-PRIORITY ALARM HISTORY ID CATEGORY DESCRIPTION ALARM TYPE STATE DATE TIME OTHER ISD GROSS PRES WARN CLEAR 9-01-18 10:00AM OTHER ISD GROSS PRES WARN ALARM 8-30-18 10:02AM SYSTEM PRINTER ERROR CLEAR 8-29-18 10:11AM SYSTEM PAPER OUT CLEAR 8-29-18 10:11AM T 4 TANK UNL 2 LOW TEMP WARNING CLEAR 8-29-18 10:08AM T 4 TANK UNL 2 LOW TEMP WARNING ALARM 8-29-18 10:08AM SYSTEM PRINTER ERROR ALARM 8-29-18 10:07AM SYSTEM PAPER OUT ALARM 8-29-18 10:07AM T 4 TANK UNL 2 HIGH PRODUCT ALARM CLEAR 8-29-18 10:06AM T 4 TANK UNL 2 HIGH PRODUCT ALARM ALARM 8-29-18 10:06AM T 3 TANK DSL LOW TEMP WARNING CLEAR 8-29-18 10:06AM T 3 TANK DSL LOW TEMP WARNING ALARM 8-29-18 10:06AM T 2 TANK UNL 1 HIGH PRODUCT ALARM CLEAR 8-29-18 10:03AM T 2 TANK UNL 1 HIGH PRODUCT ALARM ALARM 8-29-18 10:03AM T 1 TANK PNL DELIVERY NEEDED CLEAR 8-29-18 10:03AM T 1 TANK PNL INVALID FUEL LEVEL CLEAR 8-29-18 10:03AM T 1 TANK PNL DELIVERY NEEDED ALARM 8-29-18 10:03AM
T 1 TANK PNL INVALID FUEL LEVEL ALARM 8-29-18 10:03AM T 1 TANK PNL HIGH PRODUCT ALARM CLEAR 8-29-18 10:02AM T 1 TANK PNL HIGH PRODUCT ALARM ALARM 8-29-18 10:01AM T 1 TANK PNL DELIVERY NEEDED CLEAR 8-29-18 9:34AM T 2 TANK UNL 1 DELIVERY NEEDED CLEAR 8-29-18 9:33AM T 1 TANK PNL DELIVERY NEEDED ALARM 8-29-18 9:32AM T 2 TANK UNL 1 DELIVERY NEEDED ALARM 8-29-18 9:32AM OTHER ISD GROSS PRES WARN CLEAR 8-23-18 10:23AM T 2 TANK UNL 1 DELIVERY NEEDED CLEAR 8-20-18 10:29AM
T 2 TANK UNL 1 DELIVERY NEEDED ALARM 8-20-18 7:53AM OTHER ISD GROSS PRES WARN ALARM 8-18-18 10:03AM OTHER ISD GROSS PRES WARN CLEAR 8-15-18 10:00AM OTHER ISD GROSS PRES WARN ALARM 8-13-18 10:02AM T 3 TANK DSL DELIVERY NEEDED CLEAR 8-10-18 7:00AM T 3 TANK DSL DELIVERY NEEDED ALARM 8-09-18 12:58PM OTHER ISD GROSS PRES WARN CLEAR 8-06-18 9:08AM OTHER ISD GROSS PRES WARN ALARM 7-31-18 10:02AM h 6 OTHER FP6: BLEND3 DEGRD COLLECT WARN CLEAR 7-02-18 10:00AM h 6 OTHER FP6: BLEND3 DEGRD COLLECT WARN ALARM 7-01-18 10:03AM SYSTEM PRINTER ERROR CLEAR 6-09-18 7:11PM SYSTEM PAPER OUT CLEAR 6-09-18 7:11PM SYSTEM PRINTER ERROR ALARM 6-09-18 7:11PM SYSTEM PAPER OUT ALARM 6-09-18 7:11PM SYSTEM PRINTER ERROR CLEAR 6-09-18 7:11PM SYSTEM PAPER OUT CLEAR 6-09-18 7:11PM SYSTEM PRINTER ERROR ALARM 6-09-18 7:09PM SYSTEM PAPER OUT ALARM 6-09-18 7:09PM T 1 TANK PNL DELIVERY NEEDED CLEAR 5-14-18 3:46PM T 1 TANK PNL DELIVERY NEEDED ALARM 5-14-18 12:09PM T 1 TANK PNL LOW TEMP WARNING CLEAR 5-14-18 11:14AM T 1 TANK PNL LOW TEMP WARNING ALARM 5-14-18 11:14AM T 2 TANK UNL 1 INVALID FUEL LEVEL CLEAR 5-14-18 11:09AM T 2 TANK UNL 1 DELIVERY NEEDED CLEAR 5-14-18 11:09AM I20600 SEP 5, 2018 8:38 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 TANK ALARM HISTORY TANK 1 PNL HIGH WATER ALARM OCT 23, 2017 4:51 PM APR 12, 2016 6:22 PM APR 12, 2016 3:53 PM OVERFILL ALARM AUG 24, 2016 12:17 PM APR 26, 2016 9:45 AM SEP 10, 2013 9:42 AM LOW PRODUCT ALARM AUG 29, 2018 10:03 AM AUG 29, 2018 9:32 AM OCT 23, 2017 5:08 PM SUDDEN LOSS ALARM AUG 29, 2018 9:31 AM OCT 19, 2017 9:42 AM OCT 19, 2017 9:32 AM HIGH PRODUCT ALARM AUG 29, 2018 10:01 AM SEP 6, 2017 9:50 AM AUG 30, 2017 10:04 AM INVALID FUEL LEVEL AUG 29, 2018 10:03 AM OCT 23, 2017 5:08 PM OCT 19, 2017 9:46 AM
PROBE OUT AUG 29, 2018 10:02 AM AUG 29, 2018 9:32 AM JUN 26, 2018 10:43 AM HIGH WATER WARNING OCT 23, 2017 4:51 PM APR 12, 2016 6:22 PM APR 12, 2016 3:53 PM DELIVERY NEEDED AUG 29, 2018 10:03 AM AUG 29, 2018 9:32 AM MAY 14, 2018 12:09 PM LOW TEMP WARNING MAY 14, 2018 11:14 AM SEP 19, 2016 10:10 AM SEP 19, 2016 10:00 AM TANK 2 UNL 1 HIGH WATER ALARM MAY 14, 2018 11:05 AM OVERFILL ALARM APR 17, 2018 11:38 AM MAR 25, 2018 3:32 AM MAR 23, 2018 12:53 AM LOW PRODUCT ALARM MAY 14, 2018 11:09 AM OCT 19, 2017 9:23 AM JUL 8, 2015 8:37 AM SUDDEN LOSS ALARM AUG 29, 2018 9:31 AM OCT 19, 2017 9:10 AM OCT 19, 2017 9:08 AM HIGH PRODUCT ALARM AUG 29, 2018 10:03 AM APR 17, 2018 11:40 AM SEP 6, 2017 9:51 AM INVALID FUEL LEVEL MAY 14, 2018 11:08 AM MAR 19, 2018 10:53 PM JAN 29, 2018 3:45 PM PROBE OUT AUG 29, 2018 10:14 AM AUG 29, 2018 10:04 AM AUG 29, 2018 10:04 AM HIGH WATER WARNING MAY 14, 2018 11:05 AM DELIVERY NEEDED AUG 29, 2018 9:32 AM AUG 20, 2018 7:53 AM MAY 14, 2018 11:09 AM LOW TEMP WARNING OCT 24, 2017 7:57 AM AUG 24, 2016 12:28 PM SEP 9, 2015 11:32 AM TANK 3 DSL HIGH WATER ALARM AUG 19, 2016 3:20 AM AUG 9, 2016 7:23 PM FEB 12, 2015 12:05 PM OVERFILL ALARM AUG 29, 2018 10:05 AM AUG 24, 2016 12:34 PM
SEP 9, 2015 11:36 AM LOW PRODUCT ALARM OCT 6, 2014 8:40 PM NOV 13, 2012 10:04 PM SUDDEN LOSS ALARM AUG 29, 2018 9:33 AM OCT 19, 2017 8:40 AM SEP 6, 2017 9:26 AM HIGH PRODUCT ALARM SEP 6, 2017 9:52 AM AUG 30, 2017 9:59 AM SEP 19, 2016 10:07 AM INVALID FUEL LEVEL OCT 19, 2017 8:54 AM AUG 30, 2017 10:09 AM MAY 8, 2016 10:16 AM PROBE OUT AUG 29, 2018 10:05 AM AUG 29, 2018 9:33 AM OCT 19, 2017 12:18 PM HIGH WATER WARNING AUG 24, 2016 11:34 AM AUG 19, 2016 3:20 AM AUG 9, 2016 7:23 PM DELIVERY NEEDED AUG 9, 2018 12:58 PM OCT 19, 2017 8:51 AM AUG 30, 2017 9:22 AM LOW TEMP WARNING AUG 29, 2018 10:06 AM SEP 19, 2016 10:11 AM AUG 24, 2016 12:35 PM TANK 4 UNL 2 OVERFILL ALARM JUL 11, 2018 1:37 PM JUL 11, 2018 1:32 PM JUL 11, 2018 1:29 PM LOW PRODUCT ALARM MAY 31, 2015 4:37 PM NOV 13, 2012 3:02 PM SUDDEN LOSS ALARM AUG 29, 2018 9:34 AM OCT 19, 2017 12:19 PM OCT 19, 2017 12:14 PM HIGH PRODUCT ALARM AUG 29, 2018 10:06 AM SEP 6, 2017 9:53 AM AUG 30, 2017 9:58 AM INVALID FUEL LEVEL MAY 14, 2018 10:17 AM JAN 5, 2018 9:12 PM OCT 19, 2017 12:20 PM PROBE OUT AUG 29, 2018 10:07 AM AUG 29, 2018 9:34 AM MAY 14, 2018 10:14 AM HIGH WATER WARNING OCT 23, 2017 9:55 AM DELIVERY NEEDED MAY 14, 2018 10:17 AM JAN 5, 2018 4:10 PM OCT 19, 2017 12:15 PM
MAX PRODUCT ALARM DEC 7, 2013 12:57 AM LOW TEMP WARNING AUG 29, 2018 10:08 AM OCT 24, 2017 8:22 AM SEP 6, 2017 9:57 AM I38200 SEP 5, 2018 8:39 AM I30200 SEP 5, 2018 8:39 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 LIQUID ALARM HISTORY REPORT SENSOR LOCATION 1 DISP 1-2 AUG 29, 2018 12:00 PM SENSOR OUT ALARM AUG 29, 2018 9:58 AM FUEL ALARM SEP 6, 2017 11:27 AM SENSOR OUT ALARM 2 DISP 3-4 AUG 29, 2018 12:00 PM SENSOR OUT ALARM AUG 29, 2018 9:52 AM FUEL ALARM SEP 6, 2017 11:27 AM SENSOR OUT ALARM 3 DISP 5-6 AUG 29, 2018 12:00 PM SENSOR OUT ALARM AUG 29, 2018 9:43 AM FUEL ALARM SEP 6, 2017 11:27 AM SENSOR OUT ALARM 4 DISP 7-8 AUG 29, 2018 12:00 PM SENSOR OUT ALARM AUG 29, 2018 9:50 AM FUEL ALARM SEP 6, 2017 11:27 AM SENSOR OUT ALARM I31600 SEP 5, 2018 8:39 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 SMART SENSOR ALARM HISTORY REPORT SENSOR LOCATION 1 PS 1-2 APR 17, 2014 9:59 AM COMMUNICATION ALARM 2 FM 1-2 3 FM 3-4 4 FM 5-6 5 FM 7-8
I40200 SEP 5, 2018 8:39 AM I40300 SEP 5, 2018 8:39 AM I34200 SEP 5, 2018 8:39 AM I34700 SEP 5, 2018 8:39 AM IV0100 SEP 5, 2018 8:39 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 ISD ALARM STATUS REPORT EVR TYPE: VACUUM ASSIST ISD TYPE: 01.01 VAPOR PROCESSOR TYPE: NO VAPOR PROCESSOR OVERALL STATUS :PASS EVR VAPOR COLLECTION :PASS EVR VAPOR CONTAINMENT :PASS ISD MONITOR UP-TIME :100% STAGE I TRANSFERS: 0 of 0 NOTEST EVR/ISD PASS TIME :100% WARNING ALARMS DATE TIME DESCRIPTION READING VALUE 18-08-31 10:02:30 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.42 18-08-30 10:02:30 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.99 18-08-23 10:01:55 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 3.32 18-08-22 10:02:00 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 3.32 18-08-21 10:01:57 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 3.29 18-08-20 10:02:34 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 3.29 18-08-19 10:02:58 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 2.67 18-08-18 10:03:03 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.80 18-08-14 10:02:42 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.56 18-08-13 10:02:39 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.56 FAILURE ALARMS DATE TIME DESCRIPTION READING VALUE 18-03-22 10:01:18 A/L RATIO GROSS BLOCKAGE FP 7 BLEND3 BLKD 17-12-11 10:01:25 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 3.98 17-03-20 10:03:18 VAPOR CONTAINMENT LEAKAGE CFH@2 INCHES WC 12.61 16-07-31 08:43:30 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.95 16-06-04 10:02:17 A/L RATIO GROSS BLOCKAGE FP 1 BLEND3 BLKD 14-11-28 10:01:25 A/L RATIO GROSS BLOCKAGE FP 7 BLEND3 BLKD 14-09-26 10:02:26 A/L RATIO DEGRADATION FP 6 BLEND3 0.76
13-02-26 10:01:38 A/L RATIO GROSS BLOCKAGE FP 3 BLEND3 BLKD 13-02-25 10:01:43 A/L RATIO GROSS BLOCKAGE FP 4 BLEND3 BLKD 13-02-25 10:01:43 A/L RATIO GROSS BLOCKAGE FP 3 BLEND3 BLKD SHUTDOWN & MISCELLANEOUS EVENTS DATE TIME DESCRIPTION ACTION/NAME 18-09-01 10:02:38 READINESS ISD:PP EVR:PP ISD & EVR READY 18-08-31 10:02:30 READINESS ISD:PP EVR:PF CHECK EVR SYSTEM 18-08-30 10:02:30 READINESS ISD:PP EVR:PF CHECK EVR SYSTEM 18-08-29 11:59:35 READINESS ISD:PP EVR:NN EVR READINESS PENDING 18-08-29 11:59:35 ISD STARTUP 18-08-29 11:59:26 ISD SHUTDOWN 18-08-23 10:23:11 CONTAINMENT GROSS & DEGRD TEST MANUALLY CLEARED 18-08-06 09:08:14 CONTAINMENT GROSS & DEGRD TEST MANUALLY CLEARED 18-06-03 10:02:06 READINESS ISD:PP EVR:PP ISD & EVR READY 18-06-02 11:16:13 READINESS ISD:PP EVR:NN EVR READINESS PENDING AFTER
Responses Received: I10200 SEP 5, 2018 10:38 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 SYSTEM CONFIGURATION SLOT BOARD TYPE POWER ON RESET CURRENT 1 8SMARTSENSOR BD 39273 39330 2 4 PROBE / G.T. 162789 162998 3 INTERSTITIAL BD 200210 200695 4 UNUSED 4746087 4828504 5 UNUSED 4742381 4821100 6 UNUSED 4738903 4815441 7 UNUSED 4738965 4816881 8 UNUSED 4742029 4815035 9 WPLLD POWER BD 201795 202157 10 WPLLD POWER BD 200557 200792 11 AC INTERFACE BD 163722 163781 12 RELAY BOARD 14951 14952 13 UNUSED 4739676 4818775 14 UNUSED 4738869 4814759 15 UNUSED 4738289 4815104 16 UNUSED 4738434 4816260 COMM 1 ELEC DISP INT. 100769 100721 COMM 2 RS232 SERIAL BD 14826 14830 COMM 3 WPLLD COMM BD 200940 200968 COMM 4 UNUSED 4740856 4814090 COMM 5 RS485 SERIAL BD 68190 68148 COMM 6 RS232 SERIAL BD 14847 14850
I90200 SEP 5, 2018 10:39 AM SOFTWARE REVISION LEVEL VERSION 327.04 SOFTWARE# 346327-100-E CREATED - 07.02.06.10.28 S-MODULE# 330160-066-a SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS CSLD ISD PMC PLLD 0.10 AUTO 0.20 REPETITIV WPLLD 0.10 AUTO 0.20 REPETITIV I11100 SEP 5, 2018 10:39 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 PRIORITY ALARM HISTORY ID CATEGORY DESCRIPTION ALARM TYPE STATE DATE TIME T 1 TANK PNL PROBE OUT CLEAR 9-05-18 10:30AM T 1 TANK PNL PROBE OUT ALARM 9-05-18 10:29AM W 2 OTHER UNL 1 WPLLD SHUTDOWN ALM CLEAR 9-05-18 10:28AM W 2 OTHER UNL 1 GROSS LINE FAIL CLEAR 9-05-18 10:28AM W 3 OTHER DSL WPLLD SHUTDOWN ALM CLEAR 9-05-18 10:28AM W 3 OTHER DSL GROSS LINE FAIL CLEAR 9-05-18 10:28AM W 2 OTHER UNL 1 WPLLD SHUTDOWN ALM ALARM 9-05-18 10:26AM W 2 OTHER UNL 1 GROSS LINE FAIL ALARM 9-05-18 10:26AM W 3 OTHER DSL WPLLD SHUTDOWN ALM ALARM 9-05-18 10:21AM W 3 OTHER DSL GROSS LINE FAIL ALARM 9-05-18 10:21AM W 4 OTHER UNL 2 WPLLD SHUTDOWN ALM CLEAR 9-05-18 10:06AM W 4 OTHER UNL 2 GROSS LINE FAIL CLEAR 9-05-18 10:06AM W 4 OTHER UNL 2 WPLLD SHUTDOWN ALM ALARM 9-05-18 10:04AM W 4 OTHER UNL 2 GROSS LINE FAIL ALARM 9-05-18 10:04AM W 1 OTHER PNL WPLLD SHUTDOWN ALM CLEAR 9-05-18 9:59AM W 1 OTHER PNL GROSS LINE FAIL CLEAR 9-05-18 9:59AM W 1 OTHER PNL WPLLD SHUTDOWN ALM ALARM 9-05-18 9:57AM W 1 OTHER PNL GROSS LINE FAIL ALARM 9-05-18 9:57AM T 1 TANK PNL PROBE OUT CLEAR 9-05-18 9:50AM T 1 TANK PNL PROBE OUT ALARM 9-05-18 9:50AM T 2 TANK UNL 1 PROBE OUT CLEAR 9-05-18 9:48AM T 2 TANK UNL 1 PROBE OUT ALARM 9-05-18 9:48AM T 3 TANK DSL PROBE OUT CLEAR 9-05-18 9:47AM T 3 TANK DSL PROBE OUT ALARM 9-05-18 9:46AM T 4 TANK UNL 2 PROBE OUT CLEAR 9-05-18 9:45AM T 4 TANK UNL 2 PROBE OUT ALARM 9-05-18 9:44AM T 4 TANK UNL 2 OVERFILL ALARM CLEAR 9-05-18 9:42AM
T 4 TANK UNL 2 OVERFILL ALARM ALARM 9-05-18 9:41AM W 4 OTHER UNL 2 WPLLD SHUTDOWN ALM CLEAR 9-05-18 9:39AM W 3 OTHER DSL WPLLD SHUTDOWN ALM CLEAR 9-05-18 9:39AM W 2 OTHER UNL 1 WPLLD SHUTDOWN ALM CLEAR 9-05-18 9:39AM W 1 OTHER PNL WPLLD SHUTDOWN ALM CLEAR 9-05-18 9:39AM L 2 DISP PAN DISP 3-4 SENSOR OUT ALARM CLEAR 9-05-18 9:39AM L 1 DISP PAN DISP 1-2 SENSOR OUT ALARM CLEAR 9-05-18 9:39AM L 4 DISP PAN DISP 7-8 SENSOR OUT ALARM CLEAR 9-05-18 9:39AM L 3 DISP PAN DISP 5-6 SENSOR OUT ALARM CLEAR 9-05-18 9:39AM L 4 DISP PAN DISP 7-8 SENSOR OUT ALARM ALARM 9-05-18 9:38AM L 3 DISP PAN DISP 5-6 SENSOR OUT ALARM ALARM 9-05-18 9:38AM L 2 DISP PAN DISP 3-4 SENSOR OUT ALARM ALARM 9-05-18 9:38AM L 1 DISP PAN DISP 1-2 SENSOR OUT ALARM ALARM 9-05-18 9:38AM W 4 OTHER UNL 2 WPLLD SHUTDOWN ALM ALARM 9-05-18 9:38AM W 3 OTHER DSL WPLLD SHUTDOWN ALM ALARM 9-05-18 9:38AM W 2 OTHER UNL 1 WPLLD SHUTDOWN ALM ALARM 9-05-18 9:38AM W 1 OTHER PNL WPLLD SHUTDOWN ALM ALARM 9-05-18 9:38AM W 4 OTHER UNL 2 WPLLD SHUTDOWN ALM CLEAR 9-05-18 9:32AM W 3 OTHER DSL WPLLD SHUTDOWN ALM CLEAR 9-05-18 9:32AM W 2 OTHER UNL 1 WPLLD SHUTDOWN ALM CLEAR 9-05-18 9:32AM W 1 OTHER PNL WPLLD SHUTDOWN ALM CLEAR 9-05-18 9:32AM L 1 DISP PAN DISP 1-2 FUEL ALARM CLEAR 9-05-18 9:32AM L 1 DISP PAN DISP 1-2 FUEL ALARM ALARM 9-05-18 9:32AM I11200 SEP 5, 2018 10:39 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 NON-PRIORITY ALARM HISTORY ID CATEGORY DESCRIPTION ALARM TYPE STATE DATE TIME T 1 TANK PNL DELIVERY NEEDED CLEAR 9-05-18 10:30AM T 1 TANK PNL DELIVERY NEEDED ALARM 9-05-18 10:29AM T 1 TANK PNL INVALID FUEL LEVEL CLEAR 9-05-18 9:51AM T 1 TANK PNL INVALID FUEL LEVEL ALARM 9-05-18 9:50AM T 2 TANK UNL 1 INVALID FUEL LEVEL CLEAR 9-05-18 9:49AM T 2 TANK UNL 1 INVALID FUEL LEVEL ALARM 9-05-18 9:48AM T 3 TANK DSL INVALID FUEL LEVEL CLEAR 9-05-18 9:47AM T 3 TANK DSL INVALID FUEL LEVEL ALARM 9-05-18 9:47AM T 4 TANK UNL 2 HIGH PRODUCT ALARM CLEAR 9-05-18 9:41AM T 4 TANK UNL 2 HIGH PRODUCT ALARM ALARM 9-05-18 9:41AM T 3 TANK DSL HIGH PRODUCT ALARM CLEAR 9-05-18 9:22AM T 3 TANK DSL HIGH PRODUCT ALARM ALARM 9-05-18 9:21AM T 3 TANK DSL HIGH PRODUCT ALARM CLEAR 9-05-18 9:20AM T 3 TANK DSL HIGH PRODUCT ALARM ALARM 9-05-18 9:16AM T 2 TANK UNL 1 HIGH PRODUCT ALARM CLEAR 9-05-18 9:14AM T 2 TANK UNL 1 HIGH PRODUCT ALARM ALARM 9-05-18 9:14AM T 1 TANK PNL HIGH PRODUCT ALARM CLEAR 9-05-18 9:11AM T 1 TANK PNL HIGH PRODUCT ALARM ALARM 9-05-18 9:11AM T 1 TANK PNL DELIVERY NEEDED CLEAR 9-05-18 8:53AM T 1 TANK PNL DELIVERY NEEDED ALARM 9-05-18 8:52AM T 3 TANK DSL DELIVERY NEEDED CLEAR 9-05-18 8:52AM T 3 TANK DSL DELIVERY NEEDED ALARM 9-05-18 8:51AM OTHER ISD GROSS PRES WARN CLEAR 9-01-18 10:00AM OTHER ISD GROSS PRES WARN ALARM 8-30-18 10:02AM SYSTEM PRINTER ERROR CLEAR 8-29-18 10:11AM SYSTEM PAPER OUT CLEAR 8-29-18 10:11AM T 4 TANK UNL 2 LOW TEMP WARNING CLEAR 8-29-18 10:08AM
T 4 TANK UNL 2 LOW TEMP WARNING ALARM 8-29-18 10:08AM SYSTEM PRINTER ERROR ALARM 8-29-18 10:07AM SYSTEM PAPER OUT ALARM 8-29-18 10:07AM T 4 TANK UNL 2 HIGH PRODUCT ALARM CLEAR 8-29-18 10:06AM T 4 TANK UNL 2 HIGH PRODUCT ALARM ALARM 8-29-18 10:06AM T 3 TANK DSL LOW TEMP WARNING CLEAR 8-29-18 10:06AM T 3 TANK DSL LOW TEMP WARNING ALARM 8-29-18 10:06AM T 2 TANK UNL 1 HIGH PRODUCT ALARM CLEAR 8-29-18 10:03AM T 2 TANK UNL 1 HIGH PRODUCT ALARM ALARM 8-29-18 10:03AM T 1 TANK PNL DELIVERY NEEDED CLEAR 8-29-18 10:03AM T 1 TANK PNL INVALID FUEL LEVEL CLEAR 8-29-18 10:03AM T 1 TANK PNL DELIVERY NEEDED ALARM 8-29-18 10:03AM T 1 TANK PNL INVALID FUEL LEVEL ALARM 8-29-18 10:03AM T 1 TANK PNL HIGH PRODUCT ALARM CLEAR 8-29-18 10:02AM T 1 TANK PNL HIGH PRODUCT ALARM ALARM 8-29-18 10:01AM T 1 TANK PNL DELIVERY NEEDED CLEAR 8-29-18 9:34AM T 2 TANK UNL 1 DELIVERY NEEDED CLEAR 8-29-18 9:33AM T 1 TANK PNL DELIVERY NEEDED ALARM 8-29-18 9:32AM T 2 TANK UNL 1 DELIVERY NEEDED ALARM 8-29-18 9:32AM OTHER ISD GROSS PRES WARN CLEAR 8-23-18 10:23AM T 2 TANK UNL 1 DELIVERY NEEDED CLEAR 8-20-18 10:29AM T 2 TANK UNL 1 DELIVERY NEEDED ALARM 8-20-18 7:53AM OTHER ISD GROSS PRES WARN ALARM 8-18-18 10:03AM I20600 SEP 5, 2018 10:39 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 TANK ALARM HISTORY TANK 1 PNL HIGH WATER ALARM OCT 23, 2017 4:51 PM APR 12, 2016 6:22 PM APR 12, 2016 3:53 PM OVERFILL ALARM SEP 5, 2018 9:11 AM AUG 24, 2016 12:17 PM APR 26, 2016 9:45 AM LOW PRODUCT ALARM SEP 5, 2018 8:52 AM AUG 29, 2018 10:03 AM AUG 29, 2018 9:32 AM SUDDEN LOSS ALARM SEP 5, 2018 8:52 AM AUG 29, 2018 9:31 AM OCT 19, 2017 9:42 AM HIGH PRODUCT ALARM SEP 5, 2018 9:11 AM AUG 29, 2018 10:01 AM SEP 6, 2017 9:50 AM INVALID FUEL LEVEL SEP 5, 2018 9:50 AM AUG 29, 2018 10:03 AM OCT 23, 2017 5:08 PM
PROBE OUT SEP 5, 2018 10:29 AM SEP 5, 2018 9:50 AM SEP 5, 2018 8:53 AM HIGH WATER WARNING OCT 23, 2017 4:51 PM APR 12, 2016 6:22 PM APR 12, 2016 3:53 PM DELIVERY NEEDED SEP 5, 2018 10:29 AM SEP 5, 2018 8:52 AM AUG 29, 2018 10:03 AM LOW TEMP WARNING MAY 14, 2018 11:14 AM SEP 19, 2016 10:10 AM SEP 19, 2016 10:00 AM TANK 2 UNL 1 HIGH WATER ALARM MAY 14, 2018 11:05 AM OVERFILL ALARM SEP 5, 2018 9:16 AM APR 17, 2018 11:38 AM MAR 25, 2018 3:32 AM LOW PRODUCT ALARM MAY 14, 2018 11:09 AM OCT 19, 2017 9:23 AM JUL 8, 2015 8:37 AM SUDDEN LOSS ALARM SEP 5, 2018 8:52 AM AUG 29, 2018 9:31 AM OCT 19, 2017 9:10 AM HIGH PRODUCT ALARM SEP 5, 2018 9:14 AM AUG 29, 2018 10:03 AM APR 17, 2018 11:40 AM INVALID FUEL LEVEL SEP 5, 2018 9:48 AM MAY 14, 2018 11:08 AM MAR 19, 2018 10:53 PM PROBE OUT SEP 5, 2018 9:48 AM SEP 5, 2018 8:52 AM AUG 29, 2018 10:14 AM HIGH WATER WARNING MAY 14, 2018 11:05 AM DELIVERY NEEDED AUG 29, 2018 9:32 AM AUG 20, 2018 7:53 AM MAY 14, 2018 11:09 AM LOW TEMP WARNING OCT 24, 2017 7:57 AM AUG 24, 2016 12:28 PM SEP 9, 2015 11:32 AM TANK 3 DSL HIGH WATER ALARM AUG 19, 2016 3:20 AM AUG 9, 2016 7:23 PM FEB 12, 2015 12:05 PM OVERFILL ALARM SEP 5, 2018 9:19 AM SEP 5, 2018 9:17 AM AUG 29, 2018 10:05 AM
LOW PRODUCT ALARM OCT 6, 2014 8:40 PM NOV 13, 2012 10:04 PM SUDDEN LOSS ALARM SEP 5, 2018 8:51 AM AUG 29, 2018 9:33 AM OCT 19, 2017 8:40 AM HIGH PRODUCT ALARM SEP 5, 2018 9:21 AM SEP 5, 2018 9:16 AM SEP 6, 2017 9:52 AM INVALID FUEL LEVEL SEP 5, 2018 9:47 AM OCT 19, 2017 8:54 AM AUG 30, 2017 10:09 AM PROBE OUT SEP 5, 2018 9:46 AM SEP 5, 2018 8:51 AM AUG 29, 2018 10:05 AM HIGH WATER WARNING AUG 24, 2016 11:34 AM AUG 19, 2016 3:20 AM AUG 9, 2016 7:23 PM DELIVERY NEEDED SEP 5, 2018 8:51 AM AUG 9, 2018 12:58 PM OCT 19, 2017 8:51 AM LOW TEMP WARNING AUG 29, 2018 10:06 AM SEP 19, 2016 10:11 AM AUG 24, 2016 12:35 PM TANK 4 UNL 2 OVERFILL ALARM SEP 5, 2018 9:41 AM JUL 11, 2018 1:37 PM JUL 11, 2018 1:32 PM LOW PRODUCT ALARM MAY 31, 2015 4:37 PM NOV 13, 2012 3:02 PM SUDDEN LOSS ALARM SEP 5, 2018 8:51 AM AUG 29, 2018 9:34 AM OCT 19, 2017 12:19 PM HIGH PRODUCT ALARM SEP 5, 2018 9:41 AM AUG 29, 2018 10:06 AM SEP 6, 2017 9:53 AM INVALID FUEL LEVEL MAY 14, 2018 10:17 AM JAN 5, 2018 9:12 PM OCT 19, 2017 12:20 PM PROBE OUT SEP 5, 2018 9:44 AM SEP 5, 2018 8:51 AM AUG 29, 2018 10:07 AM HIGH WATER WARNING OCT 23, 2017 9:55 AM DELIVERY NEEDED MAY 14, 2018 10:17 AM JAN 5, 2018 4:10 PM OCT 19, 2017 12:15 PM
MAX PRODUCT ALARM DEC 7, 2013 12:57 AM LOW TEMP WARNING AUG 29, 2018 10:08 AM OCT 24, 2017 8:22 AM SEP 6, 2017 9:57 AM I38200 SEP 5, 2018 10:39 AM I30200 SEP 5, 2018 10:39 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 LIQUID ALARM HISTORY REPORT SENSOR LOCATION 1 DISP 1-2 SEP 5, 2018 9:38 AM SENSOR OUT ALARM SEP 5, 2018 9:32 AM FUEL ALARM AUG 29, 2018 12:00 PM SENSOR OUT ALARM 2 DISP 3-4 SEP 5, 2018 9:38 AM SENSOR OUT ALARM SEP 5, 2018 9:31 AM FUEL ALARM AUG 29, 2018 12:00 PM SENSOR OUT ALARM 3 DISP 5-6 SEP 5, 2018 9:38 AM SENSOR OUT ALARM SEP 5, 2018 9:30 AM FUEL ALARM AUG 29, 2018 12:00 PM SENSOR OUT ALARM 4 DISP 7-8 SEP 5, 2018 9:38 AM SENSOR OUT ALARM SEP 5, 2018 9:31 AM FUEL ALARM AUG 29, 2018 12:00 PM SENSOR OUT ALARM I31600 SEP 5, 2018 10:39 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 SMART SENSOR ALARM HISTORY REPORT SENSOR LOCATION 1 PS 1-2 APR 17, 2014 9:59 AM COMMUNICATION ALARM 2 FM 1-2 3 FM 3-4 4 FM 5-6 5 FM 7-8
I40200 SEP 5, 2018 10:39 AM I40300 SEP 5, 2018 10:39 AM I34200 SEP 5, 2018 10:39 AM I34700 SEP 5, 2018 10:39 AM IV0100 SEP 5, 2018 10:39 AM HOWARDS MINI MART 3200 PANAMA BAKERSFIELD 93312 ISD ALARM STATUS REPORT EVR TYPE: VACUUM ASSIST ISD TYPE: 01.01 VAPOR PROCESSOR TYPE: NO VAPOR PROCESSOR OVERALL STATUS :PASS EVR VAPOR COLLECTION :PASS EVR VAPOR CONTAINMENT :PASS ISD MONITOR UP-TIME : 99% STAGE I TRANSFERS: 5 of 5 PASS EVR/ISD PASS TIME :100% WARNING ALARMS DATE TIME DESCRIPTION READING VALUE 18-08-31 10:02:30 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.42 18-08-30 10:02:30 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.99 18-08-23 10:01:55 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 3.32 18-08-22 10:02:00 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 3.32 18-08-21 10:01:57 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 3.29 18-08-20 10:02:34 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 3.29 18-08-19 10:02:58 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 2.67 18-08-18 10:03:03 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.80 18-08-14 10:02:42 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.56 18-08-13 10:02:39 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.56 FAILURE ALARMS DATE TIME DESCRIPTION READING VALUE 18-03-22 10:01:18 A/L RATIO GROSS BLOCKAGE FP 7 BLEND3 BLKD 17-12-11 10:01:25 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 3.98 17-03-20 10:03:18 VAPOR CONTAINMENT LEAKAGE CFH@2 INCHES WC 12.61 16-07-31 08:43:30 CONTAINMENT GROSS OVER PRESSURE WEEKLY 95% 1.95 16-06-04 10:02:17 A/L RATIO GROSS BLOCKAGE FP 1 BLEND3 BLKD 14-11-28 10:01:25 A/L RATIO GROSS BLOCKAGE FP 7 BLEND3 BLKD 14-09-26 10:02:26 A/L RATIO DEGRADATION FP 6 BLEND3 0.76 13-02-26 10:01:38 A/L RATIO GROSS BLOCKAGE FP 3 BLEND3 BLKD
13-02-25 10:01:43 A/L RATIO GROSS BLOCKAGE FP 4 BLEND3 BLKD 13-02-25 10:01:43 A/L RATIO GROSS BLOCKAGE FP 3 BLEND3 BLKD SHUTDOWN & MISCELLANEOUS EVENTS DATE TIME DESCRIPTION ACTION/NAME 18-09-05 10:38:39 READINESS ISD:PP EVR:NN EVR READINESS PENDING 18-09-05 10:38:39 ISD STARTUP 18-09-05 10:31:12 ISD SHUTDOWN 18-09-05 10:16:28 READINESS ISD:PP EVR:NN EVR READINESS PENDING 18-09-05 10:16:28 ISD STARTUP 18-09-05 10:06:30 ISD SHUTDOWN 18-09-05 10:04:10 READINESS ISD:PP EVR:PP ISD & EVR READY 18-09-05 09:38:02 READINESS ISD:PP EVR:NN EVR READINESS PENDING 18-09-05 09:38:02 ISD STARTUP 18-09-05 09:37:43 ISD SHUTDOWN
SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and
printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: Date of Testing:
Facility Address:
Facility Contact: Phone:
Date Local Agency Was Notified of Testing :
Name of Local Agency Inspector (if present during testing):
2. TESTING CONTRACTOR INFORMATION
Company Name:
Technician Conducting Test:
Credentials1: CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Specify) __________________
License Number(s):
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: Hydrostatic Vacuum Other
Test Equipment Used: Equipment Resolution:
Identify Spill Bucket (By Tank
Number, Stored Product, etc.)
1234
Bucket Installation Type: Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Bucket Diameter:
Bucket Depth:
Wait time between applying
vacuum/water and start of test:
Test Start Time (TI):
Initial Reading (RI):
Test End Time (TF):
Final Reading (RF):
Test Duration (TF –TI):
Change in Reading (RF -RI):
Pass/Fail Threshold or
Criteria:
Test Result: Pass Fail Pass Fail Pass Fail Pass Fail
Comments –(include information on repairs made prior to testing, and recommended follow-up for failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician’s Signature:________________________________________________ Date:_________________________
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
Jaco #33351 Howard's Mini Mart #4 09/05/2018
3200 Panama Ln
Omero Garcia 661-393-7000
8/14/2018
Kris Karns
Confidence UST Services, Inc.
Timothy Capehart
804904
Lake test 0.0625”
12.0” 12.0” 12.0”12.0”
13.0” 13.0”13.5” 14.0”
5 mins 5 mins 5 mins 5 mins
9:00am 9:00am 9:00am 9:00am
12.0” 12.0” 12.0” 12.0”
10:00am 10:00am 10:00am 10:00am
12.0” 12.0” 12.0” 12.0”
60 mins 60 mins 60 mins 60 mins
0.0” 0.0” 0.0” 0.0”
0.0625” 0.0625” 0.0625” 0.0625”
09/05/2018
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Unleaded Unleaded 2 Premium Diesel
8414476