HomeMy WebLinkAboutFMC 2022Appendix VI
Underground Storage Tank
Monitoring System Certification Form
CERS = California Environmental Reporting System, GPH = Gallons Per Hour, ID = Identification,
ICC = International Code Council, LLD = Line Leak Detector, NA = Not Applicable, SW = Single-
Walled, UDC = Under-Dispenser Containment, UST = Underground Storage Tank,
VPH = Vacuum/Pressure/Hydrostatic
Page 1 of 6
TYPE OF ACTION Installation Repair 12 Month
1. FACILITY INFORMATION
CERS ID Certification Date
Facility Name
Facility Address City ZIP Code
2. SERVICE TECHNICIAN INFORMATION
Company Performing the Certification Phone
Mailing Address
Service Technician Performing Test
Contractor/Tank Tester License Number
ICC Number ICC Expiration Date
3.TRAINING AND CERTIFICATIONS
Manufacturer and Test Equipment Training Certifications Expiration Date
4.CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST
I hereby certify that the monitoring system is operational in accordance with California Code
of Regulations, title 23, division 3, chapter 16, section 2638; that required supporting
documentation is attached; and all information contained herein is accurate.
Service Technician Signature Date Total # of Pages
Underground Storage Tank
Monitoring System Certification Form
Page 2 of 6
5.MONITORING SYSTEM AND PROGRAMMING
A separate Monitoring System Certification Form must be prepared for each control panel.
Make of Monitoring System
Control Panel
Model of Monitoring System
Control Panel
Software Version Installed
Attach the post-certification reports if the monitoring system is capable of generating
either; Monitoring System Set-up Alarm History Report Yes No NA
All monitoring equipment is operational per manufacturer’s specifications?
Secondary containment systems are free of damage, debris, or liquid?
Are the audible and visual alarms operational?
All sensors have been: 1) visually inspected for wiring kinks, breaks and residual
buildup on floats; and 2) tested for functionality and confirmed operational?
Are all sensors installed to detect a release at the earliest opportunity in the
secondary containment?
The monitoring system set-up was reviewed, and proper settings confirmed?
Was the monitoring control panel’s backup battery visually inspected, functionally
tested, and confirmed operational?
Does the flow of fuel stop at the dispenser if a release is detected in the under-
dispenser containment?
Does the turbine automatically shut down if the piping secondary containment
monitoring system fails to operate or is electrically disconnected?
Does the turbine automatically shut down if the piping secondary containment
monitoring system detects a release? Which sensors initiate positive shut down?
(Check all that apply) Sump UDC
If monitoring system alarms are relayed to a remote monitoring center, is all
communication equipment operational?
Describe all answers marked “No” or “Fail” and proposed remedy in Section 9.
List all monitoring equipment either replaced or repaired in Section 9
Underground Storage Tank
Monitoring System Certification Form
Page 3 of 6
6. SENSOR TESTING RESULTS
List only sensors tested on date of this certification. List “Sensor ID” as labeled in system
programming. Additional copies of this page may be attached to accommodate all sensors tested.
Sensor ID Sensor Model Component(s) Monitored Pass Fail
Describe all answers marked “No” or “Fail” and proposed remedy in Section 9.
List all monitoring equipment either replaced or repaired in Section 9
Underground Storage Tank
Monitoring System Certification Form
Page 4 of 6
7. LINE LEAK DETECTOR TESTING
Check this box if line leak detectors ARE NOT installed. (Do not complete this section.)
Simulated release rate verified: (Check all that apply.)
3 GPH 0.1 GPH 0.2 GPH Yes No NA
Has the testing apparatus been properly calibrated?
For emergency generator tank systems, does the LLD create an audible and visual
alarm when a leak is detected?
For mechanical LLDs, does the LLD restrict the flow through the pipe when a
release is detected?
For electronic LLDs, does the turbine automatically shut off when a release is
detected?
For electronic LLDs, does the turbine automatically shut off if any portion of the
monitoring system is disabled or disconnected?
For electronic LLDs, does the turbine automatically shut off if any portion of the
monitoring system malfunctions or fails a tightness test?
For electronic LLDs, have all accessible wiring connections been visually inspected
for kinks and breaks?
Were all items on the equipment manufacturer’s maintenance checklist completed?
Were all LLDs confirmed operational within regulatory requirements?
LLD ID LLD Model Lines Monitored Pass Fail
Describe all answers marked “No” or “Fail” and proposed remedy in Section 9.
List all monitoring equipment either replaced or repaired in Section 9
Underground Storage Tank
Monitoring System Certification Form
Page 5 of 6
8. IN-TANK GAUGING TESTING
Check this box if tank gauging is used only for inventory control.
Check this box if NO tank gauging equipment is installed.
(Do not complete this section if either box is checked.)
Yes No NA
All wiring has been: 1) visually inspected for kinks, breaks and proper entry and
termination; and 2) tested for ground faults?
Were all in-tank gauging probes visually inspected for damage and residue buildup
to ensure that floats move freely, functionally tested, and confirmed operational?
Was accuracy of system’s product level readings tested?
Was accuracy of system’s water level readings tested?
Were all probes reinstalled properly?
Were all items on the equipment manufacturer’s maintenance checklist completed?
Probe ID Probe Model Tanks Monitored Pass Fail
9. COMMENTS
Describe all answers marked “No” or “Fail” and proposed remedy.
List all monitoring equipment either replaced or repaired.
Monitoring System Certification
UST Monitoring Site Plan
Site Address: 6100 District Blvd., Bakersfield, CA. 93313
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Date map was drawn: I I.
I[structions
If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring
System Certiflcation. On your site plan, show the general layout of tanls and piping. Clearly identi$ locations of the following
equipment, if installed: monitoring system control panels; sensors monitoring tank amular spaces, sumps, dispenser pans, spill
containers, or other secondary gontairunent areas; mechanical or electronic line leak detectors; and in+ank liquid level probes (ifused
for leak detection). In the space provided, note the date dris Site Plan was prepared.
Page 4 of 4
$ww.unidocs.orguN-036 - 4/,r Rev. 0l/17l0t
08 22 22
<I20100AUG 22, 2022 8:22 AM
265022 6100 DISTRICT BLVDBAKERSFIELD CA
IN-TANK INVENTORY
TANK PRODUCT VOLUME TC VOLUME ULLAGE HEIGHT WATER TEMP 1 DIESEL 7415 7327 4585 64.95 0.77 86.29
><I90500AUG 22, 2022 8:22 AMSOFTWARE REVISION LEVELVERSION 421.00SOFTWARE# 346421-100-A CREATED - 00.11.15.13.40
NO SOFTWARE MODULE
><I50201AUG 22, 2022 8:22 AM
SHIFT TIME 1 : 12:15 AM
><I50202AUG 22, 2022 8:23 AM
SHIFT TIME 2 : DISABLED
><I50203AUG 22, 2022 8:23 AM
SHIFT TIME 3 : DISABLED
><I50204AUG 22, 2022 8:23 AM
SHIFT TIME 4 : DISABLED
><I54600AUG 22, 2022 8:23 AM
TANK PER TST NEEDED WRN: DISABLED
><I54900AUG 22, 2022 8:23 AM
TANK ANN TST NEEDED WRN: DISABLED
><9999FF1B><I55600AUG 22, 2022 8:23 AM
LINE PER TST NEEDED WRN: DISABLED
><I55900AUG 22, 2022 8:23 AM
LINE ANN TST NEEDED WRN: DISABLED
><I51400AUG 22, 2022 8:23 AM
H-PROTOCOL DATA FORMATHEIGHT
><I51A01AUG 22, 2022 8:23 AM
DAYLIGHT SAVING TIMEENABLED ON
><I51B00AUG 22, 2022 8:23 AM
DAYLIGHT SAVING TIME
START DATE MAR WEEK 3 SUN 2:00 AM
END DATE NOV WEEK 1 SUN 2:00 AM
>
<I51600
AUG 22, 2022 8:23 AM
RE-DIRECT LOCAL PRINTOUTDISABLED
>
<I50400
AUG 22, 2022 8:23 AM
232 SECURITY CODE
PORT SECURITY CODE STATUS
1 000000 DISABLED 2 000000 DISABLED
3 000000 DISABLED
><9999FF1B>
<9999FF1B><9999FF1B>
<I88101
AUG 22, 2022 8:23 AMPORT SETTINGS:
COMM BOARD : 1 (S-SAT )
BAUD RATE : 9600 PARITY : NONE
STOP BIT : 1 STOP DATA LENGTH: 8 DATA
RS-232 SECURITYCODE : DISABLED
DTR NORMAL STATE: HIGH
><
I88102AUG 22, 2022 8:24 AM
PORT SETTINGS:
COMM BOARD : 2 (RS-232) BAUD RATE : 1200
PARITY : ODD STOP BIT : 1 STOP
DATA LENGTH: 7 DATA
RS-232 SECURITYCODE : DISABLED
><I88103AUG 22, 2022 8:24 AM
><I60100AUG 22, 2022 8:24 AM
TANK CONFIGURATION
DEVICE LABEL CONFIGURED 1 DIESEL ON 2 OFF 3 OFF 4 OFF
><I60200AUG 22, 2022 8:24 AM
TANK PRODUCT LABEL
TANK PRODUCT LABEL 1 DIESEL 2 3 4 ><I60300AUG 22, 2022 8:24 AM
TANK PRODUCT CODE
TANK PRODUCT LABEL 1 DIESEL 1 2 2 3 3 4 4><I60900AUG 22, 2022 8:24 AM
TANK THERMAL COEFFICIENT
TANK PRODUCT LABEL 1 DIESEL 0.000450
2 0.000000
3 0.000000 4 0.000000
><
I60700AUG 22, 2022 8:24 AM
TANK DIAMETER
TANK PRODUCT LABEL INCHES
1 DIESEL 109.50 2 0.00
3 0.00 4 0.00
><
I60A00AUG 22, 2022 8:24 AM
TANK FULL VOLUME
TANK PRODUCT LABEL TANK PROFILE GALLONS
1 DIESEL 1 PT 12000
2 1 PT 0
3 1 PT 0
4 1 PT 0
><
I60400AUG 22, 2022 8:24 AM
TANK FULL VOLUME
TANK PRODUCT LABEL GALLONS
1 DIESEL 12000 2 0
3 0 4 0
><
I60500AUG 22, 2022 8:24 AM
TANK 4 POINT VOLUMES
TANK PRODUCT LABEL GALLONS
1 DIESEL 12000 0 0 0
2 0 0 0 0 3 0 0 0 0 4 0 0 0 0
><I60600AUG 22, 2022 8:24 AM
TANK 20 POINT VOLUMES
TANK PRODUCT LABEL GALLONS 1 DIESEL 12000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
><9999FF1B><I62F00AUG 22, 2022 8:25 AM
MAG PROBE FLOAT SIZE
TANK PRODUCT LABEL FLOAT SIZE: 1 DIESEL 4.0 INCHES
><I62700AUG 22, 2022 8:25 AM
TANK HIGH WATER WARNING LIMIT
TANK PRODUCT LABEL INCHES 1 DIESEL 5.0>
<9999FF1B>
<I62400
AUG 22, 2022 8:25 AM
TANK HIGH WATER LEVEL LIMIT
TANK PRODUCT LABEL INCHES 1 DIESEL 5.0
><
I62800AUG 22, 2022 8:25 AM
TANK MAXIMUM VOLUME LIMIT
TANK PRODUCT LABEL GALLONS
1 DIESEL 12000 2 0
3 0 4 0
><
I62300AUG 22, 2022 8:25 AM
TANK OVERFILL LEVEL LIMIT
TANK PRODUCT LABEL GALLONS
1 DIESEL 10800 2 0
3 0 4 0
><
I62200AUG 22, 2022 8:25 AM
TANK HIGH PRODUCT LIMIT
TANK PRODUCT LABEL GALLONS
1 DIESEL 11400 2 0
3 0 4 0
><
I62900AUG 22, 2022 8:25 AM
TANK DELIVERY REQUIRED LIMIT
TANK PRODUCT LABEL GALLONS
1 DIESEL 600
2 0 3 0 4 0><I62100AUG 22, 2022 8:25 AM
TANK LOW PRODUCT LIMIT
TANK PRODUCT LABEL GALLONS 1 DIESEL 500 2 0 3 0 4 0><I62600AUG 22, 2022 8:25 AM
TANK LEAK ALARM LIMIT
TANK PRODUCT LABEL GALLONS 1 DIESEL 99 2 99 3 99 4 99><I62500AUG 22, 2022 8:26 AM
TANK SUDDEN LOSS LIMIT
TANK PRODUCT LABEL GALLONS 1 DIESEL 99 2 99 3 99 4 99><I60800AUG 22, 2022 8:26 AM
TANK TILT
TANK PRODUCT LABEL INCHES 1 DIESEL 0.00 2 0.00 3 0.00 4 0.00><I60B00
AUG 22, 2022 8:26 AM
STICK HEIGHT OFFSET ENABLE STATUS
DISABLED
><
I60C00AUG 22, 2022 8:26 AM
TANK STICK HEIGHT OFFSET
TANK PRODUCT LABEL INCHES 1 DIESEL 0.00
2 0.00 3 0.00
4 0.00>
<I61200
AUG 22, 2022 8:26 AM
TANK MANIFOLDED PARTNERS
TANK PRODUCT LABEL MANIFOLDED TANKS 1 DIESEL NONE
2 NONE 3 NONE
4 NONE>
<I63600
AUG 22, 2022 8:26 AM
PERIODIC LEAK TEST MIN VOLUME
TANK PRODUCT LABEL GALLONS 1 DIESEL 0
2 0 3 0
4 0>
<I62A00
AUG 22, 2022 8:26 AM
ANNUAL LEAK TEST MIN VOLUME
TANK PRODUCT LABEL GALLONS 1 DIESEL 0
2 0 3 0
4 0>
<
I62C00AUG 22, 2022 8:26 AM
TANK PERIODIC TEST TYPE
TANK PRODUCT LABEL PERIODIC TEST TYPE 1 DIESEL STANDARD 2 STANDARD 3 STANDARD 4 STANDARD
><I62D00AUG 22, 2022 8:26 AM
TANK LEAK TEST FAIL ALARMS
TANK PRODUCT LABEL 1 DIESEL GROSS TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED
2 GROSS TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED
3 GROSS TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED
4 GROSS TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED
><I63100AUG 22, 2022 8:26 AM
TANK LEAK TEST AVERAGING
TANK PRODUCT LABEL ANNUAL PERIODIC 1 DIESEL OFF OFF 2 OFF OFF 3 OFF OFF 4 OFF OFF
><I63000AUG 22, 2022 8:26 AM
IN-TANK LEAK TEST NOTIFY
TANK PRODUCT LABEL TANK TEST NOTIFY: 1 DIESEL OFF
2 OFF
3 OFF 4 OFF
>
<I63200
AUG 22, 2022 8:27 AM
TANK TEST SIPHON BREAK
TANK PRODUCT LABEL SIPHON BREAK 1 DIESEL OFF
2 OFF 3 OFF
4 OFF
><
I61000AUG 22, 2022 8:27 AM
TANK DELIVERY DELAY
TANK PRODUCT LABEL
1 DIESEL 5 2 1
3 1 4 1
><9999FF1B>
<I61100
AUG 22, 2022 8:27 AM
LEAK TEST METHOD- - - - - - - - - - - -
TEST ON DATE : ALL TANKJAN 1, 1996
START TIME : DISABLEDTEST RATE :0.20 GAL/HR
DURATION : 2 HOURS
TST EARLY STOP:DISABLED
><
I61300AUG 22, 2022 8:27 AM
CSLD PROBABLITY OF DETECTION
>
<
I61400AUG 22, 2022 8:27 AMCSLD CLIMATE FACTOR
><9999FF1B><I61A00AUG 22, 2022 8:27 AM
IN-TANK LEAK TEST EARLY STOP
TANK PRODUCT LABEL TST EARLY STOP: 1 DIESEL DISABLED 2 DISABLED 3 DISABLED 4 DISABLED><I61B00AUG 22, 2022 8:27 AM
IN-TANK LEAK GROSS TEST AUTO-CONFIRM
><I61C00AUG 22, 2022 8:27 AM
CSLD REPORT ONLY
><9999FF1B><9999FF1B><9999FF1B><I70200AUG 22, 2022 8:27 AM
LIQUID LABEL
DEVICE LABEL 1 ANNULAR 2 DISPENSER 3 SOUTH SUMP 4 NORTH SUMP 5 DISPENSER PAN 6 7 8
>
<I70300
AUG 22, 2022 8:27 AM
LIQUID TYPE
SENSOR LOCATION TYPE 1 ANNULAR TRI-STATE (SINGLE FLOAT)
2 DISPENSER TRI-STATE (SINGLE FLOAT) 3 SOUTH SUMP TRI-STATE (SINGLE FLOAT)
4 NORTH SUMP TRI-STATE (SINGLE FLOAT) 5 DISPENSER PAN TRI-STATE (SINGLE FLOAT)
6 TRI-STATE (SINGLE FLOAT) 7 TRI-STATE (SINGLE FLOAT)
8 TRI-STATE (SINGLE FLOAT)
><
I70400AUG 22, 2022 8:28 AM
LIQUID CATEGORY
SENSOR LOCATION CATEGORY
1 ANNULAR ANNULAR SPACE 2 DISPENSER DISPENSER PAN
3 SOUTH SUMP STP SUMP 4 NORTH SUMP STP SUMP
5 DISPENSER PAN DISPENSER PAN 6 OTHER SENSORS
7 OTHER SENSORS 8 OTHER SENSORS
>
<I80700
AUG 22, 2022 8:28 AM
RELAY LABEL
DEVICE LABEL 1 REMOTE ALARM
2 POSITIVE SHUTOFF
><
I80900AUG 22, 2022 8:28 AM
RELAY ORIENTATION
RELAY DESIGNATION ORIENTATION
1 REMOTE ALARM NORMALLY OPEN
2 POSITIVE SHUTOFF NORMALLY OPEN
><I80B00AUG 22, 2022 8:28 AM
RELAY TANK ASSIGNMENT
RELAY DESIGNATION TANK 1 REMOTE ALARM NONE 2 POSITIVE SHUTOFF NONE
><I80A00AUG 22, 2022 8:28 AM
RELAY TYPE
RELAY DESIGNATION TYPE 1 REMOTE ALARM STANDARD 2 POSITIVE SHUTOFF STANDARD
><I80800AUG 22, 2022 8:28 AM
RELAY SETUP REPORT
R 1:REMOTE ALARM TYPE: STANDARDNORMALLY OPEN
IN-TANK ALARMS ALL:OVERFILL ALARM ALL:LOW PRODUCT ALARM ALL:HIGH PRODUCT ALARM ALL:PROBE OUT ALL:HIGH WATER WARNING ALL:DELIVERY NEEDED ALL:MAX PRODUCT ALARM
LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM ALL:WATER ALARM ALL:HIGH LIQUID ALARM ALL:LOW LIQUID ALARM ALL:LIQUID WARNING
R 2:POSITIVE SHUTOFF
TYPE: STANDARD
NORMALLY OPEN
- NO ALARM ASSIGNMENTS -
>
<9999FF1B><9999FF1B>
<9999FF1B><9999FF1B>
<9999FF1B><9999FF1B>
<9999FF1B><9999FF1B>
<9999FF1B><9999FF1B>
<I90200
AUG 22, 2022 8:29 AMSOFTWARE REVISION LEVEL
VERSION 421.00SOFTWARE# 346421-100-A
CREATED - 00.11.15.13.40
NO SOFTWARE MODULE
><
I11100AUG 22, 2022 8:29 AM
265022
6100 DISTRICT BLVDBAKERSFIELD CA
PRIORITY ALARM HISTORYID CATEGORY DESCRIPTION ALARM TYPE STATE DATE TIME
D 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE CLEAR 2-24-22 8:08PMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE ALARM 2-23-22 8:11PM
L 4 STP SUMP NORTH SUMP SENSOR OUT ALARM CLEAR 6-30-21 12:50PML 3 STP SUMP SOUTH SUMP SENSOR OUT ALARM CLEAR 6-30-21 12:50PM
L 1 ANNULAR ANNULAR SENSOR OUT ALARM CLEAR 6-30-21 12:50PML 5 DISP PAN DISPENSER PAN SENSOR OUT ALARM CLEAR 6-30-21 12:50PM
L 1 ANNULAR ANNULAR SENSOR OUT ALARM ALARM 6-30-21 12:50PML 4 STP SUMP NORTH SUMP SENSOR OUT ALARM ALARM 6-30-21 12:50PM
L 3 STP SUMP SOUTH SUMP SENSOR OUT ALARM ALARM 6-30-21 12:50PML 5 DISP PAN DISPENSER PAN SENSOR OUT ALARM ALARM 6-30-21 12:50PM
L 5 DISP PAN DISPENSER PAN FUEL ALARM CLEAR 6-30-21 12:43PM
L 5 DISP PAN DISPENSER PAN FUEL ALARM ALARM 6-30-21 12:43PMT 1 TANK DIESEL MAX PRODUCT ALARM CLEAR 6-30-21 12:43PMT 1 TANK DIESEL MAX PRODUCT ALARM ALARM 6-30-21 12:41PML 4 STP SUMP NORTH SUMP FUEL ALARM CLEAR 6-30-21 12:38PML 4 STP SUMP NORTH SUMP FUEL ALARM ALARM 6-30-21 12:38PML 1 ANNULAR ANNULAR FUEL ALARM CLEAR 6-30-21 12:33PML 1 ANNULAR ANNULAR FUEL ALARM ALARM 6-30-21 12:33PML 3 STP SUMP SOUTH SUMP FUEL ALARM CLEAR 6-30-21 12:33PML 3 STP SUMP SOUTH SUMP FUEL ALARM ALARM 6-30-21 12:33PML 5 DISP PAN DISPENSER PAN SENSOR OUT ALARM CLEAR 9-24-20 11:17AML 4 STP SUMP NORTH SUMP SENSOR OUT ALARM CLEAR 9-24-20 11:17AML 1 ANNULAR ANNULAR SENSOR OUT ALARM CLEAR 9-24-20 11:16AML 1 ANNULAR ANNULAR SENSOR OUT ALARM ALARM 9-24-20 11:16AML 5 DISP PAN DISPENSER PAN SENSOR OUT ALARM ALARM 9-24-20 11:16AML 4 STP SUMP NORTH SUMP SENSOR OUT ALARM ALARM 9-24-20 11:16AMT 1 TANK DIESEL PROBE OUT CLEAR 9-24-20 11:16AMT 1 TANK DIESEL OVERFILL ALARM CLEAR 9-24-20 11:15AMT 1 TANK DIESEL PROBE OUT ALARM 9-24-20 11:15AMT 1 TANK DIESEL OVERFILL ALARM ALARM 9-24-20 11:14AMT 1 TANK DIESEL PROBE OUT CLEAR 9-24-20 11:12AMT 1 TANK DIESEL PROBE OUT ALARM 9-24-20 11:11AML 5 DISP PAN DISPENSER PAN FUEL ALARM CLEAR 9-24-20 11:10AML 5 DISP PAN DISPENSER PAN FUEL ALARM ALARM 9-24-20 11:09AML 1 ANNULAR ANNULAR FUEL ALARM CLEAR 9-24-20 11:08AML 1 ANNULAR ANNULAR FUEL ALARM ALARM 9-24-20 11:08AML 3 STP SUMP SOUTH SUMP FUEL ALARM CLEAR 9-24-20 11:07AML 3 STP SUMP SOUTH SUMP FUEL ALARM ALARM 9-24-20 11:07AML 4 STP SUMP NORTH SUMP FUEL ALARM CLEAR 9-24-20 11:06AML 4 STP SUMP NORTH SUMP FUEL ALARM ALARM 9-24-20 11:06AMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE CLEAR 11-04-19 7:36PMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE ALARM 11-03-19 6:23PMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE CLEAR 11-03-19 6:23PMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE ALARM 11-02-19 7:00PMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE CLEAR 9-26-19 8:23AMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE ALARM 9-22-19 5:53AMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE CLEAR 9-22-19 5:53AMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE ALARM 9-21-19 1:00PMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE CLEAR 9-21-19 1:00PMD 8 OTHER VEEDER ROOT (FMS) AUTODIAL FAILURE ALARM 9-19-19 6:40PM
><I11200AUG 22, 2022 8:30 AM
265022 6100 DISTRICT BLVDBAKERSFIELD CA
NON-PRIORITY ALARM HISTORYID CATEGORY DESCRIPTION ALARM TYPE STATE DATE TIME SYSTEM PRINTER ERROR CLEAR 5-24-22 7:01PM SYSTEM PAPER OUT CLEAR 5-24-22 7:01PM
SYSTEM PAPER OUT ALARM 5-24-22 7:01PM
SYSTEM PRINTER ERROR ALARM 5-24-22 7:01PM SYSTEM PRINTER ERROR CLEAR 5-24-22 7:01PM
SYSTEM PAPER OUT CLEAR 5-24-22 7:01PM SYSTEM PRINTER ERROR ALARM 5-24-22 7:01PM
SYSTEM PAPER OUT ALARM 5-24-22 7:01PM SYSTEM PRINTER ERROR CLEAR 5-24-22 7:01PM
SYSTEM PAPER OUT CLEAR 5-24-22 7:01PM SYSTEM PRINTER ERROR ALARM 5-24-22 2:55PM
SYSTEM PAPER OUT ALARM 5-24-22 2:55PM SYSTEM PRINTER ERROR CLEAR 5-24-22 2:53PM
SYSTEM PAPER OUT CLEAR 5-24-22 2:53PM SYSTEM PRINTER ERROR ALARM 5-24-22 2:52PM
SYSTEM PAPER OUT ALARM 5-24-22 2:52PM SYSTEM PRINTER ERROR CLEAR 5-24-22 2:52PM
SYSTEM PRINTER ERROR ALARM 5-24-22 2:52PM SYSTEM PRINTER ERROR CLEAR 5-24-22 2:52PM
SYSTEM PAPER OUT CLEAR 5-24-22 2:52PM SYSTEM PRINTER ERROR ALARM 5-24-22 2:52PM
SYSTEM PAPER OUT ALARM 5-24-22 2:52PM SYSTEM PRINTER ERROR CLEAR 5-24-22 2:51PM
SYSTEM PAPER OUT CLEAR 5-24-22 2:51PM SYSTEM PAPER OUT ALARM 5-24-22 2:51PM
SYSTEM PRINTER ERROR ALARM 5-24-22 2:51PM SYSTEM PRINTER ERROR CLEAR 5-24-22 2:50PM
SYSTEM PAPER OUT CLEAR 5-24-22 2:50PM SYSTEM PRINTER ERROR ALARM 5-24-22 2:42PM
SYSTEM PAPER OUT ALARM 5-24-22 2:42PM SYSTEM PRINTER ERROR CLEAR 5-24-22 2:41PM
SYSTEM PAPER OUT CLEAR 5-24-22 2:41PM SYSTEM PRINTER ERROR ALARM 5-24-22 2:41PM
SYSTEM PAPER OUT ALARM 5-24-22 2:41PM SYSTEM PRINTER ERROR CLEAR 5-24-22 2:41PM
SYSTEM PAPER OUT CLEAR 5-24-22 2:41PM SYSTEM PRINTER ERROR ALARM 5-24-22 2:41PM
SYSTEM PAPER OUT ALARM 5-24-22 2:41PM SYSTEM PRINTER ERROR CLEAR 5-24-22 2:41PM
SYSTEM PAPER OUT CLEAR 5-24-22 2:41PM SYSTEM PRINTER ERROR ALARM 5-24-22 2:41PM
SYSTEM PAPER OUT ALARM 5-24-22 2:41PM SYSTEM PRINTER ERROR CLEAR 5-24-22 2:40PM
SYSTEM PAPER OUT CLEAR 5-24-22 2:40PM SYSTEM PRINTER ERROR ALARM 5-24-22 2:40PM
SYSTEM PAPER OUT ALARM 5-24-22 2:40PM SYSTEM PRINTER ERROR CLEAR 5-24-22 2:40PM
SYSTEM PAPER OUT CLEAR 5-24-22 2:40PM SYSTEM PRINTER ERROR ALARM 4-27-22 2:38PM
SYSTEM PAPER OUT ALARM 4-27-22 2:38PM
><
I20600AUG 22, 2022 8:31 AM
265022 6100 DISTRICT BLVDBAKERSFIELD CA
TANK ALARM HISTORY
TANK 1 DIESEL
OVERFILL ALARM SEP 24, 2020 11:14 AM SEP 3, 2019 3:23 PM JUL 18, 2019 11:05 AM
LOW PRODUCT ALARM JUL 18, 2019 10:50 AM MAR 6, 2008 12:25 AM
HIGH PRODUCT ALARM JUN 30, 2021 12:41 PM JUN 17, 2014 9:38 AM JUN 12, 2012 8:51 AM
INVALID FUEL LEVEL JUL 18, 2019 10:50 AM JUN 12, 2012 8:14 AM APR 8, 2011 4:03 PM
PROBE OUT SEP 24, 2020 11:15 AM SEP 24, 2020 11:11 AM JUL 18, 2019 11:37 AM
DELIVERY NEEDED JUL 18, 2019 10:50 AM MAR 6, 2008 12:15 AM
MAX PRODUCT ALARM JUN 30, 2021 12:41 PM JUN 17, 2014 9:38 AM JUN 12, 2012 8:51 AM
LOW TEMP WARNING MAR 13, 2019 8:25 PM JUN 17, 2014 10:44 AM JUN 12, 2012 9:18 AM
><9999FF1B><9999FF1B><I30200AUG 22, 2022 8:31 AM
265022 6100 DISTRICT BLVDBAKERSFIELD CA
LIQUID ALARM HISTORY REPORT
SENSOR LOCATION 1 ANNULAR
JUN 30, 2021 12:50 PM SENSOR OUT ALARM JUN 30, 2021 12:33 PM FUEL ALARM
SEP 24, 2020 11:16 AM SENSOR OUT ALARM 3 SOUTH SUMP
JUN 30, 2021 12:50 PM SENSOR OUT ALARM JUN 30, 2021 12:33 PM FUEL ALARM
SEP 24, 2020 11:07 AM FUEL ALARM 4 NORTH SUMP
JUN 30, 2021 12:50 PM SENSOR OUT ALARM JUN 30, 2021 12:38 PM FUEL ALARM
SEP 24, 2020 11:16 AM SENSOR OUT ALARM 5 DISPENSER PAN
JUN 30, 2021 12:50 PM SENSOR OUT ALARM JUN 30, 2021 12:43 PM FUEL ALARM
SEP 24, 2020 11:16 AM SENSOR OUT ALARM
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<I10200
AUG 22, 2022 8:32 AM
265022 6100 DISTRICT BLVD
BAKERSFIELD CA
SYSTEM CONFIGURATION
SLOT BOARD TYPE POWER ON RESET CURRENT
1 FOUR PROBE BD. 2003 2000 2 INTERSTITIAL BD 201230 201314
3 UNUSED 9851524 9520139 4 UNUSED 9849790 9521085
5 UNUSED 9849459 9522738 6 UNUSED 9849615 9520929
7 UNUSED 9849778 9522520 8 UNUSED 9848289 9520618
9 UNUSED 9851854 9523795 10 UNUSED 9850097 9522581
11 UNUSED 9850979 9522881 12 UNUSED 9851667 9523122
13 UNUSED 9851714 9521154 14 UNUSED 9851807 9524055
15 UNUSED 9850221 9522406 16 COMBO I/O BOARD 10028 10029
COMM 1 SERIAL SAT BD 40490 477645 COMM 2 RS232 SERIAL BD 15036 15040
COMM 3 PRINTER BOARD 10032 10029
>
<I90200AUG 22, 2022 8:32 AMSOFTWARE REVISION LEVELVERSION 421.00SOFTWARE# 346421-100-A CREATED - 00.11.15.13.40
NO SOFTWARE MODULE
>
SHEAR VALVE OPERATION INSPECTION
Facility Name: Owner
Address: Address
City, State, Zip Code: City, State, Zip Code:
CERS I.D. #:Owner Phone #:
Testing Company: Phone #:
This data sheet is for inspecting shear valves located inside dispensers. See PEI/RP1200 Section 10 for the inspection procedure.
Product Grade
Dispenser ID#
Shear ValveType (Product/Vapor)
1. Is the shear valve rigidly
anchored to the dispenser box
frame or dispenser island?
Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No
2. Is the shear section posi-
tioned between ½ inch above
or below the top surface of the
dispenser island?
Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No
3. Is the lever arm free to move?
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
4.Does the lever arm snap the
the poppet valve shut?
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
5. Can any product be dispensed
when the product shear valve is
closed?
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
A “No” to Lines 1-4 or a “Yes” for Line 5 indicates a test failure.
Test Results Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Comments:
Tester’s Name (print) Tester’s Signature
Reference PEI/RP1200-19 Appendix C-10
Date:
Latest Version 3/14/2022