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Home My WebLink AboutFMC 2023 REPAIRAppendix 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 10023037 12-22-23 Jaco #3347 Fastrip #6 2698 Oswell Street Bakersfield 93306 Nwestco LLC (800) 339-9930 2209 Zeus Court, Bakersfield, CA 93308 Rockland Kirk 1073967 10241356 9-29-24 GVR C32654 9-28-24 12-22-23 3 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 L4 420 DSL ANNULAR L6 420 91 ANNULAR L14 208 Trans Sump South Underground Storage Tank Monitoring System Certification Form Page 6 of 6 10. MONITORING SITE PLAN Date site plan was prepared: If a site plan has been prepared that shows all required information, you may include it, rather than this page, with your Monitoring System Certification Form. The site plan must show the general layout of tanks and identify locations of the monitoring panel, and all leak detection equipment and monitoring locations. Include a legend for all symbols depicted. PRICE SIG N NOPARKING EXISTING BUILDING G H CATCHBASIN W W SLOPE RETAINING WALL DRAINAGE WAY SLOPE AL6AL4AL2AL8 F V F V F V F12,000 GALLONPREMIUM12,000 GALLONDEISEL12,000 GALLON87-1 UNLEADED12,000 GALLON87-2 UNLEADEDSTPL7STPL1STPL3STPL15L10 34L912L13L1278L1156L14N AUBURN ST. PROPERTY LINE OSWELL ST.DUMPSTERCOLUMN SUPPORTINGRESTAURANT SIGN (2x) STORAGE CONTAINER LEGEND L1 87-1 STP L2 87-1 ANNULAR L3 DSL STP L4 DSL ANNULAR L6 91 ANNULAR L7 87-2 STP L8 87-2 ANNULAR L9 UDC 1 - 2 L10 UDC 3 - 4 L11 UDC 5 - 6 L12 UDC 7 - 8 L13 N TRANS SUMP L14 S TRANS SUMP L15 91 STP 87 GAS 3/2 INCH DBL WALLED PIPE 91 GAS 3/2 INCH DBL WALLED PIPE DIESEL 3/2 INCH DBL WALLED PIPE VAPOR RETURN 3 AND 2 INCH SINGLE WALL PIPE VAPOR VENT 2 INCH SINGLE WALLED PIPE PRODUCT SPILL CONTAINER VAPOR SPILL CONTAINER ANNULAR EMERGENCY SHUT-OFF OVERFILL ALARM FIRE EXTINGUISHER GAS METER SHUT-OFF WATER METER SHUT-SHUT OFF HEALY CAS EVACUATION MEETING POINT AUTOMATIC TANK GUAGE CIRCUIT BREAKER UST ELECTRICAL PANEL AIR AND WATER HAZ-WASTE DRUM W G A H P V SCALE: SITE MAP C1 VICINITY MAP PROJECT DATA 1"=10'-0" INCHES012 SHEET SIZE 22 X 34 2698 OSWELL ST. BAKERSFIELD, CA 93306 PROJECT OWNER: JACO HILL PO. BOX 82515 BAKERSFIELD, CA 93380 CONTACT: SITE PLOT PLAN FOR: FACILITY ID: 15-021-00300 CERS ID 10023037 FASTRIP #3347 2698 OSWELL ST. BAKERSFIELD, CA 93306 01/10/17 REV.OSWELL ST.HWY 178