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Home My WebLink About2025 FMC 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 10134226 1/28/2025 Jaco #3346 Fastrip #621 805 -34th- Street Bakersfield 93301 Nwestco LLC (800) 339-9930 2209 Zeus Court, Bakersfield, CA 93308 Zachary Elder 1073967 10381559 05/06/2026 VR B47853 10/14/2026 1/28/2025 5 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.) 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 X 3 GPH 0.1 GPH 0.2 GPH X X X X X X X X X XT4 FX1DV DSL 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. VFFN PRIC E S I G N PROPERTY LINE PROPERTY LINE141.50'125'EXISTING BUILDING W H G W 34TH ST.Q ST.VFSTPL112,000 GALLON87-1 UNLEADED12,000 GALLON87-2 UNLEADED12,000 GALLON91 PREMIUM12,000 GALLONDIESELVFSTPL3STPL5STPL7AL2AL4AL6AL8L9L11L12L10L13L1465874321L12L10DUMPSTER NOPARKINGLEGEND L1 87-1 STP L2 87-1 ANNULAR L3 87-2 STP L4 87-2 ANNULAR L5 91 STP L6 91 ANNULAR L7 DSL STP L8 DSL ANNULAR L9 UDC 1 -2 L10 UDC 3 - 4 L11 UDC 5 - 6 L12 UDC 7 - 8 L13 E. TRANS SUMP L14 W. TRANS SUMP 87 GAS 2 INCH SINGLE WALLED PIPE 91 GAS 2 INCH SINGLE WALLED PIPE DIESEL 2 INCH SINGLE WALLED PIPE VAPOR RETURN 3 AND 2 INCH SINGLE WALL PIP 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 EVACUATION MEETING POINT AUTOMATIC TANK GAUGE UST ELECTRICAL PANEL AIR AND WATER DISPENSER HAZ-WASTE DRUMS G A P V SITE MAP SITE PLAN C1 TAB:CERS 1"=10'-0" INCHES012 SHEET SIZE 22 X 34 DATE REVISIONS DATE: DRAWN BY: CHECKED: APPROVED: RAC FASTRIP - 3-346 CADFILE: SHEET NO.3346-MSP A.P.N.: 002-032-14-00-8 SCALE: FASTRIP OIL COMPANYCONVENIENCE MARKET FOR: BAKERSFIELD, CALIFORNIA 93301 JACO HILL 805 34TH ST. 3101 STATE RDBAKERSFIELD, CA 93308 PROJECT OWNER: DRAWING: CD 03/25/2021 805 34TH ST. BAKERSFIELD, CA 93301 Q ST. 34TH ST. PROJECT OWNER: JACO HILL PO. BOX 82515 BAKERSFIELD, CA 93380 CONTACT: SITE PLOT PLAN FOR: FACILITY ID 15-021-03017 CERS ID 10134226 FASTRIP #3346 805 34TH ST. BAKERSFIELD, CA 93301 03/05/2021 REV. VICINITY MAP PROJECT DATA