HomeMy WebLinkAboutMITIGATION09-11-Z004
From-OE$ HG $^CRA,NENTO W/C
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916-845-8910
T-654 P.O01/OOi F-595
Hazardous Materials Spill Report
IC°~rR°~'"
JOES. 04-47i~
_[NRC. 734786.
5. PAG/CELL:
· 5. PAG/CELL:
I;ogn~oo~ : I m~CE/V~-~Yi .........
0554 [OES- Somme Phillips
lOSeR` _
~.., e~o~ ~~ ~ov~ows o~:
1. N~: 2. AGENCY: 3. PHO~ 4. E~:
, ~ ~y ~eH OU P~uc~ US 661-326~396 _
1. N~: 2. AGENCY: 3. PHONE~: 4. Ext:
2. a. SUBSTANCE: b. QTV:~=c Amour Meautre c. TYPE:
q. $02 ~ ~00 Cbs. VAPOR
2. NOX > ] 0 L.~. VAPOR
3. =
e. DESCRIPTION: A wet gas compressor was lost.
f. CONTAINED: g. WATER INVOLVED: h. WATERWAY:
Uuk~own No
L DRINKING WATER IMPACTED
No
3, a. INCIDENT LOCATION: 3663 Gibson St.
b. CITY: e. COUNTY:
Bakersfield I(~rn County
d, ZIP:
93308
4, INCIDENT DESCRIPTION:
a. DATE:09/11/2004 b. TIME (llgltt~): 0500
d. INJURIES# e. FATALS #:
0 0
SITE: Ret'mery
EVACS #: g. C/.~ANUP BY:
N/A
5. SUSPECTED RESPONSIBLP- PARTY:
a. NAME: b. AGENCY; ¢. PHONE#; d. EXT.:
Liz ~y SheU Oil Pro~ US ~i-32~396
e. ~ ~D~SS: f. CITY: g, STATE:
~ ~x 1476 B~field CA 93302
~oNNOTIFIcATiON'I~O~TION:
b. OTHER ON SCENE:
e. OT/-~R NOTIIqED:
d, ADM]~. AGENCY: Em Cu. Envlmnn~mal H~ ~iccs e. SEC, AGENCY; Bak~'~ld Fin:
f. NOTIFICATION LIST: DOG Unit:
MONITORING SYSTEM CERTIFICATION
For Use By ,411durisdictions Within the State of California
,4uthority 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 equip.ment. 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.
A. General Information
Facility Name: __ Wholesale Fuel's
Site Address: 2200 E. Brundage Lane
Facility Contact Person:
Make/Model of Monitoring System:'"l"~__¢/~
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced:
Bldg. No.:
City: Bakersfield Zip: 93307__
Contact Phone No.: (/,:J~i) ,~) ~ -
b~,'c~-bx~Date of Testing/Servicing: /D ~,~ /
Tank ID: ~
1~1 In-Tank Gauging Probe. Model:
[] Annular Space or Vault Sensor. Model:
[21 Piping Sump / Trench Sensor(s). Model:
[] Fill Sump Sensor(s). Model:
[] Mechanical Line Leak Detector. Model:
[] Electronic Line Leak Detector. Model:
[] Tank Overfill / High-Level Sensor. Model:
[] Other (speci~ equipment type and model in
Section E on Page 2).
Tank ID: ~.)
[] !n-Tank Gauging Probe. Model:
[21 'Annular Space or Vault Sensor. Model:
[] Piping Sump / Trench Sensor(s). Model:
[] Fill Sump Sensor(s). Model:
[3 Mechanical Line Leak Detector. Model:
[3 Electronic Line Leak Detector. Model:
[] Tank Overfill / High-Level Sensor. Model: k/~_i_t,,-j,~
[] Other (specify equipment type and model in Section E on Page 2).
Tank ID: ~
[] In-Tank"U~ug~ng Probe. Model:
[21 Annular Space or Vault Sensor. Model:
[] Piping Sump / Trench Sensor(s). Model:
[] Fill Sump Sensor(s). Mo4tel:
[21 Mechanical Line Leak Detector. Model:
[] Electronic Line Leak Detector. Mo~lel:/<!~,~r,q;
[] Tank Overfill / High-Level Sensor. Mo~el:
Fl Other (specify equipment type and modql in Section E on igage 2).
Tank ID: ,.','~--~t' ~<;~
[] In-Tank Gauging Probe.
[] Annular Space or Vault Sensor.
[] Piping Sump / Trench Sensor(s).
[3 Fill Sump Sensor(s).
FI Mechanical Line Leak Detector.
[] Electronic Line Leak Detector.
Model:
Model:
Model:
Model:
Model:
Model:
[] Tank Overfill / High-Level Sensor. Model: k._~(~¢; tgczc'~ c-
[] Other (specify equipment type and model in Section E on Page 2).
Dispenser ID:
~ Dispenser Containment Sensor(s). Model: \~,t2r~3A-' ~'~'~
[] Shear Valve(s).
[] Dispenser Containment Float(s) and Chain(s).
Dispenser ID:&'~
lia Dispenser Containment Sensor(s). Model: M!~_-O2~'~ ~'~,k \"~
[3 Shear Valve(s).
[] Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
1~1 Dispenser Containment Sensor(s). Model: k
[] Shear Valve(s).
[] Dispenser Containment Float(s) and Chain(s).
.Dispenser C~ntainment Sensor(s).
Model:
Dispenser ID:
~ Dispenser C°-~tainment Sensor(s). Model:~,~-r~.cj
[] Shear Valve(s).
[21 Dispenser Containment Float(s) and Chain(s).
D,spenser ID: _ .. '
i]' Dispenser Containment Sensor(s). ~'odelk[?t%'~_r-c,V
Dispenser ID: . ~
[3 Shear Valve(s).
[]Dispenser Containment Float(s) and Chain(s).
[] Shear Valve(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 - I certify that the equipment identified in this document was inspected/servicedl in accordance with the manufacturers'
guidelines. Attached to this Certification is information (e.g. manufacturers' c~c~sary to verify that this information is
correct and a Plot Plan Showing the layout of monitoring equipment. For anff~ui~m. ~fit ~.ap. ayl9 of generating such reports, I have also
attached a copy of the report; (check.~all that apply): [~ System set-u~ ~Al~q2n;/histoJ'y report
Certification No.: {")C ,C~C~ qO~( '~ License.~7-No-~-..· .... 589571
Testing Company Name: Sunset Mechanical Phone No. :(_661_) __322-0660
Site Address: __4617 Kimber Avenue Bakeysfield, CA. Date of Testing/Servicing: ~] / ~7/Oc//
Page I of 3 03/01
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed:
Com ~lete the followin checklist:
~ 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) rn Sump/Trench Sensors; [3 Dispenser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? [] Yes; [] No.
1~ Yes [] No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no
[21 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? c~ ~7-~ %
[] Yes* :liil 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* ~t No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) []
Product; 71 Water. If yes, describe causes in Section E, below.
~ Yes [] No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable
~ Yes [] No* 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:
Page 2 of 3 03/01
F. In-Tank Gauging / SIR Equipment:
Check this box if tank gauging is used only for inventory control.
Check this box if no 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:
11~ Yes [21 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
[i~ Yes 121 No* Were all tank gauging probes visually inspected for damage and residue buildup?
[~ Yes [] No* Was accuracy of system product level readings tested?
'~it~ Yes [] No* Was accuracy of system water level readings tested?
li~ Yes [] No* Were all probes reinstalled properly?
~il Yes 121 No* Were all items on the equipment manufacturer's maintenance Checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): [] Check this box ifLLDs are not installed.
Complete the following checklist:
~ 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: ~i1~3 g.p.h.; [] 0.1 g.p.h; ~ 0.2 g.p.h.
l~} Yes [] No* Were all LLDs confirmed operational and accurate within regulatory requirements?
fi~ Yes [] No* Was the testing apparatus properly calibrated?
[] Yes [] No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
[] N/A
/t~ Yes [] No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
[] N/A
~! Yes [] No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
[21 N/A or disconnected?
tl~ Yes [] No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions
I--I N/A or fails a test?
i~ Yes [] No* For electronic LLDs, have all accessible wiring connections been visually inspected?
[] N/A
~ Yes El No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 3 03/01
Monitoring System Certification
Site Address:
UST Monitoring Site Plan
2200 E. Brundage Lane Bakersfield
· ' ' o:~~ ' ' '
........................... ,,~¢'¢~' ~.:~ ..................
........................... .~;~,~2- · ..,-~ ..................
.......... ...................... ............ · ~:.~ :::,~ '!~¢'-' ...................
· . . .LO~DC~&__ _~ .... fl' · ...............
..... :. ,--~, ..~67, v-? .~-~... ............
: ::: ::: ::: :: :::: :,::::: ::::::::::::::::::::::::::::::::::::::
....................... l,,.&.~/ - .~'-,~ '~, ,~ ....................
::::::::::::::::::::::::::: .....
...................... +. ....................
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:::::::::::::::::::::: % f',~. · ~}¢. · ' ..............
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:::::::::::::::: '::::::: ~ ~.~~,-~,,~,~,,,:'v~ ~¢::::::::::::::::
....................... p.-...~ .'~,~.~_ .,..~_~, ..................
Date map was drawn:
Instructions
If you already have a diagram that shows all required information, you may include it, rather than this page, with your
Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify
locations of the following equipment, if installed: monitoring system control panels; sensors 'monitoring tank annular
spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak
detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
was prepared.
Page__ of__ 05/00
SYSTEM SETUP
SEP i?. 2004 10:55 AM
SYSTEM UNITS
SYSTEM LANGUAGE
ENGLISH
SYSTEM DATE/TIME FORMAT
MON DD YYYY HH:MM:SS xM
WHOLESALE FUEL
2200 E BRUNDAGE LN'
BAKESFIELD CA
93504
SHIFT TIME ! 11:00 PM
SHIFT TIME 2 12:00 AM
SHIFT TIME 3 1:00 AM
SHIFT TIME 4 2:00 AM
TANK PER TST NEEDED WRN
DISABLED
TANK ANN TST NEEDED WRN
DISABLED
LINE RE-ENABLE METHOD
PASS LINE TEST
LINE PER TST NEEDED WRN
DISABLED
LINE ANN TST NEEDED WRN
DISABLED
PRINT TO VOLUMES
ENABLED
TEMP COMPENSATION
VALUE (DEG F ): 60,0
STIOK HEIGHT OFFSET!
DISABLED
DAYLIGHT SAVING TIME
ENABLED
START DATE
APR WEEK 1 SUN
START TIME
2:00 AM
END DATE ~/
OCT WEEK 6 SUN
END TIME
2;00 AM
SYSTEM SECURITY
CODE : 000000
CUSTOM ALARM LABELS
DISABLED
IN-TANK SETUP
T i:L-S DIESEL
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
1
.000450
95.00
1 PT
10000
FLOAT SIZE: 4.0 IN.
WATER WARNING : 4.0
HIGH WATER LIMIT: 5.0
MAX OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
10000
90~
9000
95~
9500
100
LOW PRODUCT : 0
LEAK ALARM LIMIT: 75
SUDDEN LOSS LIMIT: 99
TANK TILT : 2.40
PROBE OFFSET : 0.00
SIPHON MANIFOLDED TANKS
T~: NONE
LINE MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC: iOZ
: 1000
LEAK MIN ANNUAL : 10~
: 1000
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 1MIN
PUMP THRESHOLD : iO.OOX
T 2:PRE-UNLEADED
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
2
.000700
95.00
1 PT
10000
FLOAT $ I ZE:
WATER WARN I NO :
HIGH WATER LIMIT:
MAX OR LABEL VOL:
OVERF ILL L I M I'T
HIGH PRODUCT
DELIVERY LIMIT
LOW PRO~)UC~ ;':' :
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT :
PROBE OFFSET :
4.0 IN.
4.0
5.0
10000
90g
9000
95~
9500
100
0
· 75
99
2.95
0.00
SIPHON MANIFOLDED TANKS
T~: NONE
LINE MANIFOLOED TANKS
T¢: NONE
· LEAK MIN PERIODIC: 10~
: 1000
LEAK MIN ANNUAL : 10N
: 1000
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 1MIN
PUMP THRESHOLD : 10.00~
T 3:CLEAR-DIESEL
PRODUCT CODE
THERMAL OOEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
3
.000450
120.00
I PT
20563
FLOAT SIZE:
WATER WARNING :
HIGH'WATER LIMIT:
MAX OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
4.0 IN.
4.0
5,0
20563
90~
18506
95~
19535
205
LOW PRODUCT : 0
LEAK ALARM LIMIT: 75
SUDDEN LOSS LIMIT: 99
TANK TILT :- 0.50
PROBE OFFSET : 0.00
SIPHON MANIFOLDED TANKS
T~: NONE
LINE MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC: 10~
: 2056
LEAK· MIN ANNUAL : 10N
: 2056
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 1 MIN
PUMP THRESHOLD : 10.00~
T 4:UNLEADED
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
4
,000700
120.00
1 PT
20563
FLOAT SIZE: 4.0 IN.
WATER WARNING : 4.0
HIGH WATER LIMIT: 5.0
MAX OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
20563
90M
18506
95~
19535
205
LOW PRODUCT : 0
LEAK ALARM LIMIT: 75
SUDDEN LOSS LIMIT: 99
TANK TILT : O.O0
PROBE OFFSET : 0.00
SIPHON MANIFOLDED TANKS
T~: NONE
LINE MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC: 10~
: 2056
LEAK MIN ANNUAL : 10A
: 2056
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER'TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 1MIN
PUMP THRESHOLD : lO.OO~
T 5:DYED-DIESEL
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
5
,000450
120.00
1 PT
20563
FLOAT ~IZE: 4.0 IN.
WATER WARNING : 4.0
HIGH WATER'-LIMIT-: .... 5.0
MAX OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
20563
90~
18506
95~
19535
205
LOW PRODUCT : 0
LEAK ALARM LIMIT: 75
SUDDEN LOSS LIMIT: 99
TANK TILT : 0.00
PROBE OFFSET : 0.00
SIPHON MANIFOLDED TANKS
T~: NONE
LINE MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC: 10~
: 2056
LEAK MIN ANNUAL : I0~
: 2056
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 1
PUMP THRESHOLD : 10.00~
T 6:EPA-DIESEL
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
6
.000450
120.00
1 PT
20563
FLOAT SIZE: 4.0 IN.
WATER WARNING : 4.0
HIGH WATER LIMIT: 5.0
MAX OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
20563
90~
18506
95~
19535
205
LOW PRODUCT : 0
LEAK ALARM LIMIT: 75
SUDDEN LOSS LIMIT: 99
TANK TILT :- 2,00
PROBE OFFSET : 0.00
SIPHON MANIFOLDED TANKS
T~: NONE
LINE MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC: 10~
: 2056
LEAK MIN ANNUAL : 10~
: 2056
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 1MIN
PUMP THRESHOLD : iO.OOZ
T 7:EPA-2
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
7
.000450
120.00
1 PT
20563
FLOAT SIZE: 4.0 IN.
WATER WARNING : 4.0
HIGH WATER LIMIT: 5.0
MAX OR LABEL VOL: 20563
OVERFILL LIMIT : 90~
: 18506
HIGH PRODUCT : 95~
: 19535
DELIVERY LIMIT : 1~
: 205
LOW PRODUCT : 0
LEAK ALARM LIMIT: 75
SUDDEN LOSS LIMIT: 99
TANK TILT :- 2.00
PROBE OFFSET : 0.00
SIPHON MANIFOLDED TANKS
T~: NONE
LINE MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC: 10~
: 2056
LEAK MIN ANNUAL : 10~
: 2056
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 1MIN
PUMP THRESHOLD : 10.00~
T 8:UL~C-DIESEL
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
8
.000450
96.00
I PT
t2000
FLOAT SIZE: 4.0 IN.
WATER WARNING : 4.0
HIGH WATER LIMIT: 5.0
MAX OR LABEL VOL: 12000
OVERFILL LIMIT : 90%
: 10800
HIGH PRODUCT : 95~
: 11400
DELIVERY LIMIT : I~
: 120
LOW PRODUCT : 0
LEAK ALARM LIMIT: 75
SUDDEN LOSS LIMIT: 99
TANK TILT :- 5.00
PROBE OFFSET : 0.00
SIPHON MANIFOLDED TANKS
T~: NONE
LINE MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC: 10X
: 1200
LEAK MIN ANNUAL : 10~
: 1200
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 1MIN
PUMP THRESHOLD : 10.00~
LEAK TEST METHOD
TEST MONTHLY : ALL TANK
WEEK 2 SUN
START TIME : 2:00 AM
TEST RATE :0.20 GAL/HR
DURATION : 2 HOURS
TST EARLY STOP:DISABLED
LEAK TEST REPORT FORMAT
NORMAL
LIQUID SENSOR SETUP
L I:DIS-PANS
NORMALLY CLOSED
CATEGORY : DISPENSER PAN
L 2:DIS-PANS
NORMALLY CLOSED
CATEGORY : DISPENSER PAN
L 3:DIS-PANS
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
OUTPUT RELAY SETUP
R I:POS-EPA
TYPE:
STANDARD
NORMALLY OPEN
IN-TANK ALARMS
T 7:OVERFILL ALARM
R 2:OUTSIDE ALARM
TYPE:
MOMENTARY
NORMALLY OPEN
LIQUID SENSOR ALMS
ALL:FUEL ALARM
ALL:SENSOR OUT ALARM
ALL:SHORT ALARM
ALL:WATER OUT ALARM
ALL:HIGH LIQUID ALARM
R 3:PANS 1,2,3
TYPE:
STANDARD
NORMALLY CLOSED
LIQUID SENSOR ALMS L I:FUEL ALARM
L 3:FUEL ALARM
R 4:PANS 4.,~,6
TYPE:
STANDARD
NORMALLY CLOSED
LIQUID SENSOR ALMS
L 2:FUEL ALARM
RECONCILIATION SETUP
AUTOMATIC DAILY CLOSING
TIME: 2:00 AM
PERIODIC RECONCILIATION
MODE: MONTHL3
TEMP COMPENSATION
STANDARD
BUS SLOT FUEL METER TAN~
~A~K'M~P-E~PTY
~HOLESALE F~EL
2200 E BRUNDAGE LN
BAKESFIELD CA
93304
SEP 17, 2004 11:.04 AM
LEAK TEST REPORT
T 2:PRE-UNLEADED
PROBE SERIAL NUM 254008
TEST STARTING TIME:
SEP 12, 2004 2:00 AM
TEST LENGTH = 2.0 HRS
STRT VOLUME = 558.0 GAL
START TEMP = 90;0 F
END TEMP = ,90,0 F
TEST PERIODS 2-4
-0.00 ~0.00 0.00
LEAK TEST RESULTS
RATE = 0.00 GAL/HR
0.20 GAL/HR TEST INVL
0.20 GAL/HR FLAGS:
LOkl LEVEL TEST ERROR
PERCENT VOLUME TOO LOW
INVALID FUEL LEVEL
~ ~ ~ ~ ~ END ~ ~ ~ ~ ~
WHOLESALE FUEL
2200 E BRUNDAGE LN
BAKESFIELD CA
93304
SEP 17, 2004 11:03 AM
LEAK TEST REPORT
T I:L-S DIESEL
PROBE SERIAL NUM 005380
TEST STARTING TIME:
SEP 12, 2004 2:00 AM
TEST LENGTH = 2.0 HRS
STRT VOLUME = 6891.4 GAL
START TEMP = 91.2 F
END TEMP = 91.2 F
TEST PERIODS 2-4
0.02 0.02 0.02
LEAK TEST RESULTS
RATE = 0.01 GAL/HR
0.20 GAL/HR TEST PASS
WHOLESALE FUEL
2200 E BRUNDAGE LN
BAKESFIELD CA
SEP 17, 2004 11:04 AM
LEAK TEST REPORT
T 5:DYED-DIESEL
PROBE SERIAL HUM 006005
TEST STARTING TIME:
SEP 12, 2004 2:00 AM
TEST LENGTH = 2.0 HRS
STRT VOLUME = 7563.8 GAL
START TEMP = 94.5 F
END TEMP = 94.4 F
TEST PER I ODS 2-4
-0.08 -0.07 -0.07
LEAK TEST RESULTS
RATE = -0.05 GAL/HR
0.20 GAL/HR TEST INVL
0.. 20 GAL/HR FLAGS:
RECENT' DEL I VERY
~ ~ ~ ~ ~ END ~ ~ ~ ~ ~
WHOLESALE FUEL
2200 E BRUNDAGE LN
BAKESFIELD CA
93804
SEP 17, 2004 11:04 AM
LEAK TEST REPORT
T 4:UNLEADED
PROBE SERIAL NUM 006003
TEST STARTING TIME:
SEP 12, 2004 2:00 AM
TEST LENGTH = 2.0 HRS
STRT VOLUME =14956.9 GAL
START TEMP = 90.7 F
'END TEMP = 90.7 F
TEST PERIODS 2-4
0.11 0.19 0.21
LEAK TEST RESULTS
RATE = 0.14 GAL/HR
0.20 GAL/HR TEST INVL
0.20 GAL/HR FLAGS:
RECENT DELIVERY
PRODUCT LEVEL INCREASE
WHOLESALE FUEL
2200 E BRUNDAGE LN
BAKESFIELD CA
93304
SEP 17, 2004 11:04 AM
LEAK TEST REPORT
T S:CLEAR-DIESEL
PROBE SERIAL NUM 006004
TEST STARTING TIME:
SEP 12, 2004 2:00 AM
TEST LENGTH = 2.0 HR:
STRT VOLUME =15230,7 GA:
START TEMP = 94.3 F
END TEMP = 94.2 F
TEST PERIODS 2-4
-0.00 0.12 0,17
LEAK TEST' RESUL'~S
RATE : 0.11 GAL/HR
0.20 GAL/HR TEST INVL
0.20 GAL/HR FLAGS:
RECENT DELI VERY
WHOLESALE FUEL
2200 E BRUNDAGE LN
BAKESFIELD CA
93304
SEP 17, 2004 11:03 AM
LEAK TEST REPORT
T 8:CLEAR DIESEL
PROBE SERIAL HUM 005379
TEST STARTING TIME:
SEP 12, 2004 2:00 AM
TEST LENGTH = 2.0 HRS
STRT VOLUME = 605.3 GAL
START TEMP = 84.2 F
END TEMP = 82.5 F
TEST PERIODS 2-4
0.00 -0.01 -0.03
LEAK TEST RESULTS
RATE = -0.02 GAL/HR
0.20 GAL/HR TEST INVL
0.20 GAL/HR FLAGS:
LOW LEVEL TEST ERROR
CHANGE IN TANK TEMP ZONE
TEMP~ CHANGE TOO LARGE
PERCENT VOLUME TOO LOW
~ ~ ~.~ ~ END ~ ~ ~ ~ ~
WHOLESALE FUEL
2200 E BRUNDAGE LN
BAKESFIELD CA
9~304
SEP I?, 2004 11:04 AM
LEAK TEST REPORT
T 7:EPA-2
PROBE SERIAL NUM 255709
TEST STARTING TIME:
SEP 12, 2004 2:00 AM
TEST LENGTH = 2.0 HRS
STRT VOLUME = 930.0 GAL
START TEMP = B5.4 F
END TEMP = B2.7 F
TEST PERIODS 2-4
-0.04 0.05 0.06
LEAK TEST RESULTS
RATE = 0.04 GAL/HR
0,20 GAL/HR TEST INVL
0,20 GAL/HR FLAGS:
LOW LEVEL TEST ERROR
CHANGE IN TANK TEMP ZONE
TEMP CHANGE TOO LARGE
PERCENT VOLUME TOO LOW
~ x ~ N ~ END x ~ ~ N ~(
WHOLESALE FUEL
2200 E BRUNDAGE LN
BAKESFIELD CA
93304
SEP 17, 2004 11:04 AM
LEAK TEST REPORT
T 6:EPA-DIESEL
PROBE SERIAL HUM 006636
TEST STARTING TIME:
SEP 12, 2004 2:00 AP1
TEST LENGTH = 2.0 HRS
STRT VOLUME = 2752.5 GAL
START TEMP = 89.2 F
END TEMP =. ,89'2 F
TEST PERIODS 2-4
-0.00 -0.02 -0.03
LEAK TEST RESULTS
RATE = -0.02 GAL/HR
0.20 GAL/HR TEST INVL
O, 20 GAL/HR FLAGS:
LOW LEVEL TEST ERROR
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, Tffle 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 oreoared
for each monitoring system comm~ panel by the technician who performs the work. A copy of this form must be provided to the tank
system owner/operator. The owner/opemto~must submit a copy of this form to the local agency regolating UST systems within 30
days of test date.
A. General Information ~
Facility Contact Person: /~,~t/,
Make/Model of Monitoring System: ~'/~
B. Inventory of Equipment Tested/Certified
W km: 7-/ l
.l~"~-Tank Gauging Prchc. Mode:
I;~'Annulnr Space or Vault Sensor. Model:
9fPiping sump/T~h Sends). Mode:
12 Fill Sump Sensor(s). Model:
~1 Mechanical Line Leak Detector. Model:
12 Eleclmnic Line Leak Detector. Model:
rn Tank Overfill / High-Level Sensor. Model:
12 Other (specify equipment type and model in Seclion E on Page 2).
Tank Gauging Probe. Model: ~
nular Space or Vault Sensor. Model:
lng Sump / Trench Sensor(s). Model:
i 12 Fill Smnp Sense'(s). Model:
12 Mechnnical Line Leak Detector. Model:
12 Elec~onic Line Leak Detector. Model:
12 Tank Overfill / High-Level Sensor. Model:
12 Other (specif~ equipment t]q~e and model in Seclion E on Pa~e 2).
[
I ~l.~)ispenser Containment Sensor(s). Model:
I~Shear Valve(s).
12 Disl~-.~ Co-~i-m~nt ~ont(s) and Chain(s).
S 'hearSpenser Containment Sensor(s). Model:
Valve(s).
12 Di.na~n~,~ Contnlnm~-m Float(s) and
12~Djsponser Containment Sensor(s). Model:
~'-Shear Valve(s).
r-lDispenser Containment Float(s) and Chnin(s).
*If the facility contains mote tanks or dispensers, copy this form. Include
City: ff~/(~n,,v ~e~.,~ Bldg. No.:
ContactPhoncNo.:(~'~;;/ ) ~
12 In-Tank Gauging Probe. Model:
12 Annular Space or Vault Sensor. Model:
12 Piping Sump I Trench Sensor(s). Model:
12 FtH Sump Sensor(s). Model:
~{ Mechanical Line Leak Detector. Model:
12 Electronic Line ~ Detector. Model:
12 Tank Overfill / High-Level Sensor. Model:
12 ~ (specif~ equipment type and model in Section E on Pa~e 2).
Tank ID:
12 In-Tank Gauging Probe. Model:
12 Annular Space or Vault Sensor. Model:
12 Piping Sump I Trench Sensor(s). Model:
12 Fill Sump Sensor(s). Model:
12 Mechanical Line Leak Detector. Model:
12 Eleclronic Line Leak Detector. Model:
rn Tank Overfill / High-Level Sensor. Model:
vi Other (specif~ equipment tl~e and model in Section E on Page 2).
12 DispenserContai~nent Sensor(s). Model:
/~S'~aear Valve(s).
vi Dispenser Containment Float(s) and Chain(s).
VI Dispetls~ntainment Sensm(s). Model:
12 Shear
12 Dispenser Contain6~-'loat(s) and Chain(s).
12 Disponser Containment Sen~)~'~~. odel:
12 Shear Valve(s).
I~ Disponser Containment Float(s) and Chain(s).~.~
informalion for every tank and disposer at the facility. ~,~
C. Certification - i eer~ tlmt the eqa~mem identified in this dacumem was I~n~altservkud in aecanhnee "ii~ the mmmfacturers'
guidelines. Attached to this Certification is infornmflon (e.g. nmnufaciure~' checMis~) neeessary to verify that this infornmtion is
correct and a Plot Plan showing the layout ~f nmnitm/ug equi~m~ For an~ equi~m~ t caimble of generating such reports, I have also
attadmiaeopyoftherepq~(d~_kalltkatappty): I~'~ystem set-up I~Aij~his~b report ~
Technician Name (print): /n~t~ ~~ Signature: ~ ~
C , ,OonNo.:. '
Date of Testing/Servicing:
0.3/01
MONITORING SYSTEM CERTWICATION
For Use By All Jurisdictions Within the State of California
Authority Cited: Chapter6.7, 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 cerdfica6on or report mus~ be prepared,
for e~_¢h m0nitorin_~ System control ~anel 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.
A. General Info _rma:~n~,~ ,~ ~
Facility Contact Person: /~-t~ ~
Make/Model of Monitoring System: /~
B. Inventory of Equipment Tested/Certified
-i-~--,~F-~ - ---, ._-~ _~-__ -? ~ --q - __
~'Annular Spac~ or Vault Seusor. Model:
I~'l~ping Sum0 ! T,~neh Sensor(s). Mod~l:
~ Fill Sump Sem~o~s). Model:
~ Mechanical Line Leak De~tor. Model:
~ Ekn:~oni¢ Line ~ D~,emor. Model:
I~ Tank Ov~fill I High-Level Sm~sor. Model:
I~ Other (sp~x~y equlp.-,~a~ type and model in S~n_'on E on Page 2).
c~s ~.~ Moaa: ~'
~l~nular Space or Vault Sensor. Model:
la'Piping Sump / Trench Sensor(s). Model:
O Fill Sump Sensor(s). Model:
~ Mechanical Line Leak Detector. Model:
iZ! Elecl~onic Line Leak Detector. Model:
~ Tank Overfill / High-Level Sensor. Model:
~ Other (specify equipment type and model in ._qec_ Jinn E on Pa~e
~ ~ Containment Sensor(s). Model:
.l~-$hear Valve(s).
[~ Di~f~O' Co,,i~,:~,,Y,,,~,~ Floa[($) alld _Chain(S).
~ Coominment Sensor(s). Model:.
El Shear Valve(s).
Bldg. No.:
c.y: zip:
Contact ~aone No.: ( ~ ~/~ ~/~'~
i~ co,~t sen~r(.,). Mo~l:
Shear Valve(s).
ODist~m~r Con~-~,,t Float(s) and Chain(s).
· ff the facility contains mm~ tanks ~ dispans~s, copy flmis fom~- Include inf°mmai°a f°~ everY tank and di~l~as~x at tbe faei~
Tank Gauging Probe. Model: L/~wrff~.~
~'Jamular Space or Vault Sensor. Model:
~[~iping Sump I Trench Sensor(s). Model:
C] Fill Sump Sensor(s). Model:
Q Mechanical Line Leak Detector. Model:
~l Electronic Line ~ Detector. Model:
C] Tank Overfill I High-Level Sensor. Model:
~l Other (specify equi~nt type and model in Section E on Page 2).
Tank ID:
C] ~ Gauging Probe. Model:
O Annular~r~r Vault Sensor. Model:
C] Piping Sump/~ensor(s). Model:
Cl FiU Sump Sensor(s). ~ Moael:
~ Mechanical Line Leak Detec~Model:
C] Tank Overfill I High-Level Sensor. Model:~
I~! Other (s?ci~y equip~ot type and model in Section E on Page 2).
~! Dispenser Contaim~t Sensor(s). Model:
~bear Valve(s).
I"l Dis~-nner Ctmtainment Float(s) and Chain,s).
it Sensor(s). Model:
t Fl~!t~s) and Chain(s).
[J Di~l~n~- Containment Sen~o--~('~Modeh
[-I Dispellser Containment Float(s) and Ch~.
C. C~tion - x certify mat the equip,,,mt ~ in ~ doom,em w~ ~servieed in amnxUa~ ,,ia ~ .,,,-,,,r,,ctur~'
eorr~t nnd a Plot Plan ahowing li~ Inyont of m~ equilnnent- For any eqUilm~nt thimble of generniing moth reports, I have nlso
aOadmi a ~ ' ~ ~~.~ ~): rn System set. up
Technician Nnme (print): /~c~,.-J ~ = ~ Signature:
Site Address:
Pa~ l~f3
Monitoring System C~-tifl~ation
03/01
D. Results of Testing/Servicing
ve io.
C~m ~le!e the f~llowin cheekilY=
i~.Yes I~1 No* Is th~ audible alarm operational?
li~ .Yes Cl No* Is the visual alarm operational?
I~Yes I~1 No* Were all ~n_~rs vis.ually' inspected, functionally tes~:d,.and .confirmed oI~ra~onal?
l~'Yes I~ No* Were all sensom installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their p~o. per operation7
FI Yes' "~1 No* ff alarms are relayed to a remote monitoring stati°n' is all communications equipment (e.g. modem)
I~N/A operational?
I~Yes ~1 No* For pressurized 'piping systems' does the h~'bine automatically'~hut d0w~ if the 'Piping s~condary Containment
Fl N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? ff yes: which sensors initiate
positive shut-down? (Check all that apply) I~ump/Trench Sensors; Fl Dispenser Containment Sensors.
Did you confirm positive, shut-down due to leaks and .s~..nsor failure/disconnection? ti~'~Ires; Fl No. ..
Fl Yes I~!~,~o* For tank systems that utilize the monitoring system as the primary tank oveffdl warning device (i.e. no
I~ N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank
fill point(s) ~nd.oper_n_ tln~ properly? ~f so, at what percent of tank capaci~ does the alarm trigger? . %
I~res* 'Q No was any monitoring equipment rePlaced? If yes, identify specific sensors, prObes, or other eqUipment replaced
and list th~ mannfacturer name and mode. l. for all replacement ~.~ in Section. E, below.
cl Yes* I~-~o Was liqUid found inside any secOndary containment systems designed as dry systems? (C~eck all that apply) Fl
Product~ I~ Water. If yes, describe causes in Section E, below.
l~l~es I~1 No* Was m~nitorin~ system set°uP reviewed to ensure ~.~Per s~tings? Attach set uP reports~ i~' aPPlicab~e
I~l"~Yes Fl No* Is all monitoring equipment, operational per manufacturer's specifications?
* In Section E below, describe how and when these deficiencies were or will be
E. Com nt :, . --07
Page2 o~3 ~3~1
F. In-T~nk Gauging ! SIR F~quipment:
~lheck this box if tank gauging is used only for inventory control.
ca Check this box if no tank gauging or SIR equipment is installed.
This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring.
Ca dete the followin cheeklL~t:
4~f/Yes ca No* Has a~~ input wiring been inspected f~r pr~per entry and termina~~n~ including testing for gr~nnd fauRs?
yes n No* Were all tank gauging ~ visually inspected for damage and residue buildup?
~Yes r'l No* Was accuracy o~f system pw~tct level readings tested?
No* was ;fsy m level re a gs
l~Yes ~ N~* Wet~ all probes reinstalled properly?
[~¥es ca No* Were all i~r~ on ~ equipment manufactm~r's maintemmce checklist
* In the Section H, below, descn*be how and when these deficiencies were OF will be corvecte~
G, Line Leak Detectors (LLD): I~"~heck this box if LLr~s arc not installed.
Con~ )le~ the followi~ che~kli.qt*-
vi Yes vi No* For equipment start-up or annual equipment certification, w~s a leak 'sin~lated to "verify ~ performance?
vi lqlA {Check all that apply) Simulated leak rate: ca3g.p.h.; ~0.1g.p.h; Cl0.2g.p.h.
Ca Yes ca No* Were aU LLD~ confirmed opemtionai and accurate withi,, regulatory requi~mefits? '"
~ Yes ca N°* Was the testing apparatus properly calibrated?
ca Yes ca 1~o* ' For meChanical LLDs, does the l-l-D restrict product flow'i~ it detects a leak? '"
ca N/A
ca Yes ca No* ~:or electronic I.LDs, do~s the tm~oine automatically sh~t off ff the LLD detects a l~ak.~'
I~ N/A
ca Y~s ca No* For ele~atronic !.l.l~'does the tu~'ine auton~ticaH~ shut offif any portion'of the m~nitoring system is disabled
ca N/A or disconnected?
ca Yes' ca No*' For electr°ni~'LLDs,'d°es the turbine automatically'shut offif any portion of the monitoring system malfunctions
ca N/A or fails a West?
ca Yes Ca No* For'electro~u'c !.l'~Ds, ha;e"~tll aeceasil~le wiring connections been visually inspected?
ca N/A
ca Yes ca No* Were all items on the equipment manufacturer's maintenance checklist completed.?
* In the Section H, below, deseflbe how and wben these ddieiencles were oF will be coFrected-
H. Comments:
Page 3 of 3
Monitoring System Certification
.~,~?~ ~~ Monitoring Site Pla~n/~/~¢? ~,~/~ ~
2~22~22~22~~2~ ......................... ~...
:..:: .... ::::::::::::::
Instructions
If you already have a diagram that shows all required information, you may include it, rather than this page, with your
Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify
locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular
spaces, s,,mps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak
detectors; and_ in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
was prepared.
Page __ of __ ~
~, ,.,I EH SETUP
JUL 14. 2004 8:27 APl
SYSTEH UN t TS
U.S.
SYSTEM LANGUAGE
ENGL 1SH
,~VE;'['EM [~TE..-. T i HE FORI"~T
HON DD YYYY HH:HH:S'~; ×1'~
F~-~I'R l P 640
8001 WHITE Lt.l
BAKERSF 1 ELD CA _~3309
SHIFT TIHE I : 12:00 Riff
SHIFT TIME 2 : DIS~4BLED
SHIFT TIME 3 : DISABLED
SHIFT TIHE 4 : DIP:~BLED
TANK PER I OD i C WARN I t~3S
D I S~BLED
TANK ANNUAL W~RNI~
b I S~BLED
LINE PERIODIC [~RNINGS
D I ~BLED
L I NE ANNUAL WARN l ~
D I SRBLED
PRI~ TC VOLL~ES
ENABLED
TB~P COMPEN~T 10~
VALUE (DEG F }: 60.0
~ICK HEIGHT OFFSET
D I ~BLED
H-PROT~OL DAT~ FOR~T
HE I G~F
DAYLIGHT SAVING TIME
D l SABLED
RE-DIREC~ L~ PRINTOUT
D l ~BLED
SYSTEM SECUE I TY
OODE : 000000
COMMUNICATIONS SETUP
IN-'rANK SETUP
T I:UNLEADED 366
PRODUCT CODE : 1
THERMAL COEFF :.000700
TANK DIAMETER : 120.00
TANK PROFILE : I PT
FULL VOL : 12000
FLOAT SIZE: 4.0 IN. 8496
lAtTER WARNING : 2.0
HIGH kIRTER LIMI'r: 3.0
PlAX OR L~BEL VOL: 12000
OVERF ILL L I M I T :
: 11400
H I GH PRODUCT : 97~.~,
: I 1640
DELIVERY LIMIT :
600
LOW PRODUCT : §00
LEP~ A~ LIMIT: 99
SUDDEN LOSE; LIMIT: 50
TANK T I LT : 0.00
MANIFOLDED TANKS
T.: NONE
LEAK MIN PERIODIC:~ l~C
: 1200
LF_~K MIN ANNUAL : 10~
: 1200
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
~LRP, I-1 DISABLED
GROSS TE~T FAlL
ALARH D t P_V-~BLED
~NN TEST AVE~AG I NG: OFF
~E~ TEST AVERAG I NG: OFF
TANK TEST NOT I ~: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 15
T 2: PERM I UPI 366
PRODUCT CODE : 2
THERMAL COEFF :. 000700
T~NK DIAMETER : 120.00
TANK PROFILE : I PT
FULL VOL : 12000
FLORT SIZE: 4.0 IN. 8496
WATER .I,gARNING : 2.0
HIGH WATER LII'II'I': 3.0
MA~ OR LABEL VOL: 12000
OVERFILL LIMIT : 95~
: 11400
HIGH PRODUCT : 97~
: 11640
DELIVERY LIMIT : I~
: 1200
LOW PRODLE:T : 500
LEAK AL~RPI LIMIT: 99
SUDDEN LOSS LIMIT: 50
TANK TILT : 0.00
P~NIFOLDED TANKS
T#: NONE
LF_AK MIN PERIODIC: 10~
: 1200
LEAK MIN ANNUAL :
: 1200
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TF_,ST FAIL
AI.~RM DISABLED
GRO,~ TEST FAIL
AI..P~ DISABLED
~NN TES~ RVEEAGII~J: OFF
PER TEST AVERfiGING: OFF
TANK TES~' NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 15
T 3:DIE.~EL 366
PRODI.E:T CODE : 3
THEEH~L COEFF :.000450
TANK DIAMETER : 120.00
TANK PROFILE : I PT
FULL VOL : 12000
FLO~T SIZE: 4.0 IN. 8496
~RTER WARNI~ : 2.0
HIGH WATER LIMIT: 3.0
PM× OR I.-.~BEL VOL: 12000
OVERFILL LIMIT : 95~
: 11400
HIGH PRODUCT :
: 11640
DELIVERY LIMIT : t
: 1200
LOW PRODUCT : 500
LEAK P~-ARM LIMIT: 99
SUDDEN LO~S LIMIT: 50
TANK TILT : 0.00
MANIFOLDED TANKS
T~; NONE
LF..~K HIM PERIODIC:
: 1200
LEAK HIM ANNUAL : 10~
: 1200
PERIODIC TEST TYPE
STANIW4RD
ANNUAL TEST FAIL
ALARM DISABLED
PF. RIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TF~ MOTIf/: OFF
TNK TST SIPHON BRF_.~K:OFF
DELIVERY DELAY : 15 MIN
T 5:UNLEADED 367
P~ODUCT CODE : 5
THERH~L COEFF :.000700
TANK DIAMETER : 120.00
TANK PROFILE : 1 PT
FULL VOL : 12000
FLOAT SIZE: 4.0 IN. 8496
W~TER WARNING : 2.0
HIGH WATER LIMIT: 3.0
PlAX OR l.~C~iEL VOL: 12000
OVERFILL LIMIT : 95~
: 11400
HIGH PRODUCT : 99~
: 11880
DELIVERY LIMIT : 5~
: 600
LOW PRODUCT. : 500
LEAK ALARM LIMIT: 99
SUDDEN LO~S LIMIT: 50
TANK TILT : 0.00
MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC:
: 1200
LERK HIM ANNUAL : 10~
: 1200
PERIODIC TEST 'F~PE
STANDARD
ANNUAL T~gT FAIL
ALRk~I DIP~BLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TF_.S~ FAIL
ALARM DISABLED
ANN TEST AVEFfck?,iNG: OFF
PER TEST AVER$¥GING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BRF.~K:OFF
DELIVERY DELAY : 1§
T 6:PRFJflI~fl
PRODUCT CODE : 6
THEEf'I~L COEFF :.000700
TANK DI~ETER : 120.00
TANK PROFILE : I PT
FULL VOL : 12000
FLO~T SIZE: 4.0 IN. 8496
WATER WARNING : 2.0
HIGH WATER LIMIT: 3.0
~qX OR LABEL VOL: 12000
OVERFILL LIMIT : 95~
: 11400
HIGH PRODUCT : 97~
: 11640
DELIVERY LIMIT : 10%
: 1200
LOW PRODUCT : 500
LEP~ ALARM LIMIT: 99
SUDDEN LO.~ LIMIT: 50
TANK TILT : O.O0
M~NIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC: 10~
: 1200
LEAK M1N ANNUAL : 10°4
: 1200
PERIODIC TEST TYPE
STANDARD
RNNLIRL TE~ FAIL
ALARM DISABLED
PERIODIC TEST FAIL
AI..~RM DISABLED
GROSS TEE;T FAIL
ALARM L'I~BLED
ANN ]'EST ~VERAGING: OFF
PER TEST AVERAGING: OFF
TANK T~T NOTI~f: O~
T~ ~T SIPHON B~E~K:OFF
DELIVEE~ DE~Y : 15 HIM
T 7:DIESEL 367
PRODUCT CODE
THERHAL COEFF
T~NK DIAMETER
TANY PROFILE
FULL VOL
7
.000450
120.00
I PT
12000
FLOAT SIZE: 4.0 IN. 8496
t.~TER WARNING : 2.0
HIGH WATER LIMIT: 3.0
P~< OR I~BEL VOL: 12000
OVERFILL LIMIT : 95%
: 11400
HIGH PRODUCT : 97%
: 11640
DELIVERY LIMIT ; 1 ~
: 1200
LOW PRODUCT : 500
LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT:
TANK TILT : 0.00
t'~C~Nl FOLDED TF~NKS
Tt~: NONE
LEAl< I"l I H PER I OD
: 1200
LEAK MIN ANNUAL : 10~
: 1200
PERIODIC TEST TYPE
S~TANDARD
MANUAL TEST FAIL
Al.ARM DIALED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIPZ: OFF
TNK TST SIPHON BRF~K:OFF
DELIVERY DELAY : 15 MIN
LE~K TE~T METHOD
TEST ON DATE : AL1. TANK
.JAN 1. 2000
~'FA~T TIME : 2~Ofi AM
· ;t] --;; ',L.. l'~'
TEST R~[E :O ~- "'
DURATION : 2 HOURS
LI~UID SENSOR SETUP
L I:~T SIDE SOUHT ANNU
TRI-STATE (SINGLE FLOAT)
, CATEGORY : ANNUI.~R SPACE
L 2:EAST SIDE STP SUMPS
NOPJ'IRLLY CLOSED
CATEC~RY : STP SUMP
L 3:F_.~T SIDE ERST ANNUL
NOILLY CLOSED
C~TEGOFt7 : ANNULAR SPACE
L 4:EAST SIDE WEST ANNUL
NORMALLY CLOSED
CATEGORY : ANNULAR SPACE
L 5:WE..%'T SIDE SOUHT RNNU
NORI"IALLV CLOSED
CATEGORY : ANNULAR SPACE
L 6:WEST SIDE STP SUMPS
NORMALLY CLOSED
CATEGORY : STP SUMP
L ?:WEST SIDE WEST ANNUL
NORMALLY CLOSED
CATEGORY : ANNULAR SPACE
L B:WEST SIDE EAST ANNUL
NORMP~.LV CLOSED
CATEGORY : ANNULAR SPACE
L 9:WEST SIDE 87 STP
NORMALLY CLOSED
CATEGORY : ~P SUMP
OUTPUT RELR\' SETUP
R I :POSITIVE SHIJTOFF IdES
'WPE:
STANDARP
NORMRLIA: C:LO.c-;E r'
I H-TANK ALARMS
T I :LEAK RI.ARM
T 2: LFd4K ALARM
T 3:LEAK ALARM
T 4: LEAK ~LRRM
T I:HIGH ~T~
T 2:HIGH WATER ALARH
T 3:HIGH ~TER A~I
T 4: H l GH WATER ALARM
LIOUID SE~OR L ~: FOEL ALARM
L 6:FUEL ALARM
L 7 :FUEL ALARM
L 8 :FUEL
L 9:FOEL ALA~
L S:SE~OR O~ At. RRM
L 6:SE~)R OUT
L ~:SS~R OUT
L 8:SE~OR O~ A~
L 9:SE~OR OUT
L 5:SHORT RLARM
L 6: S~RT ~ARM
L 7 :S~RT
L 8:S~R~ ALARM
L 9:S~ ALA~
R 2:~OSITIVE SHOTOFF E~
TYPE:
STAN~RD
~RI.LY GLGSED
IN-'rANK ALARMS
T 5:LE~K ALARM
T 6:LEAK ALARM
T ?:LEAK ALARM
T 5:HIGH WATER ALARM
T ~:H!GH ~TER ALARM
T 7:HIGH WATER ALARM
LIGUID SENSOR L I:FUEL
L 2:FUEL ALA~
L B:FUEL
L 4:FUEL ~L~I
L i:~E~O~ OUT ~L~Dtl
L 3:SE~OR OUT A~RM
L 4:SE~OE OUT
L i:~HORT ~1
l_ 2 :SHOR~ ~L~RM
L 3:S~ORT ALA~I
· ALARM. HISTORY REPORT-
MAS; 14. 2004 8:34 t~
PR INTER ERROR
MAY 14. 2004 8:34 t~
BATTERY IS OFF
JAN 1.. 1996 B:O0 APl
ALARM H I STORY REPORT
IN-TANK ALARM
T I: UNLEADED :366
H 1GH WATER
MAY 11, 2003 8:03
C)VERFILL ~L~RM
APR 25. 2004 11:22 AM
APR 25, 2004 10:57 ~t
FEB 18. 2004 11:04 AH
LOW PRODUCT ALARM
Ht4Y 14. 2004 3:26 PM
FEB 22, 2004 6:02 P~
DEC 22. 2003 10:46 mM
HIGH PRODUC_.T ALARM
APR 25. 2004 11:24 ~1t
SEP 3, 2003 12:07 PM
AUG~ 18, 2003 8:46 AM
INVALID FUEL LEVEL
MAY 14. 2004 3:55 PPi
OCT 21. 2003 8:35 PM
SEP 16, 2003 5:46 PM
PROBE OUT
SEP 11. 2003 12:52 PM
SEP 10. 2003 12:10 PM
MAY 13. 2003 10:14 AM
HIGH WATER WARNII'~;
MAY I1, 2003 8:03 AM
DELIVERY NEEDED
MAY 14. 2004 2:48 PN
FEB 22, 2004 5:44 PM
DEC 22. 2003 10:01 AM
i-~X pRODUC_.T AI~RH
SEP 3. 2003 12:00 F~
AD3 18. 2003 8:47 AM
A~ 18. 2003 0:35 AH
ALARM HISTORY REPORT
.... IN-TANK ALARM ......
T 2:PREMIUM 366
LC~ PRODUCT ALP~M
SEP 27, 2003 12:42 PM
SEP 20. 2003 4:34 PPi
MAR !. 2003 12:04
INVALID FUEL LEVEL
SEP 27. 2003 2:02 PM
SEP 20. 2003 7:00 ~
DEC 21. 2001 5:28 AM
PROBE OUT
SEP 11. 2003 12:35 PM
FEB 12. 2003 5:18 PM
~T 25, 2002 9:29 AH
DELIVERY NEEDED
APR 16. 2004 8:06 AM
aPR 12. 2004 11:39 AM
DEC 5. 2003 12:15 PM
LOW TFJ~Ia/~NII~
~EP 11. 2003 1:57 PM
OC~ 9. 2002 1:12 PM
OCT 2. 2002 9:38 P¢l
ALARM HI~TORY REPORT
IN-TANK ALARH ........
T 3:DIE~EL ~66
HIGH WATER ALA6H
MAR 8. 2000 2:58 PM
LOW PRODUCT ALARM
f~R 7. 2000 9:14 AH
INVALID FUEL LEVEL
HAP 7, 2000 9:16 AM
PROBE OUT
DEC 22. 2003 12:25
SEP 11. 2003 8:27 AM
SEP 10. 2003 1:01 PM
HIGH WATER WARNING
MAR 8, 2000 2:58 PH
ALAP. M H I SI'O~:Y REPOgF
..... IN-TANK ALEPH ........
T 4:
gETUP DATA I,.~4RN I Ng
MAR 31. 2004 6:09 PM
LOW PRODUCT ALARM
MAR 31. 2004 6:00 PM
MAR 27, 2004 10:54 RN
MAY 12. 2003 10:22 PM
INVALID FUEL LEVEL
H~R 31, 2004 6:08 PM
MAR 31, 2004 6:00 PPI
MAR 25. 2004 3:59 PM
PROBE OUT
MAR 31. 2004 4:55 PM
MAR 31. 2004 4:36 PH
SEP 11. 2003 11:22 AM
DELIVERY NEEDED
MAR 31, 2004 6:08 PM
MAR 31, 2004 G:00 ~
MAR 11. 2004 7:25 PPI
LOW TEMP W~RNI
n'~. ~ ~ . .>nc,.':, ~ - n'-/ D~.,. DEl. I V,,2pv
HL~R[~I HI'TOff REPORT
.... I N-TANK ALARM .....
T 5:UNLEADED 367
OVERFILL ALAn'1
SEP 10. 2003 4:52 Riff
~LIG 12. 2003 7:22 PM
APR 25. 2003 2:18 RM
LO~ PRODUCT RL~EH
JUN 27. 2004 4:54 PH
APR 13. 2004 5;40 PH
APR 7. 2004 8:tB aM
HIGH PEODLIC~
SEP lO. 2003 4:56 (~1
SEP
~UN 4. 2002
INVALID FUEL LEVEL
APR 13. 2004 6:01 PM
JAN 8. 2004 8:22 PM
OCT 28. 2003 9:40 PM
PROBE OUT
DEC 22. 2003 12:45 PM
DEC 22. 2003 12:40 PH
DEC 22. 2003 12:37 PM
DELIVER'/ NEEDED
JUN 27. 2004 4:32 PH
APR 13. 2004 5:22 PM
APR ?. 2004 ?:4? AM
MaX PRODUCT ~tJ%RM
SEP 10. 2003 4:57 AM
SEP 3. 2002 1:09 PM
JUN 4. 2002 1:38 PM
LO~ TEMP WARNING
DEC 22. 2003 12:35 PM
3AN t?. 2003 4:51P~t
0(~ 24. 2002 3:00 PM
ALARM HISTORY REPORT
.... I N-T~NK RIJ4RH ......
T 6:PE~I~ 307
~ 18, 2001 9:40 PH
S~ 24. 2000 7:50 ~
aPR 3. 2000 4:01 ~
l~lP FU~ L~EL
~ 19. 2001 4:2~ ~
S~ 24. 2000 7:50 ~
aPR 3. 2000 5:16 ~
PROBE O~
~ 12. 2003 11:12 ~H
FEB 12. 2003 4:51 PM
DELIVERY NEEDED
NOV 3. 2003 4:05 PM
NOV 11. 2001 7:16 PM
APR 19. 2001 G:58 P~t
LOI,J TEMPI~RNING
OCT 24. 2002 1:21 PM
OCT 2. 2002 10:39
ALa~I HI~'I'ORY REPORT
IN-TANK ALARM
T 7:DIESEL 367
LOW P~ODUCT AI~RPI
FEB 28. 2000 2:36 PM
I~ALiD FUEL LEVEL
OCT 8. 2002 1:44 PH
FEB 20. 2000 2:30 PM
PROBE OUT
DEC 22. 2003 12:33 PM
DEC 22. 2003 12:27 PM
SEP 12. 2003 9:01 AH
DELIVERY NEEDED
Pier 16. 2001 11:12 PH
JAN tO. 2001 12:01PH
NOU 26. 2000 11:56 RM
LOM TEHP IAqRNING
DEC 22. 2003 12:37 PH
OCT 24. 2002 12;05 PM
i"FaR I. 2000 9:10 RM
~LARM HiS'~'O~'V REi:'OP.T
..... SENSOR ALARM .....
L 1 :EAST SIDE SOUHT ANNU
ANNULAR SPACE
FUEL ~L.APJ"I
RU~ t3, 2BOG B:50 AM
FUEL ALARM
AUC~ 6. 2002 1:10 PM
SENSOR OUT ALARM
AUG 6, 2002 1:04 PM
AL,%RM H l STORY REPORT
..... SENSOR ALARM
L 3: EAST S I DE EAST ANNUL
ANNULAR SPACE
FUEL ALARM
JUL 14. ~004 9:24 ~
FU~L ALARM
R~ 13. 2003 8:50 ~M
FU~L ~
~ G. 2002 12:09 PM
~ALARM HlgrORY REPORT
..... SENSOR ALARI9 .....
L 5:WEST SIDE SOUHT ANNU
ANNULAR SPACE
SENSOR OUT ALARM
AUG 19. 2003 8:32 ~vl
FUEL ALARM
AUG 13. 2003 8:29 AM
FUEL ALARM
AUG 6. 2002 1:50
ALARM HISTORY REPORT
...... SENSOR ALARM .....
L 2 :EAST S I DE STP SUMPS
STP SUMP
FUEL AIJaRM
JUL ~4, 2004 9:28 AM
FUEL ALARM
JUL 14. 2004 9:27 AM
FUEL ALARM
JUL 14. 2004 9:25
ALARM HISTORY REPORT
..... SENSOR ALARH .....
L 4:EAST SIDE WEST ANN~JL
ANNULAR SPACE
FUEL ALARM
AUG 13. 2003 8:52 ~'1
SENSOR OUT ALARM
AUG 6. 2002 12:24 PM
SE~3OR OUT ALARM
SEP 19, 2001 6:04 AM
~L~RM HISTORY REPORT
...... SENSOR ALARM .....
L 6:WEST S1DE STP SUMPS
FUEL ALARM
J0L 14. 2004 9:05
FOEL ALARM
JUL 14. 2004 9:04 AM
FUEL ALARM
JUL 14, 2004 9:03
ALARM HISTORY REPORT
..... ~ENSOR ALARM ......
: 7:WEST SIDE WEST ANNUL
~NNULAR SPACE
FUEL ALARM
JUL 14- 2004 9:01 ~
FUEL ALARM
~ 13, 2003 8:28 ~'1
FUEL ALARM
~UG 6, 2002 1:43 PM
~LARM HISTORY REPORT
..... SENSOR ALARM
L 8:WE~ SIDE F_~q~ ANNUL
ANNULAR SPACE
FUEL ALARM
AUG 13. 2003 8:29 AM
FUEL ALARM
~UG 6. 2002 1:45 PM
FUEL ALARM
OCT 6. 2001 3:42 PM
ALARM HISTORY REPORT
..... SENSOR ALARM .....
L 9:WEST SIDE 87 STP
STP
FUEL ALARM
JUL 14, 2004 9:02 e'.'.'~l
FUEL ALARM
AUG 13, 2003 8:29
FUEL ALARM
AUG 6. 2002 1:33 PM
ALARM HISTORY REPORT
..... SENSOR ALAPJfl .....
L 1 :EAST SIDE SOUHT ANNU
ANNULAR SPACE
FUEL AI.~RM
RUG 3. 2Q04 9:16 AH
FUEL ALARM
AUG 13. 2003 8:50
FUEL ALARM
AUG 6. 2002 1:10 ~
ALARM HISTORY REPORT
SENSOR ALARM
L 3:EAST SIDE E~ST ANNUL
ANNULAR SPACE
FUEL ALARM
JUL 14. 2004 9:24 APl
FUEL ALARM
AUG 13. 2003 8:50 APl
FUEL ALARM
AUG 6. 2002 12:09 PM
ALARM HISTORY REPORT
SENSOR ALARM
L 5:WE~ SIDE SOUHT ANNU
ANNULAR SPACE
FUEL ALA~I
AUG 3. 2004 '9:14 Att
SENSOR OUT ALARM
AUG 13. 2003
FUEL ALARM
AUG 13. 2003 8:29 AM
ALARM HISTORY REPORT
..... SENSOR ALA]~
L 2:EAST SIDE STP SUMPS
STP SUMP
FUEL ALARM
JUL t4, 2004 9:28 AH
FUEL ALARM
JUL 14, 2004 9:27 AM
FUEL ALA~
JUL 14. 2004 9:25 P.M
ALARM HISTORY REPORT
..... SENSOR ALARM ....
L 4:EAST SIDE WE~T ANNUL
ANNULAR SPACE
FUEL ALARM
AUG 3. 2004 9: 15 AM
FUEL ALARM
AUG 13. 2003 8:52 APl
SENBOR OUT ALARM
AUG 6. 2002 12:24 PM
ALARM HISTORY REPORT
SENSOR t:-~L~ .....
L 6:WEST BIDE STP SUMPS
STP SUMP
FUEL ALARM
JUL 14. 2004 9:05 AM
FUEL ALARM
JUL 14. 2004 9:04 AM
FUEL ALARM
JUL 14. 2004 9:03
~L.~RM HISTORY REPORT
..... SENSOR ALAR~i .....
L 7:WEST SIDE WEST ANNUL
ANNULAR SPACE
FUEL AIJ4RM
JUL 14, 2004 9:01 AM
FUEL ALARM
AUG 18, 200:3 8:28 AM
FUEL ALARM
AUG 6. 2002 1:4:3 PM
ALARM HISTORY REPORT
SENSOR ~LARM
L 8:WEST SIDE ~ ANNUL
ANNULAR SPACE
FUEL ALARM
AUG 3, 2004 9:1:3 AM
FUEL ALARM
AUG 13. 2003 8:29 AM
FUEL ALARM
AUG 6. 2002 1:45 PM
Tanknology
8501 N. MoPac Expressway, Suite 400
Austin, Texas 78759
Phone: (512) 451-6334
Fax: (512) 459-1459
Date Printed and Mailed: 09/08/2004
BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
INSPECTOR STEVE UNDERWOOD
900 TRUXTUN AVE., STE. 210
BAKERSFIELD, CA. 93301
Test Date: 08/27/2004
Order Number: 3136161
Dear Regulator,
Enclosed are the results of recent testing performed at the following facility:
CHEVRON 206561
3360 PANAMA LN.
BAKERSFIELD, CA. 93304
Testing performed:
Leak detector tests
Monitor Certification
Secondary Containment-Spill Container
Sincerely,
Dawn Kohlmeyer
Manager, Field Reporting
~L~ ~n~Jc~31~jy TANKNOLOGY CERTIFICATE OF TESTING
8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757
TELEPHONE (512) 451-6334 FAX (512) 459-1459
PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT
TEST DATE: 08/27/04 WORK ORDER NUMBER: 3136161
CUSTOMER PO:
CLIENT: CHEVRON U.S.A. SITE: CHEVRON 206561
P.O. BOX 2292 3360 PANAMA LN.
145 S. STATE COLLEGE BLVD. BAKERSFIELD, CA 93304
BREA, CA 92822-2292
SAM STEVENSON MANAGER
(909)765-6536 (661)396-7047
TEST TYPE: TLD-t
Product Pipe Tight~ess Test Result~
;1 i SUPREME DW FIBERG PRESSURE Y
2 2 PLUS DW FIBERG PRESSURE Y
3 3 UNLEADED DW FIBERG PRESSURE Y
Existing Line Leak Detector Test
2 2 RED JACKET FXlV 10401-8864 P
3 3 FE PETRO ~D BJ256 P
New Re~a~eme~ U~e leak De~e~o~ Tes~
~C~ ~E~K~D E~E~TOR~~ ~ ~ ~RE~CED
For o~ detailed r~o~ info~ation, visit ~.tanknolo~.com and select On-Linc Rcpo~-W~P, or contact your local Ta~olo~ o~cc.
Tester Name: ALBERT J. QUEIROS Technician Ce~ifi~tion Number: 91-1~8
Printed 09/08/2004 09:43 SBOWERS
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
'ran
TEST DATE: 08/27/04 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3136161
CLIENT: CtI~VRON U. S . A. AUSTI N, TEXAS 78757 (512) 451-6334 SITE: Ctl~/'RON 2 06563.
NEORM~T!~N~ t;~
Tank ID: 3.
Product: suPR~
Capacity in gallons: 13-, 849
Diameter in inches: 3.2O. 00
Length in inches:
Material: DW
Tank manifolded: NO
Vent manifolded: YES
Vapor recovery manifolded: YES
Overfill protection: YES
Overspill protection: YES
Installed: ATO
CP installed on: !
Bottom to top fill in inches: 168.5
Bottom to grade in inches: 3.76.0
Fill pipe length in inches: 45.0
Fill pipe diameter in inches: 4.0
Stage I vapor recovery: DUAL
Stage II vapor recovery: BALANCE
COMMENTS
Start (in)
Dipped Water Level:
Dipped Product Level:
Probe Water Level:
Ingress Detected: Water
Test time:
Inclinometer reading:
VacuTect Test Type:
VacuTect Probe Entry Point:
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method):
Result:
Bubble
NOT
TESTED
'COMMENTS
End (in)
Ullage
New/passed
L.D. #1
Make: F~. PETRO
Model: MLD
S/N: ~2 s s
Open time in sec: 9.0o
Holding psi: 28
Resiliency cc: 240
Yest leak rate mi/m: z89. o
Metering psi: zo
Calib. leak in gph: 3. oo
Results: PASS
Failed/replaced New/passed Failed/replaced
L.D. #1 L.D. #2 LD. #2
COMMENTS
NOT
TESTED
COMMENTS
Material:
Diameter (in):
Length (ft):
Test psi:
Bleedback cc:
Test time (min):
Start time:
End time:
Final gph:
Result:
Pump type:
Pump make:
DW FIBERG
2.0
175.0
NOT
TESTED
PRESSURE
FE PETRO
NOT NOT NOT
TESTED TESTED TESTED
Impact Valves Operational: YES
Printed 09/08/2004 09:43
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
Tank jy
TEST DATE:08/27/04 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBERS136161
CLIENT: CH~'v'RON O. S . A . AUSTIN. TEXAS 78757 (512) 451-6334 SITE: CHEVRON 2 06561
Tank ID: 2 2
Product: PLus
Capacity in gallons: 11,849
Diameter in inches: 120.00
Length in inches: 245
Material: DW F'rBERe
COMMENTS
Tank manifolded: No
Vent manifolded:
Vapor recovery manifolded:
Overfill protection:
Overspill protection: YES
Installed: ATe
CP installed on: /
Bottom to top fill in inches: 172.0
Bottom to grade in inches: 176.0
Fill pipe length in inches: 49.0
Fill pipe diameter in inches: 4.0
Stage I vapor recovery: DUAL
Stage II vapor recovery: BALANCE
Start (in)
Dipped Water Level:
Dipped Product Level:
Probe Water Level:
Ingress Detected: Water
Test time:
Inclinometer reading:
VacuTect Test Type:
VacuTect Probe Entry Point:
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method):
Result:
End (in)
Bubble Ullage
COMMENTS
NOT
TESTED
New/passed
L.D. #1
Make: RED JACKET
Model: Fxlv
S/N: ',o4oz-88~
Open time in sec: 4.00
Holding psi: 32
Resiliency cc: 200
Test leak rate mi/m: 189. o
Metering psi: z5
Calib. leak in gph: 3. oo
Results: PASS
COMMENTS
Failed/replaced New/passed Failed/replaced
L.D. #1 L.D. #2 L.D. #2
NOT
TESTED
COMMENTS
Material:
Diameter (in):
Length (ft):
Test psi:
Bteedback cc:
Test time (min):
Start time:
End time:
Final gph:
Result:
Pump type:
Pump make:
DW FIBERG
2.0
175.0
NOT
TESTED
PRESSURE
FE PETRO
NOT NOT NOT
TESTED TESTED TESTED
Impact Valves Operational: YES
Printed 09/08/2004 09:43
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
TEST DATE:08/2?/04 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER313 6161
CLIENT: CHEVRON O. S . A. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: CHE'v'RON 206561
Tank ID: 3 3
Product: UNLEADED
Capacity in gallons: 11,849
Diameter in inches: 120.00
Length in inches: 245
Material: DW FTEERe
COMMENTS
Tank manifolded: NO
Vent manifolded:
Vapor recovery manifolded:
Overfill protection:
Overspilt protection:
Installed: ATe
CP installed on: /
Bottom to top fill in inches: 176.0
Bottom to grade in inches: 182.0
Fill pipe length in inches: 52.0
Fill pipe diameter in inches: 4.0
Stage I vapor recovery: DUAL
Stage II vapor recovery: BALANCE
Start (in)
Dipped Water Level:
Dipped Product Level:
Probe Water Level:
Ingress Detected: Water
Test time:
Inclinometer reading:
VacuTect Test Type:
VacuTect Probe Entry Point:
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method):
Result:
Bubble
NOT
TESTED
COMMENTS
End (in)
Ullage
New/passed
L.D. #1
Make: F,, P~.TRO
Model: MLD
S/N: ,,~2s6
Open time in sec: 8. oo
Holding psi: 3o
Resiliency cc: 240
Test leak rate mi/m: 189.0
Metering psi: lO
Calib. leak in gph: 3. oo
Results: PASS
COMMENTS
Failed/replaced New/passed Failed/replaced
L.D. #1 L.D. #2 L.D. ~2
NOT
TESTED
COMMENTS
Material:
Diameter (in):
Length (ft):
Test psi:
Bleedback cc:
Test time (min):
Start time:
End time:
Final gph:
Result:
Pump type:
Pump make:
DW FIBERe
2.0
175.0
NOT
TESTED
PRESSURE
FE PETRO
NOT NOT NOT
TESTED TESTED TESTED
Impact Valves Operational: XES
Printed 09/08/2004 09:43
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, Califomia Code of Regulations
This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate
certification or report must be prepared for each monitorin.q 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.
A. General Information
Facility Name: CHEVRON 206561 City: BAKERSFIELD CA Zip: 93304
Site Address: 3360 PANAMA LN.
Facility Contact Person: MANAGER
Make/Model of Monitoring System:VEEDEROOTTLS350
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced
Contact Phone No: 396-7047
Date of Testing/Service: 08/27/2004
Work Order Number: 3136161
Tank ID: 1-91
~ In-Tank Gauging Probe. Model: MAG-2
r~ Annular Space or Vault Sensor. Model: 409
Piping Sump/Trench Sensor(s). Model: 352
X'~ Fill Sump Sensor(s). Model: 352
] Mechanical Line Leak Detector. Model: MLD
] Electronic Line Leak Detector. Model:
] Tank Overfill/High-Level Sensor. Model: MAG-2
] Other (specify equipment type and model in Section E on page 2).
Tank ID: 3-87
ank ID: 2-89
In-Tank Gauging Probe.
Annular Space or Vault Sensor.
P
iping Sump/Trench Sensor(s).
Fill Sump Sensor(s).
] Mechanical Line Leak Detector.
] Electronic Line Leak Detector.
Model: MAG-2
Model: 409
Model: 352
Model: 352
Model: FX1V
Model:
~ In-Tank Gauging Probe.
X---I Annular Space or Vault Sensor.
~ Piping Sump/Trench Sensor(s).
X---I Fill Sump Sensor(s).
X'~ Mechanical Line Leak Detector.
'-I Electronic Line Leak Detector.
X---] Tank Overfill/High-Level Sensor.
~l Other (specify equipment type and
Dispenser ID: 1/2
[] Dispenser Containment Sensor(s) Model: 322
[] Shear Valve(s).
[] Dispenser Containment Float(s) and Chain(s).
] Tank Overfill/High-Level Sensor. Model: MAG-2
] Other (specify equipment type and model in Section E on page 2).
Tank ID:
Model: MAG-2 []
Model: 409 []
Model: 352 []
Model: 352 []
Model: MLD "-1
Model: -~
Model: MAG-2 ~
model in Section E on page 2).
Dispenser ID: 5/6
[] Dispenser Containment Sensor(s) Model: 322
[~ Shear Valve(s).
~'] Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
E~ Dispenser Containment Sensor(s) Model:
[] Shear Valve(s).
~] Dispenser Containment Float(s) and Chain(s).
In-Tank Gauging Probe. Model:
Annular Space or Vault Sensor. Model:
Piping Sump/Trench Sensor(s). Model:
Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model:
Electronic Line Leak Detector. Model:
Tank Overfill/High-Level Sensor. Model:
--1 Other (specify equipment type and model in Section E on page 2).
Dispenser ID: 3/4
X~] Dispenser Containment Sensor(s) Model: 322
X'~ Shear Valve(s)
---~ Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 7/8
'~ Dispenser Containment Sensor(s). Model: 322
'~ Shear Valve(s).
~] Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
--~ Dispenser Containment Sensor(s). Model:
~1 Shear Valve(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
I 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 Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached
a copy of the (Check all that apply): [~-] System set-up
Technician Name (print): ALBERT J. QUEIROS
Certification No.: 000-00-2808
Testing Company Name:Tanknology
Site Address: 8900 Shoal Creek, Bldg. 200 Austin, TX 78757
J'-~ Alarm history report
Signature:
License. No.:
Phone No.: (800) 800-4633
Date of Testing/Servicing: 08/27/2004
Monitoring System Certification Page 1 of 3 Based on CA form dated 03/01
Monitoring System Certification
Site Address: 3360 PANAMA LN.
Date of Testing/Service: 08/27/2004
D. Results of Testing/Servicing
Software Version Installed: 112.02
Complete the following checklist:
[] 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 * [] N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational?
For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
[] Yes [] No * [] 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 * [] N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical
overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating
properly? If so, at what percent of tank capacity does the alarm trigger? 95 %
[] Yes* [] 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* [] 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.
[] Yes [] No * Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable.
[] Yes [] No * IS all monitoring equipment operational per manufacturers' specifications?
* In Section E below, describe how and when these deficiences were or will be corrected.
E. Comments:
Page 2 of 3 Based on CA form dated 03/01
Monitoring System Certification
Site Address: 3360 PANAMA LN.
Date of Testing/Service: 08/27/2004
F. In-Tank Gauging / SIR Equipment
[] Check this box if tank gauging is used only for inventory control.
[] Check this box if no 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 manufacturers' maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): [] Check this box if LEDs are not installed.
Complete the following checklist:
For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
[] Yes !r-'] No* r~N/A (Check all that apply) Simulated leak rate: [] 3 g.p.h [] 0.1 g.p.h r--lo.2 g.p.h
[~ Yes [] No * Were all LLDs confirmed operational and accurate within regulatory requirements?
[] Yes [~No* Was the testing apparatus properly calibrated?
[] Yes E~No * [] N/A For mechanical LEDs, does the LLD restdct product flow if it detects a leak?
[] Yes E~No * [] N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
[] Yes ~'~No * [] N/A: For electronic LEDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected?
[] Yes ['~No* [] N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test?
[] Yes E~No* [] N/A For electronic LEDs, have all accessible wiring connections been visually inspected?
]Yes r'-']No * Were all items on the equipment manufacturers' maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 3 Based on CA form dated 03/01
SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS
~%, Tanimology
TEST DATE:08/2?/2004
CLIENT: CHE~'RON U.S.A.
P.O. BOX 2292
145 S. STATE COLLEGE BLVD.
BREA CA
SAM STEVENSON
909-765-6536
92822
Tank Interstital Tests
SITE:
WORK ORDER NO.: 3136161
CHEVRON 206561
3360 PANAMA LN.
BAKERSFIELD CA
Piping Interstital Tests
93304
Sum & Under-Dispenser Containment Tests
I OPW Pass
2 OPW Fail
3 OPW Pass
Tanknology representative: JERRY BELLOLI
Services conducted by: ALBERT J. QUEIROS
~¢¢~ Test Date: 08/27/2004
4~ ~ Work Order: 3136161
SUMP TESTS SECONDARY CONTAINMENT TEST RESULTS
Type I Tank ~r Disp I Manufacturer IM°de' °rMaterial I Diam'A~'i(~th/Length'' Depth I Test Meth°d (" ) I Start I Initial I Level I Finish I Final I Pass/ Time Level Change Time Result Fail
Spill Container 1 OPW Plastic 12" 5 GAL 10:50 8" FROM NONE 1 li20 8" FROM Pass
Spill Container 2 OPW Plastic 12" 5 GAL 10:50 8" FROM 7" 11:20 1" FROM Fail
Spill Container 3 OPW Plastic 12" 5 GAL 10:50 8" FROM NONE 11:20 8" FROM Pass
Comments: SUSPECT PLUS BUCKET IS NOT TIGHT WHERE PLASTIC FLEX, BOLTS TO BOTTOM PLASTIC DISH,
SITE DIAGRAM
8900 SHOAL CREEK, BUILDING 200
AUSTIN, TEXAS 78757
(512) 451-6334
FAX (512) 459-1459
TEST DATE: 08/2?/04
CLIENT: CHEVRON O. S. A.
WORK ORDER NUMBER3136161
SITE: CHEVRON 206561
PLU
UL
S
SUP
VENTS
E
CHEVRON
#206561
Pdnted 09/08/2004 09:43 SBOWERS
Work Order:
3136161
CI.~-%~ON ~ CSI-1849
3360 P~NP~IR
SS-20651 PH-396-7047
At,K~ 2?° 2004 8:02
{M_L FUNGTIOI~
.... I~NBOR ~I~R~ .....
L 2:92-FILL SUMP
PIPING 8UMP
HIGH LIQUID ~
hUG 27, 2004 8159 ~
L 2.'92-FILL SLII'~
PIPING SUMP
HIGH LIQUID RLRRt't -
· Ftl. IO, 27, 2004
..... SENSOR ~7_.~r.,1
L $:87-FlLL SUMP
PIPZN0 BUffip
LIQUID
RUG 27. 2004 9:03 AI"I
..... SENSOR RLRRPt .....
L B:8?-FILL SUMP
PIPING SUNP
HIGH LIQUID ~
RUG 27. 2004 9:03 ~
L 3: 92*-STP 8ttlflP
BTP
LIQUID idP, RN] NG
RUG 2'/. 2004 8.'54 PJI
..... DElE;OR R[.~R~ ......
L 2: 92-FILL
LIQUID
R~ 27. 7004 9
.... I N-TANg ~
T ]
PROBE OUT
RUG 21. 2004
L 3:92~ 8L.IIIP
LIQUID tJRRNI NG
RUG 27. 2004 ,':J:54 (IH
...... BE h~OR hLqRH .....
L 2:92-FILL ~LefP
PIPING BLelP
H[O~ LIQUID ~
AUG 27. 2004 9:00 P,H
.... l N-T/~INg RLAi~ .....
T I :BLIP~lIE
I NVAL I D FUEL LEVEL
AUG 27. 2004 9:04 Rtt
L !: 92---RNNLE~R
FUEL Rt.R~
AUG 27, 2004
..... I~NSOR FLRR~ .....
L ? -' 07'-RNNLLRR
RNNLLqR ~PHCE
FUEL RLRRrl
~UG 21. 2004 9:01 RII
..... aENSOR Al. Rial
L 4: Bg-&NNUZA~
RUG 2.. 2004 9
L 2:92-FILL c:[],~
PIPING -qU'~
ttlCIt LIQUID at./kRt'l
RUG 2'/, 2004 8;59 Rtl
..... SENSOR ~ ....
L 8:87-FI LL
PIPING
HIGH LIQUID ALP, Rtl
~1~; 27.-2004 9;02
L 5:89~FILL SUmP
PlPIWG '~LHP
HIGH LIQUID
RUG 27
Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757
Work Order:
3136161
..... ~EN~IOR ~ .....
'L §:09-PILL S1JmIP
PIPiN~ BtJl~
RUG 27. 2004 9:10 ~
.... IN-TANK RLA{~'I .....
T I:SUPRF_.HE
HIGN ~d~TE~ t,NO, RNIPJG
AUG 27, 2004 9:25P{q
L 5189-F11/. SUHP
PIPING~Lk~
HIGH LIQUID PJ.a°J~
AUG 27, 2004 9:10 APl
T 3:UNLF-.flDED
RUG 2?° 2004 9:18 PJ'l
T 2:PLU~ .
HIGH r~RTER
AUG 27, 2004 9:25
T 3:UNL.F~DED
PROBE OUT
AUG 27. 2004
.... IN-TAN{( ~ .....
T 3: UN'LEf/aDED
HIGH PRODUCT ~
RUG 27o 2004 9:19 Pti
.... IN-TAI~AI.ARfl .....
T 2:PLI. B
HIGH I~TI-~I,ARNING
RUG 27. 2004 9t25 F:~
..... IN-TN,~A[.A];~
T 2:PLL~
DELIVERY NEEDED
At. JG 27. 2004
IN-TANK ~ .....
.T 2 -' PLI. I~
.AI~.'27, 2004 9:15 Pti
.... [ ~-?~,NK R I...G~ .....
T 2.' PLU~
INVRLID FUEL LEVEL
· RUG 27. 2004 ~J:15 P~
T 1 :BUPREHE
] NVE~JW ] N~RF.d~E
] hlCRF.~£ STP~RT
AUG 27. 2004 9:04
VOUJI~ - 1881 OiWT~
latTER = 0.00 INCI~S'
TEHP -'- 86.2 DING: F
AUG 27,, 2004 9:22
VOL{.IIE - 10025 ~
14flTER = 8.16 lhl~14{~
~ '- 86.1 DI~; F
CROE{S INCRF. ASE- 0144
TO NET l~= 799,5
.... IN-TANK flLflRH .....
T l :SUPR{~'IE
IIIGH hATER ALfl,Rll
RUG 2'{'. 2004 9:25 ~
.... I N-TP, N~ PJ..RRt'I ......
T ! :SUPRB'E
H]GH PRODUCT
AUG 27- 2004 9:
T* 3: UI~F_.ADED
[ NVENTORY I~
[ NCP. F_.,d~ b-"TP~T
AUG 27, 2004
UOLLt'IE - 9878 ~
M~TF.~ - 6.15
~ = GS.B DEX~ F
1~ END
AUG 27. 2004 9:39 P~
VOLIJHE ,,, 10807 GRLS
I~TE']? = O. OO INCH'.:'~
TE{~P ., 87.6 U,{~G F
ORO..qS l NCREF~k~£' 929
NET [ NCR;A,q£- 898
Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757
Work Order:
3136161
INCEF. ASE EHD
RUG 27, 2004 9:51P~
VOLLI~E - 10804 GALS
k~-tt~ ' O,O0 INCH~S
~ - 80.6 DBO F
GR0~ 1NcREqSE= 779
TO 'NET INCRE/~= 755
L. 6;89-tlIP 9LIMP.
ST}' SUM}'
LIOU1B I,,&qRNING
RUG 27. 2004
T 2 :PLL. E{
INVENTORY [ NCRF_~
I NCREAt{E START
AUG 2?° 2004 lO:0? ~
= 7992 ~ ·
= O.OO I~H~
- 93.1 D~ F
! NCREASE END
AUG 27, 2004 10:23
¥OLLI~ - 9,506 GALS
-, O. 00 I NCIE:S
~'I~- 1544
TC NET INC~= 1509
.... IN-TANK At,RRM .....
T 2:PLLIS
OVERFILL ~
AUG 27, 2004 10:40 AM
.... IN-TAI~( ALA];~fl .....
T I;~tiPRE'4.~
OVERFILL ALARM
RUG 27. 2004 10:40 P~I
T 3: UNLEADED
I NVEhTTORY I~
! NOREg~t= START
RUG 27. 2004 9152 Pti
VOLt. II'rE - 8951 ~
I,~TI~R = O. O0 INCHI~
TI9'~ - 9I..?-DEG F
INC'~ END
RUG 27. 2004 10:09 AM
VOLt, I'4~ "9203 OALE;
WATER - 0.0O INCHEi)
TE>'IP - 91.9 DI~F
GROE;B l NCR]F..,~E= 352
TC ~ I~- 343
..... ~l~iOR ~L~i~ .....
L 6:89-STP SUMP
t{TP
LIGU]DKIRRNING
AU~ 27. 2004 10:23,'q~
.... IN-TANK~ .....
T 3:UNLEADED
RUG 27, 2004 10:41 APt
.... [N-TANKP&JAEM .....
T 2:PLUB
DELIVERY NEEDED
RUG 27, 2004 10:44 ~
.... IN-TRI~ AL~ .....
T 2:PLtI8
HIGH PRODUCTAL,/:ktffl
RUG 27, 2004 10:40 P~I
.... i N-TAt~( ~ .....
T 1 :SUPRE~
DELIVERY
RUG 27. 2004 10:44
Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757
Work Order:
3136161
LIO:DI$i>£NGER PAN 1-2
8IOH LIOUID AIJaJ~
AUG 27, 2004 10;46
.... l N-TAI~( ~
T 1
].,Old PRODUCT ~
RUG 27. 2004 10:49 P~I
.... IN-TANK
T 2 :PLUS
L~ PRODUCT ~
P~LIG 27. 2~4 10:49
---- IN-TAN~iM~a~J~ .....
T:3:UNLFADED
DI~I~NEEDED
RUG 2'7. 2004 10:49~1
T 2:PLU~
1~ STP~T
AU~ 27. 2004 10:26
VOLUME - 9536 GRLS
~ ,, 93.7 DEG
I Nc~.~;E
RUG 27. 2004 l O; 56 Pt1
VOLt,IIE = 117~ ~
ktqTER '- 0,00 INCtE~
'r]E]~ - 94.2 I~G F
GRO~ INCRP_,/~= 2170
TC I~T I~- 2115
T I :SUPKE~E
I N~RY ]
] NCRF. PE~ STP, ET
AUG 27. 2004 10: 26 P/~
VOLLIME - 10144Glql~
· 79.9 DEG F
I NCREflSE £1~
AUG 27. 2004 t 0t56 fit1
VOLtI~E - 11834 G;q~
i,tATER - 0,00 INCHES
~ - Bl .B DEG F
GR0~ INCI~.flE~= 1690
T~ I~T II~- 1651
T 3: UI'~DED
l NVERTORY I NCRF. P,,SE
1~ START
AUG 27. 2004 I0:40 ~
VOLI.],~ = 9203 QALS
b~TE~ - O .00 1NC~
~ = 95.2 DL~; F
I~ END
RUG 27, 2004 10:57
11414 Cw~L8
0.O0 I NCH~B
95.2 D~G F
GROWl [NCRF_.P~'E- 2211
TC ~ INCREP~E= 2156
.... I N-TAI~ JRLARH .....
3: UtE.EADI~
PRODUCT ~
27. 2004 10:57
.... IN-TANK ALARM .....
T 2:PLL~
PROI~ OUT
AUG; 27- 2004 10:57~1
.... IN-TAI~( ~ .....
T 2:PLLEI
LOW TE~W~NING
AUG 27, 2004 10:58 AH
PIPING gUHP
SENSOR OUT RLA]~
RI.JO 27. 2004 IO:59AM
.... 1N-TflNKRLP~fl .....
T I;SI~EI~E
PRO]~ OUT
AUG 27, 2004 10;59 F~l
.... I N-TAI~ ~ .....
T I :SIJ~RE]~
INVALID FIJi_. LEVEL
AUG 27. 2004 ll:OO P~
..... 9EN~OR ALAla4 ....
L 2:92-PILL SUMP
PIPING SI.~IP
HIGH LIQUID ALARM
AUO 27, 2004 ll:OO lqM
Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757
Work Order:
3136161
AUG 27, 2004
L 8:0T-FILL
PIPI I~I SUMP
8EN~O~ Ottr ~
T l
{ NV£NTORY !
A~ 27, 2004 10:59
633 ~
~ INC~E-~ 2081
TC NET ltOF_.P~ ~o4?
T 2:PL~8-
AUG 27, 2004 10157
~L~ -
T~ - 97.7
I NCIW..~E
2004
~ lhiCRF_./N~- 3154
TC Nffl' I h~.r.,~..,N~- 0086
CHEVRON ~ CSI~1849
3360 PAllet'iq L,qNE
]~YJ;I~f;i;FIEJ..D CR.93304
SS-206§1PH-096-?047
~UG 27, 2004 11;29~/q
~ ~'TA?I, J8 REPORT
(~LL FUNCTIOF~ NOI;aflRL
Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757
0B/21/200~ 09:26 66132§2529 OAL VALLEY PAGE 01
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 3261-3979
APPLICATION TO PERFORM
FUEL MONITORING CERTIFICATION
NO
TANK # VOLUME CONTraS
! .... !0 V.. ,, ~7
NAM]g OF TF__,STINO COMPANY_..C~/- ~,/o,//¢~¥ ~ ~../~'/~,~ 4~..7-
CONTRACroRs LICF:fWSE # 7~'~,,/7~__~
NAM~ & PHONE NUMBER OF CONTACT PERSON ,~Y't,~: ~/~_.c/.~.~ ~.g/._qMT~$~f/
DATE & TIM~ TEST IS TO BE CONDUCTED ~c_?'oM~-~ .,% 2.~, (~'//./'7~, ......
APPROVED BY DATE
SIGNATURE OF APPLICANT
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 sepm"ate 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 ownerlopemtor. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30
days of test date.
A. General Information
vacuity 7
Site Address: ,.~ -20o
Facility Contact Person:
Wk 3Vfoae Uonito g Sy m:
B. Inventory of Equipment Tested/Certified
T km: 7-'/-- //6o_%
I~-Tank Gauging Probe. Model:
ca Annular Space or Vault Sensor. Model:
I-I Piping Sump / Trench Sensor(s). Model:
ca Fill Sump Sensor(s). Model:
ca Mechanical Linc Leak Detector. Model:
I~'L~I~c Line Leak Detector. Model:
ca Tank Overfill I High-Level Sensor. Model:
ca Other (specify equipment type and model in Section E on Page 2).
ca Annular Space or Vault Sensor. Model:
ca Piping Sump I Trench Sensor(s). Model:
ca Fill Sump Sensor(s). Model:
ca Mechanical Line Leak Detector. Model:
,~q~rfecm~nic Line Leak Detector. -Model:-
ca Tank Ovenn. ll I High-Level Sensor. Model:
ca Other (Sl~cify equipment type and model in Section E on Pa~e 2).
spenser Containment Sensor(s). Model: L//~..
~a~ghe~ Valve(s).
I-1 Dis[~enser Containment Float(s) and Chain(s).
Containment '~onsor(s). Model:
J~"'Shear Valve(s).
ca Dispenser Containment Float(s) and Chain(s~.
Containment Sensor(s). Model:
ye(s).
caDispenser Containment Float(s) and Chain(s).
Bldg. No.:
City: ~:~/4 ~'~:/~[~-~ Zip:
co ta t (
ca Annular Space or Vault Sensor. Model:
ca Piping Sump / Trench Sensor(s). Model:
C) Fill Sump Sensor(s). Model:
ca Mechanical Linc Leak Detector. Model:
t~'~ectroulc Linc Leak Detector. Model:
I-I Tank Overfill I High-Level Sensor. Model:
r-t Other (Sl~cif~ equipment t]~ and mod~l in Section E on Page 2).
T ID:
~ ~~ll~' g Pmbe. Model:
r-t Annular Space~.,a~ Sensor. Model:
ca Piping Sump I Trench b'L, ns~. Model:
ca F'fll Sump S~sor(s). ~-,,,~odel:
O Mechanical Line Leak Detector. lVl~odef~l~l:~
r-t Electronic Line Leak Detector. M
rn Tank Overfill I High-Level Sensor. Model:
ca Other (specify equipment type and model in
Section E on
ca Dispen~'Containment Sensor(s). Model:
ca Shear Van~).
ca Dispenser Con~a~ment Fioat(sI and Chain(s).
Dispemer ID:
ca Dispenser Containment~"S~0,?r(s). Model:
ca Shear Valve(s).
ca Dispenser Containment Float(s) bl~ Chain(s).
ca Dispenser Containment Sensor(s). Mode~x,'
ca Shear Valve(s).
ca Dispenser Containment Float(s) and Chain(s).
*ffthe facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility.
C. Certification - I certify Ilmt the equipment identified in this document was impeetenYserviced in accordance with the manufacturers'
correct and, Plot Plan showing the layout of monRori~ ~ For any ~~.~.~ of generating such reports, 1 Imve ulso
aP, ached a copy of the report; ~ all ~ apply):. CTSystem set-up la"~~ report
Technician Name (print): /x'-~ ,,~.~ ~-'-,L.d Signature:
Ce .cation No.: Ucense. No.:
Testing Company Name: ~'-/~t2.~L~ ~'~T,~tg~ PhoneNo.:~r'~/
Site Addre~: /~"'~'~ <~-~5~'~:~O .~.~. / ,,~"~~
Page 1 of 3
Monitoring System Certification
D. Results of Testh~Servicing
Software Version Installed:
Corn !ete the followin checklist:
la~.es C3 No* Is the visual alarm operational?
l~'~Yes Cl No* Were all sensors visually inspected, functionally tested, and confirmed operational?
~es r~ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their proper operation?
C] Yes ~ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem)
I;~/A operational?
l~l'~es ~1 No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
~1 N/A monitoring system deters a le~, falls to operate, or is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check all that apply) 0 Sump/Trench Sensors; ~l~sl~nser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ~'s; I~1 No.
~ Yes ~ No* For tank systems that utilize the monitoring system as tbe primary tank overfill warning device (i.e. no
O~'IA mechanical overfill prevention valve is installed), is the oveffdl warning alarm visible and audible at the tank
fill point(s) and operating properly? If so, at what Percent of tank capacity does thc alarm triggcr? __ %
,l~es. I-t 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.
I-I Yes* I~1~1~o Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) 0'
Product; I~1 Water. If yes, describe causes in Section E, below.
4~l"~es ~ No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable
t.~l~yes I-I No* Is al,! monitorin~ equipment operational per manufacturer's specifications?
* In Section E below, describe how and when tlr-~e deficiencies were or will be corrected.
E.
Page2 of 3 03/01
F. In-Tank Gauging / SIR Equipment:
.~eck this box if tank gauging is used only for inventory control.
VI Check this box if no tank gauging or SIR equipment is insudlcd.
This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring.
Corn slete the following checklist:
~'~Y'es Vi No* H~s all input wiring been inspected for proper enU7 and termination, including testing for ground faults?
', vi No* Were aH tank gauging probes visually inspected for damage and residue buildup?
Yes vi No* Was accuracy of system product level readings tested?
~.Yes vi No* Was accuracy of system water level readings tested?
Y,~ vi No* Were all probes reinstalled properly?
Yes vi No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe how nmi when these deficiencies were or will be corrected.
G. Line Lenk Detectors (LLD): vi Check this box ifLLDs arc not installed.
Corn ~lete the foflowing checklist: ,
~Y'es vi No* Fo-r equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
vi N/A (Check all that apply) Simulated leak rate: ffl~g.p.h.g vi0.1 g.p.h: vi 0.2 g.p.h.
~es vi No* Were all LI.Ds confu'med operational and accurate within regulatory requirements?
l~""Yes vi No* Was the testing apparatus properly calibrated?
vi Yes vi No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
~es vi No* For electronic LLDs~ does the turbine automatically shut off if the II.D detects a leak?
.... vi N/A
~ Yes vi No* For electronic lJ.r)s, does the turbine automatically shut off if any portion of the monitoring system is disabled
vi N/A or disconnected?
~f"Yes vi No* For electronic LI.Ds, does the turbine automalically shut off if any portion of the monitoring system malfunctions
vi N/A or falls a test?
I~es vi No* For electronic 1J.Ds, have aH accessible wiring connections been visually inspected?
VI N/A
~es vi No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section Il, below, describe how and when these deficiencies were or will be correctetL
Page 3 of 3 0.V01
Monitoring System Certification
InstFuctions
If you already have a diagram that shows all required information, you may include it, rather than this page, with your
Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify
locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular
spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak
detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
was prepared.
Page __ of __ o~oo
SYSTat1 .SETUP
SEI:' 7. 2004
1:48 PM
SY~': '. UN I TS
U.~.
.SYSTEM
EP~3L I SH
SX~T~ ~TE/TIME FOR~T
~N DD ~Pl HH:~:~ xM
33U0 PLANZ RD
~Kg~FIELD OR 9:3309
b61 -~ 1-0606
~HIFT TI~E
SHIFT TIME 2 : DIBBLED
SH~FT TINE 3 :
SHI~ TI~E 4 : DI~L~
T~NK PE~ I OD 1C
D I SABLED
T~NK ~NN~L
D I ~BLED
LINE PERIODIC W~t41~
D 1 ~LED
L I NE ~NNU~L
D l
PR 1NT TC ~OL~
E~L~
T~ C~E~T I ON
V~LOE (DEG F ): 60.0
STICK HEIG~
DI~BL~
fl-PROTOCOL D~T~ FO~T
~ECIfllON T~T DOnaTiON
HOO~: 12
~YLIG~ ~VI~ TItlE
E~BLED
~R~T ~TE
APR ~EEK I SUN
6~RT T I ME
2:00 ~
END
O~ WEEK 6 SUN
E~D TIPE
2:00 ~
RE-D I RECT L~AL PR I NTO~
D 1SABLED
SYST~ SECUR I
CODE : 000000
C~IMUN I CAT I Otis SETUP
PORT SE'rT I Nc~:
CO~l"l BOARD : 3 (R'3-232)
BAUD RATE : 9600
PARITY : NONE
STOP BIT : 2 STOP
DATA LENGTH: 8 DATA
AUTO TRANSM I T S~FT I ~:
AUTO LEAK ~L~ET'I LIMIT
DISABLED
AUTO HIGH I~TER LIMIT
DISABLED
AUTO OVERFILL LIMIT
DISABLED
AUTO LOW PRODUCT
DISABLED
AUTO THEFT LIMIT
DISABLED
AUTO DELIVEE~ START
DISABLED
AUTO DELIVEr! END
DISABLED
AUTO EXTERNAL INPUT ON
DIF:~C~LED
AUTO EXTERI'~i. INPUT OFF
DISABLED
AUTO SENt30R FUEL ALSOft
DISABLED
AUTO SENSOR L~ATERRLARM
DISABLED
AUTO SENSOR OUT ALA~9
DISABLED
RS-232 SECURITY
CODE : 000000
ES-232 END OF M~E
DISABLED
II-TANK SETUP
T I:PLUS
PRODUCT CODE : 1
THERMAL COEFF :.000700
TANK DI~flETER : 96.00
TANK PROFILE : I PT
FULL VOL : 12000
FLO~T SIZE: 4.0 IN. 8496
I,J~TE~I~4RNING : 2.0
HIGH I~-tTER LIMIT: 3.0
MAX OR I../4BEL VOL: 12000
OVERFILL LIMIT :
: 10800
HIGH PRODUCT :' 95%
: 11400
DELIVER"/ LIMIT : 1
: 1200
LOW PRODUCT : 500
~ RLRIk~t LIMIT: 99
SUDDEN LOSS LIMIT: 50
TANK TII.T :- 1.30
MANIFOLDED TANI~S
T~: ~NE
LERK MIN PERIODIC: 10~
: 1200
LEAK M1N ANNUAL : 1~
: 1200
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC ]'EST FAIL
ALgAl9 DIBBLED
GROC~ TEST FAIL
ALARM DISABLED
ANN TEST A~ERAGING: OFF
PER TEb"T AVER~ING: OFF
TAN~ TEST NOT 1 FY: OFF
TN]{ T~ SIPHON BREAK:OFF
DELIVE~Z DELAY : 1§ M!N
T 2: UNLEADED
PRO'D~-~ CODE : 2
THErmAL ¢OEFF :. 000700
TANK D I ~E~ : 96. O0
T~NK P~FILE : I PT
FULL VOL : l~O00
FLOAT SIZE: 4.0 IN. 8456
WATER WARNING : 2.0
HIGH WATER LIMIT: 3.0
P~× OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
12000
lOBO0
11400
1200
LOW PRODUCT : §00
LEaK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 50
TANK TILT :- 1,10
MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC:
: 1200
LEAK M1N ANNUAL : I~W
: 1200
PERIODIC T~ST TYPE
STANDARD
ANNdAL TEST FAIL
ALARM DI,~BLED
PERIODIC TEST FaIL
ALARM DI.S~BLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST R~ERAGING: OFF
PER TEST AVEF~GIi~k3: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 15 HIN
T ~:PREMI~a
PRODUCT CODE : 3
THERHAL COEFF :.000700
TANK DIAMETER : 96.00
TANK PROFILE : I PT
FULL VOL : 12000
FLOAT SIZE: 4.0 IN. 8496
IAqTER ~RNING : 2.0
HIGH W~TER LIMIT: O.O
t'lFtX OR L~BEL VOL: 12000
OVERFILL LIHIT : 90%
: 10800
HIGH PRODUCT :
: 11400
DELIVERY LIMIT : 10~
: 1200
LOW PRODUCT : §00
LE~K ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 50
TAN~ TILT :- 0.90
MANIFOLDED TANKS
T#: NONE
LEAK M1N PERIODIC: 10~
: 1200
LEAK HIN ANNUAL : IOZ
: 1200
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST F~IL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TF-.ST FAIL
ALARM DISABLED
ANN TEST AVER~ING: OFF
PER TE~T AVERAGING: OFF
T~NK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 15 MIN
LEAK TEST METHOD
TEST ANNUALLY: ALL TANK
JAN WEEK I SUN
START TIME : 2:30 AM
TF_~ RATE :0.20 G~L.'HR
DURATION : 2 HOURS
LEAK TEST REPORT FORMAT
I,~IAL
WPLLD LINE LEAK SETUP
W I :91
P I PE TYPE: STEEL
LINE LENGTH: 100 FEET
O. 20 GPH TEST: DISABLED
SHUTDOWN RATE: 3.0 GPH
O. l 0 GPH TES~ MM,-DD
I?~TE : '?'..~.~ 0
TANK; NONE
W 2:87
PIPE TYPE: ~TEEL
LINE LENGTH: 100 FEET
0.20 GPH TEST: DISABLED
SHUTDOWN RATE: 3.0 GPH
O. 10 GPH TEST ~'I/DD
I~TE : ~?? 0
TANK: NONE
W ~:89
PIPE TYPE: STEEL
LINE LENGTH: 100 FEET
0.20 GPH TEST: DISABLED
SHUTDOWN RATE: ~.0 GPH
L I NE LEaK LOGKOUT .CjETUI"
LOCKOUT SCHEDULE
DALLY
START TIME: DISABLED
STOP TIME : DISABLED
~PLLD LINE DISABLE ~ETUP
W 1:91
LIQUID SENSOR ALMS
aLL:FUEL ALARM
W 2:87
LIQUID SEN~OR ~LMS
ALL:FUEL ALARM
LIQUID SENSOR ALMS
ALL:FUEL ALARH
aLaRM HISTORy REPORT
..... SENSOR ALARM .....
L I:DISP 1
DISPE~ER PAN
FUEL ALARM
SEP 7. 2004 1:44 PM
FUEL RLR~
SEP 7, 2004 1:37 PM
LIQUID SENSOR SETUP
L I:DISP 1
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L 2:DISP '2
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L 3:DISP 3
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PaN
SOFTWARE REVISION LEVEL
VERSION 15.01
SOFT~AREfl 346015-100-B
CREATED - 97.10.23.08.56
S-P~DULE# 330160-010-A
SVSTB~ FEATURES:
PERIODIC IN-TANK TESTS
ANNUAL IN-TANK T~STS
PRECISION PLLD
aLARM HISTORY REPORT
..... SENSOR RLRRI,I .....
L 2:DISP 2
DISPENSER PaN
FUEL ALARM
SEP 7, 2004 1:38 PM
L 4:DISP 4
TRI-STATE {SINGLE FLOAT)
CATEGORY : DISPENSER PaN
L 5:DISP 5
TRI-STATE (SINGLE FLOAT;
C~TEGOR¥ : DISPENSER PAN
ALARM H 1 STORY REPORT
..... SYSTEM ALARM .....
PAPER OUT
JAN 1, 1996 8:00 AM
PRINTER ERROR
JAN I, 1996 8:00 aM
BATTERY IS OFF
JAN 1, 1996 8:00 RI~I
L 6:DISP 6 '~--.-
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER
aL~i~i HISTORy REPORT
..... ~EI%~OR aLaRM
L 3:DISp 3 .....
DISPENSE~ PAN
FUEL ALa~-i
SEP 7. 2004 I:S8 PM
ALARM H I STORY REPORT
..... SENSOR ALARM
L 4:DISP 4
DISPENSER PAN
FUEL
SEP 7. 2004 1:38 PM
ALARM HISTORY REPORT
..... SENSOR ALA~H
~ 1:91
~PLLD SH~FD~N ~LM
~EF' 7, 2004 1:44
ALARM HISTORY REPORT
..... SENSOR aLARM
W ;3:89
~PLLD SHUTDOWN ~LI9
SEP 7. 2004 1:44 PH
ALARM H 1 STORY REPORT
..... SEN~OR ALARM
L 5:DISP 5
DISPENSER PAN
FUEL ALARM
SEP 7, 2004 1:39 PM
ALARM HISTORY REPORT
..... SEI%SOR ALARM .....
W 2:87
WPLLD SHUTDf~N ALM
~EP 7, 2004 1:44 PM
HOWaRDS
3000 PLRNZ RD
B~KERSF1ELD CA 93309
661-831-0606
SEP 7- 2004 1:49 PM
SYSTEM STATUS REPORT
ALL FUNC'TIOI%S NORMAL
MLARM HISTORY REPORT
..... SENSOR ALARM .....
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Wtthin the State of California
Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, C~lifornia Code of Regulations
This form must be used to docunmnt testing and servicing of moniloring equipment. A .sep0rate certification or r~oort must be orc~
for ,each monitorin~ system control panel by the technician who performs the work. A copy of this form must he provided to the tank
system owner/operator. The owner/operator must submit a copy of thi~ form to the local agency regulating UST systems within 30
days of te~t date.
A. General Information
Facility Name: ~ ~-[ .. ///~'~',~-~9,5 ~ ~/
B. ~ven~ of ~p~nt T~~r~
~ ~p~g S~ I T~ ~s). M~I:
~ Wdi S~ ~s). M~I:
~ M~ ~ ~ ~. M~I:
~~c ~e ~ ~r. M~: ~.
~ ~(~,~~~ ~~2).
~ ~ S~ ~ V~lt ~. M~I:
~ ~g S~ I T~ ~s). M~:
~ W~ S~ ~s). M~I:
~~c L~e ~ ~. M~I:
~ T~ ~! 1 ~1 S~. M~I:
~ ~ (~ ~.~t ~ ~d ~el ~ ~6on E ~ Pa~e 2). ,
.
V~v~s). '
~~ ~n~nt ~s). M~I: U J~ ....
~ V~s).
......
Bldg. No.:
City: ~ ~<~'~ ~:~,~c~, Zip:
Comet Phone No.: ( ~'~/1 ~'..~3 -- /~/
D~ ofTe~o~/~g: ~( /~/~
C. Certification. ! eenif~ that the equqmmt ~ ~ this ~ was ~- -~ in ammlan~ with the '~'~f~turers'
guld,,nn~_ Alladaed ~o this ~ is Intommlt~ (e.g. mnnuf__,~__a~m' eheekli~) neemsaty to verify that this information is
eorre~ ami a PI~ Plan showing ~ ~ ~~ ~ For any ~ such reports, I have also
atlm:hed a m~ ~f the relmrt;.~lm~ a//J~tt aPP/Y): ~'S~stem set-up
Technician Name (print): /~ OnJ ~",,L~ , Signature:
D. Results of Testin~Servicin~
SoRwam Version Inslalled: ~/ / .~,.~ !
~Ym ~ No* ~ ~ ~ ~ ~o~? .....
~Y~ u No* W~ ~ ~ ~ ~ ~~S ~ ~ ~ o~Uo~
~Y~ ~ No* W~ ~ ~ ~1~ at l°w~t ~t of ~ ~n~t ~ ~ifion~ ~ ~t'o~r ~p~n~ ~11
~ ~ ~ ~ ~ o~on? ,
~ Y~ ~o*
~ NIA o~o~?
~ ~.~ ~~~ ~ ~1 .f!~ ~ .~pl~t ~ ~ ~on ~ ~low.
* In Section E below, descrf~ how and when these defieieneles were or m3i be eorreet~
E. Comments:
.. ~- ~-o~ ~,~-~ D..~v~-~ p~ ~,~'~> ~ ~,. ~ _, c~.~..~
Page 2 of 3 03frO1
F. In. Tank Gauging I SIR Equipment:
~'Check this box if tank gauging is used only for inventory control.
. C] Check this box if no tank gauging or SIR equipment is installed.
This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring.
Cnm ,!~_te the [ollowin checkli.~t:
~Yes Cl No* Were all Lunk gauging probe~ visually inspected for damage and residue buildup?
j~-VeS I~ No* Wasaccuraeyofsys'~mPmductlev,elreadin§stested? ,.' ....
J~Yes C3 No* Was accuracy of system wa~ level readings tested?
Yes r-n No* Were all probes reinstalled prOPerly? ....
Y= O 'sa* w~'~u i.~ o... ~tmp.~a m~.~..~'s ~..~m~ Ch~:~,,~;mp! ,~i? .....
G. Line Leak Detectors (LLD): ~u'~h~k ~s box if ~ ~ not installed-
Corn dete the followin
~ ~A (Check all t~t apply) Si~ 1~ m~: ~ g.p~; ~ 0.1 g.p.h; ~ 0.2 g.p.h.
~V~ 0 No* W~~~p~y,~b~? , . ,
~ Y~ O No* F~ ~~ ~ d~ ~ ~ ~ct ~u~ flow if it d~ a
O~A
~v~ ~ ~o* ~ elam= ~.~"d~'~ ~ ~mo~y'~t o~if
~Y~ '~ No* ~ el~c I J.~ d~ ~ ~ a~~ly shut off ~ ~y ~on of ~ ~Mt~ng sys~ ~fio~
~ ~A orf~a~t?
~ Y~ ~ No* 'For'el~ I J ~ ~ve ~ ~ible ~g c°~fi~s
~ N/A
* In the Sectfon H, below, desc2'ibe how and whpn these deficiencies were or will be mrrected.
IL Comments: ~ /T~" ,f~,~.S ~/~c.~,~ ~, ~:~ ~_~/~ ~ ~c_7~ .~ ~ f~
Page 3 of 3 o.~ol
Monitoring System Certification
Sim Address:
UST Monitoring Site Plan
.................... ........................
L__~"~ ........................
::::::::::::::::::::::::::::::::::::::::::::::::::
::::::::::::::::::::::::::::::::::::::::::::::::::::
!!!!!i :::::::::::::::::::::::::::::::::::::::::
lnstFuctions
If you already have a diagram that shows all required information, you may include it, rather than this page, with your
Monitor/nE System Cert/ficatio~ On your site plan, show the general layout of tanks and p/ping, Clearly identify
locations of the following equipment, if installed: monitoring system control panels; sensors monitoring .,nk annular
spaces, sumps, dispenser pans, spill containers, or oth,~ sooonda~ Ooutainment aroas; m~hanical or electronic line leak
dctcciors; and in-tank liquid l~vel probes (if used for leak de~ection). In tho spac~ provided, note the date this Site Plan
was prepar~
Page __ of__ oS/Oo
SA'STEM SETUP
AUG !!, 2004
SYSTEM UN I TS U.S.
ENOL I SH
~t'STFJ'I I~TE/TIME FOI~IAT
MON DD '~' HH:MM:SS xl'l
HoIAqRDS MI NI --M~
:3200 PANA~ LN.
BAKER~FI ELD CLq.
805-83:3-
SHIFT TIHE I : 6:00
SHIFT TIME 2 : DI.,~qBLED
SHIFT TIME :3 : DISRBLED
SHIFT TIME 4 : DI.,~qBLED
T~NK PF~IODIC t4ARNINGS
D I
TANK ANNUAL t4ARNING~
D I I~BLED
LINE PERIODIC
DISABLED
LINE ANNUAL I~qRNIN(~
D I SABLED
PRINT TC VOLU~ES
ENABLED
TEHP CO~IPENS~T 1 ON
VALUE (DEG F ): 60.0
ST I CK HE IGHT OFFSET
D I ~qBLED
H-Pi~TOCOL DATA FORMAT
PREC I S [ ON TEb-~ DUi~AT l ON
HOIJ~9: 12
~%'LIGHT .~%VtNG TI{'IE
EN~J~LED
~PR t~EEK I SUN
START TIME
2:00 ~
END DATE
OCT [~EEK 6 9UN
END TIHE
2:00
RE-DIRECT LOCAL PRINTOUT
01SRBLED
SYSTEM SECUR I TY
CODE : 000000
I N-TAmP
T i: UNL. PLt~
PRODUCT CODE : 1
THEI~'tAL COEFF :. 000700
TANK D I ~ : 95.50
TAN{( PEOFIL£ : I PT
FOLL VOL : 12000
FLORT SIZE: 4.0 IN. 8496
I,~qTER IAeh~N 1NG : 2.0
HIGH I,iRTER LIMIT: 3.0
MF~ORLABELVOL: 12000
OVERFILL LIMIT :
: 11400
HIGH PRODUC~ : 97%
: 11640
DELIVERY LIMIT :
: 600
LO,J PRODUCT : 500
~ ALAl~ LIMIT: 99
SUDDEN LOSI~ LIMIT: 50
TAN]( TILT : 2.71
H~NIFOLDED TANKS
T#: NONE
LEAl< MIN PERIODIC:
: 1200
LEA~MIN ANNUAL : lO~
: 1200
PERIODIC ~ TYPE
STAND/~D
ANNL~L TI~'T FAIL
RLREttDI~LED
PERIODIC TE.G~ FAIL
ALAR~DI~qBLED
GROC,:,:,:,:,:,:,:,:,~3TE~T FAIL
~ DIF~qBLED
ANN TE~T A~IN(]: OFF
PF_.~TE.b-'T AVE. RAOINO: OFF
TANK TE~T NOT I F%': OFF
· .-~I, NK~ ~~: OFF
DELIVERY DEL~Y : 15
T 2:UNLF-~DED 1
pRODUCT CODE : 2
THERM~L~ :.000700
TANK DIAHETER : 95.50
TANK PROFILE : I PT
FULL VOL : 12000
FLOAT SIZE:
4.0 IN. 8496
MATER I~qRNING : 2.0
HIGH t4RTER LIMIT: 3.0
MP~OR~EL VOL: I2000
OVERFILL LIMIT : 9..5~.
: 11400
HIGH PRODUCT : 97~
: 11640
DELIVEI~ LIMIT : 5~.
: 600
LOI~ PRODUCT : 500
LE~K RI.~ LIMIT: 99
SUDDEN LOS~ LIMIT: 50
TAI~PK TILT : 2.16
HRNIFOLDED TANKS
T~: NONE
LEic~ MIN PERIODIC:
: 1200
LEAK HIN ~NNU~L : 1~4
: 1200
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FA 1L
ALARM D I SABLED
PERIODIC TF_~T FAlL
ALAEM DIBBLED
GROSS TEST FAIL
a[.qRH DISABLED
ANN TEST AVERAGING: OFF
PER TE._qTAVEERGING: OFF
TAI~. TEST NOTI~/: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DEL~Y : 15 MIN
T 2 :DI~F.L
PeODUCT CO~ 3
THEI~IP, L COEFF :. 000450
TANK DIt~fl'IETER : 95.50
TANK PROFILE : I PT
FULL VOL : 12000
FLOAT SIZE: 4.0 IN. 8496
W~TERWA~NII~ : 2.0
HIGH WATER LIMIT: 3.0
MAN ORLABELVOL: 12000
OVERFILL LIMIT :
: 11400
HIGH PRODUCT :
: 11640
DELI~FJ~ LIMIT :
: 600
LOM PRODUCT : 500
LEAK RLRRMLIMIT: 99
SUDDEN LOS~LIMIT: 50
TANK TILT : 2.54
MANIFOLDED
T~: NONE
LEAK MIN PERIODIC: 10~
: 1200
LF./~HIN ANNUAL : 10~.
: 1200
PERIODIC TEb-'T TYPE
ANNUAL TEST FAIL
ALARM D I,~qBLED
PERIODIC TEST FRIL
RI..qR~ D ISRBLED
GROSS TEST FAIL
ALfg~ DI E;f~L~
ANN TE/~'T ~VE]a./:~ I i~: OFF
PFJ~ ~ AVF..6cg) I NG: OFF
TANK TEST NOT I FY: OFF
TNK TST S I PHON BREAK: OFF
DELIVERY DELAY : 15 MIN
T 4:PREM. UNL.
PRODUCT CODE---'7~. _ 4
THERMAL COEFF :. 000700
TANK D I f~IETER : 95.50
TANK PROFILE : I PT
FULL VOL : 12000
FLOAT SIZE: 4.0 IN. 8496
i~A'I'I~ b/~,RN I N~ : 2.0
HIGH WGTER LIMIT: 3.0
~ OR LABEL VOL: 12000
OVERFILL LIMIT :
: 11400
HIGH PRODUG~ :
: I 1640
DEL I VE]~/ LIMIT :
: 600
LOW PRODUCT : 500
~ RL~qRM LIMIT: 99
SUDDEN LO~LIMIT: 50
TANK TILT : 2.58
M~NIFOLDED TANKS
T#: NONE
LERKMIN PERIODIC:
: 1200
L6qKMIN ANNUAL :
: 1200
PER [ OD I C TEST TYPE
STANDARD
ANNUAL TEI3T FAlL
~ D I SRBLED
PERIODIC TEST FAIL
~LARM D I..~qBLED
0R0~3~3 TEST FA 1L
RLa%~M D I.~qBLED
ANN TEST ~VEPa~G; I NG: OFF
PER TE~3T /aVEPdq~ I NG: OFF
TANK TE~T NOTIFY: OFF
TNK T~T SIPHON BREAK:OFF
DELIt.'E]~ DELAY : 15 MIN
WPLLD LLY~~ ' ~^v SETUP
W I :UNL.PLUS
P I PE TYPE: STEEL
LINE LENGTH: 100 FEET
O. 20 ~PH TEST: D I SRBLED
SHUTDOWN RATE: 3.0 GPH
O. lO GPH TEST MM/DD
DATE : ~ 0
T I :UNL.PLLIS
D I BPEN~E MODE:
STANI~RD
W 2:UNLEADED I
P I PE TYPE: STEEL
LI NE LENGTH: 200 FEET
O. 20 GPH TEST: D I SABLED
.c:HUTDOWN PATE: 3.0 GPH
O. 10 GPH TE6~ MM/DD
DATE:'?'?"? 0
T 2:UNLEADED 1
D I SPENB~E MODE:
W 3:DIESEL
PIPE TYPE: 5TEF_.L
LINE LENGTH: 200 FEET
0.20 GPM TEST: DI.~C~BLED
SHUTIX)WN PATE: 3.0 GPH
O. 10 GPH TE~T
DATE : 'FF? 0
T 3 :DIESEL
D I SPENSE MODE:
STANI)~WD
TE/rI'MONTHLY : ALL TANK
WEEK 1 SUN
START TIME : 2:00 AM
TEBT RATE :0.20C-LAL/HR
DUI~TION : 2 HOURS
W 4: pRB'I. UNI~-
PiPE TYPE:
LE r.:
0.20 OPH ~:
BB~N ~; 3.o
0.10 GPH ~ ~DD
~ :~ 0
T 4;P~. O~.
D I~PE~E ~DE
LINE LERK LOCKOUT SETUP
~O~KOUT SCHEPUL£
D~IL¥
STRRT TIME: D1F~BLF-D
iBTOP TIME : DISABLED
LI(aUID SEN~R)R SETUP
L 1 :PLU~
TRI-gT~TE (SINGLE FLO~T)
CRTEGORY : DISP£N~ER PAN
L 2:UNL (SINGLE FLOAT)
TR I -sTATE
CATEGORY : DlgPENSER PAN
L 3 :PREM
I--~TATE (SINGLE FLO~T)
~C_~EOOR¥ : DIgPENSER PAN
L 4 :DIESEL
I STi~TE (SINGLE FLOAT)
TR - . NSER PAN
~T~ - DISPE
L :UNL
CATEGORY
L 6:pLUS (SINGLE FLOAT)
TRI-STAT£. Di~P£N~ER PAN
L 7':PLUS
TRI-STATE (SINGLE FLOAT)
CF~TEOORM : DI~P~:~I~- PAN
L 8:UNL
TRI-I~rATE <SINGLE FLO~T>
CATE~OR~ : DISPENSER PAN
L 9:PREM
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
LIO:DIESEL
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENI~ER PAN
LII:UNL
TRI-gTATE (SINGLE FLOAT)
CATEGORY : DISPEt4~ER PAN
LI2:PLi.~
TRI--~fATE (SINGLE FLOAT)
CAT£GORY : DISPENBER PAN
~OFTMPd~ REVISION LEVE
VER~ I ON 15.01
SOFThlqRE# 346015-100-B
CRE~TED - 97.10.23.08.
S~D~ 330160-0i0~
~ ~TU~:
P~IODIC IN-TA~ T~'
ANN~ I N-TA~ T~S
pR~ISION PLLD
HOMARDE;MINI-HART
3200 PANI~a~qLN-93312
BAKERSFIELD CA.
805-833-1561
AUG 11, 2004 10:16
AL/. FUNCTIONI~ NO~
SETUP
SEP 3, 2004 8:53 RM
SYSTEM UNITS
ENGL I SH
S¥6"rEM D~TE/TIHE FORMAT
HON DD YYYY HH:HM:~ xM
HOtAqRD~ M I NI --M~d~T
-3200 PAl~C~ LN.93312
B~KERSF I ELD CR.
805 -833-
SHIFT TIHE I : 6:00 Riff
SHIFT TIHE 2 : DIBBLED
SHIFT TIHE 3 : DIS~BLE~
SHIFT TIME 4 : DIEa~LBLED
TANK PERIODIC WRRNI~
DISABLED
TANK ANNIJ~L
DISABLED
LINE PERIODIC IA~RNING~
D l
L [ NE ANNUAL W/4RN I
D I SRBLED
PRINT TC VOLUMES
ENABLED
TEMP COMPE~TI ON
VALUE (DEG F ): 60
STICK HEIGI-rr OFFSET
D [,SRBLED
H-PROTOCOL DATA FORMAT
HEIGHT
PRECISION TEST DURATION
HOUE~: 12
DAYLIGHT E~V[NG TIHE
Ei~BLED
b-'TART D~TE
APR WEEK I SUN
b-'TART TIHE
2:00
END I)~TE
OCT WEEK 6 SUN
END TIME
2:00 ~M
RE-DIRECT LOC~ PRINTOUT
DISABLED
b-~-"T E M SECURITY
CODE :' 000000
COf~flUN I~T I O~ SETUP
PORT SETTINGS:
COHMBO~RD : I (R~-232)
B~UD P~TE : 9600
PARITY : NONE
f~l'OP BlT : I STOP
D~TA LENGTH: 8 DATA
AUTO TRANEiHIT E~ETTINGB:
AUTO LF_,n~ ~ LIMIT
D I I~ABLED
AUTO HIGH W~TER LIMIT
DISABLED
AUTO OV~FI~ LIMIT
DI~
R~O L~ P~D~
D I ~LED
A~O T~T LIMIT
D l ~LED
n~o D~ I V~ ~T
A~O D~ I ~ END
D I ~BL~
A~O ~~ I NP~ ON
DI~
A~O ~~ I NP~ OFF
DI~
R~O SE~ F~ ~
DI~L~
DI~L~
A~O 8E~OR O~ ~
D I ~L~
]~-232 SECURI'I~
CODE : 000000
RS-232 END OF M~E
DISABLED
IN-TANK SETUP
T I:UNL.PLUS
PRODUCT CODE : 1
THERMRLCOEFF :.000700
TANK DI¢~IETER : 95.50
TANK PROFILE : I PT
FULL VOL : 12000
FLOAT SIZE: 4.0 IN. 8496
W~TERWARNING : 2.0
HIOHW~TER LIMIT: 3.0
HRXORLRBELVOL: 12000
OVERFILL LIMIT : 95%
: 11400
HIGH PRODUCT : 97%
: 11640
DELIVERY LIMIT :
: 600
LOll PRODUCT : 500
LE. RKRLRRMLIMIT: 99
SUDDEN LO~SL1MIT: 50
TANK TILT : 2.71
MANIFOLDED TANKS
T#: NONE
LE, AK MIN PERIODIC:
: 1200
~ BIN ANNUPJ- : 10%
: 1200
PERIODIC TEST TYPE
STAND~RD
ANNUAL TEST FAIL
RI_~RM DISABLED
PERIODIC TF-~T FAIL
RLRRH DI~BLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERRGI NG: OFF
PER TEST AVEERGI NG: OFF
TANK TI~3T NOTIFY: OFF
TNK TST SIPHON BRERK:OFF
DEL I VERY DELAY : 15 M I N
T 2: UNLEADED !
PI~DUCT CODE : 2
THERHAL COEFF :. 000700
TAI~ DIAMETER : 95.50
TAI~ PROFILE : 1 PT
FULL VOL : 12000
FLOAT SIZE: 4.0 IN. 8496
/4q TEA /,4~RN I b~ : 2.0
HIGH klRTER LIMIT: 3.0
M~X OR L~BEL VOL: 12000
OV~FI ~ LIHIT : 9~
: 11400
H I GH PROD~ :
: I 1 ~40
D~IVE~ LIHIT :
: 600
LO~ PROD~ : 500
L~K ALa~ LIHIT: 99
~UDDEN L~ LIHIT: 50
T~ TILT : 2. l
~N I FOLDED
Ta:
LE~K MIN PERIODIC:
: 1200
LEAK MI N ANNUAL : 1
: 1200
PERIOD I C TEST TYPE
STANDARD
ANNUAL TEST FA I L
AI..~EM D I SRBLED
PERIODIC T~ F~IL
R~ D I ~L~
~ ~ FR I L
~ DI ~B~
~NN T~ ~V~ I ~: O~
P~ ~ ~VE~ I ~: OFF
TR~ ~ ~TI ~: O~
T~ ~ SIP~N B~:OFF
D~IV~ D~Y : 15 MIN
T 3 :DIESEL
PRODUCT CODE : 3
TI-IERHRL COEFF :. 000450
TANK DIAl'S'TEA : 95.50
TANK PROFILE : I PT
FULL VOL : 12000
FLOAT SIZE: 4.0 IN. 8496
[4qTER ~a, RN i NG : 2.0
HIGH 14~TER LIMIT: 3.0
~ OR LABEL VOL: 12000
OVERFILL LIMIT :
: 11400
HIGH PRODUCT : 97~
: 1 1640
DELIVERy LIMIT :
: 600
.e;aK 014 PRODUCT : 500
AL~ LIHIT: 99
-~UDDEN LOBS LIMIT: 50
T~qNK TILT : 2.54
HRNI FOLDED TANKS
T#: NONE
~ HIM PERIODIC:
: 1200
LF. qK MIN ANNUAL :
: 1200
PERIODIC TEST T~PE
b"TAND~RD
ANNtb:kL TEST FAIL
AL~EH D I~BLED
P~IODIC T~ F~IL
O~ T~ F~ I L
~ DI~BL~
~NN ~ ~ I ~: OFF
P~ ~ ~V~I ~: OFF
T~ T~ {~TI~: O~
T~ ~ B I P~N B~K: OFF
D~IV~ DE~V : 15 HIM
T 4:PREH. UNL.
PRODUCT CODE : 4
THERHRLCOEFF :.000700
TANK DIAHETER : 95.50
TANK PROFILE : I PT
FULL VOL : 12000
FLO~T SIZE:
4.0 IN. 8496
t, JATERi~qRNING : 2.0
HIGH tdATER LIMIT: 3.0
MA><ORLABELVOL: 12000
OVERFILL LIMIT : 95%
: 11400
HIGH PRODLICT :
: 11640
DELIVERY LIMIT :
: 600
LOt,{ PRODUCT : 500
LF~ A~ LIMIT: 99
BUDDEN LOSS LIMIT: 50
TANK TILT : 2.58
I'~NIFOLDED TANKS
T#: NONE
~ HIN PERIODIC: 1~
: 1200
LF~K MIN ANNUAL : l lY,~.
: t2OO
PERIODIC TEb-'T TYPE
STANDARD
ANNLIRLTEST FAIL
AL/M~ DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROE~f3 ~ FAIL
~ DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BRE~K:OFF
DELIVERY DEL.AY : 15 HIN
LE~ TEST METHOD
TEEiT MONTHLY : ALL TANK
~ I SUN
'START TIHE : 2:00 ~
TEST RATE :0.20 GAL/HE
DURATION : 2 HOURS
l:av T~.C[T ~]D'{' FORMAT
I~PLLD LINE LEAK SETUP
Ig I :UNL.PLUS
P I PE T~PE: STEEL
LI NE LENGTH: 1 O0 FEET
0.20 GPH TI~'T: DIBBLED
SHOTDOI~N ~: 3.0 CPH
O. 10 GPH T~ ~DD
D~TE : ~ 0
T I :U~.PL~
DI~PE~E ~DE:
~AN~D
~ 2:UNLEADED I
PIPE TYPE: STEEL
LINE LENGTH: 200 FEET
0.20 GPH TEST: DISABLED
SHUTDOIgN RATE: 3.0 GPH
0.10 GPH ~ H H/DD
DATE : 9?? 0
T 2:UNLEADED 1
DISPENSE H ODE:
STANI~qRD
~ 4:PREH.UNL'.
P I PE TYPE: STEEL
LINE LENGTH: 200 FEE~
0.20 GPH TEST: D I S°,BLED
SHUTDOWN l;bqTE: :3.0 GPH
0.10 GI:'H TEST PIM~DD
DATE : "~.-_? 0
T 4:PREN. UNL.
D I b-~EI~E MODE:
STAND~RD
LINE LE~K LOCKOUT SETUP
LOCKOUT SCHEDULE
DAILY
START TIPIE: DISABLED
STOP TIPIff : DI,~qBLED
LIQUID BENBOR SETUP
L I:PLU~
TRI-STATE (SINGLE FLOAT)
CATEX~I~ : DISPENSER PAN
L 6:PLUS
TRI-STATE {SINGLE FLOr:t3
CATEGORY : DISPENSER
L 7: PLU..q
TRI---~TATE (SINGLE FLO~T
CATF. GORy: DISPENSER
L 8:UNL
TRI-WI'ATE (SINGLE FLO~T)
C~TEGORY : DISPENSER PA~
L 9: PREPI
TR I -b--'TATE (S INGLE FLOAT )
CATE, GORY : DISPENSER PAN
LIO:DIEBEL
TRI-STATE (SINGLE FLOAT>
CATEGORy : DISPENSER PAN
LII:UNL
TRI-STATE (SINGLE FLOAT)
C~qTEGOR¥ : DIBPENSER PAN
LI2:PLUB
TRI-STATE (BINGLE FLOAT}
C~T£G;ORY : DISPENSER PAN
L 2:UNL
TRI-STATE (SINGLE FLOAT)
C~TEC~RY : DISPENSER PAN
W 3:DIESEL
PIPE TYPE: STEEL
LINE LENGTH: 200 FEET
0.20 GPH TEST: DISABLED
SHUTDO{AN RATE: 3.0 GPH
0.10 OPH TE!3T HH/DD
I~TE : ~ 0
T 3:DIEBEL
DIBPENSEHODE:
b--~ANDARD
L 3:PREH
TRI-b-'TATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L 4:DIF_~EL
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L 5:UNL
TRI-STATE (SINGLE FLOAT)
C_,RTEC~R¥ : DISPENSER PAN
L 3 :PREM
DISPENSER P~N
FUEL ~LRRM
-qEP 3. 2004 8:59 Riff
WPLLD LINE LF~K
W I:UNL.PLU~
WPLLD,RHUTDOMNAI..M
`REP 3. 2004 8:59
LINE LEt~KsqLt~F~'I
2:UNLF_.,t:~ED ]
~PLLD,RHIJT[K)I4N AUff
3. 2004 9:09 t.~l
L 4:DIESEL
D1,RPENSF_.~ PAN
FUEL RL~EM
~EP 3. 2004 9:11
b-'TORY REI>ORT
..... SENSOR ~ .....
W I:UNL.PLUS
IdPLLD ,RHUTDOWN RI.Iff
`REP 3. 2004 8:59 f~
WPLLD ,RHUTDOIdNt~LH
mUG 11. 2004 10:26
klPLLD ,RHUTDOIdN AL. PI
RPR 20. 2004 6:09 PM
~PLLD LINE LF_.aJ( ~
~ 2:UNLERDED 1
~pLLD ,RHUTDOIdN RUff
`REP 3. 2004 8:59
~"- ,RENSOR
LIO:DIESEL
D I SPENSER PAN
FUEL RLa. RH
3. 2004
WPLLD LINE LEP, K P, Lt~i;~I
~ 3:DIESEL
WPLLD,RHUTDOIdNRLPi
`REP 3. 2004 8:59 t:~l
[4PLLD LINE LERK ~LREP!
~ 4:PREPI.UNL.
BPLLD ,RHUTDOWN RLPI
SE.P 3. 2004 8:59
~HINI-IfRRT
3200 PANt:e,I~ LN.93312
BRKEI~FIELDCR.
805-833-1561
`REP 3. 2004 9:14
SYSTEM STRTUS REPORT
Id I :[dPLLD ,RHUTDOIdN Pd. Jf
Id 2:klPLLD SHUTDOIdN
I,d 3:klPLLD SHUTDOIdN t~LPI
Id 4:IdPLLD ,RHUTDOIdN RLPI
STORY REPORT
,RENSOR RLREP1 .....
Id 2:UNLF_.RDED l
IdPLLD ,RHUTIX)klN Pg..M
`REP 3. 2004 9:09 t-~
EpLLD SHUTDOIdN ALH
3, 2004 8:59 RM
tdPLLD SHUTDOMN RI,Iff
AUG ti. 2004 10:26 Rtl
..... ,RENSOR RLRRPI
L 9 :PREH
D I SPENSER P~N
FUEL t~Lf~RP!
SEP 3. 2004 9:09 ~
~PLLD LINE DISABLE
~ I: UN[..
I N-T~NK
T I :LEAK AI..FI~
LIQUID ~ENSOR
~ 2: U~
T 2:L~
LIQUID
~: FU~
~ 3:DI~
I N-T~
T ~ :L~
LIQUID SE~R
~ :F~L
~ 4: PR~
T
LIQUID
~L :FU~
RL~LRP{ HISTORY REPORT
IN-TANK ~
T I:UNL.PLUS
SUDDEN LO~P~
MAY 28. 2003 10:28 AM
INVALID FUEL LEVEL
MAR 4. 2002 6;28 1~
NOV 19. 2001 6:07 &,PI
NOV 12, 2001 4:40 PM
PROBE OUT
MAY 28. 2003 10:20 AM
LOW TEMPWRRNI~
28, 2003 2:17
ALARM HISTORY REPORT
IN-TANK AI..qRM ---
T 3:DIEI{EL
HIGH W~TER~I. ARH
JAN 3. 2001 4:35 AM
SUDDEN LOSS f~cAPJ'm
HRY 28. 2003 12:16 PPi
HRY 28. 2003 9:18 AM
AUG 5. 2002 5:11 PM
INVALID FUEL LEVEL
APR 17. 2003 11:58 AM
MRR 29. 2003 11;39 RM
AUG 17. 2002 10:17 AM
PROBE OUT
I~[q¥ 28. 2003 9:18
JAN 3, 200l 2:09
JRN 3. 2001 9:27
HIGH t4qTER i4qRNING
JAN 3, 2001 4:35 miff
LOW TEMPWRRNING
MAY 28, 2003 12:13
SOF'I3~RE REVISION LEVEL
VE. EE{ION 15.01
SO~# 346015-100-B
CREATED - 97.10.23.00.56
S-HODULElt 330160-01
SYSTEH FF_~TURES:
PERIODIC IN-TANK TESTS
ANNLtqL IN-TANK TES'~
PRECISION PLLD
RLARH HISTORY REPORT
..... S¥STEM PJ. A R~ .....
PAPER OUT
AUG 7. 2004 12:11 ~
PRINTER ERROR
RUG ?. 2004 12:11 AM
BATTERY IS OFF
JAN 1. 1996 8:00 PJ'!
SVS SECUEITVI~RNING
{"IR¥ 14, 1999 11=28 AM
HIS'TORY REPORT
.... I N-TANK AI~ .....
T 2:UNLF. ADED I
OVERFILLALAEM
MAY 6. 2004 8:21 PM
MAY 19, 2003 9:07 ~
MAY 16, 2003 3:27 PM
AUG 11, 1998 5:12 PM
HIGH PRODUCT ALARM
NOV 13, 2002 12:11 PPi
M~¥ 16. 2000 10:15 PM
~PR 23, 2000 7:37 AM
INVALID FU~ ~EL
~ 7. 200~ 10:52 ~
~V 21. 2~03 6:31 ~
~V 20. 2003 12:17 ~
PROBE OUT
I'~¥ 28. 2003 9:51 AM
DELIVEY~ NEEDED
SEP 13. 2002 5:27 PH
JUN 20. 2000 11:03 AM
JUN 5. 2000 8:30 AM
ALARM HISTORY REPORT
..... BENE~R ~ .....
L I :PLUS
D l SPENSER PAN
FUEL
AUG 11o 2004 10:26 AM
SENSOR OUT
AUG 13. 2003 9:16 AM
FUEL ~
JUL 24, 2003 5:14 PM
,qI~RH {-ill,TORY REPORT
..... SENSOR ALAI~ .....
t~ {] :DIESEL
WPLLD SH~N ~
~EP 3. 2004 8:59 ~
~PL~ BH~N ~
R~ 11. 2004 10:26 ~
NPL~ SH~N R~
~R 20. 2004 6:09 ~
Rl.aq{~ HISTOI~! REPORT
SENSOR RLRP, M .....
L 2:UNL
D I SPENSER PRN
FUEL RIJ~RH
RUG lt. 2004 10:26 PPI
SENSOR OUT
RUG 13. 2003 9:16
FUEl.. RI.REH
JUL 24, 200,3 5:15 PPI
HISTORY REPOK:'T
SENSOR RI~l~
L 4 :DIESEL ~ ....
D I SPENSER PRN
SENSOR OUT RLRRI'I
RUG 13, 2003 9:16 ~
FUEL RL. RRP1
JUL 24. 2003
RLRRH HISTORY REPOI;FI'
..... SENSOR ~-~I..~EH .....
W 4:PEEH.UNL.
WP~SHU'rDOI4N
SEP 3, 2004 8:59 P~I
OROSSLINE FRIL
RUG 26, 2004 5:56
WPLI..D SHUTDOi4N_~LH
RUG ti, 2004 10:26 I~l
~LPJ~ HISTORY REPORT
..... SENgOR
L 3:PREH
DISPENSER PRN
SENSOR OUT
RUG 13, 2003 9:16 Piti
FUEL ~
JUL 24, 2003 5:16 PPi
,qLR{~ H ISTOF~ REPORT
SENSOR Rl..P,R~fl .....
L 5:Ult..
DISPENSER PRN
FUEL RLRI~
RUG 11, 2004 10:28 AH
S 0 0
FUEL Pd..~l;~
JUL 24. 2003 5:21 1:~
END x )~ ~ )~ ~
RI.RRM H ISTOE~~ REPORT
..... SENSOR ~ .....
L 6 :PLUS
D I SPEN~ER PAN
FUEL RL/:6~
RUG Il. 2004 10:28 RM
SENCA)R OUT ~
AUG 13. 2003
FUEL/:~RRM
JUL 24, 2003 5:22 PM
HISTORY REPORT
..... SENSOR Ri. ARM
L 8:UNL
DISPENSER PAN
FUEL RLREM
RUG lt. 2004 10:28 PJ'l
SENSOR OUTALREM
AUG 13. 2003 9:17 AM
FUEL ~
JUL 24,. 2003 5: 24 I'M
P~RM HISTORY REPORT
..... SENSOR RLARM ....
LI I :UNL
DIESPENSER PRN
FUEL ~
RUG II, 2004 10:27
SENSOR OUT RLRRH
AUG 13. 2003 9:
FUEL RLARM
JUL 24. 2003 5:26 PM
ALARM HISTORY REPORT
..... SENSOR~ .....
L ?:PLIJ~
DISPENSER PAN
FUEL RI.~RM
RUG 11o 2004 10:26 ~
SENSOR OUT ALAI~
AUG 13. 2003 9:17
FUEL
JUL 24, 2003 5;24 PM
RLARM HISTOR¥~REPORT
..... SEf/b-'OR~ ......
L 9:PREM
DISPENSER PRN ~
FOELRL~RM
JUL 24, 2003 5:26 PM
END )/ )~ ~ * ~
~ HISTORY REPORT
SENSOR~RM .....
LI2:PLUS
DISPENSER PRN
FUEL/:~ARM
RUG 11. 2004 10:27 RM
SENSOR OUT AlaRM-
RUG 13. 2003 9:17 A~'I
FIJELRI~RM
JUL 24. 2003 5:27 PM
RI. RRM HIS~rORY REPORT
SENSOR RL~J~I .....
LIO:DIESEL .
FUEL RI..~RM
APR 20. 2004 6:09 PM
SENSOR OUT ALARM
AUG 13. 2003 9:
FUEL
JUL 24, 2003 5:19 PM
FR'r
BKSFLD FIRE pREVEHTIOH
,. .. ~ .!.
CITY OF BAKERSFIELD;
OFFICE OF ENVIRONMENTAL . . '.
1'/15 Chester Ave., Bakersfield, . ..
APPLI CATION TO PERFORM ·
'i!':;:!' ..i" :';:::;. ";'' '. : .'~ i.
FUEL. MONITORING CERTIFICATION.
............... ~ - - ....................... ~"
. ..'....?': .:i.,. ~ .'i: '.~.~:::!:.'-. '
N ,or ~, ~,~A~A~~ ......
~o=~^c~~',~~~~ ~~ ~o .....
, '.: := :.::..~
TANK ~ VOL~ ~ ~~T,$"'::; ' . ,.
,, .____..::..::-;.': .,.~:;:. _ ..
~ ,,. , .... ~....=~.. ~::..,..,.....:. .. :~.~
. . r.:. ,.... ~:
=. ~ ~ .. .... ~ __, _ q .. ~.:.: '.: ,::,.;.: ..... .: ~..
o;Co~=~-0~L ~~~{;~:~~"
. ] :' . ~i'::.'~
'
~0~ ~Y DA~
7'an
PURPOSE: COMPLIANCE
TEST DATE: 07113/04
CLIENT: VALERO
685 WEST THIRD ST
HANFORD, CA 93230
Sandy Huff
(559)583-3298
1
89 4 PLUS
20k 6 DIESEL
20k 7 DIESEL
TANKNOLOGY CERTIFICATE OF TESTING
8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757
TELEPHONE (512) 451-6334 FAX (512) 459-1459
TEST RESULT SUMMARY REPORT
WORK ORDER NUMBER: 3135565
CUSTOMER PO: '
SITE: ULTRAMAR 074
3225 BUCK OWENS BLVD.
HWY 991HWY 58
BAKERSFIELD, CA 93301
Manager
(661)324-9481
TEST TYPE: TLD-I
· Product Pipe Tightness Test Results
D. ~ZBERG PRESSURE P 0,00~
D. ~ZSERG PRESSURE P 0.006
D. ~ZSERG PRESSURE P P ~ P 0.003 0.003 0.003 o.oo9
DW FIBERG PRESSURE P P '0.003 0.014
Y
Y
Y
Existin Line Leak Detector Test
r89 4 RED JACKET FXiV 111796 P
20k 6 RED JACKET FX2-DV 21199 9638 P
20k.. 7L RED JACKET FX2-DV 4120 4744 P
New Re )lacement Line Leak Detector Test
RED JACKET FX1-DV · 10304 8268
For owner dctailcd report information visit www.tanknology.com and select On-Linc Reports-WRAP, or contact your local Tanknology office.
Tester Name: WILLIAM ROGERS
Technician Certification Number: 1647
Printed 07/27/2004 15:32 KOHLMEYER
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
TEST DATE: 07/3.3/04 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER~3-35565
CLIENT:VALERO AUSTIN, TEXAS 78757.(512) 451-6334 SITE:ULTAAMAR 0'74
Tank ID: 8'7
Product: OZ~E,~ED
Capacity in gallons: 14,139
Diameter in inches: 95. oo
Length in inches: 33'7
Material: DW STEE~.
Tank manifolded: NO
Vent manifolded:
Vapor recovery manifolded:
Overfill protection: YZS ·
Overspill protection:
Installed:
CP installed on: !
Bottom to top fill in inches: 140.5
Bottom to grade in inches: 146.0
Fill pipe length in inches: 44.5
Fill pipe diameter in inches: 4.0
Stage I vapor recovery: DOAZ,
Stage II vapor recovery: ASSTST
COMMENTS
Start (in) End (in)
Dipped Water Level:
Dipped Product Level:
Probe Water Level:
Ingress Detected: Water Bubble
Test time:
Inclinometer reading:
VacuTect Test Type: NOT
, VacuTect Probe Entry Point: TESTED
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method): .
Result:
Ullage
COMMENTS
New/passed Failed/replaced
L.D. #1 L.D. #1
Make: RED JACKET RED JACKET
Mode~: FX1-DV FX2V
S/N: ~o3o~ 8268 ~zo2~o2
Open time in sec: 4 .oo
Holding psi: ~2
Resiliency cc: . zso
TeSt leak rate mi/m: z89. o
Metering psi: 4o
Calib. leak in gph: 3 .oo 3 .oo
Results: PASS PASS
New/passed Failed/replaced
L.D. #2 L.D. #2
NOT
TESTED
COMMENTS
COMMENTS
Material: DW
Diameter (in): 2. o
Length (ft): 30.0
Test psi: 50
Bleedback cc: o
Test time (min): 40
Start time: 15 .' 03
End time: 15
Final gph: o. 006
Result:
Pump type: P~ESSmU~
Pump make: ~.ED JACKET
NOT NOT NOT
TESTED TESTED TESTED
Impact Valves Operational:
Printed 07/27/2004 15:32
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
TEST DATE: 0 ? / 13 ! 04 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER313 55 6 5
CLIENT:V3i,ERO AUSTIN, TEXAS 78757 (512) 451-6334 SITE:O'LTI~V, AR 0?4
Tank ID: 89
Product: PLOS
Capacity in gallons: 10,139
Diameter in inches: 95. oo
Length in inches: 33?
Material:' DW STEEL
Tank manifolded: NO
Vent manifolded: ~s
Vapor recovery manifolded:
Overfill protection:
Overspill protection: ¥~s
Installed: ATe
CPinstalled on: / /
Bottom to top fill in inches: 138.5
Bottom to grade in inches: 145.0
Fill pipe length in inches: 42.5
Fill pipe diameter in inches: 4.0
Stage I vapor recovery: DOAL
Stage II vapor recovery: ASSIST
COMMENTS
Start (in) End (in)
Dipped Water Level:
Dipped Product Level:
Probe Water Level:
Ingress Detected: Water
Test time:
Inclinometer reading:
VacuTect Test Type:
Va~.uTect Probe Er~try Point':
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method):
Result:
COMMENTs
Bubble Ullage
NOT
TESTED
New/passed
L.D. #1
Make: ~]3 JACKET
Model: FXlV
'S/N:
Open time in sec: 2. oo
Holding psi:
Resiliency cc: lO o
Test leak rate mi/m: 189.0
Metering psi:
Calib. leak in gph: 3. oo
Results: PASS
Failed/replaced New/passed Failed/replaced
L.D. #1 L.D. #2 L.D. #2
NOT
TESTED
COMMENTS
COMMENTS
Material: DW FIB]~.(~
Diameter (in): 2.0
Length (ft): 3 0.0
Test psi: 50
Bleedback cc: 0
Test time (min): 4 0
Start time: 15 .' 03
End time: 15; 43
Final gph: o. 006
Result: PASS
Pump type: PZ~S so'm~
Pump make: PJ~D JAC.~ET
NOT NOT · NOT
TESTED TESTED TESTED
Impact Valves Operational: ~s
Printed 07/27/2004 15:32
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
TEST DATE: 07/13/04 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3135565
CLIENT:VALERO AUSTIN, TEXAS 78757 (512) 451-6334 SITE:ULTRAMAR 0?4
Tank ID: 20k
Product:- DIESEL
Capacity in gallons: 20,068
Diameter in inches: 12 9.00
Length in inches: 358
Material: DW STEEL
COMMENTS
Lines b, c,
Tank manifolded: NO
Vent manifolded: NO
Vapor recovery manifolded: NO
Overfill protection:
Overspill protection: Y~S
Installed:
CP installed on: /
d and a & b form tank #7 are all stilite lines.
Bottom to top fill in inches: 193. o
Bottom to grade in inches: 2 ol. o
Fill pipe length in inches: 64. o
Fill pipe diameter in inches: 4. o
Stage I vapor recovery: NONE
Stage II vapor recovery: NONE
Start (in)
Dipped Water Level:
Dipped Product Level:
' Probe Water Level:
Ingress Detected: Water
Test time:
Inclinometer reading:
VacuTect Test Type:
VacuTect Probe Entry Point:
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method):
Result:
End (in)
Bubble Ullage
COMMENTS
NOT
TESTED '
New/passed
L.D. #1
Make: ]U~D JACKET
Model: FX2 -DY
S/N: 2~.~.~ 9~8
Open time in sec: 6. oo
Holding psi: z4
Resiliency cc: 4so_
Test leak rate mi/m: z89. o
Metering psi: 42
Calib. leak in gph: 3.00
Results: PASS
Failed/replaced New/passed Failed/replaced
L.D. #1 L.D. #2 L.D. #2
NOT
TESTED
COMMENTS
COMMENTS
Material: DW FIBERG DW FIBERG DW FIBERG DW FIBERO
Diameter (in): 3.0 3.0 3 .'0 3.0
Length (ft): 220.0 2O. 0 2O. 0 2o. 0
Test psi: 5o 50 50 5o
Bleedback cc: 0 0 0 0
Test time (min): 5 0 4 0 3 0 3 0
Start time: 09:36 12:33 11:46 11-- 06
End time: 10:26 13:13 12:16 11.-36
Final gph: 0. 003 0.0o3 0.0o3 o. 0o9
Result: PASS PASS PASS PASS
Pump type: PZU~SSUaE PaESSO'~E ~ESSOaE PRESSURE
Pump make: RED JACKET RED JACKET RED JACKET RED JACKET
Impact Valves Operational: ~1~s
Pdnted 07/27/2004 15:32
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
TEST DATE: 07/13/04 ' 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER31355 65
CLiENT~.V~ERO AUSTIN, TEXAS 78757.(512) 451-6334 SITE:O"LTZ:U~'~ 0?4
Tank ID: 20k
Product: DIESEL
Capacity in gallons: 2 0,000
Diameter in inches: 12 9.00
Length in inches: 35?
Material: DW STEEL
COMMENTS
this tank does not exist.
Tank manifolded: NO
Vent manifolded: NO
Vapor recovery manifolded: NO
Overfill protection: Y~s
Overspill protection:
Installed: AT~
CP installed on: /
Bottom to top fill in inches: 3.93.0
Bottom to grade in inches: 203-. 0
Fill pipe length in inches: 64. o
Fill pipe diameter in inches: 4. o
Stage I vapor recovery: NOt~
Stage II vapor recovery: NOI~
it is put in on1¥ to be able to show all of the satellite lines for the diesel tank.
Start (in)
Dipped Water Level:
Dipped Product Level:
Probe Water Level:
Ingress Detected: Water
Test time~
Inclinometer reading:
VacuTect Test Type:
VacuTect Probe Entry Point:
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method):
Result:
End (in)
Bubble Ullage
~,OMMENTS
NOT
TESTED
Make:
Model:
'S/N:
Open time in sec:
Holding psi:
Resiliency cc:
Test leak rate mi/m:
Metering psi:
Calib. leak in gph:
Results:
New/passed
L.D. #1
RED JACKET
FX2-DV
4120 4744
4.00
480
189.0
44
3.00
PASS
Failed/replaced New/passed Failed/replaced
L.D. #1 L.D. #2 L.D. #2
NOT
TESTED
COMMENTS
-~-COMMENTS
Material: DW FIBER~ DW .FIEERG
Diameter (in): 3.0 3.0
Length (fi): 2O. 0 2O. 0
Test psi: 5O 5o
Bleedback cc: 0 0 0
Test time (min): NOT 0 5O 3O
Start time: TEST~): 00 09:36 10:32
End time: o o: 00 10: 26 3-3-: 02
Final gph: o. ooo o. 003 o. o14
Result: PASS PASS
Pump type: PREssoP.~. PP.~SSOR~
Pump make: RED JACKET RED JACKET
Impact Valves Operational: YES
NOT
TESTED
Printed 07/2712004 15:32
· , 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. If more than one monitoring system control panel is installed at the facility, a'separate
certification or report must be prepared for each monitorinq 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.
A. General Information
Facility Name: ULTRAMAR 074
Site Address: 3225 BUCK OWENS BLVD.
HWY 99/HWY 58
Facility Contact Person: Manager·
Make/Model of Monitoring System:GILBARCO EMC
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced
ITank ID: 87
City: BAKERSFIELD CA Zip: 93301
Contact Phone No: 324-9481
Date of Testing/Service: 07/13/2004
Work Order Number: 3135565
X~ In-Tank Gauging Probe. Model:
X~] Annular Space or Vault Sensor. Model:
X--~ Piping Sump/Trench Sensor(s). Model:
"~ Fill sump Sensor(s). Model:
'~ Mechanical Line Leak Detector. Model:
'--~ Electronic Line Leak Detector. Model:
~] Tank Overfill/High-Level Sensor. Model:
730 ·
42O
2O8
FX 1 DV
Lank ID: 89
.[L~ In-Tank Gauging Probe.
~SJ Annular Space or Vault Sensor.
Model:
Model:
i Piping Sump/Trench Sensor(s). Model:
Fill Sump Sensor(s). Model:
] Mechanical Line Leak Detector. Model:
] Electronic Line Leak Detector. Model:
] Tank Overfill/High-Level Sensor. Model:
73O
420'
2O8
FXlV
-'~ Other (specify equipment type and model in Section E on page 2).
Tank ID: DIESEL
X---'l In-Tank Gauging Probe. Model:
Model:
Model:
] Model:
] Model:
73O
Annular Space or Vault Sensor. 420
Piping Sump/Trench Sensor(s). 208
Fill Sump Sensor(s).
Mechanical Line Leak Detector. FX2DV (2)
[] Other (specify equipment type and model in Section E on page 2).
Tank ID:
[] In-Tank Gauging Probe. Model:
[] Annular Space or Vault Sensor. Model:
[] Piping Sump/Trench Sensor(s). Model:
] Fill Sump Sensor(s). Model:
] Mechanical Line Leak Detector. Model:
] ElectronicLine Leak Detector.
] Tank Overfill/High-Level Sensor.
] Other (specify equipment type and model in Section E on page 2).
Dispenser ID: 1/2
[] Dispenser Containment Sensor(s) Model:
[] Shear Valve(s).
[] Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 5/6
r']Dispenser Containment Sensor(s) Model:
r~ Shear valve(s).
[] Dispenser Containment Float(s) and Chain(s).
Dispenser ID: DSL 1
-']Dispenser Containment Sensor(s) Model:
[] Shear Valve(s).
[-']Dispenser Containment Float(s) and Chain(s).
Model: [] Electronic Line Leak Detector. Model:
Model: ---~ Tank Overfill/High-Level Sensor. Model:
~] Other (specify equipment type and model in Section E on Page 2).
Dispenser ID: 3/4
'-'] Dispenser Containment Sensor(s) Model:
X'~ Shear Valve(s)
~ Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 7/8
'-'] Dispenser Containment Sensor(s). Model:
~ Shear Valve(s).
~ Dispenser Containment Float(s) and Chain(s).
Dispenser ID: DSL2 '
D Dispenser Containment Sensor(s). Model:
X--~ Shear Valve(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
I 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 Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached
a copy of the (Check all that apply): r-~ System set-up
Technician Name (print): WILLIAM ROGERS
Certification No.: 8520
Testing Company Name:Tanknology
Site Address: 8900 Shoal Creek, Bldg. 200 Austin, TX 78757
~-~J Alarm history report
Signature: ~'//~~/ '
License. No.:
Phone No.: (800) 800-4633
Date of Testing/Servicing: · 07/13/2004
Monitorin~ Svstem Certification Page 1 of 3 BaSed on CA form dated 03/01
Monitoring System' Certification
Site Address: 3225 BUCK OWENS BLVD.
HVVY 99/HVVY 58
D,. Results of Testing/Servicing
Software Version Installed: 7.03
Date of Testing/Service:
07/13/2004
Complete the following checklist:
[] 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 * ~ N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational?
[] Yes. [] No * [] N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
monitoring system detects a le.ak, fails to__operate, or is electrically disconnected? If yes: which sensors initiate positive
shut-down? (check all that apply) I I Sump/Trench Sensors; [] Dispenser Containment Sensors.
Did you confirm positive shut'down due to leaks and sensor failure/disconnection? [] Yes [] No
[] Yes [] No * [] N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device.(i.e.: no mechanical
overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating
properly? If so, at what percent of tank capacity does the alarm trigger? 90 %
[] Yes* [] 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* [] 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.
[] Yes [] No * Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable.
[] Yes [] No * IS all monitoring equipment operational per manufacturers' specifications?
* In Section E below, describe how and when these deficiences were or will be corrected.
E. Comments:
THERE WAS AN ADDITIONAL SUMP CALLED A FILTER SUMP- SENSOR (208)
REPLACED 1 FXIDV LEAK DETECTOR IN THE 87 LINE.
Page 2 of 3 Based on CA form dated 03/01
Monitoring System Certification
Site Address: 3225 BUCK OWENS BLVD.
HVVY 99/HWY 58
F. In-Tank Gauging I SIR Equipment
Date of Testing/Service: 07/13/2004
[] Check this box if tank gauging is used only for inventory control.
[] Check this box if no tank gauging or SIP, 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 manufacturers' maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G.' Line Leak Detectors (LED): [] Check this box if LEDs are not installed.
Complete the following checklist:
For equipment start-up or annual equipment certification, was a leak simulated to verify LED performance?
[] Yes. [] No* ~]N/A (Check all that apply) Simulated leak rate: [] 3 g.p.h [] 0.1 g.p.h ~0.2 g.p.h '
[] Yes [] No * Were all LEDs confirmed operational and accurate within regulatory requirements?
[] Yes []No* Was the testing apparatus properly calibrated?
[]Yes •No * [] N/A For mechanical LEDs, does the LED rastdct product flow if it detects a leak?
[] Yes' ONo * [] N/A For electronic LEDs, does the turbine automatically shut off if the LED detects a leak?
[] Yes []No * [] N/^ For electronic LEDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected?
[] Yes •No * [] N/A For electronic LEDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test?
[] Yes •No * [] N/A For electronic LLDs, have all accessible wiring connections been visually inspected?
r-~ Yes i []No * Were all items on the equipment manufacturers' maintenance checklist completed?
· In the Section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 3 Based on CA form dated 03/01
.. 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.' If more than one monitoring system control panel is installed at the facility, a separate
certification or report must be prepared for each mon torin,q 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 I.I,e local agency regulating UST systems within 30 days of test date.
A. General Information
Facility Name: ULTRAMAR 074
Site Address: 3225 BUCK OWENS BLVD.
HWY 99/HWY 58
Facility Contact Person: Manager
Make/Model of Monitoring System:
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced
City: BAKERSFIELD CA Zip: 93301
Contact Phone No: 324-9481
Date of Testing/Servica: 07/13/2004
Work Order Number: 3135565
nk ID:
In-Tank Gauging Probe. Model:
Annular Space or Vault Sensor.. Model:
Piping Sump/Trench Sensor(s). Model:
Tank ID:
~1 Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model:
] E ectronic Line Leak Detector. Model:
] Tank Overfill/High-Level Sensor. Model:
-'~ Other (specify equipment type and model in Section E on page 2).
Tank ID:
~ In-Tank Gauging Probe. Model:
IAnnular Space or Vault Sensor. Model:
Piping Sump/Trench Sensor(s). Model:
Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model:
Electronic Line Leak Detector. Model:
Tank Overfill/High~Level Sensor. Model:
--'] Other (specify equipment type and model in Section E on page 2).
Dispenser ID: DSL 3
X~.~__j Dispenser Containment Sensor(s) Model:
Shear Valve(s).
"~ Dispenser Containment Float(s) and Chain(s).
Dispenser ID: DSL 5
[] Dispenser Containment Sensor(s) Model:
[] In-Tank Gauging Probe. Model:
[] Annular Space or Vault Sensor. Model:
[] Piping Sump/Trench Sensor(s). Model:
[] Fill Sump Sensor(s). Model:
] Mechanical Line Leak Detector. Model:
] Electronic Line Leak Detector. Model:
] Tank Overfill/High-Level Sensor. Model:
Other (specify equipment type and model in Section E on page 2).
Tank ID:
'-] In-Tank Gauging Probe. Model:
Annular Space or Vault Sensor. Model:
Piping Sump/Trench Sensor(s). Model:
~ Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model:
Electronic Line Leak Detector. Model:
~ Tank Overfill/High-Level Sensor. Model:
Other (specify equipment type and model in Section E on page 2).
Dispenser ID: DSL 4
[] Dispenser Containment Sensor(s) Model:
[] Shear Valve(s)
~ Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
[] Dispenser Containment Sensor(s). Model:
X--]Shear Valve(s).
--'] Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
-']Dispenser Containment Sensor(s) Model:
[] Shear Valve(s).
[] Shear Valve(s).
[] Dispenser Containment Float(s) and Chain(s).
L~penser ID: .
~ Dispenser Containment Sensor(s). Model:
Shear Valve(s). ~
[] Dispenser Containment Float(s) and Chain(s).
~-'J 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
I 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 Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached
a'copy of the (Check all that apply): [] System set-up [~ Alarm history report
Technician Name (print): WILLIAM ROGERS
Certification No.:
Testing Company Name:Tanknology
Site Address: 8900 Shoal Creek, Bldg. 200 Austin, TX 78757
Signature:
License. No.:
Phone No.: (800) 800-4633
Date of Testing/Servicing: 07/1312004
Monitoring System Certification
Page 1 of 3
Based on CA form dated 03/01
SITE DIAGRAM
~ T-an~
8900 SHOAL CREEK, BUILDING 200
AUSTIN, TEXAS 78757
(512) 451-6334
FAX (512) 459-1459
TEST DATE: 07/13/04
CLIENT: ~-T~O
WORK ORDER NUMBEP,33.35565
SITE: o"r_.,'Z'RAZ¢3~ 0?4
~) sump
0 olo0~ 0 0
0 O0 VENTS
3225 Buck Owens Blvd.
(7) . Bakersfield, CA
WASF
DSL
Printed 07/27~2004 15:32 KOHLMEYER
Work Order:
3135565
Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757
~'o'rk Order:
3~35565
Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757
8900 Shoal Creek Blvd, Building 200
Austin, Texas 78757
Phone: (512) 451-6334
Fax: (512) 459-1459
BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
INSPECTOR STEVE UNDERWOOD
900 TRUXTUN AVE., STE. 210
BAKERSFIELD, CA. 93301
Date Printed and Mailed:O7/28/2004
Test Date: 07/13/2004
Order Number: 3135565
Dear Regulator,
Enclosed are the results of recent testing performed at the following facility:
ULTRAMAR 074
3225 BUCK OWENS BLVD.
HWY 99/HVVY 58
BAKERSFIELD, CA. 93301
Testing performed:
Leak detector testS
Line tests
Monitor Certification
Sincerely,
Dawn Kohlmeyer
Manager, Field Reporting
'Tanknology
8900 Shoal Creek Blvd, Building 200
Austin, Texas 78757
Phone: (512) 451-6334
Fax: (512) 459-1459
Date Printed and Mailed: 07/28/2004
KERN CTY- ENVIROMENTAL HEALTH
2700 M STREET
SUITE 300
BAKERSFIELD, CA. 93301
Test Date: 07/13/2004
Order Number: 3135565
Dear Regulator,
Enclosed are the results of recent testing performed at the following facility:
ULTRAMAR 074
3225 BUCK OWENS BLVD.
HWY 99/HWY 58
BAKERSFIELD, CA. 93301
Testing performed:
Leak detector tests
Line tests
Monitor Certification
Sincerely,
DaWn Kohlmeyer
Manager, Field Reporting
~__ TANKNOLOGY CERTIFICATE OF TESTING
~ ~1" l~J~J~1~ 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757
TELEPHONE (512) 451-6334 FAX (512) 459-1459
PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT WORK ORDER NUMBER: 3135565
TEST DATE: 07/13/04 CUSTOMER PO:
CLIENT: VALERO SITE: ULT~MAR 074
685 WEST THIRD ST 3225 BUCK OWENS BLVD.
HANFORD, CA 93230 H~ 99/H~ 58
BAKERSFIELD, CA 93301
Sandy Huff Manager
(559)583-3298 (661)324-9481
Tank Tightness Tests Results TEST ~PE: VacuTect
87 ~E~ED 14,139 95.00 DW STEEL
89 PLUS 10,139 95.00 DW STEEL
20k DIESEL 20,068 129.0 DW STEEL
20k DIESEL 20,000 129.0 DW STEEL
*Where regulations require, for VacuTect external water level may be depth of du well or water is ~sumed at lowest point that c~ be confi~ed d~.
Product Pipe Tightness Test Results ~ ~
87 3 DW FIBERG P~SS~ P 0. 006 T~-I Y
89 4 DW FIBERG P~SS~ P 0. 006 T~-I Y
20k 6 DW FIBERG P~SS~ P P P P 0.0Q3 0.003 0.003 0.009 T~-i Y
20k 7 DW FIBERG P~SS~ P P 0.003 0.014 T~-i Y
5X~SU~ U~e leak De~e=~ les~ ....
87 3 ~D JACET ~2V 110211102 P
89 4 ~D JAC~T ~iV 111796 P
20k 6 ~D JAC~T ~2-DV 21199 9638 P
20k 7 ~D JAC~T ~2-DV 4120 4744 P
New Re~a~eme.~ t~.e ~ak De~e=~ Tes}~ ~
87 3 ~[-DV [0304 8268 ~
For owner detailed rcpo~ info~ation, visit ~.t~knolo~y.com ~d select On-Linc Ecpo~s-W~, or contact your local Tanknolo~ office:
Tester Name: WILLIAM ROGERS Technician Ce~ification Number: 1647
Tester Signature: ~~~s~ Date Signed: ~0~
I decl~e under penal~ of perju~ that 1 am t~k tester in the State of California ~d that ~e info~ation contained in this repo~
is true and correct to ~e best of my knowledge.
~L~/~n~ TANKNOLOGY CERTIFICATE OF TESTING
8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757
TELEPHONE (512) 451-6334 FAX (512) 459-1459
PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT
TEST DATE: 07113/04 WORK ORDER NUMBER: 3135565
CUSTOMER PO:
CLIENT: VALERO SITE: ULTRAMAR 074
685 WEST THIRD ST 3225 BUCK OWENS BLVD.
HANFORD, CA 93230 HWY 99/HWY 58
BAKERSFIELD, CA 93301
Sandy Huff Manager
(559)583-3298 (661)324-9481
TEST TYPE: TLD-1
Product Pipe Tightness Test R~sults
EUNCTI~
87 3 TTh-r_~EAOED DW ffIEERG PREBSTTRE P 0.006 ¥
89 4 PLUS DH FIBERG PRESSURE P 0. 006 Y
20k 6 DIESEL DW FIBERG PRESSURE P P P P ,0.003 0.003 0.003 0.009 Y
20k 7 DIESEL DW FIBERG PRESSURE m m 0.003 0.014 Y
Existing Line Leak Detector Test
87 3 RED JACKET m. FX2V 110211102 .:P
89 4 RED JACKET FXlV 111796 P
20k 6 RED JACKET FX2-DV 21199 9638 P
20k 7 RED JACKET FX2-DV 4120 4744 P
New Replacement Line Leak Detector Test
8J 3 RED JACKET FX1-DV 10304 8268 :P
For owner detailed report information, visit www.tanknology.com and select On-Line Reports-WRAP, or contact your local Tanknology office.
Tester Name: WILLIAM ROGERS Technician Certification Number: 1647
Printed 07/28/2004 07:50 SBOWERS
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
Tan
TEST DATE:0?/13/04 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER~135565
CLIENT:VAI'.I~RO AUSTIN, TEXAS 7875'7 (512)451-6334 SITE:ULTRAMAR 074
Tank ID: 8?
Product: UNLEADED
Capacity in gallons: 14,139
Diameter in inches: 95.00
Length in inches: 33?
Material: DW STEE~,
COMMENTS
Tank manifolded: NO
Vent manifolded:
Vapor recovery manifolded:
Overfill protection:
Overspill protection:
Installed: ATe
CP installed on: /
Bottom to top fill in inches: 14o. 5
Bottom to grade in inches: 146. o
Fill pipe length in inches: 44.5
Fill pipe diameter in inches: 4.0
Stage I vapor recovery: DUE
Stage II vapor recovery: ASS'rST
Start (in)
Dipped Water Level:
Dipped Product Level:
Probe Water Level:
Ingress Detected: Water
Test time:
Inclinometer reading:
VacuTect Test Type:
VacuTect Probe Entry Point:
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method):
Result:
End (in)
Bubble Ullage
COMMENTS
NOT
TESTED
New/passed Failed/replaced
L.D. #1 L,D. #1
Make: RED JACKET RED JACKET
Model: FX1-DV FX2V
S/N: ~o3o4 82~8 ~zo2~zzo~
Open time in sec: 4.oo
Holding psi: 12
Resiliency cc: lso
rest leak rate mi/m: 159. o
Metering 'psi: 4 o
Calib. leak in gph: 3. oo 3. oo
Results: P~,ss PASS
COMMENTS
New/passed Failed/replaced
L.D. ~2 L.D. #2
NOT
TESTED
COMMENTS
Materiali DW FIBERG
Diameter (in): 2.0
Length (ft): 30.0
Test psi: 50
Bleedback cc: 0
Test time (min): 40
Start time: 15; 03
End time: 15 .- 43
Final gph: 0. 006
Result: PASS
Pump ~pe: PRESSURE
Pump make: RED JACKET
NOT NOT NOT
TESTED TESTED TESTED
Impact Valves Operational: YES
Printed 07/28/2004 07:50
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
TEST DATE:0?/3.3/04 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBERS3.35565
CLIENT:VALERO AUSTIN, TEXAS 78757 (512)451-6334 SITE:O'LTZ~V._AR 0?4
Tank ID: 89
Product: PLUS
Capacity in gallons: 10,139
Diameter in inches: 95.00
Length in inches: 33?
Materiai: DW STEEL
COMMENTS
Tank manifolded: NO
Vent manifolded: YES
Vapor recovery manifolded: YES
Overfill protection: YES
Overspill protection: YES
Installed: ATe
CP installed on:
Bottom to top fill in inches: 3.38.5
Bottom to grade in inches: :[45. o
Fill pipe length in inches: ~,2.5
Fill pipe diameter in inches: 4. o
Stage I vapor recovery: DUAL
Stage II vapor recovery: ASSIS?
Start (in)
Dipped Water Level:
Dipped Product Level:
Probe Water Level:
Ingress Detected: Water
Test time:
Inclinometer reading:
VacuTect Test Type:
VacuTect Probe Entry Point:
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method):
Result:
End (in)
Bubble Ullage
COMMENTS
NOT
TESTED
New/passed Failed/replaced
L.D. #1 LD. #1
Make: RED JACKET
Model: ~x~v
S/N:
Open time in sec: 2.oo
Holding psi:
Resiliency cc:
'est leak rate mFm: 18~. c
Metering psi: 4o
Calib. leak in gph: 3. oo
Results: Z~ASS
COMMENTS
New/passed Failed/replaced
ED. #2 L.D. ~
NOT
,TESTED
COMMENTS
Material: DW
Diameter (in}: 2.0
Length (ft): 30.0
Test psi: 50
Bleedback cc: o
Test time (min):
Start time: 15: 03
End time:
Final gph: 0. OO6
Result: PASS
Pump type: PRESS~/RE
Pump make; RED JACKET
NOT NOT NOT
TESTED TESTED TESTED
Impact Valves Operational: YEs
Pdnted 07/28/2004 07:50
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
TEST DATE:0?/13/04 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBERS135565
CLIENT:VAZ.EEO AUSTIN, TEXAS 78757 (512) 451-6334 SlTE:ULTRAMAR 074
Tank ID: 20k
Product: DIESEL
Capacity in gallons: 20,068
Diameter in inches: 129.00
Length in inches: 358
Material: DW STEEL
COMMENTS
Tank manifolded: ~TO
Vent manifolded: NO
Vapor recovery manifolded: NO
Overfill protection: YES
Overspill protection: YES
Installed: ATe
CP installed on: /
d and a & b form tank 97 are all stil~te lines.
Bottom to top fill in inches:
Bottom to grade in inches:
Fill pipe length in inches:
Fill pipe diameter in inches:
Stage I vapor recovery:
Stage II vapor recovery:
193.0
201.0
64.0
4.0
NONE
NONE
Start (in)
Dipped Water Level:
Dipped Product Level:
Probe Water Level:
Ingress Detected: Water
Test time:
Inclinometer reading:
VacuTect Test Type:
VacuTect Probe Entry Point:
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method):
Result:
End (in)
Bubble Ullage
COMMENTS
NOT
TESTED
New/passed
L.D. #1
Make: RED JACKET
Model: FX2-DV
S/N: 2zz99 9~9
Open time in sec: 6.00
'Holding psi: 14
Resiliency cc: 450
Jest leak rate mi/m: ls9.0
Metering psi: 42
Calib. leak in gph: 3.00
Results: t~ASS
COMMENTS
Failed/replaced New/passed Failed/replaced
L.D. #1 LD. #2 L.D. #2
NOT
TESTED
COMMENTS
Material: DW FTBERG
Diameter (in): 3.0
Length (ft): 220.0
Test psi: 50
Bleedback cc: o
Test time (min): 50
Start time: 09: 36
End time: 10: 26
Final gph: 0.0O3
Result: PASS
Pump type: PRESSURE
Pump make: RED JACKET
DW FIBERG DW FIBERG DW FIBER~
3.0 3.0 3.0
20.0 20.0 20.0
50 50 50
0 0 0
40 30 30
12:33 11:46 11:06
13:13 12:16 11:36
0.003 0.003 0.009
PASS PASS PASS
PRESSURE PRESSURE PRESSURE
RED JACKET RED JACKET RED JACKET
Impact Valves Operational: YES
Printed 07/28/2004 07:50
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
TEST DATE: 0'//13/04 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER9135565
CLIENT:VALERO AUSTIN, TEXAS 78757 (512)451-6334 SITE:O"r.,TZ~I~MA~ 0.'/4
Tanl~ ID: 20k
Product: DIESEL
Capacity in gallons: 20,000
Diameter in inches: 129.00
Length in inches: 35'/
Material: DW STEEL
COMMENTS
Tank manifolded: NO
Vent manifolded: NO
Vapor recovery manifolded: NO
Overfill protection: YES
Overspill protection: YES
Installed: ATe
CP installed on: /
Bottom to top fill in inches: 193.0
Bottom to grade in inches: 201.0
Fill pipe length in inches: 64.0
Fill pipe diameter in inches: 4.0
Stage I vapor recovery: NON~
Stage II vapor recovery: NOtrE
put in only to be able to show all of the satel~$te lines for the diesel tank.
Start (in)
Dipped Water Level:
Dipped Product Level:
Probe Water Level:
Ingress Detected: Water
Test time:
Inclinometer reading:
VacuTect Test Type:
VacuTect Probe Entry Point:
Pressure Set Point:
Tank water level in inches:
Water table depth in inches:
Determined by (method):
Result:
End (in)
Bubble Ullage
COMMENTS
NOT
TESTED
New/passed
L.D. #1
Make: RED JACKET
Model: FZ2-DV
S/N: ~.2o
Open time in sec: 4. oo
Holding psi:
Resiliency cc: 480
rest leak rate mi/m: ~Lag. 0
Metering psi: 4,~
Calib. leak in gph: 3.oo
Results: P~ss
COMMENTS
Failed/replaced New/passed Failed/replaced
L.D. #t L.D. ~ L.Do #2
NOT
TESTED
COMMENTS
Material:
Diameter (in):
Length (ft):
Test psi:
Bteedback cc:
Test time (min)-:
Start time:
End time:
Final gph:
Result:
Pump type:
Pump make:
DW FIBERG
3.0
20.0
0
0
NOT
TEstS:00
00:00
0.000
PRESSURE
RED JACKET
DW FIBERG
3.0
20.0
50 50
0 0
50 30
09:36 10:32
10:26 11:02
0.003 0.014
PASS PASS
PRESSURE
RED JACKET
Impact Valves Operational: YES
NOT
TESTED
Printed 07/2812004 07:50
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, Califomia Code of Regulations
This form must be used to document testing and servicing of monitoring equipment, If more than one monitoring system control panel is installed at the facility, a separate
certification or report must be prepared for each monitorin,q 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.
A. General Information
Facility Name: ULTRAMAR 074
Site Address: 3225 BUCK OWENS BLVD.
HWY 99/HWY 58
Facility Contact Person: Manager
Make/Model of Monitoring System: GILBARCO EMC
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced
City: BAKERSFIELD CA Zip: 93301
Contact Phone No: 324-9481
Date of Testing/Service: 07/13/2004
Work Order Number: 3135565
nk ID: 89
In-Tank Gauging Probe.
Annular Space or Vault Sensor.
Model: 730
Model: 420
[~L-J' Piping Sump/Trench Sensor(s). Model: 208
Fill Sump Sensor(s). Model:
aMechanical Line Leak Detector. Model: FXIV
Electronic Line Leak Detector. Model: ~
Tank Overfill/High-Level Sensor. Model: ~
Other (specify equipment type and model in Section E on page 2).
nk ID:
nk ID: 87
In-Tank Gauging Probe. Model: 730
Annular Space or Vault Sensor, Model: 420
Piping Sump/Trench Sensor(s). Model: 208
'--~ Fill Sump Sensor(s). Model:
'~ Mechanical Line Leak Detector. 'Model: FX1DV
D E
lectronic Line Leak Detector. Model:
--] Tank Overfill/High-Level Sensor. Model:
"~ Other (specify equipment type and model in Section E on page 2).
Tank ID: DIE~SEL
X~] In-Tank Gauging Probe. Model: 730
X--'] Annular Space or Vault Sensor. Model: 420
X---[ Piping Sump/Trench Sensor(s), Model: 208
~] Fill Sump Sensor(s). Model:
X'~ Mechanical Line Leak Detector. Model: FX2DV (2)
~ Electronic Line Leak Detector. Model:
] Tank Overfill/High-Level Sensor. Model:
] Other (specify equipment type and model in Section E on page 2).
Dispenser IL): 1/2
In-Tank Gauging Probe. Model:
Annular Space or Vault Sensor. Model:
Piping Sump/Trench Sensor(s). Model:
Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model:
-] Electronic Line Leak Detector. Model:
[] Tank Overfill/High-Level Sensor. Model:
[] Other (specify equipment type and model in Section E on page 2).
'DispenserlD: 3/4
[] Dispenser Containment Sensor(s) Model:
[] Shear Valve(s).
~ Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 5/6
-'~ Dispenser Containment Sensor(s) Model:
X'~ Shear Valve(s).
'~ Dispenser Containment Float(s) and Chain(s).
Dispenser ID: DSL 1
---~ Dispenser Containment Sensor(s) Model:
[] Shear Valve(s).
[~ Dispenser Containment Float(s) and Chain(s).
[] Dispenser Containment Sensor(s) Model:
~-~ Shear Valve(s)
DJ--Ii Dispenser Containment Float(s) and Chain(s).
spenser ID: 7/8
[] Dispenser Containment Sensor(s). Model:
'~ Shear Valve(s).
~'~ Dispenser Containment Float(s) and Chain(s).
Dispenser ID: DSL 2
Z] Dispenser Containment Sensor(s). Model:
X~ Shear Valve(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
I 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 Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached
a copy of the (Check all that apply): r~ System set,up ~-~ Alarm history report
Signature: ~/~/~C~'~'~/
Technician Name (print): WILLIAM ROGERS
Certification No.: 8520
Testing Company Name: Tanknology
Site Address: 8900 Shoal Creek, Bldg. 200 Austin, TX 78757
License. No.:
Phone No,: (800) 800-4633
Date of Testing/Servicing: 07/13/2004
Monitoring System Certification
Page 1 of 3
Based on CA form dated 03/01
Monitoring System Certification
Site Address: 3225 BUCK OWENS BLVD.
HWY 99/HWY 58
D. Results of Testing/Servicing
Software Version Installed: 7.03
Date of Testing/Service:
07/13/2004
Complete the following checklist:
[~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* r~N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational?
For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
[] Yes [] No * [] 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 * [] N/^ For tank systems that utilize the monitoring system as the primary tank ovedill warning device (i.e.: no mechanical
overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating
properly?. If so, at what percent of tank capacity does the alarm trigger?. 9o %
[] Yes* [] 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*, [] No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) [] Product;
~ [] Wa,er. I~ yes, describe causes in Section E, below.
[] Yes [] No Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable.
[] Yes [] No IS all monitoring equipment operational per manufacturers' specifications?
* In Section E below, describe how and when these deflciences were or will. be corrected.
E. Comments:
THERE WAS AN ADDITIONAL SUMP CALLED A FILTER SUMP- SENSOR (208)
REPLACED 1 FX1DV LEAK DETECTOR IN THE 87 LINE.
Page 2 of 3 Based on CA form dated 03/01
Monitoring System Certification
Site Address: 3225 BUCK OWENS BLVD.
HWY 99/HWY 58
F. In-Tank Gauging / SIR Equipment
Date of Testing/Service: 07t13/2004
[] Check this box if tank gauging is used only for inventory control.
[] Check this box if no 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 widng 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 r--]No* Was accuracy of system water level readings tested?
[~Yes [~No * Were all probes reinstalled properly?
[] Yes [] No * Were all items on the equipment manufacturers' maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LED): [] Check this box if LEDs are not installed.
Complete the following checklist:
[] Yes r--~No [~N/A For equipment start-up or annua equipment certification, was a leak simulated to verify LED perl=ormance?
(Check all that apply) Simulated leak rate: [] 3 g.p.h [] 0.1 g.p.h L--Jo.2 g.p.h
[] Yes [] No Were all LEDs confirmed operational and accurate within regulatory requirements?
[] Yes []No * Was the testing apparatus properly calibrated?
[] Yes E~]No * [] N/A For mechanical LEDs, does the LED restrict product fiow if it detects a leak?
[] Yes []No * [] N/A For electronic LEDs, does the turbine automatically shut off if the LED detects a leak?
[] Yes E~No * [] N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected?
[] Yes []No * [] N/A For electronic LEDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test?.
[] Yes []No * [] N/A For electronic LEDs, have all accessible wiring connections been visually inspected?
r~'[Yes DNo - Were all items on the equipment manufacturers' maintenance checklist completed?
· In the Section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 3 Based on CA form dated 03/01
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. If more than one monitoring system control panel is installed at the facility, a separate
certification or report must be prepared for each monitodn,q 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.
A. General Information
Facility Name: ULTRAMAR 074
Site Address: 3225 BUCK OWENS BLVD.
HWY 99/HWY 58
Facility Contact Person: Manager
Make/Model of Monitoring System:
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced
City: BAKERSFIELD CA Zip: 93301
Contact Phone No: 324-9481
Date of Testing/Service: 07/13/2004
Work Order Number: 3135565
Tank ID:
[nk ID:
In-Tank Gauging Probe.
Model:
Model:
Model:
Model:
Model:
Model:
Model:
..~ Annular Space or Vault Sensor.
Piping Sump/Trench Sensor(s).
'--~ Fill Sump Sensor(s),
~[ Mechanical Line Leak Detector.
---~ Electronic Line Leak Detector.
Tank Overfill/High-Level Sensor.
In-Tank Gauging Probe.
Annular Space or Vault Sensor.
Piping Sump/Trench Sensor(s).
Fill Sump Sensor(s).
Mechanical Line Leak Detector.
Electronic Line Leak Detector.
Tank Overfill/High-Level Sensor.
Model:
Model:
Model:
Model:
Model:
Model:
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).
Tank ID: 'Tank ID:
~ In-Tank Gauging Probe. Model:
] Annular Spaca or Vault Sensor. Model:
[] Piping Sump/Trench Sensor(s). Model:
[] Fill Sump Sensor(s). Model:
] Mechanical Line Leak Detector. Model:
] Electronic Line Leak Detector. Model:
] Tank Overfill/High-Level Sensor. Model:
] Other (specify equipment type and model in Section E on page 2).
Dispenser ID: DSL 3
[] Dispenser Containment Sensor(s) Model:
[] Shear Valve(s).
'--] Dispenser Containment Float(s) and Chain(s).
Dispenser ID: DSL 5
'--] Dispenser Containment Sensor(s) Model:
X~ Shear Valve(s).
~ Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
r~] Dispenser Containment sensor(s) Model:
[] Shear Valve(s).
~'"-~ Dispenser Containment Float(s) and Chain(s).
[] In-Tank Gauging Probe. Model:
] Annular Spaca or Vault Sensor. Model:
[] Piping Sump/Trench Sensor(s). Model:
~l Fill Sump Sensor(s). Model:
] Mechanical Line Leak Detector. Model:
] Electronic Line Leak Detector. Model:
[] Tank Overfill/High-Level Sensor. Model:
[] Other (specify equipment type and model in Section E on page 2).
Dispenser ID: DSL 4
r-"-Ilxl~ Dispenser Containment Sensor(s) Model:
Shear Valve(s)
--'l Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
~l Dispenser Containment Sensor(s). Model:
-"] Shear Valve(s).
-]Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
~] Dispenser Containment Sensor(s). Model:
'-'~ Shear Valve(s).
~] Dispenser Containment Float(s) and Chain(s).
Technician Name (print): WILLIAM ROGERS
Certification No.:
Testing Company Name: Tanknology
Site Address: 8900 Shoal Creek, Bldg. 200 Austin, TX 78757
If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility.
C. Certification
I 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 vedfy that this information is correct.
and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached
a copy of the (Check all that apply): [] System set-up [~Alarm history report
Signature:
License. No.:
Phone No.: (800) 800-4633
Date of Testing/Servicing: 07/13/2004
Based on CA form dated 03/01
Page 1 of 3
Monitoring System Certification
SITE DIAGRAM
8900 SHOAL CREEK, BUILDING 200
AUSTIN, TEXAS 78757
(512) 451-6334
FAX (512) 459-1459
TEST DATE: 07/13/04
CLI E NT: "¢2~T.~E 1~O
WORK ORDER NUMBER3 13 5 56 5
SITE: O7.,'Z'~ 0?4
sump
fCAR WASH
®
DSL
C-STORE
ENT
Ultramar #51-4
3225 Buck Owens Blvd.
Bakersfield, CA
0
0
OO'VENTS
0
0
Pdnted 07~28~2004 07:50 SBOWERS
<:~i T 1 :DI~EL 2 FUEL
L 5;DI~EL ~P ~' JUL la. 2004 8:37 ~
FUEL ~
J~ la, 2004 8:28 ~ ~
: .~57~%. : - .... SEN~ ALARM
L 6:DIE~EL ~N~ ~ ~X P~D~T A~ FUEL ~ARM
ANNU~R SP~E ~ JUL 13. 8004 8:88 AM JUL 13, 2004 2:16 PM
~L I~, 2004 ~0 ~
~ ~ I:DI~ ~ L ~:PL~
..... SE~R A~ ..... ~. D~IVE~y N~D~ STP
L 7:FILER S~P ~ JUL 13, ~004 8:38 ~ F~L A~
PIPI~ $~ '~ JUL ~. 2004 2:17 F~
JUL 13, 200~, 81~ ~
:
~ .... ~U-ra~ ~ ......
LOW P~ A~ L ~:PL~ ANUL
T t :DI~EL 2 ~ J~ 13, 200~ 81~8 Ar4 J~,UEL
....... '~,'~., ........ ,' ~,. ~UL ti~..,2~ 211,7
..... IN-TANK ~
HIgH ~TER ~ .... 1N-TA~ A~
B~ON 3074 ~ JU~ IS. 200~ 8:~8 ~ T 3:UNL~ED
3225 B~K ~~ PRO~ O~
B~E~FI~.CA 93~08 JUL 13, 2004 2;t8 PM
~61 324-9481
JUL 13, 2004 fl:37 ~
~ HIGH ~R ~i~ .... IN-TANK A~RM
~ JUL ~ 3, 8004 8:48 ~ T 3: U~EADED
~ ; NVAL~D FUEL
JUL l~, 20Q4 ~:18 ~
.... ~ N-TANK A~ ......
OVERF;LL ~ ~ ;N-TANX LARM
JUL ~3. 2004 8:3? ~ T 4:PL~
: PRODE O~
' ,]L~ 13. 2004 2;19 PM
Tanknology-NDE 8900 Shoa} Creek, Building 200 Austin, Texas 78757
Work Order: 3135565
T 3: UNLEAD~
HIGH b.,Y-,.tTER
JUL t, 3, 2O04
.... I N-TANK ALA~q
T ~
HIGH PROD~rI'
OUL 13, 2004 2125
.... [N-TANK AL~K't~ .....
T ~ 1 UNLEADED
HIGH i4~TE~ t,#~N~N6
,JUL 13, 2004 2:19 PM
.... IN-TANK
T 4:PLLIS
OVERFILL
JUL 13. 2004 2:25
.... tN~TANK ALARM .....
T 4:PLUS
HIGH L~TE~ ~LARH
JUL 13. 2~04 2:33 ~H
.... iN~TANK ~ .....
T ~:UNLF. ADED
HIGH PEODUCq' AI~
JUL 13. 2004 2:20 ~
T fl:UNLERDED
HIGH ~t~ODOCT ALARM
JUL 13, 2004 2:25
.... IN-TANK ALARM .....
T 4:PLLII3
HIGH ~&TER i,,JARNINO
JUL 13. 2004 2:33 PM
.... IN-TAN~ ALAi~H .....
T 3:UNLE~
OVERFILL ALAE~
JUL 13, 2004 2:2t PM
--- [ N-TANK AI.~:~
T 4 :PLU~
P~q× PI;~D[JCT ALARM
JUL 13. 2004 2:25 PM
.... I N-TRNM ALARH .....
T 3: UNLEADED
DEL l VERY NEEDED
JUL 13, 2004 2:22 Pt',1
.... IN-TANK ALA~ .....
PlAX PRODUCT AL~
JUL 13, 2004 2:26 PM
.... iN-TANK ALA);~'~ .....
T 3:UNLERDED
LO~ PRODt.L~ ALAigq'1
JUL 13. 2004 2:22 F1fl
.... I N-TANK ALARM
T 4 :PLU~
LO~ PRODUCt
JUL 13, 2004 2:27 PM
.... IN-T~NK ALR~M .....
T 4:PLUS
DELIVERY NEF_,.DED
Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78,757
~" 0S~0172004 10:08 661325252S CAL VALLEY PAGE 02
MONITORING SYSTEM CERTIFICATION
~ltti~'i~g Cit~' Chapter 6. Z I]~Ith ond Saf~y Code; Cl~opter 15, Dtuislon 3. Title 23, Cal~ornla C~e of Regn]atio~
'rMs fo~ must be nsed to document testing nnd so.icing of monRoring equipment. A separate certification or repo~ must be
p~epnr~d rot each monitorin~ s~s~m control p~el by Ihe t~hnicinn who petrols the wo~. A copy of this fo~ must be provided
the tank sy~em owneffo~mtor. ~e owner/o~rnlor must submit a copy of thl; Form to ~e local agency regubfing UST systems
within 30 ~ys of test date.
A. General Information
Facility Contact Person: Contact Phone No.: (~__
Make'oriel of Monitoring System: =~e~--E~ 'Y~3~O Date or T~tins~e~icing:
B. invento~ of Equipment T~fed/Certjfied
~ l~-'rnnk Onu$1ng Pr~e. Model:_ [~l~O. ~ In-Tank Gauging Pr~c. M~el:
~ Annulnr Spn~ or V~ll Sensor. Mod~l:_ ~f/~E St~ ~ Annular Sp~ or Vault Sensor. Model: ~]~N~
~ Piping Sump / T~nch ~ns~(s). M~el: ~ ~ Pip,n8 ~ump / Trench ~,sn~s), Mndel: ~
~ ~1I Sump ~n~r(s). Model; O Fill ~ump tie,sorts). M~I: --
~ M~hnn(~l Lin= Leak Detector. Model: Q ~h~lcnl ~ne L~k D~tor. Model;
~ Ele~ronic Line Le~ Om~r. Model: ~ Electronic Line Lc~k Detector. Model:
~ Olh~ (s~[~ c~uipm~t ~ nnd,,modd in $ooUon ~ on P~c 2). O O~hcr (sanity equipment ty~ and model in S~tlon
tm'rank OnusIng ~obe. Model: ~_~]~. ~ ~ ln.Tn~k Onuslng Probe, M~el;
Annular Spac~ or VnuI~ 3en~r, ~ndcl: ~/~'~O~! ~ Annul~ Spoce or Vault ~ensor, Model:
Pipfng Sump / 'rr~eh 8e~or(s). Model: ~ ~ Piping Sump / 'r~n~ Sensor(s}. M~cl:
~ Fill Sump 8cnsur{s). Mmlch O Fill Sump Sensors}, Model:
~ Me~ni~l I.tne ~ Dct~tor. M~cl; ~ Mechnn~nl Ltne Lcnk l~teotor, Model:
~ l'~k Over~ll / lllgh-Lev~l S~r, Mmlel; ~ Tank Over~ll / lltgh-Level gcns~r. Model:
Dfspen~er~bt.~ ~the~ {spear~.lequip~m~ ~ , ~pu.. .... and mode~, In S~t~on E u~ Png~_ 2). ............... O O~cr (~iry ~eipmem. ~pe~ ~d m~d in S~cdon
~ ~henr Vel ve(sI. ~ 8h~r ValvKz}.
O Dis ~r Cont~nm~t Flonl s nod
~ ~hem Valves). el: ~_~ ~ Di~cnser ~ntainmcnt ~mr(s). Modch
~ Dlspen~ C~lni~ent Ploa~l) end Chain(s),
DispenSer ID:
8b~t Valv~s). ~ O~penser Cont~inm~t Sensors). Model:
O Shear V01ve(s).
~Oi ens~ConiafnmentFl~ s ~dChal. a. ~ Di ' ' ( In s
nemco m~t~tlon for eve~ teak and dl~n~ at t
C. Certification _ ! eerit~ ~hnt the equipment identifi~ in IhIR document was InspKted/ae~iced iff accordance with Ihe
manuheturera' Kuideliflu. Atlech~ (o ihl~ CerUficn~on ly Information (e.8. minuraet*~Mra' ~heckllst9) necelsnr~ to verl~
Informnffon Is eoerett find n Plot Plnu ;howlne the layout OF moflRorln8 equipment, For ,u~ Muipmeflt capable of Renere~lfl8 such
'echnicianreperb'Namel hnve(print):nbo nllnched~~~~a copy of the ropor/l (~a~A all gh~ npp~)t O ~y~lem set..p ~ Alarm history
onitorleg System Certifieat~n Pa~ t of 3
0~/01/2004 10:08 6613252529 CAL VALLEY PAGE 03
Results o I' Testiu$/$ ervicinl~
8oltware Version Installed: f2~-~ .00
tile c!
Yes ~ No* Is the ;tudib[~ alu~m o~mtional? .........
Yes ~ No* Is t~e' visual'~la~ ~rationn~
~e~ O No~' Were all ~en~Ors tnst~lled at Io~t ~Jnt of~ondary cm~t~inmen(and ~sftfbn~
~ ln~ffcrc with their p~[ o~ration?
Y~ O No* IF alarms ~re relay~ tO a ~mote mediating s~tion, is '~11 commu~cnilons e~uipmen~' (e.~
~ N/A opera~ionnl?
Yes ~ No* For p~surfz~ plpi~B eystems, do~ turbine a~;tomnti~ali~ shut dow'" irthe~;~.8
D NIA monitoring system de~ct~ n leak, f~ils to ope~, or is electric~lly dlsconnectcd? Ir y~: which seflso~ initiate
pos}tire shut-d~wn? (~ck ~!/tho* a~p~) ~S~p~rench Sgn~ors; ~ Di~pcnse~
Did you co, Arm ~ositive shut-down due ~ I~ks and sen~ Fai)umldisconnectlon? ~Yes; O No.
~ NtA mechanical overfill prevention valve is installS), is the overfill w~ming abrm visible and audible nt/l~o tank
fill point(s)and opmtln~_properly? 1~9o, M wh~ percent o~tank c~pKity does the ~[arm
Yes* ~. ~o Was ~ny monitorinB equipment r~lac~d? IFye'~, ~d~ti~y s~eific'~ensor~, pr~b~, or olher ~uipment replaced
~d list the manufacturer n~e and model for ~11 replacement para in Section B, below.
0 Product; 0 Wat~. lfyel, d~cribe caus~ fa Section E, below.
' ' "" ~ei:u mVle~d to ~re pto~r set/in~;~ Attach'set up
Y~ ~ Nee Wed m~nnB system ~ ...............
Yes ~ No* Is All m~ni~Ori"~ ~qulpment opera~fonal pe~ manu,~mr~'a ~peeifi?lions? .,
* In Section F, below, describe how m~d whale the. st deficiencies were or will be corrected,
rhine 2 er3 oJ/OI
~ GAL VALLEY PAGE 04
~~0S/01/2004 10:08 66132§2S29
F. in-Tank Gauging / SIR Equipment:
Check this b~x it"tm~k geu6in$ L~ u~ed qnly rn~ inve~tnr¥ ccn(r~L
Check this box If no tank tau§iht or SIR equipment is installed.
This section must be completed if in-tank gauging equipment is used to perform ]oak detection monitoring.
Corn late the followi- checklist:
CI Yea rt No' Has all ,spur w,rlng I~en Ir~pect~d for proper'~ntryand terminat,on, I~cludhtg res'ting for E~ot, nd 'G'ulL~?'
CI Ye~' 0 No* Were ali tank gau~'i~g proGes v~ually inspe,~ed for damage and resiciue buildup~ "
CI ~'es C) bio* Was accuracy of.~ystem product level"readings
~3 Yes O No* Was accu~cy of syst'~ water lev'el readings tested?
1:31 Yes CI Ho*' Were ~]i probes r'~nstaiied p~erly? .....
OI Yes L-i N'Og Vv'ere'all items on the equipment manu~'acturer's ~'~intenanc~ cher. kllst ~ompletecl?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD); liS* Check this box ifLLIDs are not inslnlled.
Complete thc followin ~,,,checkllst:
[3 Yes C3 No* For equipment start-up or un','ualcen,fication, was · performance?
equipment ' leak sfmuieted to ~,erlfy I_.LD
C) N/A (Check all that appij9 Simulated ]eak rate: C) :) g.p.h.; [] O. ! g.p.h; C} 0.2 g,p.h.
Ci Yes CJ No* ~Vereall ULDs confirmed 'operntle~l'al and ~cumte Withi, rel~blatory requirements?
C] Ye~ [] No* "~as the tesflr~g apparatus prop.erly"calibrated?
Or Yes ~3'No* For mechanical LLDS~ does the LI, D restrict product flow If it detects a leak?
0 N/A
[] yes Ci No* For electronic LLbs. cl~es the ~'rb~ne a'~omaficnJly shut off ~fthe LLD del~cts n leak?
n N/A
~ Yea - O NO; For electronic LLDs. do~ the~urbine automatically sJmt off i~ any portion ~f the monitoring sy~'tem is disabled
[] N/A or dlsconnected7
Ci Yes ~l No;' For electronl¢" I,L. Ds, does thc turbine'"automnticall~ shut off il' 'any i~ortion of tl~e m~nltorlng system
1-1 N/A mnlfisnctions or rails a test?
11 y~ 0 NO* For electron~c ' ' '' "' '
LLOs, have all accessible wrong connectmns been visually insl~Cted?
CI N/^
3 Y'e's t3 I~o* Were ali'items'o, the equil~;nant ~anurncturar'~' mai'~'~tennnce che¢idist completed7 ........
' Ist the Seelino il, below, describe how and ,vben these deficiencies were or will be corrected.
L Comments: ..
Page 3 of 3
113/0 !
?--04 TUE I 4 : 07 FROM I) . $ . $ . R . I N C m p m 02
BSSR, lnc,
6630 Roscdale Hwy.,.# B, Bakcrsfiold, CA 93308 Phottc (661) 5~i8.2777 Fax (561) $88-2786
MONITORING SYSTEM CERTIFICATION
!l'h[s 'fot,ffi must be usod to document tcstlng and servicing of monitoring eqmpmcat, A_s_~.&rat..__e.cc~fical~n or t~~
'. g~L~'for each monitor~e svstc~ conffol canal by ~e toc~ic~n who po~b~ ~c work. A oopy of ~ls fo~ musl bc pmvi~d ~
:~:'.i~?;[~ ~sysl~m owag?/0p~ratgr. "~ ~wne[/opeta~or must sub~t a copy of ~is fo~ to ~e local ag~nw reguls~8 UST syste~
:.. ~i~30' days of ~st date.
' .~3 ~,,'..~eReral Information ~ ~
'" :"?'~" ' "' ' ' -'" Ci~:
.
, ", ~; .,::. :~ :. ·
~itit~ Coqm~e~soa: Contact ~on~ No,: ( ~/~)~~~
' .' of Monitors
, of Equipment Tested/Certified
Tank ID:
M. odel:~~~__ ~_ln-Tank Gauging Probe,
.S.ensot, Model:~ l:lt~Armular Space or Vault $ons~.
Piping Sump I Tr~ Scn~r~).
M~I:M~I;~ ~FillSu~Sans.(s).
Li or. Model: Mcch~icel Line Leak Detector.
:~bnic Li~ Lc~ Detector, M~el:
k'~fill / High-Level $~sor. M~cl:
~tlon E on
Mode. l:
Modeh
Model:
Model: ~
Modal;
Electronic Line Le~k Dot.tar. Model:
Tank Overfill / High-Level Sensor, Model:
~ and model in 5*ctien E on
Model: CI D~p~ser Containment Sensor(s). lot: .,
~hcar Valva{s).
Cantainmenl
Dispenser ID:
Containrr~nl Sensor(s). Mode
i and C'haln, inmcn! Float and
mOr~'t~ks m' alii'panagra, oop¥ this fonn. lnolude inform~flon fbr ~wry tank and dlspen.~cr az the facility.
~i..~Certifilcation . I certify that the equlpmeut identified tu this document wa~ inspected/serviced Iai accordance with the
.!'"!?~:jOatiuf~cturets' ~tdddim=. Attached to this Certification Is information (e.g, manal'acturer~* checklists) actuary te vm-U*y that this
!':'l'Mo~matlan Is ~r~t gad a Pint Plan showing the layout of monitoring equlpmeak~or say. equipment opable of generating su~
Page I of 3
System Certification
Containment
,gat' Space ot Vault
Sump / Trench ~.en_~s).
Leakl~teclor.
Taak ID:
~1 In-Tank Model: ~----~~
Model: ~l: Annular Spscc or Vault $~sor. Model:
Model: ~ Piping Sump / Trench ~s).
~o~i:~ ~FillSumpS~sor(~), ~/
~el: '. ~/~ ~ ~ec~nic~ Line Le~ Dot.tar, Model:
Modeh ' --; .... . ._ _ El~onic Line ~nk Detector. Model:
M~el: ~ Tank Ov~ll / ffigh-~l $~n~r, Modeh
in Section E on model in S~c~on
Disp~r ID: ~
Co~talnm=m Senso~O. Model: ..>__
~EP-- 7--04 TUE
14 :88 FROM I~. $. $. R.
XNC.
P. 0~;
,,~"i' i-'~. I~.0*~. e au~d~le ala~ op~radona .......................... ~ .... ~'~~~~'~ .... ~ ....
{~~-~* ' ls'~e v~ual a~ ope~t;onal? .... ~ .....................
~. ~ No' Were ail' se~ors installed at lowest po~to~s¢conda~ comai~cat and'posi~'on~d so'~at oaer equipment will
':'... .... ,,~t ~torfere with thck ~mp~! opc~tion?
~ ~ No~ If al~ ~ ~cd tO a re,re ~i~s s~lion, Ls all co~cagoM cquipm~
~:~ ~ ....... , . . ................
.~~ N~ ~or ~ed pip~ ~s~,. do~s ~ ~b~ avto~gca]ly sbui~owa ir ~"plplng'second~
.. ~A momtorm~ syst~'dctC¢~ a lc~ fails ~ ~te, or ~ cl~c~ll~ ~nncct~d? If~o~: which s~on
posftive shut~o~? (Chect all thai apply.) ~Su~onch $c~ors; ~ Dis~ns~ ~on~nt ~cns0rs.
Did you co~ ~osttfvc shut-down ~e to lee~ s~d se~r falur~soo~_~ctlon?~ Yes; ~
::~': 'No'. Fo~ ~ sye~e~ ~at~u~l~ ~e monitor~ '~yetcm as ~e pHm~ ~ 0v~fiH wam~8 dcv~e
::~ N/A mccha~cal owrffil prevention valve ~ ~s~ll~), is ~c ow~ll w~8 al~ vbible ~d audible at
fi~ ~o~t(s) ~ o~ ~ropcrly? If so, at what p~cent o~ t~_k ca~a~i~ docs. ~e a]~ ~il~cr?
~ No ~a ~Y'~mtu~ ~l~t ~placcd? I~y~;'iden~ ap~ifl~ sensors, pro~e, or oa~ ~quipmcnt
"'" ~d ~ ~ ~u~a¢~~ n~ ~d model ~r all r~lace~,~t pa~ ~m $~d~ ~,.. below.
'.~-N~ Wa ~uid fo.~d ~ide a~ 'secon~ ~n~'~ent sye~ d~t~ es ~ systat?" (Ciec~ all t~at"apply~
~ ~odu~ti ~ Wa~r. Ify~ d~cr~ cau!~.~}cc~on E,
i ~ ~e ' , .... , , ' .... ,- . ,
[~_~' [N~ W~ momtormR sXstcm set-up tevte~Cg lo cns~ prop~ acids? A~ch !gl ,up repoX~, ifaD~liCablo ,
[~k~o* Is aa mo~to~ ~9i~m~ngo~erafional Per ~.facmtet's sp-~ifioatio~v .........
~1~ ~ k*l~i,' J~.~k~ L~~' --~ J .-.L-~ ~ ~'~.' ~ ~m 5 ' ~' "'-' ~ '~ ;;. ;"--~ . ' ~'
· be!Ow; wheu tbe~e' defleteneie$ were or wtU be corrected.
Page 3 of 3 O3,,QI
?--04 TUE 1 4 -' 09 FROrq 3 . $ · $ . R . I NC . P . 04
BSSR, Inc.
6630 Roscdale Hwy., # B, Rakersfield, CA 93308 Phone (b61) 588.2777 Fax (061)
MONITORING SYSTEM CERTIFICATION
t
must bo used to document tcatizl$ and sorvlctn~ of mohitorml~ cqmpmcnt, A.scpa~a~_ertJCt~afion or~Rp~ m~sr
:,~,~g~'~n~.~ach mopi?rM~,s~s~m c~~ by ~e t~i¢ian who perfo~ the work, A copy ofth~ fo~ must ~e provided
'~:~.:~'Sys~m o~rlopentor. ~e owner/opener must ~b~t a copy of ~is fo~ to ~e loll agen~ regulate UST syste~
~oral Iaformation
· :.' luipment Tested/Certified
Conlainmenl: Mc~del: ~
Bldg. No.:
City: ..... Zip:
Contact Phone No.: ( _ ),
Date ofTeatiagf3e, zvioing: _,.,J_
Tank ID:
~ }n-Ta~k Gauging Probe.
O Annular Space or Vault Sensor.
C} Piping Sump / Trench Sensor(s), Maclab
C} Pill Sump Sensor(s), Model:
C! Mechanical Line Leak Dct~'~tor. Model:
CI Electronic Line Leak De~eotor. Model:
CI Tank Ove~ill ! High-Level Stair, Model:
Tank ID:
Model:
Section £ on
~' M~:lel: o O In-Tank Oauging Probe, Model:
. .:= Space or V~ult ,~n$or, Modcl: .............. O Annular Sp~e or Vault S~sor, Model:
.... :: ~i ~ench S~r(s). M~el: : _ O Piping Sump / T~nch $enso~s),
i M~dg: ..... . ~ Pill Sump Sensors). M~ch
[;al Line Le~ D~cotor, M~¢I: ~ Mechanical Line Leak ~tector, Mod~l:
.. Le~ Detec~, M~el: ' O ~le~tmaio Line Leak ~tzc~r. Mod~h
s~, M~el: _., O Tank Ov~l[ / High-~vel ~n~r, M~¢I:
S~tion B on model
Disbar
:ontain~nl Model:
liD:
Modoh
Model:
'.".Valveis),
ir'.
Dispenser lO;
Containment 0. Mo~el:
and C'h sin
Oisponser Contalnm~t Se6~0~(~).' Model;
Shear Valve(s),
, sad ChaJfll Containment Float(s)a__nd_ cha!n(s).: ...... ~- . .
·. [i.e:ilr~y c6n~aifls more ~ks oidi~na~t, ~opy this ~o~ ~clude iflFo~ation ~ot ev~ rank ~d disbar m the fuciliiy.
?;C..~r~caflon' , i ~X e.t the ~ulpment Id~Oflcd h tb~ documcot w~ ~ectc~scnic~ tn nc~rdance with the
.. ~' 'ia~l*~gmten" ~aid~a~ A~gh~d to thb C~iflca~on Is iuro~aOon (e,~. manuhc~u~' ch~kla~) necessa~ to veA~ ~at
. . 'i~'~itlon ~ co,eft and s Plot Phn showhg tho layout oF monitor, s ~uipm~t. For any ~ulpm~t ~pabJe or gcn~onS such
.' ~p:~, I have a~ offered a copy of the repofl; (~k ~dr ap~): O System setup O ~arm ~story report
'.Te~'~i~i~.Name ~t); '.. a ~ ~~ Signore: .....
. T~i~¢ompany Name: /~ ... Phone
:$i~.L~drcss: Vale orToat~ffSc~ic~g: / / .-
Pagel of 3 O3~t
System Certification
~$EP-- ?--0~ TUE 14 : 10 F~O~ ~- ~. ~ o R. Z ~.
:.I~. ~l~.-Tank Gauging / SIR Equipment:
Chcck this bna il' t=f~k ~augiaB ia used only foz' ~nvgntory control,
Check this box it' no rank gauging or SIR cquipn~ent is instaited.
must be comp!.e.ted if.in-t~nk gauging equipment is used to pert0rm leak detection monitoring.
below, d~crlbe'h~? end when these deficiencies were or will be eorrocted.
~'.'.'? r .O '~o* Hu &Il input WU'Lng been respected for proper .e. ntt,/and termmetton, including t~sting for ground fault~?
~:: [' ~ '~0$ Were ail'ts~k, 8augi~'g"probe~ visually |~{ed 'f~r dare'ge and residUe. ~{lildup.'} .... ·
!~.' '1~ No* W~ accuracy or,~i~m pro.ct level readings tested?
~ O No* Wa'aec~iacY or,~m water icCel rcadags tcs~? .........................
' ..~,: i~.~l,g~e Lc. ak Detectors (L.LD): ,~j. Che~ this box ir'LeOs ar= not i~l~d.
~iete the following checklist:
, ... N/A (C~eckedlthatn~t~ly) $imulatcdlea~rate: ~F3$.p-b.; O0.1g,p,h; O0.2g.p.h,
, .i::~-~, · ... ............
~.~. O N/AN0* For ~!c~ LL~ do~ ~e LLD ~s,ict Product. flow if tt deem a 1~?
?-~ ..... No* For cle~fi~D~, do°s ~e ~bae eu~caUy nut off ir~c LCD detee~ a tc-~ ...........
~N/A ,..
~ ~' 0 No* For ele~o~° LLD~, does ~ ~ av~lly sh~ off if=y'~on or~ ~io~ ~t=m ~'~sablcg
~ ............ . ...........
~: ;~ ~ HO* '" ~er~ ~ t~,~ t¢ equipm~t mau~a~'s ~mtcna~ oh=~list ~o~letcd?
~e..~tfSn H, below, ~,5'crfb~ hoW'and. wbeh these deficiencies were or will be ~rreeted.
Page 3 of 3 o:~tot
"S E P --
7--04 TUE I ~- .' I I FROI~I It ,. $ . S ...R ? .... ! NC . P . 06
System Certiflsatlon
UST Monitoring Site Plan
" '
.................. '~ ---- ' '-'"-' k ..........
.... ~ ...... ;1.~:~ ........
. ' ........... i iI ...........
.~ . . . $~[ ............................
' 'O .... ........
.... ~ ................................
........., , ,0: ...... . . . . . . G ..... ¢:: ·: ' ' :¢: . ......... . , . . . . .
· ~. }1 ~[ .... . ..............................
.....
~ .......... ~ .... .~ ...... ~ ..... ~ ..... ~ ........
~oi~t~' ~ ~ .......................................
'IL~,~4'~2 2 J 2 2 ......................................
.... ~, ......................
lustruc~ons_
~f ~,.o...~.~.sl~.!':~:ly have a diagram that shgws all required information, you may Lncludc fl. rather than this pa~e, with your
.~d~/l'I,?tii;i/, .,, . . System C~floa~on/ ~ yo~ sim' plan, show the gmeml layout of ~ ~d piping, Clearly idenri~
· .'~t~" ~k:'..: ...,~.~i~i. ~e .follow~g cquipm~t,, If ins~llcd: monitofln 8 system con~ol panels; sensors monitoring tank annular
~'{~:~d in'tank llouid level probes (irked for le~ dettc~on). ~ ~e ~ce provided, note ~e date this Site Plan
FiGs Of o5,'0o
SEP-- -/'--04- TUE I ,4 C I I
F.., ln~!.~:r~k Gauging / SIR Equipme, nt:.
FROM 1~. $. $. R. I NC. P. 07
0 Check ~h~s box if tartk gauging, is useci only for inventory control
0 Check this box if no tank gau$ing or SIR equipment ~ insta~llcd.
must be completed if in-tank gauging equipment is used to pertbrm lea. k detection monitoring,.
the
followint:
checklJstl
, .._o~...? , ,,---
, .~'~,':..~.~ ,..h ....... t _. , _ . : ..... ' ............. - , .
· - ~.~ ~ ,' ~ ........ ~ · · .... . .................
;~?~i~' No' Was accuracy o~systpmiproduot level readings
! :~:~[![~ No* Was accuracy of system' wa~r level tead~ tested? :
~~.~, ' , __ , ~ [ ,' ~ , .:,,. . _ ~ -- _ . ...... .... .
· ' ..;. "' ',[~ · '.', "4 '~ ' ..'." ' -- : ..' -' ....... ' .... '-'; ..........
i~.;, ,D~[[~Leak Detectors ~LD): O Check th~ box ffLLDs
~.~the followln checldtatl
',Nos Pot 'equipmimf m~.'t~'or annual equip.re, cai c. taiffioatton, wao a leek sitnulatcd to .verify LLD
· N/A (¢Ae¢/cdNr/sa~.~) $imuletcdle~r~e. G3g.p.h4 ~ 0.1 $.p.h~ O 0.2 ~.p.h.
No* ::For m~hii~ical LLDs, does the LLD real,ici prodv~t flow if it ~lct~ts a leak?
· ~a ' , ............
'No~1 :. For el~lzonic LLDs, do~ the tu~bLne automatically shut o~ if thc LLD detects ~ leak? .....
,, ....
:HOg- F0t ~leotr. o~ic LLDg~ does ~ tut'bibs' automatically abut off it' any'po-ni~ of the m0nlt0~$ systc'n~ is d. isabled
::.Cl}:'l~Io* For ele~onio LLDs; "~to~s tK'~ tu~'o'~'a~t°ma~,iiy shut off ii' any p0-~'~,, Or t~e mont~i~ i~st~m
N/A .malfua~.t!¢~ o~, faili a ~t? ...........
i.~q°' Far clCCtxoni¢ LiDs', hi~e all acccs$~le wiri~$ connections been VisuallY insp~ot~d? '
;.~. N/^' ·:
~"'~'~)* We'm ill {~n.s.on'th~...e(~..Ulpmen{..m~nu~t~'c~r's maintenance 'ch,ck]i~t cor~'t'eted? ' '
.;., S~tlbu H, below, de~CrJbe'ho~/"a'nd when the~e deficiencies were or will be corrected,
Page 3 of 3
03101
~ A~JG--~;O--04 MON 15 : 22 FROM ]~- $- $. R. I NC:.
P. 02
BSSR,
6~30 Ro,~xlale Hwy., ii B,.l~&kersfield, CA 93308 ~one (~1) 588-277~ F~ (661) 58~2~86
MONITO~G SYSTEM CERTIFICATION ~~".
. .:.~;fot_eac~ m?nltor~ svst~ conSOl ~anel by ~e ~ici~ who p~om ~e wo~. A ogPY of ~b fo~ m~t b~ p~ided~
'.;:~;~':iy~m ~/o~r. ~e ~w~/op~tor must sub~t a copy o~
: .=~ ;-.:.~..,...., . .
.. ~,i:.:::~/~::.. , ' '..' · ~ . -- ; ............ . , . -- ,
· :.- _.., , ....... . ....... .__ _
T~te~Ce~d
.Q.~iging ,. . Oauglng Probe. I:
~kl~r, or. Modeh (;t~.~nnular Spa~ ~ Vault
M~li ~tpi~ $~ / Tr~ch S~r(s).
~tcNor, M~el; 0 ~lectmnic L/ne L~ Debtor.
/ ~iSh-~v~] $~or. M~I: 0 Tank ~il / Htg~L~el
Mod~l: "
or Ysult S~n~or, MMol:
Mod~l; ,
MMoh
Leak Detector. Model:
Model:
in Section E on
s~r.,.Con~inm~nt
Model:
Modeh' Z _
Mod~:
In. Tank Gauging Probg. Modal:
Annular Space or Vault Sensor, Model:
Piping Sump / Trench Sensor(s),
Fill Sump Sen~s). M~oI:
MgchanJ~) Ling L~ ~t~tor.
Electronic Linc L~ D~tor, Modg:
Tank Ovcdill I Hish*Ld~v¢l ~:nsor. Model:
c and model In'~eOdon B on
Dlspen~r ID: "
DL;pen;er tO:
Modoh 0 Dlspormr Containm~t Sensor(s).
C::I' Shear Valve(s).
Dlspens(r ID: . ,,,,
0 DIs~nser Contalnmont Sensor(s). Modvl: '
~c(s). 0 Shear Valvcis).
: imo~t PlOal
' '~l~,~atton u ~ ~d a PI0t Pbn ~g ~e hyout of moultorhg equlp~uL gev auy~ulpm~t upbl, or gco~da8 such
Page I of $ O~t
System
Certification
AU~--~O-- 04 MON I 5 : 24 FROM I~ . $ . $ . R . I NC . P . 0~
.of Testlug/$ervlclug
l~ ~ v~l ala~ mai? , , _
~e aH s~s~ v~dally inspired, ~n~gonallx ~ed, and coufl~ed o~ratona{?
We~ mH sS~. ~tallod at {ow~i ~i ofmeGon~ oou~ai~enl and posiHone~ mo ~M o~er equtpm~ni wil{
not h~c~ wi~ ~ p~o~_o~agon?
ff el~ ~ ~lay~' to a ~mo~ monitor{ s~tfon, ~ ~I cad.Hans ,equlpmcut (e.{, m~cm)
op~Ho~l?
FO~ ~ed piping systcma, docs the tm'Mne automatically shut down if the piping secondary con~inment
most '.orin8 s~cm d~tecla a leak, fails m operate, or is electrically disconnected? lfye~: which sensors initiate
I~..~itlve shUt. down? (Check all tAat apply) G Sump/'lYench'Sensors; C3 Dispenser Containment Sensors.
c~ht"mn due to leeks Ct Yes: C3 No,
For ta~k ~ystc~' that utilize ~c monitoring system e~ thc primary ~enk overfill warning d~ice (i.e. no
me .oheaica.! overfill preventi.o.n valve h~ inemll~l), is th~ overfill warning alarm vis,lc end a~dlhlc
, doea the
W~ any mOo/to~us equipm~t'~Placcd? If yea, identify specific sensors, probc~ or other equipment t*~placed
and list d~e m--,,t'adurc~ ,~-~-_ and model few ell rcp~..mcnt....R__a~ In Sec_fio~ B, below.
Wes ti~_ufd found Insl,de eny"eecondax7 containment aystema designed as dry systems? (Ct, ecl~
C3 Producq O Wat~.. ffyes* d_e~crroc taus?in Scctlon_.~ .bc.low.
Was ~ i'evicwcd to cnsu~o Attach set
I~ all ;iflcaUons?
, ~el~w,'de~crlbe how ~mi wheia th;e~' deficiencies w~re or wfl] be corrected.
F- lJX~..ank..., ... Gauging / SIR Equf,pmeut:
FROM ~. S. S.R. INC. P. 04
Q Check ties box if tank gauging is u. scd op, ly ('or inveutory control,
0 ~k ~is box if no t~ g~ug~ or SIR e~u~nt ~ i~alled.
~On...~: m~t be ~mpict~. if ~-~.gau~, ~uipm~t i~ us~ m pcr~o~ lc~ det~on mo~tofing.
the foHow~ ~: '
· -, . mpu... ~..?a ~,,ected t'or proper entry and term~ation, irtcl-d~.g te~,,.S for ~rom~l ~aults?
W~r¢ a!l ~ gaugmg l~"ob~ vtsuaHy respected for de.go and ~iduc buildup? ' - "
Was acc.u~, Cy o.f sy-<~..?~ prod.,uc.t 1~ol r~dings t~stcd? -
bdo. w, delhi, be'hoW ~hd wheh th~s~ defldeu~les were or will be core. ted.
G: '~.~'~ L~ak Detectors (LLD): ~cd~ thL~ box ~LLDs aro not imtaU~d.
Page 3 of 3
o3/~t
AUG--SO-- 04 MON 1 5 = 25 FROM ~ - $ - $ - R .
INC. P. 015;
:p.u a.h'a~..y ~ve a d~a~ram d!a.t ~sho.~'p all ~ ~f~on, you my
i~fing 8~ C~~. ~:yo~ si~ p~, ahow ~c ~i hyou,
~.. of the follow~' ea~u~' if ~lled: m~tto~s ~s~ con~l pence; s~sors monitor, s
'a~ ...... a~a~ ~ ~ti~on~. or o~ ~n~ con~t ~, m~ical ~ clec~mc ]mc I~ak
¢~; ~~ .!iq~d level pm~ (~ ~ for 1~ ~c~). ~ ~c ~ ~dcd. note ~ date ~s S~ PI~
.
Page ~ of ~ o~oo
A~aJ~;-- ;~;0-- 04 [~lON 1 5 : 26 FROr, I l~ . $ . $ . R . I NC = P . 06
E. l.a,,Tank Gauging / SIR Equipment:
Check this box if tank gatr~ins is used only tot ir~vcntory control.
Check this box if no ~a]'~k giug~as or SIR equipmcnt i$ install~d.
T.,hi~. s~'tig, n must be compl.ot~ ifin-~imk gauging equipm. ~nt
. ......~..., ,. . , )~ / ..~ .
~,(loU ~, belows' duci4be hOW and when th~b defldende~ were or will be corrected.
!
,
,;. ;
Page 3 of 3
o3/ol
~"' .JUL 29
2004
13SN{-{S ;3L09~£I99 9G :0'~ P00~/9'1:/60
6613252529 C~L VALLEY PAC-~
MONITORING SYSTEM CERTIFICATION
For Use ~), All J. ri~d~tio~O ~ttAl~ the State
A~thortt~ C~ted; Chapter g. 7, lt~l¢h and,Salty C~: C~ lg. DI~L~gon J. ~tge 23, C~l¢~nio Co~ ~ReRulotio.$
'~ form must be used W d~um~nt t~qting and ~icing of monitoring equipmenL ~ se~mte ~ific~ion or repo~ must b~
p~ for each m~it~fl~ sys~m ~ntroi penel by the techni01~ w~ ~rfo~s the work, A copy ofthis ro~ must be provided to
U~e tank syatem owns/operate. ~tg owner/operator must submit a copy of this fo~ [o the local a~e~y r~ulatl~g
within 30 days of test date.
A. General lnformzfion
F~cility Conm~ Pemon: ,. Comact Phone No.: ( ., ),
Mak~odel of Monitoring System: ~'/~rEo ~ ~_. Date of Tes[in~rvicing:
B. Invenlo~ of Equipment Tested/Certified
~ lfl-'r~k Omr$in$ ~o~. ModH: _~. 0 In-T~kbzogi.$ ~b~ Model'.
Anfluler Spn~ or vault S~sor. Model: ~/~4.~ ~h~r O A~ulnr S~ or V~II ,~cnsor.
Piping Sump/Tre~h ~nsor(s~ ~odeh ~ ~o~ ~ Plpin8 ~mp/Tr~ch Scflso~s).
~FIII Sump 5~Ks). M~el: ~ Pill Sump 8~s~o). M~el:
~ ~cchnfli=ul Linc ~k ~el~. Mudel; ~ " ' ,," O ~h~i~{ ~i~ Lcnk ~tccmr.
O El~unle L~no Leak Do~i~, M~J; O GJe~mni~ Linc L~k D~Ktor.
~ 'l'~.k o~mr / l,~h-~evcl ~r. ~ode{; O Tnk ~crflll / {lish-I.~v~ Sensor. ~udel:
~ Olh~ (~ciry c~uJpmm( type end m~ci in So.ion B ~ Pp8c 2). J O ~r (top.fy ~{pmeni ~ nd model Jn ~{{~ ~ on {'USe 2).
· In-T~k O~8ing ~ Model: ~ , I O fn-Tnk ~JflS Pmk. M~eI:
{ Annular Space or Va. lt 8~sor. Model: ~~a~ ~A~{ ~ Annular 8~ce ~ Vault 8u~nt. M~e{:
{ Piping Sump 1 T~ch ~nso~a). Model: _~~ { O ~pin8 Sump / T~nch 8ensues). Model:
~ Fill Sump 9c~mr(m). M(~cI: O Fill 8~p 8~s). Mndcl:
I Mechanical Linc Leak I~e~lor. Model: ~ ~ O M~an{~l Line Lok I~or. Modch
3 El~lmnle IJne I.~k ~t~l~. M~{: ~ Ele~mfllc Line !.~ Dct~ier. M~el;
3 Tunk Ovcr~ll l I Il{h-I~vel 8~n~r. Mndcl: O T~ ~011 i l H{h-Level Sea.r, Modal:
~. Oth~ (~clty equipment ~pc and m~el._, In So.ion_ I~ un I,~ge 2~, .O..~lmr' .~OP~IrY, ~lulpm~i,,, _ , lypu...end model in 8~ll~n K ~. ~e 2).
Ibpe~r IDs / -~ Dispenser
t l)}s~ns~ C~lnl~t Sa~s). Me'I; ~~ , 0 Di~o.~r Containmem Se~s). M~:
f ~h~r Valve(s). 0 8~flr Valv~s).
! Dfs~nser Coniainmpnt/qoat~s~ ,.d Choifl~s). . , ~ Di~ Containers ]qonJ(s) ni~d C~air~s)., ,~: , .
O ~n~r ID: ~-~ Obpen~r i~ -
i~n~ ~flmln~nt S~S). Mod~l: ~~ ~ ~ Dl~n~ ~n~inment R~so~s), Model:
$he~ Valves). O 8h~
Di~ns~ Canto}nmos Flora) ~d Cl~in~s}. O Di~ Conflict Floes) end ~ha{n(s~.
~p~a~r lO: Dllpen~r ID:
Di~nser Cuntni~t Sg~r(~). M~I: ~ D{~.~ Con~inm~t {c~s). Model:
8ll~r Valv~), O 8~r
~l~n~r Containment fi~ nd Cl~ain~s~. O D~s~ Containers Fl~.ttel ~d
,,, , · ,, .... 1-( ~[ , ,,
Certification - I e~(i~ that the oqulpmmi' identi~ la Ihb d~ument was lampoon/serried In IKordnnce wkh lbo
msnuhetu~r~' KaldeJln~. Attn~ lo Ibis C~fl~fion Jj InbrmtOon (e4. mnnuhchl~' ehecklif~)
tnrflrmn/inn l0 correct ~nd fl Plat Plan nhowln~ the layout 0F monHoflnB equipmuL For snF ~.ipme.t
repoffs, r have a~ attached n copy of the ~epor~ f~e~ ~flkel ~)' O System set-up ~ Alarm
:hnician Name (print): '~E ~. ~_ ~ St~m~'._~_ ~~~. ~ history report
tin.tiaa No::'~~ 7~ U~nee. No.:
7g"?/?_,, -,~/-/,,~z,
Phone NO.:(~...~.)
OMII
02
OAL VALLEY
PAGE 03
Corn ,Ieee Ihe following
v. o ,e-.diUe,,la? op,,".i;,..l! ..........
Y~S. O No* is th~ ~sUai ~la~ operationul?
Ye~ ~ No* Were .[I senso~ vi~all~ Ins~. ~ncti~ally/esi~end ~fl~
~es O ~o* We~ ~ll sen~ in.ailed at Iowe~ poi~ of s~d~W condiment and positioned ~ thut ot~ eqUipme'l will
not In{;r[~ wi~ their pro~r opemion? ,., ;
Ye~' O No* Ir ~lnnns ;re ~ l~ n ~m0~ m0~ltorms ~tl~. Is aii com~U~i~10n; equipme.~ (e.g. modem)
~ WA ope~tion;l? ,
Y~ O ~o; For pre~uri~d'pip~G ~elem~. d~ Ihe 'N~e ~me~lly ~hut down ir m~ pipi~g sec~nd;~ conlainm~t
~ N/A monilorin8 sys~m detects a leak, rail~ ~ ~, et is electrically di;~onne~ Iryes: wht~ senso~ lnltinle
posilive ;hut-~own? (C/~c~ ~1 [/~t ~p~) ~~ch 8~; ~ Db~nser Conl;inmenl ~ensors.
O~ ~ou eonfi~ ~iUve shut-down due ~ ]eB~ ~=d ~nsor railur~discon~ecrion? ~ Y~; ~, No. .
Yes ~ NO* For rank ~s~ms that utlti~he ~onit~ ~em ~ Ihg prlmsW t~k overfill ~ming ~ieg
~ N/A mg~mn{~l overfill p~v~tiofl ~lvc b ine~ll~, is ~e overfill warning ala~ visib]e and audible at Ihe
fill points)~d op~ting pr~rly? If sot,~ wh~ pe~ent ortnnk capacity d~s the ala~ ~iggtr?
Yes~ ~ No Wns enY'mo~i~in~ ~uipmen~ ~i~c~d?. Ify~ td~tify ~ol~'~ Mfl~o~, pro~, ~ ~ther ~uJPment
and list d~ mnfluhc~rer n~me and m~l ~ iii r~J~m~nt ~ in ~n E,
~ Pt~uct; ~ Wu~r. [f~ ~soH~ ~ b SecOon E~.below.
Y~ ~" No~' Is ell m.pflitorifl8 equipm~t o~(ion~l.~ ~umT*~ ~ecJfica(i°,'?. , ~ . .
* In i ~ectlon t below, dmcr~be how .nd whefl these deliclenelfs ~ere or wiU he corrected.
O3/gl
09/~6/2084 09:~8 66~3252529 C~L VALLEY
p~ 0~
Er. I[u~Tmdc Gmt~iltg / SIR I~qulpment:
(..-'hock,this box il'lAnk 8mfBinS is ttsed only Ibr inventor), eorltrol,
Gheek this box if'no tank I~au$in& or SlIT eqt*lpmumt is inslalled.
This section must be completed ]£ in-tank Saugio8 eqtfipme~t ts used to peri'ora leak detection monitoring.
Corn )lute the rotlowin checklist:
Has all input wiri~$been [napecl~d " ~ j'' " '
For proper en~ and te~Jn~Jo~, includins t~ln~ for $rou~d ¢~I~T
We~hll'tafi~gaugi~ p~b~s visually ifl~ected ~ da~age and r~i~e ~uildt*p? _." ~' ~
W~ ,11 probes miflst~lled Pr~rly? _.
Were "il items ~ the ~uipmeflt manu~r'" mat~en~nce ch~klist ~npl~ed~ ....
* lu the Section Il, below, describe how and when/bose de/leleeele,j were or will he correct_ed.
Line Leak Detectors (L, LD): C2 C;h¢ck ibis box IFLLDs are not iMtalted.
Con tlele the Folk)win cbeeklist:
ICi Yea C3 No* For equipment etaff-~l~ or annual equtpmeqt oertlflcatton, was a leak simulated to verity LL,D performance?
(~ N/A (Checkall/t~ala,,~p/y) SimuleCedleakra~: 133&.p.h.; 130.1 g.p.h;
-1~ Ye~' 13 No* Were -Il ]L,LDs confirmed opera~ion.al and~ee".m?te ~ithin re~ulatory-requfremant"? ....
~ Ye~ I;] No* Wes the ~estin~ apparatus properly calibraled? .......
C] 4/~ O No* For mechanical LLDs, does the i~LD res~ct p-t~lct ~O~ it' t~leteCt~ al leak?
C3 N/A
C] Yes ~ C] No* -. F<3~elecl~Oni~"LLD~, does the terblne aulx~.n~ttcaily ~u'! off~f ~e LLD detect, a leak? .....
C] N/A
C3 yes C] N~; I~or el'~tna~ic~LDs, docs the turbine ,ul~nlUcally shut of TiF any porttoe or Ihe monitoring syslcm is dir~bied
13 NtA or disconnectcd?
;-i Yes C) Nee FOr e['eclr°~ic I.l.,Ds: d°% the tu~'bine' ~lu~ma~r-ally shut off if ~ny porti~)n bY ti~e moniturin§ system
Ci N/A malfunctions or Jails a test?
3 Yes C] No~ per electronic IL,i. Ds,' hav~ aifecceasible'wirln~ connections been visually inspected?
CI N/A
~ Y~ CI No* Were ali items o~ the equipment manuractur~'s ~'ainteflaflee c~ecklisl completed? '
Itt lite Section H, below, describe how attd ~hett these deflehutlu were or will be corrected.
!. Comments;
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.
A. General Inform__taflon ~ ..- . ~..
Make/Model of Monitoring System: ~/~' ~ '~2>'~3~
B. Inventory of Equipment Tested/Certified
J O"~_n-Tank Gaugin§ ~. ~ Model: /~ I'O'~h-Taak Gaugin~ Pro~.
J~ping Sump / Trench Sensor(s). Medcl: /-~//~.. J J~Pipin§ Sump. / Trench Sensor(s).
I~ Fill Sump Sensor(s). M~el: El Fill Sump Sensor(s).
ri Mechanical Line Leak Detector. Model: n Mechanical Line Leak Detector.
ri Electronic Linc Leak Detector. Model: ri Elecuonic Line Leak Detector.
rn Tank Overfill I High*Level Sensor. Model:
~_~Tank Gauging Probe.
~_~0~nular S~ ~ Vault Sen~r.
~ ~ping S~ I T~h S~s).
0 ~H S~ ~nsoffs).
~ M~i~ ~ne ~ ~mr.
Bldg. No.:
City: d~,~'~ ~-/~L Zip: ~,~3Z:~ ~'
Contact Phone No.: ( ~/ ) --~5) 7 ~ ~~
Model:
Model:
Model:
Model:
Model:
Model:
Tank Overfill / High-Level Sensor. Model:
Other (specify equipment type and model in Section E on Page 2).
Model: ~
Mod~l: //dx:
Model:
Model:
Model:
Tank Overfill / High-Level Sensor. Model:
Other (specify equipment t]~e and model in Section E on Pa~e 2).
I~Shear Valve(s).
Dispenser Containment Float(s~ and Chain(s).
I~l~hear Valve(s).
Other (specify equipment type and model in Section E on Page 2).
TankiD: T ~ p te,~¢~
4~l~In-Tank Gauging Probe.
[~'Annular
_ Space or Vault Sensor.
~'~ping Sump I Trench Sensor(s).
Fill Sump Sensor(s).
Mechanical Line Leak Detector.
Electronic Line Leak Detector.
Tank Overfill / High-Level Sensor. Model:
Other (s~eif~ e~ui~ent t~ and model in Section E on Pa~e 2).
[~Dispenser Containment Sensor(s). Model: ~/I
[W'Shear Valve(s). '
Dispenser Containmem Float(s) and Chain(s).
Dislm~r ID: ~'~//'~
~.-~ispen.~'Containment Sensor(s). Model:
ll]'n3hear Valve(s).
Model:
Model:
Model:
Model:
Model:
Model:
D. Resuils of Testing/Servicing
Software Version Installed:
checkli~:
~iil~Y~ ~ No* Is the audible alarm operational? "' "' ' ..........
12 No* Is the visual alarm operational?
li~Y~s 121 No* Were all sensors visually inspected, functionally tested,'and confirmed operational?
4ii'res 12 No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their proper operation?
12 Yes 1~1~2~1o* If alarms are relayed to a remote monitoring station, is' all communications equipment (e.g. modem)
~N/A
operational?
~ ,
· 1~ Yes I~ No* For pressurized' piping systems, does the turbine automatically shut down if the piping secondary containment
cl N/A monitoring system detects a leak, fails to operate~.~r is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check all that apply) I~"~mp/Trench Sensors; I~D~penser Containment Sensors.
Did you confirm positive shut-down due to leaks .~.d sensor failure/disconnection? I~l"¥brg; ~l No.
I-i Yes cl~[o* For tank systems that utilize the monitoring system as the primal3t tank overfill warning device (i.e. no
mechanical overfill prevention valve is installed), is the overl~dl 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 triff~er? __%
I~l Yes* ~'~ 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 p..artg, in Section E, below.
I~l Yes* ~ Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Q
.~. oduct; Q Water. If yes, describe causes in S.ection E, below.
t~ Fi No* Was monitoring system set-up reviewed to ensure proper settinl~s? Attach set ul~ re~rts, if applicable
· t~ Yes r~ No* Is all monitoring equi.p, ment operational per, manufacturer's specifications~.
* In Section E below, describe how and when these deficiencies were or wm be corrected.
Page
F. In-Tank Gauging / SIR Equipment:
~eck this box if tank gauging is used only for inventory control.
12 Check this box if no tank gauging or SIR equipment is installed.
This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring.
Corn dete the foilowin~ checklist:
'[~l~Yes rq No* H~s all input wiring'been inspected for proper entry and termination, including testing for ground faults?
,4~,~ 12 No* Were all tank gauging probes visually inspected' for damage and residue buildupf'
,~' Y~es 12 No* Was accuracy of system product level readings tested?
.g~Yes I~1 No* Was accuracy of system water level readings tested?
,l~ps r-t No* Were all probes reinstalled properly?
Y es ~ No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): ~Ch~ck this box if LLDs are not installed.
Corn dete the following checklist:
'"12 Yes' O No* F~ equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
r'l N/A (Check all that apply) Simulated leak rate: i~3g.p.h.; 120.1g.p.h; r'10.2g.p.h.
12 Yes 12 No* Were all LLDs confirmed operational and accurate wi~J~in regulatory requirements?
12 Yes' 12'No* Was the testing apparatus properly calibrated?
12 Yes 12 No* Pormechanicalll.Ds, does the LLD'restrict product flow if it detects a leak?
12 N/A
'12 Yes 12 No* Por electronic l.l.Ds, does the turbine automatically shut off if the LLD detects'a leak?
12 Yes 12 No* For electronic l.l.Ds, does the turbine automatically shut off if any portion of the monitoring system is disabled
12 N/A or disconnected?
12 Yes 12 No* For electronic l.l.Ds, does the turbine automatically shut off if any portion of the monitoring system malfunctions
12 N/A or fails a test?
vi Yes 12 No* Por electronic l.l.Ds, have all accessible wiring connections been visually inspectext?
12 N/A
12 Yes 12 bio* Were 'all items on the equipmem manufacturer's malntenanc~ Checklist cOmPleted?
* In the Section H, below, describe how and when these deficiencies were or will be correcte&
H. Comments:
Page 3 of 3 o.~o~
Monitoring System Certification
Instructions
If you already have a diagram that shows all required information, you may include it, rather than this page, with your
Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify
locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular
spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak
detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
was preparecL
Page __ of __ o5/00
~VSTEM SETUP
SEP ?, 2004 11:23 AM
SYSTEM UNITS
U.S.
SYSTEM LANGUAGE
ENGLISH
FASTR I P
M I NG-CHESTER
BAKERSF I ELD CA. 93304
805-397-8606
SH I FT T I ME I D I SABLED
SH I FT T I ME 2 D I SABLED
SH I FT T I ME 3 D I SABLED
SHIFT TIME 4 DISABLED
PER I OD I C TEST WARN I NGS
D I SABLED
ANNUAL TEST WARN I NGS
D I SABLED
PRINT TC VOLUMES
ENABLED
TEMP COMPENSATION
VALUE (DEG F ):
60.0
COMMUNICATIONS SETUP
PORT SETTINGS:
COMM BOARD
BAUD RATE
PARITY
STOP BIT
DATA LENGTH
I (RS-232)
9600
I,~NE
1 STOP
8 DATA
AUTO TRANSMIT SETTINGS:
AUTO LEAK ALARM LIMIT
DISABLED
AUTO HIGH WATER LIMIT
DISABLED
AUTO OVERFILL LIMIT
DISABLED
AUTO LOW PRODUCT
DISABLED
AUTO THEFT LIMIT
DISABLED
AUTO DELIVERY START
DISABLED
AUTO DELIVERY END
DISABLED
AUTO EXTERNAL INPUT ON
DISABLED
AUTO EXTERNAL INPUT OFF
DISABLED
AUTO SENSOR FUEL ALARM
DISABLED
AUTO SENSOR WATER ALARM
DISABLED
AUTO SENSOR OUT ALARM
DISABLED
RS-252 SECURITY
CODE : 000000
RS-232 END OF MESSAGE
DISABLED
IN-TANK SETUP
T I:PREMIUM
PRODUCT CODE
THEI;~L COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
1
.000700
111.50
I PT
12062
FLOAT SIZE:
WATER WARNING :
HIGH WATER LIMIT:
MAX OR LABEL VOL
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
LOW PRODUCT :
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT :
4.0 I ~K~HES
2.0
3.0
12062
10855
95~
I 1459
1
1206
'750
25
25
4.50
MAN I FOLDED TANKS
Tll: NONE
PERIODIC TEST TYPE
PERIODIC TEST FAIL
QUICK
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 15 MIN
T 2:pLUS
pRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANY pROFILE
' FULL VOL
2
.000700
111.50
I PT
12062
FLOAT SIZE: 4.0 INCHES
WATER WARNING :
HIGH WATER LIMIT
MR~ OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
2.0
3.0
12062
90%
10855
95~
11459
10%
1206
LOW PRODUCT : 750
LEAK ALARM L 1M I T: 25
SUDDEN LOSS LIMIT: 25
: 2.50
TANK T l LT
MAN I FOLDED TAI,IKS
Tt~: NONE
PERIODIC TEST TYPE OI]ICE
PERIODIC TEST FAIL
ALARM DISABLE[
GROSS TEST FAIL
ALARM DISABLE]
PER TEST AVER~31NG: OFt
TANK TEST NOTIFY: OF:
TNK TST SIPHON BREAK:OF
DELIVERY DELAY : 15 MI
T 0: UNLEADED
PRODUCT CODE
TANK I: ROF ILE
FULL VOL
3
.000700
1 11.50
1 PT
12062
FLOAT SIZE:
WATER WARNING ;
HIGH WATER LIMIT
HAT~ OR LABEL VOL:
OVERFILL LIHIT
HIGH PRODUCT
DELIVERY LIMIT
LOW pRODUCT :
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT :
MANIFOLDED TANKS
T~: NONE
LEAK MIN ANNUAL ;
PERIODIC TEST TYPE
4.0 INCHES
2.0
3,0
12062
90%
10855
95%
1 1459
10%
t206
750
25
25
4.30
0
QUICK
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 15 MIN
T 4:DIESEL
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
4
.000450
111.50
I PT
12062
FLOAT SIZE:
4.0 INCHES
WATER WARNING : 2.0
HIGH WATER LIMIT: 3.0
MAX OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
12062
90%
10855
95~
11459
5%
603
LOW PRODUCT : 50
LEAK ALARM LIMIT: 25
SUDDEN LOSS LIMIT: 100
TANK TILT : 4.44
MANIFOLDED TANKS
T#: NONE
PERIODIC TEST TYPE
OU I CK
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TSTSIPHON BREAK:OFF
DELIVERY DELAY : 15 MIN
1DISP 5-6
LI : FLOAT)
TATE (SINGLE
TRI-S . PAN
CATEGORY · DISPENSER
LEAK TEST METHOD
TEST ANNUALLY: ALL TANK
JAN WEEK I SUN
START TIME : DISABLED
TEST RATE :0.20 GAL/HR
DURATION : 2 HOURS
LIQUID SENSOR SETUP
L 1:91 STP
TRI-STATE {SINGLE FLOAT)
CATEGORY : STP SUMP
L 2:91 ANNULAR
TRI-STATE (SINGLE FLOAT)
CATEGORY : ANNULAR SPACE
L 3:89 STP
TRI-STATE (SINGLE FLOAT)
CATEGORY : STP SUI~
L 4:89 ANNULAR
TRI-STATE (SINGLE FLOAT)
CATEGORY : ANNULAR SPACE
L 5:87 STP
TRI-STATE (SINGLE FLOAT)
CATEGORY : STP SUMP
L 6:87 ANNULAR
TRI-STATE (SINGLE FLOAT)
CATEGORY : ANNULAR SPACE
L 7:DIESEL STP
TRI-STATE (SINGLE FLOAT)
CATEGORY : STP SUMP
L 8:DIESEL ANNULAR
TRI-STATE (SINGLE FLOAT)
CATEGORY : ANNULAR SPACE
DISP 7-8
LI2: FLOAT)
TRI-STATE (SINGL~R PAN
CATEGORY : DISPE.-E
~ DISP 9-10':
LI3: INGLE FLOAT)
TRI-S~7? (~,~pENSER PAN
CATEGORY :
L 9:DISP 1-2
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
LIO:DISP 3-4
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
OUTPUT RELAY SETUP
R 1:91 STP
TYPE:
STANDARD
NORMALLY CLOSED
LIQUID SENSOR ALMS
L I:FUEL ALARM
L 2:FUEL ALARM
L 9:FUEL ALARM
LI0;FUEL ALARM
LII;FUEL ALR]~
LI2:FUEL ALARM
LI3;FUEL ALARM
ALARM HI STORY REPORT
..... SENSOR ALARM .....
L I:PREMI~ SUMP
STP SUMP
FUEL ALARM
AUG 10. 2004
FUEL ALARM
AUG 10, 2004
FUEL ALRRM
AUG 12. 2003 12:50 PM
AI.~RM H/STORY REPORT
..... SENSOR ALARM .....
L 5:UNLEADED SUMP
STP SUMP
1:19 PM FUEL ALARM
AUG 10. 2004 1:20 PM
1:02 PM FUEL ALARM
AUG 10. 2004 1:18 PPI
FUEL ALARM
AUG 10, 2004 1:05 PH
R 2:89 STP
TYPE;
STANDARD
NORMALLY CLOSED
LIQUID SENSOR ALMS
L 3:FUEL ALARM
L 4:FUEL ALARM
L 9:FUEL ALARM
LIS:FUEL ALARM
Ltl:FUEL ALARM
LI2:FUEL Pi. ARM
LI3:FUEL ALARM
ALARM HISTORY REPORT
SENSOR ALARM
L 2:PREMIUM ANNULAR
ANNULAR SPACE
FUEL ALARM
AUG 10, 2004 I:19 PM
FUEL ALARM
AUG lO, 2004 1:17 PM
FUEL ALARM
AUG lO. 2004 12:58 PM
ALA~ HISTORY REPORT
..... SEN~OR ALARM .....
L 6:UNLEADED ANNULAR
ANNULAR SPACE
FUEL ALARM
AUG 10. 2004 {:21 PM
FUEL ~LARM
AUG 10. 2004 1:18 PM
FUEL ALARM
AUG 10. 2004 12:55 Piti
R 3:B7 STP
TYPE:
STANDARD
NORMRLLY CLOSED
LIQUID SENSOR ALMS
L 5:FUEL ALARM
L 6:FUEL ALARM
L 9:FUEL ALARM
LIO:FUEL ALARM
LII:FUEL ALaPJ"{
LI2:FUEL ALARM
L13:FUEL ALARM
R 4:DIESEL STP
TYPE:
NO E SLOSED
L I QU I D SENSOR ALMS
L 7:FUEL ALARM
L 8:FUEL ALARM
L 9 :FUEL ALARM
L 10: FUEL ALARM
L 1 I: FUEL ALARM
L 12 :FUEL ALARM
L 13: FUEL ALARM
ALARM HISTORY REPORT
SENSOR ALARM
L 3:PLUS SUMP
STP SUMP
FUEL ALARM
AUG 10, 2004 1:20 PM
FUEL ALARM
AUG 10, 2004 1:04 PM
FUEL ALARM
AUG 12. 2003 12:47 PM
ALARM HISTORY REPORT
SENSOR ALARM .....
L 4:PLUS ANNULAR
ANNULAR SPACE
FUEL ALARM
AUG 10. 2004 1:20 PM
FUEL ALARM
AUG 10, 2004 1:16 PM
ALARM HISTORV REPORT
..... SENSOR ALARM .....
L 7:DIESEL SUMP
STP SUMP
FUEL ALARM
AUG 10, 2004 1:21 PM
FUEL ALARM
AUG 10. 2004 1:01 PM
FUEL ALARM
AUG 12. 2003 12:50 Piti
ALARM HISTORY REPORT
..... SENSOR ALARM ......
L 8:DIEOEL ANNULAR
ANNULAR SPACE
FUEL ALARM
AUG 10. 2004 1:22 PM
ALARM HISTORY REPORT
SENSOR AI.~RM
L 9:DISP 1-2
DISPENSER PAN
FUEL ALARM
SEP ?, 2004 11:35 ~1
SETUP DATA WP~NING
AUG 10, 2004 1:15 PM
ALARM HISTORY REPORT
..... SENSOR ALARM
LID:DISP 3-4
DISPENSER PAN
FUEL AI..~RM
SEP 7, 2004 11:36
SETUP D~TA WARNING
AUG 10, 2004 1:15 PM
AL~RI'I HISTORY REPORT
..... SENSOR ALARM .....
LIS:DISP 9-10
DISPENSER PAN
FUEL RI..~RM
SEP 7, 2004 11:37 AM
SETUP I~TAWRRNING
AUG 10, 2004 I:15 PM
ALARM HISTORY REPORT
..... SENSOR ALARM .....
LII:DISP 5-6
DISPENSER PAN
FUEL ALARM
SEP 7, 2004 11:34 AH
SETUP DATA WARNING
AUG 10, 2004 1:15 PM
ALARM HISTORY REPORT
..... SENSOR ALARM .....
LI2:DISP 7-B
DISPENSER PAN
FUEL ALA]~
SEP 7. 2004 11:36 AM
SETUP DATA WARNING
AUG 10. 2004 1:15 PM
MONITORING SYSTEM CERTIFICATION
· For Use By All Jw'isdictions Within the State of California
.-lm/Wrm cJred: Chapter 6. 7, Health and Scfety Code? Chapter 16, Division 3, Title 23, Calijbrnicl Code of RegulaHons
This l"c)t, tn rtl[iai be useci to document testing~a.nd servicing of Jmonkorlng equipment. A set~arate certification or report rtlust be prepared
for each monitoring s. ystem control pane! by. the teclmictan who performs the work. A copy of this Ibrra must be provided to the tank
system owner/operator. The ownea'/operat0r fnust submit a copy of this form to the local agency regulating UST systems within 30
days o£ test date.
=~. CcncrM }information
Facility Contact Person:
Make..Model of Monkoring System: ~I-[fl-..B ~}'~122~
B. Inventory of Equipment Tested/Certified
Chcct~ xhr :~ q~ropriate ~oxes to indicate s~eci/ie e~Uipmea[ iaspeeted/s~,rvieed:
Tank iD: O~k~ ~
~-T~m[~ Gattging Probe. Model: ' ~1~6-
~ Atmutm' Space or V~dt SenSor. Model:.
~ Piping Sump/'h'ench Sensor(s). Model:
~ }:'ill 5mnp Sensor(s). Model::
~lmfical kine t.e~ Detector. Model:
~'.]cctronic Linc Le~fl; Detector. Model:: ~ Pc ~
~ l'ank Overfill / High-Level Sensor. Model:;
~.Q.[3er kspecify equipment r)'pe ~d model in ~ecrion E on Page 2}.
~ln~l'm~k Gauging Probe. Model:: ~ ~ ~ I
~ .~mular Space or Vault Sensor. Modelf.
L] Piping Smnp / Trench Sensor(s). Model:
CI Fill Sump Sensor,s). Model:
Q ~h~mical Line Le~ Detector. Model:
~Elcctronic Line Le~ Detector. Model:
~ l':mk Overfill / High-Level Sensor. Model:
.~_~)rlm7 tspeciS' equipment type ~d model in
enser Conrainmenr Sensor(s). Model:
~Shcar Valveks)./
_~ }}ispcns~r Conrmnmen[ Float(s) ~d Ch~n{s~.
Dis ~'nser ID ~ q
~enser Containment Sensor(s). ModeL:
~hear Valve(s).
.~ 0~spenser Containment Float(s} mid Chain{s~..
Dispenser ID:
~dection E on Page ~). [[
Dispenser Containment Sensor(s). Model:
city:
Contact Phone No.: (
Date of Testing/Servicing:
~.?ispenser Contai,~ment Floar(~) and Chain(s).. {2 Dispenser Containment Float(s) and
~lf the fiicili;y contains more nmks or dispensers} copy this form. Ir~elude information ~br every tank and dispenser at the facility.
Bldg. No.:
Zip: ____
)..
[~i'~nn-Tan~' Gauging Probe. Model: '~ - ~ .............
~ ~ulm Space or Vault Sensor. ModeL:
U Piping Sump / Trench Sensor(s). Model:
~ Fill Sump Sensor(s). Model:
r ~iCal Line Le~ Detector. Model:
onic Line Le~ Detector. Model:
~ Tank Overfill / High-Level Sensor. Model:
~ O~er (speci~ equipment type and model in Section E on Pa~e 2).
~ In-T~k Gauging Probe. Model:
n Utar Space or Vault Sensor. Model:
g Sump / Trench Sensor(s). Model: ~ ~
0 Fill Sump Sensor(s). Model:
~ Mech~ical Line Le~ Detector. Model:
~ Electronic Line Le~ Detector. Model:
~ T~k Ove~ill / Hi~-Level Sensor. Model:
~ Other (speci~ equipment ~pe ~d model in Seeti0n E ~n Pa~e 2): ......
Dispenser ID:
~ Dispenser Containment Sensor(s). Model:
~ She~ Valve(s).
~ Dispenser Comainmen; Float(s) m~d Chain(s).
Dispenser ID:
~ Dispenser Containment Sensor(s). Model:
~ Shem Valve(s).
~ Dispenser Containmem Float(s) ~d Chain, s).
Dispenser ID:
~ Dispenser Containment Sensor(s). Model:
~ Shem Valve(s).
Certification - 1 certify that the equipment identilied in this document was inspected/serviced in accordance with the manufacturers'
guidelines. Attached to this Certifieati6n is information (e.g, manufacturers' checklists) necessary to verify that this information is
correc~ and a Plot Plan showing the layoht of monitoring ~_qui~f. Pot any equi~'~apable of generating such r,ports, .1 have also
arfac~ed a copy of the repo~; ~ all ~];at two/y): ~ystem set=up
Certification No.: ~10 License. No.: C61/D40-
TestmgCompm~yNmne: RICH ENVIRONMENTAL PhoneNo.:(661 ) 392-8687
Address: ~0~ F~~ ~ ~"~~1
Page l of 3 03/01
5tonigoring System Certification
~. ~¢s~i~s of Testing/Servicing
Corn ,leto the followm ~ checRlist:
s ICI No* Is the audible alarm Operational? _
~ ICI No* Isrhe visuatalarmop~erarionat?
¥.~-'~ I ~ No* Were all sensors visulally h~spected, ftmcrionally tested, m~d 'confirmed operational? --
C~'~'c-s [ [] 'No* Were all sensors h~stalled at I. owest point of secondary containment and poskioned so that other equipmem w~[I
nor imerfere with the? proper operation?
Yes ~N/'~ It' '/dm'ms are relayed [o a remote mOnitorixxg station, is all conmmnications equipment (e.g. modem)
I_.} operational? .
[] No* For pressurized piping systems, does the turbine automatically shut down if ~e piping secondary containment
CI N/A monkoring system d¢'cects a leak, fails to op~ate~A:~r--is elecn'ically discojr,,m:lae~d? If yes: which sensors h~iriat¢
positive shut-down? :(Check all that cqat~lyJ 11~l~3ump/Trench Sensors; [] Dispenser Cont~o~_enr Sensors.
Did you confirm positive shut-down dae to leaks and sensor failure/discormection? ~es; IZl No.
~ [] ~ For r'ardr systems that utilize the monitoring system as the primary tmxk overfill warning device (i.e.
i~ N/A mechanical overfill prevention' valve is installed), is the overfill warning alarm visible and audible at the
~' fill poinr(s.) and operhxing properly? If so,. at what percent of tank capacity does the alarm n-i~ger? ~-?__
Yes* L.~'N'o Was any monitoring!equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced
,,,,----. and list the manufac~m'er name and model for all replacement pans in Section E, below.
'~'es:~ ~No Was liquid fotmd ins~.ide any secondary containment systems designed as dry systems? (Check all that
~ ~'~~. Product; ~ Water. !lyes, describe causes in Section E, below.
No* Was monitoring syst~m set-up reviewed to ensure proper settings? Attach set up reports, if applicable .._
No* Is all monitoring eqtiipment operational per ma. mffacmrer's specifications?
~ h~ Section E below, describe how and w~ h.en these deficiencies were or will be corrected.
Page 2 of 3 03/01
in-Tank Gauging / SIR Equipment:
C~.~ck this box if tank gauging is used only tbr inventory control.
Ca Check this box [f no tank .au.m~, or SIR equipment is installed.
This section must be completed if in-tank gaugir~g equipment is used to perfom-t leak detection monitoring.
Corn plete the following checklist:
CI \" es I gl No* H~'all inl~ut wiring ~een inspect&d mr Proper entry and termination, ineludh~g testing for ground faults? '~'
Ct Yes [ gl No* Were all tank gauging probes visually, inspected for damage and residue buildup?
Ci 'YesI [7.1 No* Was accuracy of system product level'readings tested? ....
Ct 'Yes I [2 No* Was accuracy of system water level readings tested?
G Yes I gl No* Were allprobes reinstalled properly?
ID Y cs ] ~ No* Were all items on the~, equipment manuthemrer's maintenance checklist completed?
rix,: Section 14, below, describe how and when these deficiencies were or will be corrected.
Lille Leak Detectors (LLD): gl Check fl~is box ffLLDs are not installed.
(.'o¢~tete the following checklist:
~'~'~s [] No* F;} equipment start]tip or mmual eqm'pm~nt c ,~tion, was a leak simulated to verify LLD perfo~:mance?
Ca N/A {Check ail tha~ apROn) Simulated leak rate: [~g.p.h.; [] 0.1 g.p.h; [] 0.2 g.p.h.
' No* Were all LLDs confir~med operational and accurate within regulatory requirements?
12 No* Was the 'testing apparatus properly calibrated? -
Yes' [] ~ For mechanical LLD$, does the LLD restri'ct product flow if it detects a leak?
"1~' N/A .
FI Na~. For electronic LLDs, idoes the turbine automatically shut offifthe LLD detects a leak?
~ [] No* For electronic LLDs)does tlxe turbine automatically shut off if any portion of the monitoring system is ~tisable-'~-
[] N/A or disconnected?
'~'~ I [] No* For electronic LLDs, idoes the turbine automatically shuz off if any portion of
the
monitoring
system
malftmctions
[] N/A or fails a test?
-~ [] No* For electronic LLDs, ihave all accessible wiring connections been visually inspected?
[] No* Were 'all items on theiequipment manufacatrer's nmintenance checklist completed?
· " In the Section tt below, describe how .ind when these deficiencies were or will be corrected.
Comments:
Page 3 of 3 03/o~
Mo~dto,'ing System Certification
UST Monitorine Site Plan
Ipstructions
If 3on already have a diagram that shows all required information, you may include it, rather than this page, witlx your
Monitoring System Certification. On your site plm~, shoTM the general layout of tanks and piping. Clearly identil\'
locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular
spaces, sumps, dispenser pm~s, spill containers, or off, er secondary containment areas; mechanical or electronic line teak
detectors; trod in-tank liquid level probes (if used for leak detection). In fl~e space provided, note the date this Site Plan
~x- a_< prepared.
Page ~ t~f~ 05/0o
AUG 26, 2004 9:29 AM
SYSTEM STATUS REPORT
ALL FUNCTIONS NORMAL
SOFTWARE REVISION LEVEL
VERSION 16.04
SOFTWARE~ 846016-100-E
CREATED - 98.08.03.18.43
SYSTEM FEATURES:
PERIODIC IN-TANK TESTS
ANNUAL IN-TANK TESTS
SYSTEM SETUP
AUG 26, 2004 9:30 AM
SYSTEM UNITS
U.S.
SYSTEM LANGUAGE
ENGLISH
SYSTEM DATE/T IME FORMAT
SON DD YYYY HH:MM:SS xM
SHIFT TIME
SHIFT TIME
SHIFT TIME
SHIFT TIME
DISABLED
DISABLED
DISABLED
DISABLED
TANK PERIODIC WARNINGS
DISABLED
TANK ANNUAL WARNINGS
DISABLED
LINE PERIODIC WARNINGS
DISABLED
LINE ANNUAL WARNINGS
DISABLED
PRINT TO VOLUMES
ENABLED
TEMP COMPENSATION
VALUE (DEG F ): 60.0
STICK HEIGHT OFFSET
DISABLED
H-PROTOCOL DATA FORMAT
HEIGHT
PRECISION TEST DURATION
HOURS: 12
DAYLIGHT SAVING TIME
DISABLED
RE-DIRECT LOCAL PRINTOUT
DISABLED
SYSTEM SECURITY
CODE : 000000
COMMUNICATIONS SETUP
PORT SETTINGS:
COMM BOARD I (F×MOD)
BAUD RATE 2400
PARITY: ODD
STOP BIT I STOP
DATA LENGTH: 7 DATA
DIAL TYPE : TONE
ANSWER ON : 1 RING
RECEIVER SETUP:
NONE
AUTO DIAL TIME SETUP:
NONE
R8-232 SECURITY
CODE : 000000
RS-232 END OF MESSAGE
DISABLED
AUTO DIAL ALARM SETUP.
I N-TANK SETUP
· T 1 :.SUPER
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
1
.000070
95.00
l': PT
11845
FLOAT SIZE: 4.0 IN. 8496
WATER WARNING : 2.0
HIGH WATER LIMIT: 3.0
MAX OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
11845
90~
10660
95~
11252
log
1184
LOW PRODUCT : 500
LEAK ALARM LIMIT 99
SUDDEN LOSS LIMIT: 99
TANK TILT : 0.00
M~NIFOLDED TANKS
T#: NONE
LEAK MIN PERIODIC: 0~
PERIODIC TEST TYCE 0
STANDARD
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
.ALARM DISABLED
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON ERE~d(:OFF
DELIVERy DELAY : 15 SIN
T 2:REGULAR
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
2
.000070
95.00
1 PT
11845
FLOAT SIZE: 4.0 IN. 8496
WATER WARNING : 2.0
HIGH WATF,~ LIMIT: 3,0
MAX OR I~%BEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
11845
90g
10660
95~
11252
lOg
1.184
LOW PRODUCT : 500
LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 99
TANK ·TILT : 0.00
MANIFOLDED TANK~
T~: NONE
LEAK MIN PERIODIC: Og
: 0
PERIODIC TEST TYPE
STANDARD
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
AI..AP~ DISABLED
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 15 SIN
T B :PLUS
PRODUCT CODE
THERMAL COEiFF
TANK ;D I AMETER
TANK PROFILE
FULL VOL
3
.000070
95.00
1 PT
11845
FLOAT SIZE: 4.0 IN. 8496
WATER WARNING : 2.0
HIGH WATER LIMIT: B.O
MAX OR LABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
11845
90~
10660
95~
11252
10~
1184
LOW PRODUCT : 500
LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 99
TANK TILT : 0.00
MANIFOLDED TANKS
T~: NONE
LEAK SIN PERIODIC: O~
: 0
PERIODIC TEST TYPE
STANDARD
BERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 15 SIN
ALARM HISTORY REPORT
IN-TANK
ALARM
--~ T 4:
T I:SUPER
SUDDEN LOSS ALARM
MAR 5, 2004 7:06 PM
FEB 29, 2004 10:56 AM
FEB 22. 2'004 11:34 AM
ALARM HISTORY REPORT
..... IN-TANK ALARM
DELIVERY NEEDED
JUL 15, 2004 8:17 PM
ALARM HISTORY REPORT
..... SENSOR ALARM
L I:PIPING SUMP
PIPING SUMP.
FUEL ALARM
AUG 26, 2004 9:25 AM
FUEL ALARM
MAY 8~ 2004 1:19 PM
ALARM HISTORY REPORT
FUEL ALARM
.... IN-TANK ALARM --, MAY 3, 2004
T 2:REGULAR
OVERF ILL ALARM
MAY 15, 2004 10:19 AM
JAN 31, 2004 9:20
1:10 PM
DELIVERY NEEDED
MAR 18, 2004 11:32 AM:
ALARM HISTORY REPORT
..... SENSOR ALARM
L 3:
OTHER SENSORS
ALARM HISTORY REPORT
..... SENSOR ALARM
L 4:
OTHER SENSORS
ALARM HISTORY REPORT
..... SENSOR ALARM .....
L. 5:
OTHER SENSORS
LEAK TEST METHOD"
TEST ON DATE : ALL TANK
JAN 1. 1996
START TIME : DISABLED
TEST RATE :0.20 GAL/HR'
DURATION : 2 HOURS
LEAK TEST REPORT FORMAT
NORMAL
ALARM HISTORY REPORT
..... SYSTEM ALARM .....
PAPER OUT
FEB 15, 2004 11:36 AM
PRINTER ERROR
FEB 15. 2004 11:09 AM
BATTERY IS OFF
END ~ * * *t
tALARM HISTORY REPORT
SENSOR ALARM
L 2:
OTHER SENSORS
ALARM HISTORY REPORT
.... IN-TANK ALARM --i
T 3 :PLUS
DELIVERY NEEDED
MAY 7, 2004 ?
APR 3, 2004 12
MAR 25, 2004 9
45 AM,
07 PM
06 AM
ALARM HISTORY REPORT
SENSOR ALARM .....
L 6:
OTHER SENSORS
~LARM HISTORY REPORT
SENSOR ALARM .....
L 7:
OTHER SENSORS
W 2:REGULAR
PIPE TYPE: STEEL
LINE LENGTH: 50 FEET
SHUTDOWN RATE: S.O GPH
T 2:REGULAR
DISPENSE MODE:
STANDARD
WPLLD LINE DISABLE SETUP
~ I:SUPER
LIQUID SENSOR ALMS
ALL:FUEL ALARM
W 2:REGULAR
- NO ALARM ASSIGNMENTS -
W 3:PLUS
- NO ALARM ASSIGNMENTS -
ALARM HISTORY REPORT
IN-TANK ALARM
T 2:REGULAR
OVERFILL ALARM
MAY 15, 2004 10:19 AM
JAN 31, 2004 9:20 AM
DELIVERY NEEDED
MAR 18. 20041:1:32 AM
ALARM HISTORY REPORT
..... SENSOR ALARM .....
L 8:
OTHER SENSORS
W 8 :PLUS
PIPE TYPE: STEEL
LINE LENGTH: 50 FEET
SHUTDOWN RATE: 3.0 GPH~
TANK: NONE
LINE LEAK LOCKOUT 8ET~P:
LOCKOUT SCHEDULE
DALLY
START TIME: DISABLED
STOP TIME : DISABLED
ALARM HISTORY REPORT
SYSTEM ALARM
PAPER OUT
FEB 15, 2004 11:36 AM
PRINTER ERROR
FEB 15, 2004 11:89 AM
BATTERY IS OFF
JAN 1, 1996 8:00 AM
ALARM HISTORY REPORT
.... IN-TANK ALARM .....
T 3:PLUS
DELIVERY NEEDED
MAY 7, 2004 7:45 AM
APR 3, 2004 12:07 PM
M~.~ 25, 2004 9:06 AM
AUG 26, 2004..9:30 AM
SYSTEM STATUS REPORT
ALL FUNCTIONS NORMAL
WPLLD LINE LEAK SETUP
W I:SUPER
PIPE TYPE: STEEL
LINE LENGTH: 50 FEET
SHUTDOWN RATE; 3.0 GPH
TANK: NONE
LIQUID SENSOR SETUP ALARM HISTORY REPORT
IN-TANK ALARM
L I:PlPING SUMP
TRI-STATE (SINGLE FLOAT:'T I:SUPER
CATEGORY : PIPING SUMP
SUDDEN LOSS ALARM
MAR 5, 2004 ?:06 PM
FEB 29, 2004 10:56 AM
FEB 22. 2004 11:34 AM
DELIVERY NEEDED
JUL 15, 2004 8:17 PM
OUTPUT RELAY SETUP ,'
R I:ALARM
TYPE:
STANDARD
NORMALLY OPEN
LIQUID SENSOR ALMS
ALL:FUEL ALARM
ALARM HISTORY REPORT
.... IN-TANK ALARM .....
T 4:
ALARM HISTORY REPORT
..... SENSOR ALARM
L i:PIPING SUMP
PIPING SUMP
FUEL ALARM
AUG 26, 2004 9:25 AM
FUEL ALARM
MAY 3, 2004 1:19 PM
FUEL ALARM
MAY 3, 2004 i:lO PM
ALARM HISTORY REPORT
...... SENSOR ALARM "
L 4:
OTHER SENSORS
ALARM HISTORY REPORT
L 7: SENSOR ALARM .....
OTHER SENSORS
ALARM HISTORY REPORT
..... SENSOR ALARM
L 2:
OTHER SENSORS
ALARM HISTORY REPORT
SENSOR ALARM
L 5:
OTHER SENSORS
ALARM HISTORY REPORT
L 8: SENSOR ALARM .....
OTHER SENSORS
ALARM HISTORY REPORT
..... SENSOR ALARM
L.3:' -,
OTHER SENSORS
ALARM HISTORY REPORT
..... SENSOR ALARM .....
L 6:
OTHER SENSORS
AUG 26, 2004 B':32 AM
' ~TEM STAT US !: REPORT
~ <-~:~ ...... L ......
08/24/2504 87:55
BKSFLD FIRE ~PREVEHTIOH
6613928521
(66I)852-217~
p.1
PAGE
CITY OF BAKRRSl~ELD
OFFICE O~ ~O~~ S~~
'~oo ~n ~.-~~~, ~
. APPLICATION TO PERFORM
FUEL MONITORING CERTIflq/CATION
I~,~CILITY
O~TO]~S N&M~
I
APPROVF.,D BY
i
SIONATUE~ O1~ ~
B
D
August 4, 2004
Mr. Jung Lee
Fiesta Liquors
2023 Baker Street
Bakersfield, CA 93306.
FIRE CHIEF
EON H<AZ~
ADMINI&TIIATIVE SERVICES
2101 "H" Street
~oke~flela. CA 93301
VOICE (661) 32~911
FAX (661) S&2-2170
SUPfREa&ION SERVICES
2101 "H" Street
Bakemfleld, CA 9~301
vOICE {661) 326-3941
FAX (661) 852-2170
PREVENTION &ERVIC~
PlI1 IA/'E1Y IIlIY~D, I#VffiONMeNTiSJ, IIIVC;#
900 Truxtun Ave., Sulle 210
aakmsfield, CA 93301
VOICE (a61) 32.6~979
FAX (661) 8.52-2171
FIRE INVESTIGATION
1714 Chester Ave,, 3~ flOOr
Bako~f[eid, CA 93301
VOICE (661) 326-39~1
FAX (661) 852-2172
TEAINING DIVL~IO N
..~42 Victor Ave,
Sokerstlel¢, CA 93308
VOICE (661) 399.4697
FAX (661) 399-5768
REMINDER OF
NOTICE.OF VIOLATION & SCHEDULE FOR COMPLIANCE
Our r~ords indicate that your annual maintenance certification on your leak detection
system will be past due on 09-02-04
You will I~ in violation of Section 2641($) of the California Code of Regulations,
"Equipment and devices used to monitor underground storage tanks shall be installed,
calibrated, operated and maintained in accordance with manufacturer's instructions,
including routine maLntenance and service cbecks at least once per calendar year for
operability and running condition,"
You are hembynotified that you have thln7 (.90) d~$ to either perform or submit
your annual certification m this office. Failure to comply will result in revocation of
your permit to operate your underground storage system.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph Huey
Director of Prevention Services
Steve Underwood
Fire Inspector/Environmental Code Enforcement Officer
Office of Environmental Services
SBU/db
TO 'd
SWKCB, January 2002 Page. of __
Sei:ondary Containment Testing Report Form
This form is intanded for u~a by contractors performing pariodic tasting of UET second~ cognizant sy~ta~. Use thw
appropriate pages of this form to report results for all components te~ted The completed form, written te~t proce~& ~d
printouts from tests (~ applicable), ,hould be provided to ~ facili~ owner/operator for ~ubmittal to the local re~lato~ agent.
~. gncIHtV ~O~t~oN,
Facility Contact: [ Phone:
Date Local Agency Was Notified of Testing:
Name of Local Agency,Inspector (if present during testi~.~, :
2. TESTING CONTRACTOR INFORMATION
Company Name: R:I CH ENV I RONMENTAL,
Teclufician Condu~:titig 'Test: .2~]~/
Credentials: ~ CSLB Licemed Contractor [] SWKCB Licensed Tank Tester
License Type,. C611D40 .' I'LicemeNumber: 809850
' Ma~Pf~emrer Trai, ine
Manufacturer ' Comoonent(s) Date Trainin~ Expires
INCON '.INCON TS-STS 8/04
3. RESULTS
Component Pass Fail Not "~Repairs Component Pass Fail Not , Re~airs
Tested: ....M. ade Teste. d~ 1V~ade
c,~L- ~ Aero ~o~ ~'~ o o o o o o
D D D D $ D D D
~D D D D D. D D D
D D D D D D O D
,..$D O S ,. O D O D
'0 O 0 O .0 O O O
If hydrostatic testing was perfgrmed, describe what was doae with the water after completion of tests:
CERTIFICATION OF TECHNICIAN RP.,~ONSIBLE FOR CONDUCTING THIS TESTING
To the best of my knowledge,~the acts stated in this docut~ent are accurate and in .full compliance with legal requirements
Technician's Signat~:~~~~~-''~ Date: ~--~d. ~::>¢/r'
SWRCB. January 2002 Page. of__
9. SPILL/OVERFILL CONTAINMENT BOXES
Facility is Not Equipped With Spill/Ove .r~i, Il Conment ,.~,oxe~
Spil~Overfill Cont~em Boxes ~e Pre~ent, but,were
Test Me.od Developed By: D Spill Buret M~
., fl O~er (Speo~) .,,
Test Mcfl~od Used: ~ ~css~e ~ Vacu~ ~ Hy&ostafic
fl ~er (Spec~)
Test Equipmcm Used: EN~ON TS-STS ..... Equipmem Resolution: · 0oo'[n.
~~~~~~ ~ ~ sPIil~ Box ~ ~ ~'F Spill Box ~ ~ ~ SPill Box ~ ( Sp~'Box~,
Wait time be~een applyMg
st~ng test: , ,
Test St~ thne: ..... q :. $O ~
lniti~ ~ading (RD: ] , ~ ~ ~ ~ ~ ... 0.. q ~ ~ ! ~ ]' ~ ~ t ~.. .
TestEnaW~e: q ', ~ ~ .. q.~~ '~ ~~ _
Cl~ge ~ Re~ing ~r-RO: , ~~
PasffFail T~eshoM or
Test Result:' ~a~a ~ ~ail ~Puss fl ~fl ~ass ~ ~afl ~ ~m$ ~ ~11
Comments - (i.n. clu, de information on repairs made prior to testin$ and recommended flo. llow-uP for failed t~ts2
SB989 TESTING F2~ILUP, E R]ZPOI~T
SITE CONTACT:
THE FOLLOWING COb~PONENTS ~ REPLACED/REPAIRED TO COlW_PLETE THE SB989
TESTING.
LIST OF PARTS REPLACED/REPAIRED:
LABOR: ~
PARTS INSTALLED
, ..... MONITORING SYSTEM CERTIFICATION
· For U.?e By All Jurisdictions Within the State of California
..4 ndwrm c,ed: Ch~'~p~er 6. 7, Health and Safety Code~ Cha£ter 16, Division 3, Title 23, Cali~brnia Code of Regulations
"£'hi~ form must be used ~o document testing!and servicing ofmonRoring equlpment. A separate certification qr repor~ must be p. repm'ed
for each monkorine system control pane[ by the technician who performs the work. A copy of this form must be provided to the tank
s)'srmn owner/operator. The owner/operator must submit a Copy of this form to the local agency regulating DST systems within .30
days of test date.
A. General Information
Fncklity Nmne: ~"IOJ~IL
Facilits. Comacr Person:
Malce~ Model of lvlonkoring System: [/L='[~'~- l~'7'''
inventory of Equipment Test{d/Certified
_~yc~ [J~5 u ~ )ropriare boxes ro indicate specific equipment ins{~eeted/serviced:
~r:funk Gauging Probe. Model:
~./~nuku' Space or Vault Sensor. Model:
Piping Sump/Trench Sensor(s). Model:
}:'ill Smnp Sensor(s). Model:
Mechmfic:-~l Line l.eak Detector. Model:
l?.t¢ctronic Line Let~k Detec[m'. Model: ·
l'ank Overfill / High-Level Sensor. Model: __
Other (s?ecify equiemem t)'pe ~d model in,Section E on Page 2).
- l'm~k Gauging Probe. Model:~ ~'~ ~
Piping Sump / Trench Sensor(s). Model:[
Bldg. No.:__
City: 7~J'e~/t(ff-~--,~F/~-~'~> Zip:
Contaet Phone No.: ( ).
'T'L 5'- ~,~-o Date of Testing/Servicing:
ank Oa~ Model:
ular Space or Vault Sensor. Model:
g Sump / Trench Sensor(s). Model:
C! Fill Sump Sensor(s). Model:
C3 Mech~ical Line Leak Detector. Model:
Q Elec~onic Line Le~ Detector, Model:
~ Tm~k Overfill / High-Level Sensor. Model:
121 Other Ispeeif~, equipment type and model in
Tank ID:
[] In-Tank Gauging Probe. Model:
[] Annular Space or Vault Sensor. lvlodeh
In Piping Sump / Trench Sensor(s). Model:
.............
_ /a/o
ROg ..........
Section Eon Pa~¢ 2)., ....
Sump Sensor(s).. Model:~
Mechm'fical Line Leak Detector. Model:,
Ekcu'onic Line Leak Detector. Model::
121 Fill Sump Sensor(s). Model:
I~1 Mechanical Line Leak Detector. Model:
[] Electronic Line Leak Detector. Model:
l';mk Overfill / High-Level Sensor. Model:i.
Q_ .Qd?' ~speci~' equipment type and model inl Section E on Page 2l'
spenser Containment Sensor(s). Model:~ ~ I
Shear Valve(s)."
,g_.Qispe{}ser Com~nmenr Floa(s) ~d Olmin(s).
_~ispenser Conraimnent Sensor(s). Model:~ ~ {
Shear V~flvets).
Dispenser Contaimnenr Floarqs} ~d Chain(s).
~enser Comainmen[ Sensor(s). Model~, ~ ~
Strum' V~dvets). :
121 Tank Overfill / High-Level Sensor. Model:
[] Other (specify equipment type and model in
enserlD: ~ '~ ~
nser Containment Sensor(s). Model:
I/Shear Valve(s).
13 Dispenser Containment Float(s) and Chain(s).
Di~t~;ser ID: '~ ~/0
~She~ Valve(s).
~ Dispenser Containment Float(s} ~d Chain(s).
D~penser ID:
121'Dispenser Containment Sensor(s). Model:
[] Shear Valve(s).
Section E on Pa~e ~,}:
g_D.!spense,;?ontainment Float(s) and Chain(s1. [] D, ispenser Containmem Float{s) and Chain(s).
~ifrhe fi~cili~y contains more Ca,z'ks or dispenser, s, copy this form. Include information for every tank and dispenser at the facility.
C. Certification - I certify that the equiipment identified in this document was inspected/serviced in accordance with the manufacturers'
guidelines. Attached to this Certificat~ion is information (e.g. manutheturers' checklists) necessary to verify that thi~ information is
correct and a Plot ma~ showing the layout of monitoring: e~ent. For any eq~t c~ble of generating such reports, I have also
.... ~m~l~ h~~ _ rt~: , ., : ,- ' .
License. No.: 40- ~ 809850
Cemficarion No.:
Testing Company .Nm'ne: RICH ElxW~ROlxlMENT~'r,
-qo/ 5 /eg>acg- g/ y
Phone No.:(661 ). 392-8687
Dare of Testing/Servicing: ~'-/t-'~/
Moni{oring System Certification
Page 1 of 3 03/(}1
,i5. t,~csut~s of Tesiing/Servieing
So~'~ m'e Version installed:
Co~ leto £he following checklist:
No'~ Is he audible alarm Operational?
No* Is d~e visualaiarm op. erationat9
No* Were all sensors vistlally h~spected, f[m¢.tipnall7 t~s[ed, ~d confirmed operational? --
No* Were alt sensors h~st~lled at lowesz po.h~t of secondly contaiment ~d positioned so that other equipment
not interfere with ~e~ir proper operation7
If attains ~e relay~ed ro a remote monitorh~g station, is att conmmnications equipment (e.g. modem)
operational?
No* For press~ized piping systems, does ~e tt=bine automatically shut do~ if ~e piping secondly conrainmen~-
N/A monitoring system db'tects a leak, fails to op~is elec~icalty disco~? lfyes: which sensors h~iriate
positive shut-down?~ (Check ~,ll that apply) ~Sump/Treneh Sensors; ~ispenser Contaim~enr Sensors.
Did you confirm positive shut-down due to le~cs ~xd sensor failure/disco~ection? ~ No.
~ For r~c systems that utilize ~e m0nitor~g system as fl~e prhnary tm~ overfill warn~g device (i.e.
mech~ical overfill Prevention' valve N ~st~led), is fl~e overfill warning alm-m visible and audible ar d~e rank
~.. fill po~t(S) ~d ope~ating properly? Ifso.~ at what p~rcenr oft~ capaci~ does fl~e alum n'i~ger?
~N'o Was any monitor~ equipment replaced? If yes, identi~ specific sensors, probes, or other equipmem reptacett
m~d list ~e manu/hc[urer name and m0~l tbr a~ replacement p~s in Section E, below.
~No Was liquid fotmd ~ide any secondly conta~xenr systems designed as d~ systetm? (Check all float
Product; ~ Water. ~Ifyes, describe ca~s in Section E, below.
No* Was monitoring system set-up reviewed to ensm'e proper seaings? A~ach set up repons, if applicable
No* Is all monitorbg eq~fipment operational per mmmhcturer's specifications?
Section E below, describe how and When these deficiencies were or will be corrected.
Page 2 of 3 r.,/o~
Gauging / SIR Equipment:
~Ckeck this box if tank gauging is used only for inventory control.
CI C[xeck this box if no tank gauging or SIR equipment is installed.
This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring.
the following checklist:
t-1 \" c,s I O No* Has all input wiring been inspect~d for'proper entry and termination, including testing for ground fa'ults?
CD ¥ cs { O No* Were all tank gauging probes vLsuatly inspected for damage and residue buildup?
Ci Y csI O No* Was accuracy of system product level ~eadings tested9
~ 'Yes } O No'* Was accuracy of system water level reft'dings tested?
CI \'es I [] No.* Were all probes rein4talled property9
L~ Yes I [] No* Were all items on the equipment mmmfacturer's maintenance checklist completed?
'tlxe Section Fl, below, describe how and when these delleiencies were or will be corrected.
Line Leak Detectors (LLD): ~this box ifLLDs are not installed.
Complete the following checldist:
23 Yes O No* For equipment start~up or annual equipment certification, was a leak simulated to verify LLD performance?
Q N/A (Check all that apply) Simulated leak rate: Cl 3 g.p.h.; gl 0.1 g.p.h; rn 0.2 g.p.h.
G Yes Q No* Were all LLDs confirmed operational oa~d accurate within regulatory requirements?
~ Yes [3 No* Was the testing appaiatus properly calibrated?
G Y es gl No* For mechanical LLD's, does the LLD restrict product flow if it detects a leak?
C] N/A
23 Yes Cl N'o* For elec=onic LLDs,i does the turbine ~t0matically shut off if the LLD detects a leak? -'
[] N/A
1'3 Yes [] No* For electronic LLDsi does tile turbine .automatically shut off if any portion of the monitoring system is disabled
~ N/A or discormected?
~ Yes Ct No* For electronic LLDs,i does tlxe turbine am6mafically shut offifany portion of the monitoring system malfunction..~
f3 N/A or fails a test?
--~ Yes [] No* For electronic LLDs,I have all accessible wiring connections been visually inspected?
[3 N/A
Q Yes Q No* Were 'all items on the equipment mamffacmrer's maintenance checklist completed?
the Section H, below, describe how and when these deficiencies were or will be corrected.
Comments:
Page 3 of 3 o3/o~
Moliitormt~ System Certification
UST Monitoring Site Plan
................. r
Date map was drawn:
Instructions
if 5ou already have a diagram that sb. ows all required information, you may include it, rather than this page, with your
Monitoring System Certification. On your site plma, show the general layout of tanks and piping. Clearly identil\'
locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular
spaces, sumps, dispenser p0aas, spill containers, or other secondary containment areas; mechanical or electronic line leak
dex'ectors; ~md in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
~¥as prepared·
Page __ (:f__ 05/00
MONITOR CERT. FAILURE REPORT
SITE CONTACT:
THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE THE MONITOR
C~:t. TIFICATION T~STING.
LIST OF PA1RTS ~EPLACED/REPAIi~ED: {
REPAIRS:
PARTS INSTALLEDi: -"~~
STOCKDALE MOBIL 2
5401STOCKDALE mY.
BAKERSFEILD CA.
AUG 25, 2004 10:00 AM
SYSTEM STATUS REPORT
ALL FUNCTIONS NORMAL .
SOFTWARE REVISION LEVEL
VERSION 14.04
SOFTWARE# 346014-100-E
CREATED - 97.07.09.14.49
NO SOFTWARE MODULE
SYSTEM FEATURES:
PERIODIC IN-TANK TEST~
ANNUAL IN-TANK TESTS
SYSTEM SETUP
AUG 25, 2004 10:00 APl
SYSTEM UNITS
U.S.'
SYSTEM :LANGUAGE
ENGL I SH. ~
SYSTEM DATE/TIME FORMAT~
MOM' DD?.:¥.~¥:¥¥ HH ~MM :SS xM
STOCKDALE 'MOB I L 2
5401 STOCKDALE HWY.
BAKERSFE I LD CA., ,
661-833-2726
SHIFT TIME 1 : 11:00 PM
SHIFT TIME 2 : 4:29 AM
SHIFT TIME 3 : 4:29 AM
SHIFT TIME 4 : 4:29 AM
PERIODIC TEST WARNIN~
DISABLED
ANNUAL TEST WARNINGS
DISABLED
PRINT TC VOLUMES
ENABLED
TEMP COMPENSATION
VALUE'(DEG F ): 60.0
H-PROTOCOL DATA FORMAT'
HEIGHT
RE-DIRECT LOCAL PRINTOUT
DISABLED
SYSTEM SECURITY
CODE : O00OOO
COMMUNIQATIONS SETUP
PORT SETTINGS:
COMM BOARD : 1
BAUD RATE : 1200
PARITY' :~ODD
STOP BIT : 1 STOP:
DATA LE:NGTH: 7 DATA ,,;
AUTO TRANSM I T SETT I NGS:
AUTO. LE~K ALARM LIMIT
DIS~BL.EU... :.~.~. : : ......
AUTO HIGH WATER::'~'IMIT
DISABLED:
AUTO OVERFILL LIMIT
'DISABLED!
AUTO LOW: PRODUCT
DISABLEDi
AUTO THEFT LIMIT
DISABLED:
AUTO DELIVERY START
DISABLED;
AUTO DEL:IVERY END
DISABLED!
AUTO EXTERNAL INPUT ON
DISABLED~
AUTO EXTERNAL INPUT OF~
DISABLED
AUTO SEN~OR FUEL ALARM
DISABLED!
AUTO SENSOR WATER ALARP
DISABLEDi
AUTO SEN~OR OUT ALARM
DISABLED:
R8-2~2 SECURITY
CODE : ~
RS-232 END OF MESSAGE
DISABLED'
!N-TANK SETUP
T ~:REGULAR 87
PRODUCT CODE : I
THERMAL COEFF :.000700
TANK DIAMETER : 96.00
TANK PROFILE : 1 PT
FULL VOL : 12245
FLOAT SIZE: 4.0 IN. 8496
WATER WARNING : 2.0
HIGH WATER LIMIT: 3.0
MA~ OR LABEL VOL: 12245
OVERFILL LIMIT :
: 11020
HIGH PRODUCT : ~5~
: 116~2
DELIVERY LIMIT : 15~
LOW PRODUCT : 800
LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 50
TANK TILT : 3.37
MANIFOLDED TANKS
T#: NONE
LEAK MIN PERIODIC:
: 0
LEAK MI N ANNUAL : O~
: 0
PERIODIC'TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
T~NK TEsT NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DF. LIVERY DELAY : 15 MIN
T 2:PREMIUM 91 .000700
PRODUCT CODE :2
THERMAL COEFF
TANK DIAMETER : 96.0~
TANK PROFILE : 1 PT
FULL VOL : 12245
FLOAT SIZE: 4.0 IN. 849~:
WATER WARNING : 1.
HIGH WATER LIMIT: 3.
MAX OR L~BEL VOL: 1224
OVERFILL LIMIT : 90~
: 11020
HIGH PRODUCT : 95~
: 11632
DELIVERY LIMIT : 15~
: 1836
LOW PRODUCT : 800
LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 50
TANK TILT : 2.94
MANIFOLDED TANKS
T#: NONE
LEAK MIN PERIODIC: 10~
: 1224
LEAK MIN ~NNUAL : 10%
: 1224
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST ~VERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BRE~K:OFF
DELIVERY DELAY : 15 MIN
T B:DIEOEL
PRODUC~OD~
THERMAL ¢OEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
3
.000450
96.00
I PT
5000
FLOAT SIZE; 4.0 IN. 8496
WATER WARNING : 2.0
HIGH WATER LIMIT: 3.0
MAX OR LABEL VOL: 5000
OVERFILL LIMIT : 90%
; 4500
HIGH PRODUCT : 95%
: 4?50
DELIVERY LIMIT : 16%
: 800
LOW PRODOCT : 500
LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 50
TANK TILT : 0.00
MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC:
LIQUID SENSOR SETUP
L I:UNL:STP
TRI-STATE <SI'NGLE FLOAT)
CATEGORY : STP SUMP
L 2:DIESEL ANNULAR
TRI-STATE (SINGLE FLOAT)
CATEGORy : ANNULAR SPACE
L 3:DIESEL STP
TRI-STATE (SINGLE FLOAT)
CATEGORY : STP SUMP
L 4:91ANNULLAR
TRI-STATE (SINGLE FLOAT)
CATEGORY : ANNULAR SPACE
L 5:PRES STP
TRI-STATE (SINGLE FLOAT:)
CATEGORY : STP SUMP
L 6:UNL;ANNULAR
16~ TRI-STATE (SINGLE FLOAT)
800 CATEGORy : ANNULAR SPACE'
LEAK MIN ANNUAL : 16~
: 800
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL '
ALARM DISABLE~
ANN TEST AVERAGING: OFF
PER TEST AVERAGINGi OFF:'
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 15 MI~
,OUTPUT RELAY SETUP
R I :87 STP SUMP
TYPE:
STANDARD
NORMALLY CLOSED
LIQUID SENSOR ALMS
ALL:FUEL ALARM
ASL:SENSOR OUT ALARM
ALL:SHORT ALARM
R 2:91 STP SUMP
TYPE:
BTANDARD
NORMALLY CLOSED
LIQUID SENSOR ALMS
ALL:FUEL ALARM
ALL:SENSOR OUT ALARM
ALL:SHORT ALARM
R @:DIESEL STP
TYPE:
STANDARD
NORMALLY CLOSED
LIQUID SENSOR ALMS
ALL:FUEL ALARM
ALL:SENSOR OUT ALARM
ALL:SHORT ALARM
..... SYSTEM ALARM .....
PAPER OUT
JUL 28, 2004 2:18 PM
PRINTER ERROR
JUL 28, 2004 2:18 PM
I~TTERY IS OFF
JAN 1, 1996 8:00 AM
CLOCK IS INCORRECT
AUG 16, 2003 2:27 PM
ALARM HISTORY REPORT
IN-TANK ALARM .....
T I:REGULAR 87
SETUP DATA WARNING
DEC 19. 1997 11:00 AM
DEC 15, 1997 4:58 PM
HIGH WATER ALARM
AUG 16, 2003 2:49 PM
OVERFILL ALARM
AUG 24. 2004 5:07 6~1
AUG 18, 2004 12:41 AM
AUG 9, 2004' 2:37 AM
LOW PRODUCT ALAP4~
AUG 7, 2004 12:25 AM
JUL 31, 2004 8:43 PM
JUL 9, 2004 9:37 PM
HIGH PRODUCT ALARM
AUG 9, 2004 2:42 AM
JUL 26. 2004 1:20 AM
MAY 23, 2004 4:35 PM
INVALID FUEL LEVEL',.
AUG 6. 2004 10:33 PM
JUL 31, 2004 8:20 PM
JUL 9, 2004 9:33 PM
PROBE OUT
JAN 22, 2004 4:28 PM
JAN 22. 2004 4:26 PM
JAN 22, 2004 3:58 PM
HIGH WATER WARNING
AUG 16, 2003 2:49 PM
DELIVERY NEEDED
AUG 11, 2004 4:25 PM
AUG 6. 2004 6:32 PM
AU~ 2, 2004 6:21 PM
LEAK ZEST METHOD
TEST ON DATE : ALL TANK
JAN 1, 1996
START TIME : DISABLED
TEST RATE :0,20 GAL/HR
DURATION : 2 HOURS
LOW TEMP WARNING
AUG 22. 2003 12:32 PM
OCT 11, 2000-4:24 PM
OCT 19, 1999 12:09 PM
LEAK TEST REPORT FORMAT
NORMAL '-
ALARM HISTORY REPORT
.... .I~-?A~< ALARM ---
T 2:PREMIUM 91
SETUP DATA WARNING
DEC 19, 1997 11:00 AM
DEC 15, 1997 4:58 PM
OVERFILL ALARM
MAY 22. 2004 1:30 AM
AUG 22, 2003 12:38 PM
AUG 16. 2003 2:30 PM
LOW PRODUCT ALARM
NOV 10, 2003 7:22 PM
AUG 7. 2003 3:43 PM
JUL 18, 2001 1:04 PM
HIGH PRODUCT ALARM
AUG 19, 2003 8:13 AM
AUG 19, 2003 8:11 AM
INVALID FUEL LEVEL
JAN 28. 2004 9:18 AM
NOV 10, 2003 6:42 PM
AUG 19. 2003 8:12 AM
PROBE OUT
JAN 22, 2004 4:10 PM
JAN 22. 2004 3:58 PM
DEC 8. 2003 1:40 PM
DELIVERY NEEDED
APR 11, 2004 4:27 PM
MAR 15. 2004 6:25 PM
MAR 14, 2004 4:25 PM
LOW TEMP WARNING
AUG 22. 2003 12:36 PM
ALARM HISTORY REPORT
iN-TANK'A[ARM ---
T 3:DIESEL
OVERFILL ALARM
AUG 5, 2004 3:32 AM
JUL 26, 2004 12:51 AM
JUL 19, 2004 3:10 AM
HIGH PRODUCT ALARM
JUL 19. 2004 3:~2 AM
JUN 4, 2004 1:02 AM'
PROBE OUT
JAN 22, 2004 3:31 PM
JAN.21. 2004 5:01 PM
JAN 20, 2004 4:11 PM
LOW TEMP WARNING
DEC 25, 2003 9:16 PM:
DEC 25, 2003 8:55
DEC 24, 2003 I0:20
ALARM HISTORY REPORT
.... IN-TANK ALARM ....
T 4: "
9~L~M HISTORY REPORT,
----~-SENSOR ALARM .....
L.4:91 'ANNULLAR
ANNULAR SPACE
FUEL ALARM
AUG 25, 2004 9:19 AM
SENSOR OUT ALARM
JAN 22, 2004 4:19 PM
FUEL ALARM
JAN 22. 2004 4:19 PM
ALARM HISTORY REPORT
..... SENSOR ALARM ---
L 1;UNL STP
STP SUMP
FUEL ALARM
AUG 25, 2004 9:18 AM
SENSOR OUT ALARM
JAN 22, 2004 4:27 PM
FUEL ALARM
JAN 22, 2004 4:26 PM
ALARM HISTORY REPORT
SENSOR ALARM
,L 5:PRES STP
.STP SUMP
· FUEL ALARM
~UG 2§, 2004 9:17 AM
SENSOR OUT ALARM
JAN 22, 2004 4:14 PM
~UEL ALARM
JAN 22, 2004 4:13 PM
SENSOR ALARM --fi,:/:
L 2:DIESEL ANNULAR
ANNULAR SPACE
FUEL ALARM
AUG 25, 2004 9:30 AM ALARM HISTORY REPORT
FUEL ALARM --' .... SENSOR ALARM .....
JAN 22, 2004 4:24 PM! L 6:UNL.ANNULAR
~ ANNULAR ~PAOE
SENSOR OUT ALARM ~ FUEL ~L~RM
JAN 22, 2004 4:23 PMj
AUG 25, 2004 9:19 AM
SENSOR OUT ALARM
JAN 22, 2004 4:16 PM
FUEL ALARM
J~N 22, 2004 4:15 PM
ALARM HISTORY REPORT.
'i
..... SENSOR ALARM --!
L 3:DIESEL STP
STP SUMP
FUEL ALARM
AUG 25, 2004 9:27 AM
SENSOR OUT ALARM
JAN 22, 2004 3:42 PM
SENSOR OUT ALARM
DEC I0. 2009 10:26 AM
ALARM HISTORY REPORT
..... SENSOR ALARM .....
L 7:
OTHER SENSORS
ALARM HISTORY REPORT
..... SENSOR ALARM .....
L 8:
OTHER SENSORS
STOCKDALE MOBIL 2
5401STOCKDaLE HWY.
BAKERSFEILD CA.
661-833-2726
AUG 25, 2004 10:01 AM
SYSTEM STATUS REPORT
ALL FUNCTION~ NORMAL
RUG 24 2004 9:26 BKSFLD FIRE PREVEHTIOH (661)852-2172 p.2
88/24/2a04 87:56
661392~21
P~ R&101
. OPHa. A~ NAM~
OWNERS NAM~ .
NAM]5 OF MOOR ~A ,
APPLICATION TO PERFORM
FUEL MONITORING CERTIFICATION
:
i t
APPRO'VRD BY
2002 Pa e of__
Sei:ondary Containment Testing Report Form
This form is intended for u~a by contractors parforming pCrt°dic testing of U~T saeond~ eonmi~ant sy~t~. Usa tha
appropriate pages of this form to report results for ~l compon~ tested The completed form, written t~tproae~es, ~d
printouts ~om tests (f applicable), shouM be provi~d to ~ f~ili~ owner~operator for ~ubmittd to the loam re~ato~ ag~n~.
'1. FACILITY ~~TION
Facility N~e: ~O~IL [ Date of Tes~g:
Facility Comact: [ Phone:
Date Local Agency W~ Nefified efTaat~g:
Name of Local Agency Inspector (ifptqsent during testin,,.~):
2. TESTING CONTRACTOR INFORMATION
Company Name: R:I CH ENV I RoNMENT..AL
Teclufician C0ndu~ti~g 'Test:- ,~~ ~%:>°7'~'
Credentials: ~ CSLB Licensed Contractor [3 SWKCB Licensed Tank Tester
License Type.. C611D40 -' ] LicenSe Number: 809850
.Ma, ,nafacmrer Trginine
Manufacturer ~0m~onent(s) Dato Training Expires
INCON INCON T, ,S,,-STS 8/04
3. SUMMARY OF TEST RESULTS
Component pass Fail iRepairs Not !Repairs
Tested.. Ma, de Component Pass Fail Tested Made
D D D D D D D D
D D D D' D D D D
B D D D D D D D
D D D D D D D D
D D D D D D D D
D D D D D D D D
D D D D D D B D
D D D D D D D D
D D D D D D D D
If hydrostatic testing was p~, .~ed, describe what wasl dane with the water after completion of tests:
RECYCLE A. ND REUSED.'.
CERTIFICATION OF TECHNICIAN RF~PONSIBLE FOR CONDUCTING THIS TESTING
?b the best of m~~uttt~nt ~re accurate and in full compliance with legal requlrem~tts
Technician's Signature:~~~~--"'~~gr'---.~o'~ Date: ~ -~
S ~,~ RCB ,raj anuary 2002 Page of .
9. )VER~ILL BOXES
Facility is Not Equipped With SpilFOve . 1Contair~, ent ,~,oxea
SpilVOverfill Con~nt,, Boxes ~e. Pre~ent,, , bm w?e
Test Me.od Developed By: ~ S~l Bucket M~~
~ ~er (Spec~) ., ,
Test Mefl~od Used: ~ Presage 0 V~um ~ Hy~osmfic
Tes~ Eq~pment Used: INC~N ~S-S~S E~uipment Resolution: · ooo'in.. ' ' '
,~}~~,~~m'. ' . .... _ ~c spl~ Sox ~ ~ ~.. . Spin aox ~ ~ t ~pm ~o~ ~ , s~ ao~'~ ,
Bucket Dep~: {~ t,
s~ng test:
Test St~ Time: ~ :10~ ~ : ~
lni~Readiag(RO: ,~l,~ ,~00,~ t.¢9~/~ [":~)~ l: Oq~'"].o~ ....
P~F~l'~eshotd or '
Criteria: . ~ t~ -
Test R~ult: ~s O FaiI ~ ......
~Pass DFail O Pass DF~ DP~s DFaii
Comments - (include information on.relaairs made t~rior to te. stin~, and recomme, nded foIlow-up for faiIed teata~
SB989 TESTING FAILURE REPORT
SITE CONTACT:
THE FOLLOWING COMPONENTS WE~ REPLACED/REPAIRED TO COF~PLETE THE SB989
TESTING.
LIST OF PARTS REPLACED/REPAIi~ED:
09/16/2004 15:15
6613252529
C~L VALLEY
RICH ENV' RO TAL
OFFZ~,(6G1) Sg2,.,e65'7 & I'AX (S6:1) 39,?,-0621
work SH~T
PAGE 03
'.%
I certify that the adore line teste we=e ¢onduc=ed acco~nq to
my k~owZedge t=ue a~d correct.'
· Tec~
%-:
MEG: C~RTI~ZCATION: # . ,60~,. L~
89/16/2004
15:15
6613252529
PAL VALLEY
PAGE
82
RICH ENVIRONMENTAL
S643 BRdOKa CT BA~R,RFIEI~D; CA.-0308'"'
u m
Pre~ition Pro~lu~ Line Test
Test Date: 8/25/2004
BILLING:CAL-VALLEY EQUIP. CO.
3500 GILMORE AVE
BAKERSFIELD, CA 93308
BITE: BAKERSFIELD CITY SCHOOLS
Ce( 't'?~ FELIZ DR
BAKERSFIELD, CA 93307
PRODUCT PRODUCT MECH,. NICAL MONITOR
_PROD_UCT$ [JNE TEST _, LEAK bETECTOR . LEAK DETEGTOR
UNL-87 0.000--PASS I~A NIA
DIESEL -0,005-PASS N/A NIA
A precision test was performed on product lirtes at the above location using the ACURITE TM
PIPEMNE TEST. i have reviewed the data preduced in conjunction with this teat for purpose of verifying
the results and ce~fylng the product line I~Z system~.'The leering wa; performes in acorrdanoe with
ACURITE TM pmtoc, ol, and therefore Satisfies all requirements for such testing as set forfl~ by NFPA 329-
92 and USEPA 40 CFR part 280.
The results of testing are shown on the following page. Included with the report are reproduction of data
compiled during the test which formed the basl; for lhese conclusion. Thl~ information is ~ored Iff a
permsn.en.t file if future verification o~ test results ia needed.
I declare under penalty of perjury that I am st II~$nted tank tester in the State of California and that
the Information contained in this report hi true and oorm(~t to the trust of my knowledge.
. MFG Certification: # 602.LT
Stat~ ~ 03-1849
ENVIRONMENTAL MANAGEMENT CONSULTANTS
August ] 7, 2004
Mr, Howard H, Wi_nes, III
- HazardOus Materials Specialist
City of Bakersfield Fire Department
1715 Chester Avenue
Bakersfield, California 93301
~'~Subje:ct: .... T ~=TR~N$IviiTT'~L= OF-DISPOS~L-DOOUMENTATIO'N=FOR
_ CHEVRON ·PRODUCTS COMPANY SERVICE STATION #9-1536
2700 OSWELL STREET, BAKERSFIELD, CALIFORNIA
Dear Mr. winesl .
On behalf of'Chevron Environmental Management Company (CEMC], Holguin, Fahan &
Associates, Inc. (HFA) is forwarding-copies of the disposal documentation for soil and
groundwater generated during the site assessment conducted in April 2004 at the
above-referenced site,- Results of the investigation were summarized in HFA's site assessment
report and closure request dated July 8, 2004. ~Disposal documentation for soil and groundwater
generated during!the investigation were not available when the report was finalized.
Holguin, Fahan & Associates, Inc. trusts that this letter meets the requirements of the City of
Bakersfield Fire Department. If you have any questions or require additional information, please
contact me at (909) 422-8988 or Jim_Haslett@hfa.com.
Respectfully submitted,
James M. Haslett, RG, REA
Senior Geologist
Holguin, Fahan, & Associates, Inc.
JMH:ang:dm:yg -
Enclosures: Disposal Documentation
cc: Ms. Natasha Molla, CEMC
L _ :--.'..-~'Ms'.' J'oan.~Thorne' ~ - -. .
~?-.' :?'~;!, """~,--. - -.~ '" : - :": '~"::' ::'.?'.': ' ;'~i-c. :' ,..'.,
· ::':~'~..~-'.- ,,.~.~.. . :. -.- ~.
ENVIRONMENTAL: . SCIENTISTS * GEOLOGISTS · ENGINEERS
Contaminated ~ite.s:Assessme~r)ts · Phase I AUdits · Site Remediation · Hazard Waste Management
143 South Figueroa Sl_reet5940 Lakeshore Drive 2820 PegastJs Drive, Suite 1
:' Venlural Califdrnia 93001 Cypress, California 90630BaRersfield. California 93308
(805)652_0219 ~ - :' (714) 236-1741- · (66'1)391_0517
- - (805) 652-0793 FAX - ' ~ (714) 236-1745~FAX (661) 391-0826 FAX
Ir~terrlet: first_lasl@hfa.cE)m Ii]terl~let:.first lasl@hfa.:con~ ll)lernel: firsl last@hfa.cor/]
=
-_ .... : - ~ .... - WWw. hfa.corn
1003 E. Cooley Drive, Suile 201 1215 South Park Lane, Suite 1
Colton, California 92324 Tempe. Arizol~la 85281
(909) 422-8988 (480) 505-3332
(909) 422-8099 FAX (480) 505-3336 FAX
lrlteri~et: fJrst_lasl@hfa.corn Irllernet: first_lasl@hl'a.corn
D~e of S~ipmen~
Responsible for Payme~e
Generator's Name and. Billing Addr~$:
Soil
Non-Hazardous Soils
Generator's Phone
Generator's US EPA ID No.
' ': Load
CHEVRON PRODUCTS
P.O. BOX 600~
SAN ~, CA 94553
Person to Contact:.
Customer Account' Number With TPS:
J, HASLETr
FAX#:
Site Phone #:
Pe~n to Contact:
FAX#:
FAX#:
Person to Contact:
LOU ~OLEY
Customer Account Number with.TPS:
BTEX
Levels
'rPH
Lo'els
AVG.
Levels
Facilit7 Permit Numbers
'fransporter's US EPA ID No.:
Transporter's DOT No.:
Transporter Name and Mailing A~I
LoNo "-,....
De~crlption of Soil
Sand a O~i~
Clay O Other.
Cl~y Q Other
,'Other
FAX#:
Approx. Oty:
427,4746
Customer Account Number with TPS:
Generator's a,~.~lo, r consultant's certification: I/We certify that the soil referenced those soils described in the Soil Data
Sheet compl'~V'd'd and certOete~..~..rcle/us f~r the Generation Site shown above and nothing has been added or done to such soil that would alter it.in
Transporter's certification: d/We acknowledge receipt of the sol1
receive~Ne further certify that this soit is'Mng ~
tg, adding,~q, subtracting from or in any wdy detayin~
; Prat or'l~ Name:
and certify that such soil is being delivered in exactly the same',.
transported from the Generation Site to the Designated Facili~
to such s, i.t~.
,d
Recycling Facility certifies the ~__~ of the soil co'oered ~
exc~,~,t ~s noti~ ~ove:
NON-HAZARDOUS WASTE DATA FORM
,,. ........... .,~.,, ~,,~,: ~ ~. ., ~, ~ ,~:'~, ~,:>:~,~,. , ,,, ~ ~k~, ¢~'~>, ~ ,,,,,
EPA
c~, ~.~ ..- .. '. - .. .. .
~PE: '* ~ TRUCK ~.TRU~S~D ~RU ~ CARTONS ~ O~ER, ,
COMP~S OF WAS~ PPM ~o ': COMPONE~S OF WAS~ ' PPM
~u.,,_,,,, "' OA% :'. · .
· S. ~ '{ ...,..
"
4.. ~" . .... '8.,, · · . ~..~' ..
PRoPERnEs: pH ~ "~- LID I ". ..
I -
.. .~,~ -~.. ~r proof ~r~l:~O~e ~r'~n~' . m~l, -
THE W~ AS DE~RIBED IS 1~%
~.. ~P~ ~:PR~ FU~ ~ME & SIGNAfURE / / '~" DA~ -,'
~u~T, ,- ". · ¥:. ."
" '' ":R o o ~ 37
.NDuST~AL SERV~CE~FINC. '" ~"
,'A o 1 4 8
~DRESS -~;, ;~.~ ,, ~B ~. ~ .... : .......
C~, STA~. lIP ...... PICK UP DATE
'~:-- :~~--- ,~- -. . . .
PHONE NO, .
U:.~. F!L~ECO~RY ~BEVICE~ ~' ', "~::1C'A D'...:-O'' 9 '7 O 3 0 9 9"'~.~'':
~ME .. · ,.' ...: '. . , -. '..~
. · '
~RESS ': -, D ~NDFI~ D o~ER ,..
~ - ~%' - . ,. .
-, : :. ].l // / /.
'" " :~h% .'
TYPE~R PRIED ~LD~E & S~NA~RE ' DATE
'~ RT~ ~F ~ DIscREP~cY ' '