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,.
MONITORING SYSTEM CERTIFICATION
For U$e By All Jurisdictions Wj¡hin the Stale of California
Awhol'iry Cired: Chi/prer 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, Calijòrnic¡ Code of RegulaTions
;t
TlÜs lonn müs\: be used lO document testing and servicing of monitoring equipment. A separate certification or repon must be prep~1red
Îùr d.::Ìl moniwl'ing sysrel11 comrol panet by. the technician who performs the work. A copy of this form must be provided to the tank
SYSlèlll owœrloperaror. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30
lbys (If lcSt diHè.
A. Gefiêralluformation
Llcilily Name: C'J-1...i ;t) ('7 tJ
SiI~' .--\.ddrè:ss: .)(,JÔ / t<./H~T.G ¿ ~
bcilil) Comacr Person: ~At JI-~Æ--IZ.
l'vL'lkçiModd of Monitoring System: J~Ò - 36"0
Bldg. No.:
City: C4XF I?ÆPI.[itJ {) Zip:
Contact Phone No.: ( )
Date of TestinglServ icing: -'CJJ ZL/ ~
ß. iJilvellto.'y of Equipment Tested/Certified
o Ç¡,,,,.!~ _fh" ."2J~rù rià¡~ bo~~s 10 indicatc s ecitic c IIi melH ills )cct~d/serviccd;
11- T¡¡nk lD: _-.Jl.AJ L % 7
I'j In-bnk Gauging Probè. Model; ~
,\.nnul.\!· Spacè or Vaulr Sensor. Modèl: 'c..¡')..O
I Piping Sump í Tl'ènch Seosor(s). Model: 'ð-O f{
~ Fill Slimp SeI1S01'(s), . Model: )-O~
o i\kê\uulical Line Leak Detector, Modèl:
o E!wl"ùllic Line Lèak De[eClOr, Model:
o LUll.;, Ol'èr!ìl1l High-Level Sensor. Model:
O_º¡h~'r lS è:cil\' è:C ui mènt t' e and model in Section E on Pae 2 ,
rLwk ill:
o In-Tank Gauging Probe, Modèl:
o A.iìnular Spaœ or Vault Sensor, Model:
o Piping Sump ¡ Trench Sel1sor(s), Model:
o FilJ Srunp SèJ1sorls). Model:
o l\ièch,U1ic,Ü Line Leak Detector. Model:
o Ek..:rrollÎc Linè Leak Detecror, Model:
o T,U1k OVër!ìJJ ¡ High-Level SèIlSOr. Model:
o Orl2èfvp.èCifYè( ui mèm ry e and mod,;] in Section E on Pae 2 .
Dispenser ID:
~ DispèllSCr Comainme1lt Sensor(s), Model:
jA. Sj¡çM Valvè:ls),
_ÇJ !)}_?l!.CJ1Sè:f C~)J1(aj¡lmènr Float(s) and Chain(s),
Disp':J1ser In:
I}{ ~ìspèn~er Comainment Sensor(s). Model: J-O' &-
~ ~hear \- ülve(s),
q L)isjJèn~,.:r COl1lainmenr FIO;;l[(s) and Chain(s),
Disµèilsèr ID:
o DispèJbèr Conrainmenr Sensor(s), Model:
o She,Il'Va]vè(S),
ODi~pèI1sèr Çonrainmel1l F]oat(s) and Chain(s),
'lfrhè f¡¡ci]iry comains more tanks or dispènsers, copy this form,
t1.JO
Tank lD: PUM.. ø¡ /
)4 In-Tank Gauging Probè. Modd: YJ~ /
o Annular Space or Vault Sènsor. Model:
)iI Piping Sump / Trench Sensor(s), Model:
~ Fill Sump Sènsor(s). Modd:
o Mechanical Line Leak Detector, Model:
o Electronic Line Leak Detecror. Model:
o Tank Overfill / High-Level Sensor, Model:
o Other (s eci' e ui ment t e and model in Section E on Pae 1),
Tank ID:
o In-Tank Gauging Probe, Model:
o Annular Space or Vault Sensor, Model:
o Piping Sump / Trench Sensor(s). Model:
o Fill Sump Sensor(s), Model:
o Mechanical Line Leak Derec1:Or. Model:
o Electronic Line Leak Detec1:Or. Model:
o Tank OveríìJl / High-Level Sensor. Model:
o Other (s ecify e ui ment e and model in Section Eon Pa e 2),
Dispenser ID: . 51
¡;r Dispensèr Containment Sensor(s), Modèl: ðOf
'8 Shear Valve(s),
o Dis enser Containme¡H FJoar(s) and Chain(s),
Dispenser ID:
~Dìspenser Containment Sènsor(s), Model:
Jjì: Shear Valve(s).
o Dis enser Containmenr Flom(s and Chain(s),
Dispenser ill:
o Dispenser Containment Sensor(s). Model:
o Shear Valve(s).
o Dis enser Containment Float(s and Chain(s ,
Include information for every tank and dispenser at the faciliry,
~~
C. Certification -I certify that the equipment identiíied in this document was inspected/serviced in accordance with the manufacturers'
guiù,,(jnes. Anached to this Certitication is information (e.g. manufacturers' checklists) necessary to verify that this information is
':OITecc ànd a Plot Plan showing the layout ot' mOllÌtoring equipment, For any equipment capable ot' generating such reports, 1 have also
_. . ,H~ach"d a .:opy o~' the re~3r& SfhJ;!'jk 1l1l1l11l~ryl!~Y)j ¡a system. ~et-up ~ ~' I'm history report
1 edlJllWUl Name (pnm): ~V t"1~JV' SlgnatLlfe: __ ~
CèrciÙcmion No,: 00&' O...ç-· 1')"" License. No.: 1/D40- #v~'p9850
Tör.ingCompanyName: RICH ENVIRONMENTAL Phone No,:(661 ) 392-8687
Sile: Address: ~ð} t..c..J f} I J£ L.AJ ¡/"'H~P-I&,L,tJ r4- Date of TestinglSerYicing: --..hi -.lL/~X.
Page 1 of3
03/01
Moü.iwfing SY$£t:m Certiíïcation
~ 'i
.{). lL:sults of Testing/Servicing
SüÌf\\ 'If': Version Installed: \ ð) ,ð Ò
Ci)Ü¡ )11:'(1:; (he followil1o checklist:
\ ~ \' èS 0 No" Is me audible alarm 0 erational?
,- ,\~ U No'" Is d1e visual alarm 0 erariol1nl?
~ y~:s 0 No'" Were all sensors visual! ins ected, functional] tested, and confinned 0 erarional?
-e \'èS 0 No" Were all sensors instal1ed at lowest point of secondary comairunent and positioned so that other equipment wilJ
nor imerfere with their ro )<:1' 0 eraÜon?
If alarms are relayed to a remote monitoring station, is all communications equipment (e.g.. modem)
operational?
For pressurized piping systems, does ¢e turbiœ automatically shut down if the piping secondary comainmènr
moniroring system detects a leak, faits to operate, or is elecfrically disconnected? If yes: which sensors iniriarè
posirive shur-dow11? (Check all that apply) ~ Sump/Trench Sensors; 'ijI. Dispenser Containmenr Sensors,
Did 'OU confirm ositive shm-down due to leaks and sensor failure/disconnection? Yes; 0 No,
For rank systems that urilize the monitoring system as the primary tank overfilJ warning device (i.e. no
mechanjcal overtìlJ prevention valve is installed), is the overfill warning alarm visible and audible at the rank
fill oim(s) and 0 eratino ro erly? If so, at what ereent of tank: ca aei does the a]arm rrí(roer? ~'¡)
Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaceJ
and list the manufacturer name and model for all re lacement arts in Section E, below,
Was liquid fOlUld inside any secondary containment systems designed as dry systems? (Check allrhCll apply) 0
Producr; 0 Water. If es, describe causes in Secrion E, below.
YèS 0 No* Was monitorin s stem set-u reviewed to ensure ro er settinas? Attach set u
't' èS 0 No* Is all monítorina e ui mem 0 erational er manufacturer's s ecifieations?
" in Si;'CCiOll E below, describe how and when these deficiencies were or wilJ be corrected.
~y,;
(YCC
I
,I
II U \\::s
:\
!
o No"
~N/A
o No'"
o N/A
o \èS,j<
o No"
.~ N/A
I
t 1. No
U YèS*
JtNo
E. CüÜï.lllerus:
- .'._---_..-~._---_..
_.,"-,-, --,.---.-..----.--
---.._~ ..,,_., -.---,-
¡¡cable
--- - ..-.~~. -- -. -- -.'
-- ~, .....,_. ---.---- ._----.
----,- ~-- _.._----~_._-
. ,_,~,~ u.+.<.___
.--------
--.-._--.-,-_. ---'
---------
- ,-----....---...---.
_ .....-... .--------
_._----,__,__.0·
-------,--'
03/01
------ .--..... ---
Page 2 of' 3
F. lû-rCmk Gauging J SIR Equipment:
~ Check th~s box ~ftank gaLlging is used only for inventory control.
o Check dus box If no tank: gauging or SIR equipment is installed,
This sècLÌon lT1USI be completed if in~tank gauging equipment is used to perform leak detection monitoring.
Clj¡'ì..0dè rllè followino checklìst'
.....
0 Yd 0 No" Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
1---
0 \' è~ 0 No" Were all tank gauging probes visually io.spected for damage and residue buildup?
U \'.,,$ 0 No* Was accuracy of sysrem product level readings tested?
LJ Yes \ 0 No" Was accuracy of system water level readings rested?
0 Yl'S 0 No* Were all probes reinsralled properly?
~_YèS 0 No" Were aH irems on rhe equipment manufacrurer's maintenance checklist completed?
" ill tile Stction H, below, describe how and when these deficiencies were or will be corrected.
G. Lint Le~tk ûetectors (LLD):
rp- Check. this box if LLDs are not installed,
c
'lL
hk.l't
0Ill\)klt (he to owmg c ec' is :
U YeS o No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
o N/A (Check all ¡hm apply) Simulated leak rate: 03 g.p.h,; 00,1 g.p,h; 00.2 g.p,h,
o YèS 0 No* Were all LLDs confirmed operational and accurare within regulatory requirements?
O\'èS I 0 No* Was me testing apparatus properly calibrated?
0 Yc.'S o No'" For mechanical LLDs, does the LLD restrict product flow jf it detects a leak?
o N/A
U YeS o No* For eJèctronic LLDs, does the turbine automatically shut off if me LLD detects a leak?
o N/A
0 'y'èS 0 No'" For eleen-onic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
0 N/A or discormected?
1--' Ús 0 No* For electronic LLDs, does the turbine automatically shut off if any p0l1ion of me monitoring system malfunctions
u
0 N/A or fails a rest?
0 Yè$ 0 No" For elecrronic LLDs, have all accessible wiring connections been visllaJ\y inspected?
0 N/A
U Yè~ 0 No" Were all items on me equipment manufacturer's maintenance checldist completed?
'" In ell!: Section H, below, describe bow and when these deticiencies were or will be corrected.
H. Cû:uunen'Cs:
- -_.._---_._,---,
----------
>-"---- ----
.--..- ._----,--
Page 301'3
03/01
lvioniw,.ing Sysrem Ceni1ìcatioll
'.~ . ,
Si[è AL1drèSS: ,ðú0
UST lVlonitoring Site Plan
W ij-~ L~. ß~t<.£a-~F)ÞLt1 r4
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l&J ~~~~~C?
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FILL.
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0' -r¡)(t;f):
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Dare map was drawn: 10 /.-!L/!!..:;t.
Instructions
If )ùL! alrc:ady have a diagram that shows all required information, you may include it, rather than this page, with your
.tvlonÜorÜlg SysTem Cen:itìcation, On your site plan, show the general layout of tanks and piping, Clearly identify
locmions of The following equipment, if installed: monitoring system control panels; sensors monitoring tank annular
SpiJCèS, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak
dè'lècrors; and in-tank liquid level probes (if used for leak detection), In the space provided, note the date this Site Plan
\.\ ,LS; prep:lred,
Page -LOf~
05/00
,¡
MONITOR CERT. FAILURE REPORT
ADDRESS: 4J
SITE NAME: (7 A-~ ~ b Q
CITY: SIGNATURE:
SITE CONTACT: 13 ~ (j~
THE FOLLOWING COMPONENTS WERE RJi:PLACED/REPAIRED TO COMPLETE THE MONITOR
CERTIFICATION TESTING.
LIST OF PARTS REPLACED/REPAIRED:
REPAIRS:
.AJ(}vE:
LABOR:
-
/!JO~ J}:a
PARTS INSTALLED:
V()V~
SOFTWARE REVISION LEVEL
VERB I ON 123,02
SOFTWARE~ 346f?3~100-C
CREATED - 02.11.25.15.17
NO SOFTWARE MODULE
SYBTEI"! FEATUREB:
PERIODIC IN-TANK TESTS
ANNUAL IN-TANK TESTS
SYSTEI"l SETUP
1_- ____
OCT 11, 2004 1: 59 PI"1
BVBTEI"1 UN ITB
U.S.
SVSTEr"1 LANGUAGE
ENGLISH
SYSTEt'l DATE/TIt"IE FORt"IAT
MON DD YYYY HH:MM:BS xM
GAS-N-GO
2601 WH ITE LN
, BACKERSF I ELD, CA
1-661-833-8553
SHIFT TII"lE 1
SHIFT TII"l£ 2
SHIFT 1'11"1£ 3
SHIFT TIt"1E 4
DISABLED
DISABLED
DIBABLED
DISABLED
TANK PER TST NEEDED \¡JRN
DISABLED
TANK ANN TST NEEDED WRNi
DISABLED
LINE RE-ENABLE METHOD
PASS LINE TEST
LINE PER TST NEEDED WRN
DISABLED
LINE ANN TST NEEDED WRN
DISABLED
PRINT TC VOLUMES
ENABLED
TEt"IP COI"IPENSAT I ON
VALUE (DEG F): 60,0
STICK HEIGHT OFFSET
DISABLED
DAYLIGHT SAVING TIME
DISABLED
BVBTEr"! SECUR I TV
CODE : 000000
CUSTOM· ALARM LABELS
DISABLED
IN-TANK SETUP
------
T 1 :PREt'l
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
. 2'
: .0007001
114.00
1 PT
8000
FLOAT SIZE:
4.0 IN.
WATER WARNING : 2.0
HIGH WATER LIMIT: 2.5
MAX OR LABEL VOL: 8000
OVERFILL LIMIT 90%
7200
HIGH PRODUCT 89%
7120
DELIVERY LIMIT 10%
800
LOW PRODUCT : 1500
LEAK ALARM LIt"lIT: 99
SUDDEN LOSS LIMIT: 99,
TANK TILT 0.001
PROBE OFFSET 0 . 001
I
SIPHON MANIFOLDED TANKS I
T~: NONE !
LINE MANIFOLDED TANKS
T~: NONE
LEAK MIN PERIODIC:
LEAK !"tIN ANNUAL
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALAR'"! DISABLED
PERIODIC TEST FAIL
ALAR!"1 D I Sf;\BLED
GROSS TEST FAIL
ALARt"1 DISABLED
ANN TEST AVERAGING: OFF!
PER TEST AVERAGING: OFF
i
TANK TEST NOTI FY : OFF!
TNK TST SIPHON BREAK:OFF'
DELIVERY DELAY 1 MIN
PUt"1P THRESHOLD 1 0 . 00%
\
T 2:UNLEADED
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL
: 1
: .000700
114 . 00
1 PT
12000
FLOAT SIZE:
4.0 IN.
WATER WARNING : 2.0
HIGH WATER LIMIT: 2.5
!"IAX OR LABEL VOL:
OVERFILL LIMIT :
HIGH PRODUCT
DELI VERY L H1 IT
12000
90%
10800
89%
10680
15%
1800
3000
99
99
0.00
0.001
LOW PRODUCT :
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT
PROBE OFFSET
SIPHON MANIFOLDED TANKS
T~: NONE
LINE MANIFOLDED TANKS
T~:' NONE
I
I
O~~
O¡
0%
o
LEAK !"tIN PERIODIC:
LEAK tH.,N ANN~k :-_ _ 0%
'''' 0
PERIODIC TEST TYPE
STANDARD
LEAK TEST METHOD
- - - - - -
TEST WEEKLY : ALL TANK
SUN
START TII"1E
TEST RATE
DURATION
- - - -
: 12: 00 AI"I
:0.20 GAL/HR
: 2 HOURS
TST EARLY STOP:DISABLED
LEAK TEST REPORT FORMAT
NOR/"!AL
LIQUID ~ENSOR SETUP
- - - - - - - - - -
L 1 :91TRUSINE
TRI-STATE (SINGLE FLOAT)
CATEGORY : STP SUMP
L 2:91FILL
TRI-STATE (SINGLE FLOAT)
CATEGORY : PIPING SUMP
0%
o
L 3: 87TRUBI NE
TRI-STATE (SINGLE FLOAT)
CATEGORY : aTP SUMP
L 4:87 FILL
TRI -STATE (SINGLE FLOAT>
CATEGORY : PIPING SUMP
ANNUAL TEST FAIL
ALAR!"1 DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARtv1 DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
~T BR 'K OFF L 7:DISP 5~6
TNK T~ SIPHON EA: : TRI-STATE (SINGLE FLOAT)
DELIVERY DELAY 1 MIN CATEGORY: DISPENSER PAN
PUMP THRESHOLD 10.00~
L 5:DISP 1~2
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L 6:DISP 3*4
TRI-STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L, 8:DISP 7*8
TRI-STATE (SINGLE FLOAT)
CATEGORY ; DISPENSER PAN
L 9: ANNULAR
TRI-STATE (SINGLE FLOAT)
CATEGORY : ANNULAR SPACE
OUTPUT RELAY SETUP
-----
- - - -
:....
R I:UNLEADED SHUT-DOWN
TYPE:
STANDARD
NORtvlALLY CLOSED
LIQUID SENSOR ALr"1S
ALL: FUEL ALARI"I
ALL:SENSOR OUT ALARM
R 2 :PREr"l SHUT-DOWN
TYPE:
STANDARD
NOR¡"1ALL Y CLOSED
LIQUID SENSOR ALMS
ALL: FUEL ALARI"I
ALL:SENSOR OUT ALARM
RECONCILIATION SETUP
- - - -
------
AUTor"lATIC DAILY CLOSI NG
T It"IE: 2: 00 AI"1
\ PERIODIC RECONCILIATION
r"10DE: 'v10NTHL Y
TEMP COMPENSATl ON
STANDARD ,
BUS SLOT FUEL IvIET~R _ T~N~
- - - - - - --
TANK ¡vIAP E\vIPTY
ALARM HISTORY REPORT
----- SYSTEM ALARM ----.
PAPER OUT ,
JUN 22, 2004 11: 44, Alv1
PRINTER ERROR
JUN 22, 2004 3:23 PM
BATTERY IS OFF. .
JAN 1. 1996 8.00 1'111
SYS SECURITY WARNING
OCT 10, 2003 2:43 PM
~ ~ ~ ~ * END ~ ~ ~ ~ ~
;'
ALARI1 HI STOR" REPORT \
---- IN-TANK ALARM --~
T 1 :PREf1
LOW PRODUCT ALARM
OCT 3. 2004 8:29 AM
APR 10. 2004 11-~35 AM .
FEB 24. 2004 10:34 P~
INVALID FUEL LEVEL ·
SEP 9. 2004 4:30 PM
AUG 10, 2004 5:42 PM'
JUL 20. 2004 7:54 PM
,..,'!'
PROBE OUT
OCT 13. 2003 9:19 AM
OCT 10, 2003 3:02 PM
ALARM HISTORY REPORT
---- IN-TANK ALARM
T 2:UNLEADED
LOW PRODUCT ALARM
OCT 3. 2004 6: 48 PI"!
SEP 19. 2004 8:30 AM
SEP 6. 2004 1:51 PM
INVALID FUEL LEVEL
SEP 2. 2004 6: 13 Alvl
AUG 25, 2004 6: 08 Plvl
AUG 2. 2004 1:51 PM
PROBE OUT
OCT 13. 2003 9:18 AM
OCT 10. 2003 3:03 PM
DELIVERY NEEDED ! DELIVERY NEEDED
SEP 18. 2004 6: 04 A(1 OCT 6, 2004 12: 37 PI'"
SEP 8. 2004 4:44 PM i SEP 21. 2004 6:46 PM
AUG 18, 2004 8:45 PM SEP 9. 2004 5:31 PM
LOW TEMP WARNING
OCT 10. 2003 3:22 PM
* * * * ~ END ~ * ~ *
ALARM HISTORY REPORT
----- SENSOR ALARM --~
L 1:91TRUBINE (
STP SUMP
FUEL ALARM
JAN 15. 2004 10:03 AM
FUEL ALAR,.!
OCT 3, 2003 g: 20 AI"! .
SETUP DATA LJARN I NG ..
SEP 80, 2003 5:47 PM
LOW TEMP WARNING
OCT 18, 2003 12:07 PM
* ~ ~ * ~ END * ~ ~ ~ ~
ALARM HISTORY REPORT
----- SENSOR ALARM
L 1 :91TRUBINE
STP SUMP
FUEL ALAR!"1
JAN 15, 2004 10:03 AM
FUEL ALARM
OCT 3. 2003 9: 20 Alvl
SETUP DATA WARNING
SEP 30. 2003 5:47 PM
~ ~ ~ ~ ~ END ~ ~ ~ ~i * ~ * ~ * END ~ * ~ * *
! .
,
\ : ii :
ALARM H I STORY REP?RT '
) ----- SENSOR A~AR~\ '. ,..~---
L 2:91FILL . \'!'
PIPING SUMP
SETUP DATA WARNINQ
SEP 80. 2008 5:47 PM
"\1'1
\,;'
¡
f
!
~
~
"
~
\
\
¡
¡,
ì.
Y
/,
I
I
~ * ~ * ~ END * ~. \~ *' ~
ALARM HISTORY REPORT
----- SENSOR ALARM
L 3:87TRUBINE
STP SUMP
; FUEL ALARM
OCT 3. 2003 9:21 AM
SETUP DATA WA~NING
SEP 80. 2003 5'-;-4-1!...P11
~ ~ ~ * * END * * ~ * *
ALARM HISTORY REPORT
----- SENSOR ALARM -----
L 4:87 FILL
; PIP I NG SUMP '
SETUP DATA WARNING
SEP 30. 2003 5:47 PM
~ * * * ~ END - * ~ ~ *
ALARM HISTORY REPORT
----- SENSOR ALARM
L 5:DISP 1",2
DISPENSER PAN
FUEL ALAR!"1
OCT 3. 2003 9:23 AM
FUEL ALAR!"1
OCT 3. 2003 9:23 AM
SETUP DATA WARNING
SEP 30. 2003 5:47 PM
~ ~ ~ ~ ~ END ~ '" '" '"
ALARM HISTORY REPORT
----- SENSOR ALARM
L 6:DISP 3*4
DISPENSER PAN
FUEL ALARM
OCT 3. 2003 9:22 AM
.. .u___~___.
....... --1-....'..'.....'.-.
-. ~-""-~_.- :. , - ,- :,_:~;--.:_,_2_~
-'-., ----...
ALARM HISTORY REPORT
----- SENSOR ALARM
L 8:DISP 7¡,E8.
DISPENSER PAN
FUEL ALARM
OCT 3. 2003 9:25 AM
FUEL ALARM
OCT 3. 2003 9:24 AM
SETUP DATA WARNING
SEP 30. 2003 5:47 PM
'" ~ ~ ~ ¡,¡ END", '" '" ~:
ALARM HISTORY REPORT
----- SENSOR ALARM
L 9:ANNULAR
ANNULAR SPACE
FUEL ALARM
OCT 3. 2003 9:35 AM
FUEL ALAR!"l
OCT 3. 2003 9: 21 ArYl SETUP DATA WARNI NG
SEP 30. 2003 5:49 PM
ALARM HISTORY REPORT
----- SENSOR ALARM
9 1:
OTHER SENSORS
'" ~ ¡,¡ ¡,¡ ¡,E END '" ¡,¡ ¡,E ¡,E ¡,E
ALARM HISTORY REPORT
---- PRODUCT ALARM
F .1 :PREM
~ ~ ~ ~ ~ END ~ ~ ~ ¡,¡ ~
----1
----- SENSOR ALARM
L 1 :91TRUBINE
STP SUMP
FUEL ALARM
OCT 11. 2004 2:16 P~
----- SENSOR ALARM --t--
L 2:91FILL
PIPI NG SUI"IP
FUEL ALARM
OCT 11. 2004 ,2:16 PMi
----- SENSOR ALARM
L 3:87TRUBINE
STP SUMP
FUEL ALARM
OCT 11. 2004 2:16 PM
SETUP DATA L~ARNI NG
SEP 30. 2003 5:47 PM ----- SENSOR ALARM
L 4:87 FILL
PIPING SUMP
FUEL ALARM
OCT 11. 2004 2:17 PM
~ ¡,¡ ¡,¡ '" '" END W ¡,¡ W '"
ALARM HISTORY REPORT
----- SENSOR ALARM
L 7:DISP 5",,6
DISPENSER PAN
FUEL ALAR!"!
OCT 3. 2003 9:24 AM
FUEL ALAR!"!
OCT 3. 2003 9:23 AM
SETUP DATA WARNING
SEP 30. 2003 5:47 PM
~ ~ ~ ~ ~ END ~ ~ ~ ~ ~
ì'
i:
,
I
~
!,
..
,
';:'~.
ft:~- '
:", ,-,-"",~.....
SENSOR ALARr"!
L 9:ANNULAR
ANNULAR SPACE
FUEL ALARM
OCT 11.2004 2:18 PM
----- SENSOR ALARM
L 6:DISP 8JoE4
DISPENSERP¡f\N
FUEL ALARM
OCT 11. 2004 2:19 PM
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Secondary Containment Testing Report Form
TJ'¡jsjÒrm is imendedfor Jlse by contractors performing psriodic testing of UST sflcondt:U')J containment systems. USfl thi4
upprdprime pages of this form to report I'esultsfor all components tested. The completedform, written teat procedures, and
pJ'i)'Jw¡¡¡sfrom tests (if applicable), should be provided to thefaciJity owner/operator for subm~ttal to the local reguJato1')J agency.
1. FACILITY INFORMATION
t,:~~ac~11;Y N~~~:~ .
\If~~~_~~}' Address: ' L-~
II Facili'lY Concact:
¡l___,
1\ [):m: Local Agency Was Notified of Testing :
.~-"'¡i:ìr:::.e of Local Agency Ins ector (ifpreaent during teatin.
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9!11pany Name: RICH ENVIRON¥
echnician Co~ductÍL1g'Test: eYA'tJ r1 ~o.v -
red.:mials: ¡g CSLB Licensed Contractor o SWRCB Licensed TaIÙC Tester
.- I License Number:
¡cease Type. C611D40 809850
~~~\7~;"·'·:·'~:l.'ti~~,:!~~::z.~~.~
Ma'J~fJ1r~r 1;'raining
Manutàcturer . COl:nnollent(s) Date Trainí.ng Expires
-_. 8/04
INCON INCON 'I'S-STS
.,_.._--~
-
-~-_.-
- -,---, - ..
2. TESTING CONTRACTOR INFORMATION'
3. SUMMARY OF TEST RESULTS
r~ Component Pass Fail Not Repairs Component Pass Fail Not Repairs
Tested Made Tested Made
1------ - f)}1
I J..h "7 f:/Ll døx 0 0 0 0 0 d 0
I/-~~--. '.Œf 0 0 0 0 0
1#£"" 91 ¡: , 11_ B.~ 0 0
0 0 0 0 0 0 a 0
-----------
0 0 0 0 0 0 0 0
-----~
0 0 0 0 0 0 0 .0
r------'----' 0 0 0 0 0 0 0 0
r-'----' 0 0 0 0 0 0 0 0
0 IJ 0 0 0 0 0 0
------.-.. 0 0
0 0 0 0 0 0
._-.--- 0
0 0 0 0 0 0 0
--~._-~
0 0 0 0 0 0 0 0
--.- _.
0 0 0 0 0 0 [} 0
- ,+ - . -
if hydrostatic testing was per~Q.l.111ed, d~críbe what:was done with the water after completion aftests:
RECYCLE AND REUSED..
.------,---.
C¡':RTlFICATION OF TECHNICIAN l\ESPONSmLE FOR CONDUCTING THiS TESTING
1~} tite best ùfmy knowledge, ti,e facts slated in dais documant aTe accurate and infuU COmplilllU:8 wtth IøgøJ rflqulre4JUmis
T éc¡'ucian'5 Signature: lrr- H ~ Dare: JO - JJ -0 Y
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:'-;ŸdZ.CB, January 2002
Page ~ of -d...
9. SPILL/OVERFILL CONTAINMENT BOXES
."~- . -..
l~f~::1t.:ility is Not Equipped With Spill/Overfill Containment Boxes 0
L~pilJ/~?,':::..'::'l:tj!~.contaiD.ment Boxes are Present, 'but were Not Tested 0
T(;SL Method D\.weloped By: 0 Spill Bucket Manufacturer
o Other {SpecifY}
o Pressure
o Other (Specifjl)
INCON TS-STS
ßa Industry Standard
o Professíonal Bn¡incer
-- -"-'- ---------.--
Tc:SL Method. Used:
o Vacuum
\HI Hydrostatic
- ._--~_. ---..
ment Resolution: . 0001 n .
T':;:Sl EqlÚpment Used:
r·~'·:·":":7"'~':··,
\r:' ßl;~'kèr Diameter:
Ij~~~:.(. Dep~~_
Waie time betwe,en applying
I prÖ~Ll.re/vacuurn/water and
!' smrclll,¿ test:
---~-,_._.~
l'esl Stan Time:
Spill Box #
Spill ox ;;
lnil:.iaJ Reading (Rj):
Test End Time:
Final Reading, (Rio):
Test Duration:
I êllangè in Reading (R¡:-R¡):
Pass/Fail Threshold or
Criteria:
]'eslt Resu.lt:
JCJ .-1 <J
ô()o.
.aJJJ"'"
lX' Pass
.OOJ,I,J
Pass OFa.U
o Pass 0 Fail
o Pass
o Fail
__ç{m.u](lení~ - (include information on repairs made prior to testing, and recommendedfolluw-up for failed tests)
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SB989
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FAILURE REPORT
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CITY:
SIGNATURE:
TECHNICIAN:
: \ .
THE FOLLOWING COMPONENTS WEJΠUE':uAOW/REPAIRED TO COMPLETE THE SB989
TESTING.
LIST OF PARTS REPLACED/REPAIRED:
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REPAIRS:
- -<J()J F"
LABOR:
A../(j.lj F
PARTS INSTALLED:
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·COPY REQDESTEn PLaASE
FAX(061)392-0621
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
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APPLICATION TO PERFORM
FUEL MONITORING CERTIFICATION
FACJI..lTY &~~ ~ 60
ADDRESS ..:J tD 0 \ \Å.~ I T'E. l :A-'V) £.¡
OPERATOlU NAME ~~t-+AA~
OWNERS NAME ß'P6~
NAME OF MONITOR MANUFAC'J."tJRBR VE- ~ ~i:L ~oo...
DOBS FACILITY HA VB DISPBNSBR PANS? YBS..L NO_
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NAME OFTBSTING COMPANY~ RICH EN'VIRDNME~1~L
CONßÄCTQ~UCBNSB# 90-1072
NAME &: PHONB NUMBER. OP CONTAcr PERSON :JAMBS aICH
DATa ~ 'I1ME TBST IS TO BE CONDtJCTBp~
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