HomeMy WebLinkAboutBUSINESS PLAN 10/17/2006_ ~ _
`~( _~ JOHNNY'S FOOD MART
----~~--~-'-1: 2612 BUCK OWENS BLVD
•~
-- - -- _ ~ -
1
i
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD !LINE TESTING
/ S8989 SECONDARY CONTAINMENT TESTING
!TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
PERMIT NO. /~~ ® , ,
BAKERSFIELD FIRE DEPT.
~iR~ Prevention Services
ARTII ! 900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
Page 1 of 1
^ ENHANCED LEAK DETECTION ^ LINE SII - ~• ^ SB-989 SECONDARY CONTAINMENT TESTING
n TANk TIf:NTNFRS TFRT F(1RM FI IFI M(]NITnR Wr CFRTIF
":SRE INFO TION
FACILITY O ~~~ ~ NAME NE NUMBER OF CONTACT PERSON
ADDRESS
~ L
OWNERS NAME
OPERATORS NAME PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED IS PIPING GOIN TO BE TESTED? ^ YES ^ NO
T K # ME
V
O
L CO TENT
/
r
~ p,
U CJ 0 ~ ~(~ ~ `- O
. ~ ~ ~ ~ ~ ~~
TANK,TESTIN COMPANY ' ....:
NAME OF TESTING C ANY ~ AME & P ONE NUMBER OF TAT ERN
MAILING ADDRESS
G
~
~
NAME 8~ PH _ NUMQ~ F. EST~I S/P
1~~~~~~ IN jO~R
~ CERTIFICATIO tf:
W1 l
DATE & TIME TES TO B ONDUCTED
r ' ~ l./11/
~
/
ICC #:
TEST METHOD
SIGNATURE OF APPLI CANT C~ DATE l _
APPROVED BY DATE E
FD 2095 (Rev. 09/05)
~~ BIt~LING & PERMIT STATEMENT
. ».
1 PERMIT NO.:
BAKERSFIELD FIRE DEPT.
a D Prevention Services
P~Re 900 TrLixtun Avenue, Suite 210
~Rrr r
Bakersfield, CA 93301
LOCATION OF PROJECT • PROPERTY O ~-
tt 11
V
STARTING DATE to OMPL 10 DATF,~ NAME .
PROJECT NAME ~n ~- ADORE PHO NO.
' YI 1 ~
PROJECTADORESS ~ 1
v rrY STATE
c ZIPCOOE
.. ._ . .
CONTRACTOR NAME CA UCENSE NO. TYPE OF LICENSE. EXPIRATION DATE PHONE N
L
)
~ C
J`
CONTRACTOR COMP E FAX N ~
.Y ~ -
ADDRESS ~• CfTY ~ ZIP COD ~ O ~y
OFFICE
I ? IJSE ...:
J
^
Alarms -New & Modfications - (Minimum Charge) •
$262
50 • ~
~ •
. 98
Over 20
000 Sq
Ft FL x
013125 =Permit fee
Sq ~
^ .
.
, .
. 98
^ Sprinklers- New & Modifications - (Minimum Charge) $210
00 ~
. . 98
^ Over 5
000 Sq
Ft 042 =Permit fee
Sq
Ft x ~
,
. .
. 98
^ Minor Sprinkler Modifications (< 10 heads) 00 ]Inspection Only)
$ 93 ~
. 98
^ Commercial Hoods -New & Modifications $ 398
26 ~
. 98
^ Additional Hoods $ 36
00 ~
. 98
^ Spray Booths -New & Mod cations $458
00 ~
. 98
^ Aboveground Storage Tanks (Installation/Insp: 1~ Time) $165.00 82
^ Additional Tanks ~ $ 26.00 82
^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82
^ Underground Storage Tanks (Instal/ation./Inspedion) $878.00 (pertank) 82
^ Underground Storage Tanks (Modification) $878.00 (persite) 82
^ Underground Storage Tanks (Minor Modification) $155.00 82
^ Underground Storage Tanks (Removal] $675.00 (per tank) 84
^ Oilwell (Installation) $ 72.00 ~ 84
Mandated Leak Detection (festin /Fuel Monit. Cert. $ 81.00 (per site) 82
^ Tents $ 93.00 (per tent) 84
^ ~. After hours inspection fee $122.00 84
^ Pyrotechnic - (Per event, Plus Insp. Fee [~ $90 per hour) $ 60.00 + (5 hrs. min. stand -by tee llnspecxion) _ $510.00 84
^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84
^ Portable LPG (Propane): NO.OF CAGES? $66.00 ~
^ Explosive Storage $249.00 84
^ Copying & File Research (Fite Research Fee $33.00 per hr) 25¢ per page ; 84
^ Miscellaneous ; 84
FD 2021 (Rev. 09/05)
1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to Flle) 1-PINK (to Customer)
- ~--- -.
~~ - - - ~-- - - -- -- l~yb5
'(~ .
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of California
Authority Cite& Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations
This form must be used to document testing and servicing of monitoring equipment. g, separate certification or report must be prepare
for each monitoring svstem control vanel by the technician who performs the work. A copy of this form must be provided to tht: tank
system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating LIST systems within 30
days of test date.
A. General Information
Facility Name; v8~~~tJS< Ie ~-f~~.Ct:a Bldg. No.:
Site Address: (~~1 al. 'i3~eIL ~y~S -Sjt.-Jo City: 'RPt1LrG(Lf5 r~EL'D Zip:
Facility Contact Person: ~~i~J ~ Contact Phone No.: L~~
Make/Model of Monitoring System: ~iyCON Date of Testing/Servicing: /Dl~/ GYM
B. Inventory of Equipment Tested/Certified
Check the a ro riate boxes to indicates ecific a ui ment ins ected/serviced:=!J ~ p .ice, ~ i"
Tank ID: ~~'~ T4nk ID:
~NL R-'7 ~'STj'~^~~
Q In-Tank Gauging Probe. Model; ~~ ,
~ In-Tank Gauging Probe. Model: 'T.n1 S A~
~ Annular Space or Vault Sensor. Model: .VGh~1 Q Annular Space or Vault Sensor. Mode L• T ~1,(CoN
® Piping Sump /Trench Sensor(s): Model: L,~, ~ ,~ Piping Sump /Trench Sensor(s). Model: t-S ~
^ Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model:
® Mechanical Line Leak Detector. Model: ,~ ~ J AG~ f Q-Mechanical Line Leak Detector. Model:
^ Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model:
(] Tank Overfill /High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model:
O Others i ui ment a and model in Section E on Pa e 2 . ^ Other s ecif ui nent a and model in Section E on P c 2).
Tank ID; P_2a~1q~ Tank ID:
Q In-Tank Gauging Probe. Model: ~7.tJ ^ In-Tank Gauging Probe. Model:
~ Annular Space or Vault Sensor. Model: T~1t:.o ~ D Annular Space or Vault Sensor. Model:
~ Piping Sump /Trench Sensors}. Model: t S - 3 ^ Piping Sump /Trench Sensor(s). Model:
O Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model:
® Mechanical Line Leak Detector. Model: ~ J At,~T ^ Mechanical Litie Leak Detector. Model:
^ Electmnic Line Leak Detector. Model: D Electronic Line Leak Detector. Model:
^ Tank (?verfill /High-Level Sensor. Model: ^ Tank pve~ll /High-Level Sensor. Model:
^ Other (specify equipment type and model in Section E on Page 2). O Other (specify uipmen[ type and model in Section E on Page 2).
Dispenser iD: 1 ,~ Dispenser ID: .3
t-~
®Dispenser Containment Sensor(s). Model: ~~d~~t„jt i
®Dispcnser Containment Sensor(s). Model: ~'~~e ~ C~,,A(}X
1$ Shear Valve(s), ®' Shear Valve(s).
D Dis eraser Containment Floats and Chains . ^Dis eraser Containment Floats and Chains .
Dispenser [D: ~~ Dispenser ID: 7t ~ ;:-
.® Dispenser Contatrunent Sensor(s). Model: ~i<t~J,Atl~c f~ Dispenser Containment Sensor(s). Modek ~:AUZ)2 ~}wx
L~. Shear Valve(s). ®Shear Valve(s),
^ Dispettser Containrttent Float(s) and Chain(s). O Dis criser Containment Floats and Chains .
Dispenser ID: Dispenser ID:
^ Dispenser Containment Sensor(s). Model: ^ Dispenser Containment Sensor(s). Model:
^ Sheaz Valve(s). ^ Shear Valve(s).
^Dispenser Containment Float(s) and Chain(s). O Dis eraser Containment Floats and Chains .
•If the facility contains more tanks or dispensers, copy this form. Include information for every tank and disperuer at the facility.
C.tC@TtifIC1t10ri - I certify that the equipment.identified In this document was Inspected/serviced in accordance with the manufacturers'
guideilnes. Attached to this Certification Is Information (e.g. manufacturers' checktlsts) necessary to verify that this information is .
correct sud a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also
attached a copy of the report; (check all that apply): ~-System set-up ~ Alarm history report
Technician Name {print): IQAit.J~7~J /Y\ ~SQ,tJ Signature: ~-~.,~-~"
Certification No.: ~~~~~~ y ~" License. No.:
"Testing Company Name: RICH ENVIRONMENTAL Phone No.: ~ 661 } 3Q.~-$6$7
Site Address: ~(rp I ~, ~tx.12 n~~~~ '~,t,l]~ , ~A~~~~~t~ ~A Date of Testing/Servicing: /O/ / 7/p(~
Page i of 3 03101
Monitoring System Certification
~~
D. Results of Testing/Servicing
Software Version Installed: ~ • ~~ ~ ~
_1_a_ aL_ C-11 .....2..... ..L .... I.I.n1.
L.V 111 IIGIC tI1G IVIIV If1 u .•. t.It..u i• _
Yes ^ o Is the audible aiarrn o erational?
Yes Q o Is the visual alarm o erational?
^ Yes ~ o Were all sensors visual) ins ected, functional) tested, and confin-ned o erational?
^ Yes ® o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their proper operation?
O Yes ^ o If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem)
~. N/A operational?
^ Yes o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
^ N/A monitoring system detects a leak, faits to operate, or is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check all that apply) ^ Sump/Trench Sensors; O Dispenser Containment Sensars.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? 18. Yes; ^ No.
^ Yes ^ o For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e, no
l~ N/A mechanical overfill prevention valve is installed), is the ove~ll warning alarm visible and audible at the tank
fill rot(s) and o ratin ro rl ? 1f so, at what rcent of tank capacity does the alarm tri ger7
~ es O 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 re lacement arts in Section E, below.
^ es ~, No Was liquid found inside any secondary containment systems designed as dry systems? (Check al! that apply) ^
Product ^ Water, If es describe causes in Section E below.
L~ Yes Q o Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u re orts, if a licable
~ Yes ^ o Is al] monitoring equipment operational per manufacturer's specifications?
• m ~eenon ~ ne~ow, aescrrbe now ana wnen znese aencrenc~es were or ww Qe currrs;~eu.
E. Comments: yl~.~~ g? ANQ u~~ 'Y>7 (SSey,o.~~ FASO `Ca f'P~VS E D~SZ Z rV~ .S~u~w,~•
~GN~Ps sA~SE uzs~P.~.~.x~ 14Uaz~iC~13~Y'^ ,tX,i)aS~T~vE ~.~4vT'[L~~~~~1L~
~~ ~IS6'D ~~',oP ~~ J>,1~RT•v~ AT~bw. g +~"~-~.21Lt~..,ST~>R~ r>u.u~,j? ,~~~s
it) E7ET k lvtg~.v-sNA.Jc~ ~~r~Pt___f;-u t! Try FT1t PR.~i~~ dfu(1, Ha~tE ~I,~.v.~~5
~G~~~~-:
Page 2 of 3 03101
f ~tSS 7
-------_
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.
Com lete the followin checklist
^ Ycs ^ o Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
^ Yes ^ o Were all tank gauging probes visually inspected for damage and residue buildup?
^ Yes ^ o Was accuracy of system product level readings tested?
^ Yes ^ o Was accuracy of system water level readings tested?
^ Yes ^ ° Were all probes reinstalled properly?
^ Yes ^ ° Were all items on the equipment manufactur'er's maintenance checklist completed?
* In the Section N, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD):
Com fete the followin checklist:
^ Check this box if LLDs are not installed.
Yes O No' For equipment start-up or annual equipment certification, was a Leak simulated to verify LLD performance?
^ N/A (Check all that apply) Simulated teak rate: 0`3 g.p,h., ^ 0. I g.p.h , ^ 0.2 g.p.h.
^ Yes o Were all LLDs confirmed operational and accurate within regulatory requirements?
• Yes ^ o Was the testing apparatus properly calibrated?
^ Yes 1~ ° For rnechanical LLDs, does the LLD restrict product flow if it detects a leak?
O N/A
^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
'® N/A
^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
~ N/A or disconnected?
^ Yes ^ o For electronic LLDs, does the turbine automatically shut offif any portion of the monitoring system malfunctions
NIA or fails a test?
^ Ycs ^ o For electronic LLDs, have all accessible wiring connections been visually inspected?
® N/A
:~ Yes ^ o Were aI] items on the equipment manufacturer's maintenance checklist completed?
" [n the Section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments: P~ tt'~°~~ ~-~.N~ t_EA1~ pl= i iTaR ~'~ ~2,t~~AC~'~ A~1'~
~~ZE~~F ~1. L~~I~' C.1=iAl~ 'f~~T~G~'d2~j jl`Q..E wDQk..x'^~.~.,Z.~~ LN.~~3- ~~ "t=
Page 3 of 3 03101
u ~~~
.~--___~
Monitoring System Certification
UST Monitoring Site Plan
Site Address: ~. ~ 'a- C. 'd U ~ k n w~n~ 31 ti S~ , 'RA lr-`c f<5 F~L`
---------------------------s -----7------------------
--------------------------- ~----CI-------------------
-------._3---
------------------------ -- -~ - -~,J - ~ ------
------------------------- - ®- - - p -o-- ------
Date map was drawn: ~c~ / ~ 7 /~~
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. Cleazly identify
Iocations 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~ os~oo
i ~~5~
5643 ST~OORS CT 9A.4C8R8~'x$I,I~,CA.93308
OFk'TC& (661? 392-96$7 & ~.2l~ (661) 3~2TQ621 '
M~C~ian*T~A~~mntr 1?'w"~'~'sG't'!JR mfiam
'RT/ 0 #
Faaa.li~y Name,.~n~~~-~ l~L~~ AR~n
k'ac:l.~.itr.y Addx~eas:,~,~1~,'Gj~u-k 4~.c~Ed.~ ~U7..~3Ak.~..Q~F~F~f~-
Frt~c;luc~ T,1rze 7C'y~ae (Pressuze, 6uc4iazt, f3z^av~.ty) _ Pi~L~'~i,~(1 ~
BR(:1DVCx' LEAK ,LIETECTOR TX~E + 7,'Eb'T TRAP PARS'
ss,&z,~z, 7p7VMEk;R ~3,EIa0AT P;32 OR
i.(D 'I.'SCB1Z R ~ D JRGj~T ~~
'~ 7
. SE.RZ.A,T, # U.v E NQ / y FA.1L
. r~/n ~~r~~ /a~r.ET SASS
9 f
!_.~ ~~~~.~ ~ 1~R£A~~~ ~o~
L./I? `xSCPE,_~£~ .1 Af.L'6T ~g~gg-~
! `'(
LIA 'I'XPE Xis PASS:
6&Ft2AL # _ --- ,NO FAIL .
I ::extify tk'~e abo~re tests wexe conducted on this daC~ aacoxding ~a
Red ~:faaket Pumps tie.ld %eat appaxatus test:i.ng procedure an limitat~,4na.
Tki~:~ Mechanical Leak Aetect.ox Test pass / fail is detex~nined by using
a 10~.~ £low threskzoJ.~ trip rate of 3 gallox2 per hour or lees aL 10 PSI.
I acknowledge tk~.at a].1 data eo7~lected ie true axed aorracC t:o the best
of rr~~ knowledge .
tech : _ ~,~ r • ~ ~.~.;.
s i.gz1=~ tuxe : ~~,~---
i
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1
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S~a~t;~ 1N.~ritr ~~,_~,,~
'
STG RELAY
K~
TIMtl INUTR :2:00 AM OFF
TIME2 INUTR 12:00 Af9 ALARM 1
OrF
KMP : NU. ARr;O AMPh1 TIMES INUTR 12:00 AM ALARM 2 OFF
2612 PIERCE RD• SCHD INURC NONE ALARhi 3 OFF
BAKERSFIELD, CA. 93303 TIME1 INURC- 12:00 Aht ALARM a OFF
SITE # 81360 TIh1E2 INURC 12:00 AM ALARM 5
TIMES INURC 12:00 AM ALARM 6 OFF
lO/1S+t2~j0F, 09:35 AM SCHD DLHST NONE ALARM 7
OFF
S'~'>TEh! SET!J P RAP^~T r
TIME1 DLHS, 12:09 AM ALARM 3
TIME2 DLHST 12:00 AM
-;nrr;,ipP~= i;~R.r, ION 0, 9910 TIMES DLHST 12:00 AM STD REG UNL SUMP .
' `"'
`T' SCHD ALHST NONE ALARM i
ALARM 2 PLUS
UN SUMP
~~
`
"`
i
~r ,~,,;p
Tur.i TIh1E1 ALHST 12:00 AM PRE
ALARM 3 UNL SUMP
~
n~rnAi ~ ARCO AMPM TIME2 ALHST 12 00 AM
~ NONE
STREET 1 2 612 PIERCE TIMES ALHST 12:00 AM ALARM NONE
STREET 2 RD. SCHD ACT AL NONE RLARM 5 NONE
CITY 1 BAKERSFIELD TIME1 ACTAL 12:00 AM ALARM ~ NONE
CITY 2 TIME2 ACTAL 12:00 AM ALARM 7
NONE
STATE CA, TIMES Ar_TAL 12:00 AM
ALARM B
ZIP CODE 93305 SCHD ALST NONE
SENSOR TYPE
SITE # 81360 TIME1 ALST 12:00 AM ^a TD
TIME2 ALST 12:00 AM SENSOR 1
2 STD
UOL UNITS GALLOhIS TIf4E3 ALST 12:00 AM SENSOR STD
LEVEL UNITS INCHES SENSOR 3 STD
TEh1P UNITS FAHRENHEIT CONFIDENCE 99.0: SENSOR 4 STD
TIME STYLE 12 HOUR LEAK TEST 0,10 ~
SENOR 5 STD
DATE STYLE MMtDDtVV SCHD TEST SENSOR 6 STD
DRVLIGHT SAU ENABLED TANK 1 NONE SENSOR 7 STD
SET TIME 9:35 AM TANK 2 NONE SENSOR 8
SET DATE 10t1St2006 ANK 3 NONE
T
T.ME TEST CONTROL OUTPUT
0
N0. TANKS 3 TANK 1 12:00 AM GRACE PERIOD
LEAK LIMIT 2,00 TANK 2 12 00 At9 W LOW 1 OUTPUT i
THEFT LIMIT 10.00 TANK_._3_...... 1.2:00 AM LO
2 OUTPUT 2
GELID LIMIT 200,00 LOW LOW 3
SNTNL MOGE OFF ALARM LOW LOW 3 OUTPUT
NONE
START SNTNL 12:00 AM TIMEOUT 30 LOW LOW #
END SNTNL 12:00 AM HIGH LIM ON NONE
DELIV DELAY 15 LOW LIM ON LOW 1 NONE
REPORT DELIV DISABLED HIGH HIGH ON LOW 2 NONE
REPORT ALRRS ENABLED LOW LOW ON LOW 3 NONE
REPORT TESTS ENABLED WATER LIM ON LOW ~}
N0. OF ALARMS 10 LEAK LIM ON
PRINT INTERVAL 5.00 SYSFAIL OFF
THEFT ON
MODE CHAN 1 NATIVE
BAUD CHAN 1 120@ RELAY
DATA BITS 1 2 7IMEOUT 15
STOP BITS 1 1 HIGH LIM OAF
PARITY 1 NOME LOW LIM OFF
SECURITY 1 HIGH HIGH OFF
ACCESS 1 LOW LOtd OFF
PHONE 1 WATER LIM, OFF
REDIAL 1 DISABLED LEAK LIM OFF
RCC~SS 2 SYSFAIL OFr"
PHONE 2 THEFT OFF
REDIAL 2 DISABLED
ACCESS ? STD ALARM
PHONE 3 ALARhI I ON
P,EDIAL 3 DISABLED ALARM 2 ON
RCCESS 4 ALARM 3 ON
PHONE d ALARM 4 OFF
REDIAL 4 DISABLEG ALARM 5 UFF
DIAL DELIV ALARM 6 OFF
DIAL ALARM RLARM 7 OFF
iGIAL LEAK ALARM B OFF
4; GH IdTR 1 NONE
HIGH tJTR 2 NONE
HIGH 1JTR 3 NONE
HIGH WTR 4 NONE
HIGH 1
HIGN 2 NONE
HIGH 3 NONE
HIGH 4 NONE
NONE
HIGH HIGH 1 NONE
HIGH HIGN 2 NONE
Hlry HIGH 3 NONE
HIGN HIr,H 4 NONE
SYSTEM FAIL NONE _
STD. 1 OIJTPUT 1
STD 2 OUTPUT 2
STD 3 OUTPUT
STD 4
STD g NONE
STD 6 NONE
STD p N0;^IE
STG $ NONE
NONE
r= ~+
KMP INU.ARCO AMPM
2612 PIERCE RG.
BAKERSFIELD~ CA. 93308
SITE # 81360
10ii8/2006 02:27 PM
ALARM HI:~70RV REPORT
10/18/2006 09 33 AM
RE6 UNL SUh1P
10/18/2006 05:39 AM'
RE6 UNL SUMP
10%1$/2006 09:42 AM
REG UNL SUMP
10/13/2006 10 36 AM
REG Ut~L SUMP
10/18/2006 10:36 AM
RE~i UNL SUI9P
10/19/2006 10 37 Ah'
PLUS UN SUMP
10/18/2006 12:03 PM
PLUS UN SUMP
10/18/2006 12:35 PM
REG UNL SUMP
10/18/2006 01:04 PM
PRE UNL SUMP
10/18/2006 01:07 ?M
PRE UNL SUMP
i ~t ~~
~-~_
x{55
MONITOR CERT. F.AII~URE REPORT
SITE NAME• aoHIJN'~ Q»4,~- ~~ DATE: !~-I'7-~~(0
ADDRESS•~2(o~~'G~,t_16- t~W ~LY~TECHNICIAN: ARAN'OO..y mAscs~U
CITY• ~A~~+R~fTE~~ ~ SIGNATURE:
THE FOLLOWING COMPONENTS WERE REPLACED(REPAIRED TO COMPLETE
TESTING.
REPAIILS: ~~ Q~P~E D 1 ;~Et~U a~ ~,~. 5E,v5ott .
.~ ~~~tt~' ~ ~ ~ E a J i'1C..1~-6 i ~ ~C 1 ~ .S•y ~ ~ Pc }~ 1~ r.~' ETU r4
LABOR: /Uv,~t/~
PARTS INTALLED: 1 ~,~'AJT~2E~AY ~t0(c bI'~~I'.u~nK ~SE,~ faOl(~ ._.
~ ~~Q.~P~r_12-ET FX111~ 1.~A1c- •~sS~cTog„!
NAME; TITLE:
SIGNATURE:
THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILTI'Y OF NOTIFYIlVG
THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR
THE ABOVE LISTED PROBLEMS AND NOTIFlCING RICH ENVIItONMANTAL FOR
ANY NEEDED RETESTING. TffiS ALSO RELEASES RICH ENVIItONMENTAL OF
ANY FINES OR PENALTIES OCCURING FROM NON-COMPLIANCE.
A COPY OF TffiS DOCUMENT HAS BEEN LEFT ON-SITE FOR YOUR
CONVIENENCE.
C_ S ~`~
SWRCB, January 24Q6
Spill Bucket Testing Report Form
1'hfs form is intended for use by contractors performing annual testing of UST spUl containment structures. The completed form and.
printouts from tests (ifapplicable), should beprovided to the facility.owner/operatorfor submittal to the local regulatory agency.
~ >cA!•Tf.i'XTV TNFt1RMATif1N
1•
Facility Name:
Dato of Testing: - l -O
Facility Address: („ I G k- ~ ,~l S F ~ E
Facility Contact: J p ,v Phone:
Date Local Agency Was Notified of Testing :.ld -~ - L •
Name of Local Agency Inspector (ifpresent during testing: ejT ~ ~ V (Z t.saoa
2. TESTING CONTRACTOR INFORMATION
Company Name: ~-~ ,.5 .~ L ,
.Technician Conducting Test: A, .J ~ a ~
Credentials: CSLB Contractor ei-vice T SWRCB Tank Tester Other (Specify
License Number(s):
3. SPii ,T ,BUCKET TESTING INFORMATION
Test Method Used: drosta Vacuum Other
Test Equipment Used: V ~ ALr Equipment Resolution:
Identify Spill Bucket {By Tank
Number, Stored Product, etc. I ~
g 7 ~ 2
$ 7 (sxe~~, 3
9 ~ 4
Bucket Installation Type: _ ect B
on ed in S t B
Contained in Sum 8~~
Contained in Sum Direct Bury
Contained in Sum
Bucket Diameter:
~.` `
l~'~
l ''
Bucket Depth; " ''
Wait time betwear applying
vacuum water and start of test:
3 V w~2N
J~
r+ti= ~ ~
Test Start Tune (T'~: Q v`~ V AI`s o
Initial Reading tR~: -. ~ ~ ~
Test End Time (TF): /b: U ,,.~ M
Find Reading (RF): ~ ` ^~'J''
Test Duration (TF - T~: M N(Z ~
Change in Reading(RF-Ril: •` d;~ ~,~
Pass/Fail Threshold or
Criteria:
C OII1Ti11EIIf:S -('include informa
~ ~~ ~ 1~
tion on repairs made prior to testur~and recomme
~`
nded follow-up for failed
tests)
CERTTFTCATION OF TECHNICL4N RESPO),VSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the lnjormation contained in thins report is true, accurati; and iit frill compltance wish iegai requirement
Technician's Signature:_ ~" ~-'- DaLC. //.~ -~ ~~ (e
~ State laws and regulations do not currently require testiag to he pcrformcd by a qualifeed coatYaCtor. However, Local requirements
may be more stripgeat.
IKss7
SB.989 TESTING_ FAILURE REPORT
SITE NAME' ~(~ Kn~N ~ ~ Q'~CY~' Area DATE: IO-r8 ~G.
ADDRES3•~{a~'a SUCK ~,~.sc,US ~L~?~, TECHNICIAN: 7~,,~A.v~p•~ y~pA1
CITY • TjPS iL.[, R.b F~Lri? SIGNATBR£: /~~-- /C-~--
SITE CONTACT• ~U N~~
THE FOLLOWING COMPONENT3 WERE REPLACED/REPAIRED TO COMPLETE THE 58989
TESTING.
LIST OF PARTS REPLACED/REPAIRED:
REPAIRS. ~~,~fC-~
LA80R : !~ G,~c/ ~
PARTS INSTALLED : ~ pN