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UNDERGROUND STORAGE TANK
i I ) ~ ?, 9'~u. ._, M 1 III (UNDERGROUND STORAGE TANKS) FILE # ~' LA BARATA MEAT MARKET _~_- 430 E. CALIFORNIA AVENUE T.--- ;;. _ . - .~ MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the Stare 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 svstem 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: HP GO GO MINI MART Site Address: 430 E CALIF. AVE Facility Contact Person: DILLON Make/Model of Monitoring System: VEEDER ROOT TLS 350 B. Inventory of Equipment Tested/Certified Cherlc the snnronriste hnzes to indicate snedfic eauioment Bldg. No.: gip; 93304 Contact Phone No.: 6( 61 ) 861-8505 Date of Testing/Servicing: 1~ 10 / Q6 Tank ID: T1-UNL Tank ID: ® In-Tank Gauging Probe. Model: ^ ln- Gagging Probe. Model: ® Annular Space or Vault Sensor. Model: ^ Am-u pace or Vault Sensor. Model: ® Piping Sump /Trench Sensor(s). Model: ^ Piping S /Trench Sensor(s). Model: ® Fill Sump Sensor(s). Model: ^ Fill Sump Se s). Model: ® Mechanical Line Leak Detector. Model: ^ Mechanical Li Detector. Model: O Electronic Line Leak Detector. Model: ^ Electronic Line tector. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Tank Overfill /High- el Sensor. Model: 0 Other ui ment and model in Searon E on P e 2). ^ Other ui ment and model in Section E on P 2). Tank ID: Tank ID• ® In-Tank Gauging Probe. Model: ^ In-Tank Gauging Probe. Model: ® Amiglar Space or Vault Sensor. Model: ^ Annular Space or Vaalt Sensor. el: ® Piping Sump /Trench Sensor(s). Model: ^ Piping Sump /Trench Sensor(s). M ® Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model: ® Mechanical Line Leak Detector. Model: ^ Mechanical Line leak Detector. Model: ^; Electronic Line Leak Detector:. .. ~ Model: ; ~,0 Electronic Line Leak Detector.- ' •Model: ^ Tank Overfill /High-Level Sensor. Model:.. ; ^. Tank Overfill /High-Level Sensor, .Model- . ^ 08iei ( ui merit ~ and model in Section E on P 2 . ^ Other ( ni merit and model in Section E on P 2). Dispenser ID• 1(2 I)ispe ID= ® Dispenser Containment Sensor(s). Model: ^ Di Containment Sensor(s). Model: ® Shear Valve(s). ^ Shear V s). ^ D' riser Containment F- sand Chains . ^ Di sec Co t Flo s) and Chains . Dispenser ID: Disperser ID: ® Dispenser Containment Sensor(s). Model: ^ Dispenser Containmen ensor(s). Model: ® Shear Valve(s). ^ Shear Valve(s). ^ user Containment Floats and Chains . ^ D' sec Containment FI d Chain s). Dispenser ID• Dispenser ID- ® Dispenser Containment Sensor(s). Model: ^ Dispenser Containment Sensor(s). M ®Shear Valve(s). ~ ^ Shear Valve(s). ODi riser Containment Floats and Chains . ^ Di n5er Containment Flo sand Chains . •If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. CertificatlOII - I crriify that the equipment identified in this document was inspected/serviced in aooordance with the manufadurers' guidelines. Attached to this Certification is information (eg. manufacturers' ~mt~) necessary to verify that this information is ' correct and a Plot Plan showing the layout ~' monitoring equipment. Far 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): RON ROGERS Signature: Certification No:: A29880 License. No.: 813616 A HAZ ICC#5246218-UT Testing Company Name: ACE PETROLEUMSERVICES, INC. Phone No::~ ~ ss1 } 387-8430 Site Address: 15540 STREBOR DR1VE / BAKERSFIELD CA 93314 . ~ - Date'of Testing/Sei•vicing: 10 / 10 06 . ~.. ~ ,. . .. I ° Page 1 of 3. 03/01 MOl11tOI7IIg System CertificatiOII . City: BAKERSFIELD D. Results of Testing/Servicing Software Version Installed: V14 Complete the followim+ checklistz ® Yes ^ No* Is the audible alarm o rational? ® Yes ^ No* Is the visual alarm tional? ® Yes ^ No* Were all sensors visual) in ted, functional) tested, and confirmed o rational? ® Yes ^ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their o 'on? ^ Yes ^ No* If alarms are relayed to a remote monitoring station, is all communications equipmem (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-0own? (Check all that apply) ®SumplTrench Sensors; ®Dispenser Containment Sensors. Did ou confirm sitive shut-down due to leaks and sensor failnre/disconnection? ®Yes; ^ No. ^ Yes ^ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ® N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill 'nt(s) and o rl ? If so, at what rcent of tank aci does the alarm tri er? % ^ 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 re lacement arts in Section E, below. ^ Yes* ®No Was liquid found inside any secondary containment systems designed as dry systems? (Check all than apply) ^ Product; ^ Water. If ,describe causes in Section E, below. ® Yes ^ No* Was monitorin s stem set u reviewed to ensure ro settin s? Attach set rts, if a livable ® Yes ^ No* Is all monitorin 'went 'opal manufacturer's 'fications? * In Section E below, describe how and when these deficiencies were or will be cwrrected. E. Comments: Page 2 of 3 o3roi F. In-Tank Gauging /SIR Equipment: ®Check this box if tank gauging is used only for inventory control. O 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 followi~ 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? li0 Yes ^ No* Were all items on the equipment manufacturer's maintenance checklist completed? * Ia the Section l3, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Complete the following checklist: ^ Check this box if LLDs are not insta[ed. ® Yes ^ No* For equipment start-up or annual equipment certification, was a teak simulated to verify LLD performance? ^ NIA (Check aU that apply) Simulated leak rate: ®3 g.p.h.; ^ 0.1 g.p.h ; D 0.2 g.p.h. ® Yes ^ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ^ No* Was the testing apparatus properly calibrated? ® Yes ®No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ NIA ^ Yes ^ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ® NJA D Yes ^ No* For electronic LLDs, does the turbine automatically shut aff if any portion of the monitoring system is disabled ® N/A or disconnected? ^ Yes ^ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ® N/A or fails a test? " D Yes ^ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ® NIA ® Yes ^ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how aid when these defidencies were or will be corrected. H. Comments: PREM LINE LEAK DETECTOR,FAILED Page 3 of 3 03ro1 onitoring System Certification UST Monitoring Site Plan Site Address: HP GO GO / 430 E CALIFORNIA AVE/ BAKERSFIE D CA 93307 ............. ................... ................... ... ............................... ................... ................................. ................... ................................. ................... ............. ............. ~uPa.~. ................... ::::::::::::: :::::.~~ti~::::::~1::::::::::::::::::: ..................................................... ..................................................... ..................................................... ..................................................... ............. .............. .s,~-.................. :::::::::::~ a ::::::::::::~ ' .::::::::::::::~~: :::::::::::~. -::::::::.s.s~~° :::::::::::::::::::::: ..................................................... ..................................................... :::::::::::::::::::::::::::::1.:::::::::::::::::::::: ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... Date map was drawn: 10 / 10 / 06 . 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 gars, 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 o5~00 swxcs, January 2006 Spill Bucket Testing Report Form This form is intendedfor use by contractorsperforming annual testing of USTspill contairrmerastructures. Tie completed form and printouts from tests (tf applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. t _ RA('Ii.iTV i11ThYlRMATinN Facility Name: HP GO GO MINI MART Date ofTesting. 10/10/06 Facility Address: 430 ECALIF AVE / BAKERSFIELD CA 93304 Facility Contact: DILLON Ph~e: 661-861-8505 Date Local AgeQCy Was Notified of Testing :10/3/06 Name of Local Agency Inspector (ifpresent during testing): 2_ TESTING CONTRACTOR INFORMATION Co Name: ACE PETROLEUM SERVICES INC Technician Conducting Test RON ROGERS G~edemialsl: 0 CSLB Contractor ®ICC Service Tech. ^ SWRCB Tank Tester ^ Other cify) License Number(s): $ ( ~ Z CC ~ S Z .62 /~- U7" 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ®H drostatic ^ Vacuum ^ Other Test Equipment Used: Equipment 1Zesolution: Identify Spill Becket (By Tank Number, Stored Product, eta 1 7 2 1 3 4 Bucket Installation Type: ^ Direct Bury Q'Contained in S ^ Direct Bury ®Contained in S ^ Direct Bury ^ Contained in S ^ Direct Bury ^ Contained in Bue Diameter: 12" 12" Bucket Depth: 12" 12" Wart torte between applying vacaum/water and start of hest Test Start Time (T~: 11:00 AM 11:00 AM Initial Reading ~ " 10 " Test End Time (I'F): 12:00 PM 12:00 PM Final Reading (Rr): 10 " Test Duration (Tg - T~: 1 HR HR Change in Reading (RF-ltd: PassJFail Threshold or Criteria: Test Result; ®Pass ^ Fail ®Pass ^ Fail ^. Pass ^ Fsil ^ Pass ^ Fail Comments - (vrdude #nformatton on repairs made prior to testing and rec~mnended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING ' I hereby 'that aAthe n co ed lit this report !s due, accurate, and in full compliance with legal requirements. Technician's Signature- Date- ~O - / f~ -l3 6 State laws a~ regulations do not currently require testing to be performed by a qualified contractor. However, local requiremments maybe more stringent. _. `:: . S1YST~p SET _ UP _ _. _. ---." ~ - ____._ ~ - -- -- ------ - dCT 10. 2006 11:07 ~- - ----- - -.1----- ~'STEhi UNITS IN-TANK SETUP - - - - - I SYSTEM LANGUAGE T I:PREM E~LISH PRODUCI• CODE LEAK TEST METHOD ~ DD YYYY HH:~I~ByFO~T ~ - THERMAL COEFF 1 TANK DIAM~R - Og0.700 g _ _ _ _ _ TEST dN DATE ALL TANK '`' XM 925 ~ GO MARKET 5 75 TANK PROFILE 1 PT -.. FULL tlOL JAN 1. 1996 START...TIME.:... DISABLED :. 0 E.C. - ALI FORM' A AVE., BAIGERSFIEI;D 1 0152 TEST R ATE .0.20 GA LHR DURATIdN 2 H 661-861-8505 93304 FLOAT SIZE: 4.0 IN. 8496 OURS SHIFT TIME ] SA$LED SffTFT TIME 2 ~ DI DISABLED SHIFT TI ~ WATER HIGH.WARILIr7IT: 3 LEAK T ., REPORT FORMAT ME ;~ SHIFT TIME 4 p j SflBL~ ED :0 MAX OR LABEI V OL' NORMAL P~I ODIC ~- W R , 10152 OVERFILL LIMIT : o 90i A M DISABLEp ~ ANNUAL T~ ~RNI NGS DISABLT~ HIGH PRODUCT 9136 95i L DELIVERY LIMIT 9644 10° IQUID SENSOR SE?'UF - - _ PRINT TC VOLUMES ENABLED I015 LOW PRODUCT i _ _ _ - _ _ L 1~1-2 DISP TEMP C~PENSATION VA LEAK ALARM LIMIT: 500 SUDDEN LOS 99 LIMI TRI-STATE {SI CATEGORY LE FI.Crg ' LUE lDEG F )• 60.0 T: g0 TANK TILT 0.00 • T> ~ DISP E~£k FAN `SYSTEM SECURITY C©DE 0 00 000 , MANIFOIDED..: TAN};g T#: .NONE - L 2: - 3 4 DISP I DELIVERY DELAY 15 MIN ' TRi- CATEGORYE (SINGLE FLpRT} ~ DISPENSER pA(V - L 3:5-6 DISP TRI-STATE _ - (SINGLE F CATEGORY ; DISPENSERp AM1J C(~P'BMUIdiCAT IONS SETUP - - - - - L 4:91 FILL TRI -STATE t S I NGLE CATEu - - - - - - PR(}DUNLEADED UCT CODE - OR`t -OAT} t}TkER si:r~p~: PORT SETTINGS: TAI ~~ •.000700 ~ NONE FOUND ~ER 1.1.3...75 TANK PRtfF L 5:87, FILL TRI- RS-232:SECURITY FULL VdL 20149 CATEGORYE•{SINGLE FLOATi DT~R SENSC~~ ConE ooooca ' FLt)AT SI ZE: 4.0 IN. 8496 - TER WFiRN I NG HIGH WATER LIMIT: 2.0 ~ L 6:91 S7•p TRI-STATE {Si1dGLE FLOATS CATEGOR pND OF MESSAGE DI -2 BL 3.0 MAX='t)R LABEL vOL : ~ 20149 OVERFILL LIM . Y :.STP. SUMP L 7:91 SA E IT 9~ ANN TRI -STAB HIGH PRt}DUCT 18134 9!y fSI -:.'CATEGORY ANN LE FLOAT} ULAR SPAC ~ ~ 19141 DELIVERY LIMIT E - 10% - :: _ = 2014 LOW PRODUCT ~ L $; TRI -STq~P S~ NALARM LIMIT: 599 LIMIT: CATEGORY STP S~LOAT} 99 TANK TILT • O.OD L 9:87:ANN MANIFOLDED TANKS ~ T#: NONE (SING cATEGORyE L.E FLOATS :ANNULAR SPACE DELIVERY DELAY 15 MIN.- HISTORY REPORT ----- SENSOR ALARM ----- L 1:1-2 DISP DISPENSER PAN :. FUEL ALARM OCT 10, 2006 11:21 AM FUEL ALARM SEP 16. 2005 9:43 AM FUEL ALARM SEP 14. 2005 3:4? PM HISTORY REPORT ?: ----- SENSOR ALARM ----- L 2:3-4 DISP DISPENSER PAN FUEL ALARM OCT 10. 2006 11:23 AM FUEL ALARM -SEP 16. 2D05 9:42 AM FUEL ALARM-! - . " SEP 14. 2005 3:49 PM ALARM HISTORY .REPORT ----- SENSOR ALARM ----- L 9:8? ANN ANNULAR SPACE FUEL ALARM OCT 10. 20D6 11:38 AM FUEL ALARM SEP 16. 2005 10:49 AM FUEL AIARM SEP 14. 2005 12:10 PM ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 3:5-6 DISP DISPENSER PAN FUEL ALARM OGT 10. 2006 11:25 AM ;FUEL ALARM SEP 16. 2005 9:44 AM FUEL ALARM SEP 14.. 2005. 3:50 PM ALARM HISTORY REPORT ----- SENSOR ALARM ----- L b:91 STP STP SUMP FUEL ALARM OCT 10..2006 ..11 1?_ aAM _- - FUEL ALARM ....:SEP 16. ;20.05 ' 9:3?'AM FUEL ALARM JAN i. 1996 8:4? AM ALARM H I ST(}RY REPORT ----- SENSOR RLARM ----- L 4:9I FILL OTHER SENSORS FUEL ALARM OCT 10. 2006 11:30 AM SENSOR OUT ALARM SEP 16. 2005 2:38 PM FUEL ALARM SEP 16. 2005 2:38.::PM ALARM HISTORY REPORT ----- SENSOR ALARM -- L 7:91 .ANN ANNULaR':::_SI?ACE FUEL'ALARM OCT 10. 2006 11:35 AM FUEL ALARM SEP 16, 2005 10:47 AM SENS4R':OUT 'AI:ARM JAN 1. 1996 8:40 AM ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 5:8? FILL OTHER SENSORS FUEL ALARM OCT 10. 2006 11:27 AM SENSOR OUT ALARM SEP 16. 2005 3:04 PM FUEL ALARM SEP 16. 2005 9:41 AM ALARM HISTORY REPORT ----- SENSOR ALARM -- L 8:8? STP STP SUMP FUEL ALARM OCT 10, 2006 11:15 AM FUEL ALARM SEP 20,.2005 2:3I PM FUEL ALARM SEF 19, 2005-''3.21 PM UNDERGROUND STORAGE TANKS B B R 3 F I D _ F/li:'B AA'T'fI! Y APPLICAT'I®(~B TO PERFORM ELD /LINE TESTING / S6989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MON170RING CERTIFICATION BAKER~FIELD FIRE DEPT. ~evention services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661} $52-21'71 Page 1 of 1 PERMIT NO. ~~~ ~ ,`~-ST ^ ENHANCED LEAK DETECTION ^ LINE TESTING ~ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ^ TO PERFORM FUEL MONITORING CERTIFICATION L-_-- _ FACILITY ~ m _ __ SIT__E it~IFORMATION ___ NAME & PHONE NUMBER OF CONTACT PERSON ODRESS nn l./'1 WNERS NAME PERATORS NAME y~ - ~.e,.'!v PERMIT TO OPERATE NO. UMBER OF TANKS TO TESTED IS PIPING GOING TO BE TESTED? YES ^ NO TANK# VOLUME CONTENTS 1 ~- TANK TESTING COMPANY - N~ AME F TESTING COMPANY. - n.- _ NAME PHONE NUMBER OF CONTACT PERSON AILIN ADDR SS D, ~Sb'? ~ 9330 AME & HONE NUMBER OFT STER OR SPECI INSPE OR ~ - 39a - ~ ~ CERTIFICATION #: oSo 3 S ~ a ~ -~ osd 3s ~ 3 ~ ATE & IME TEST TO BE CONDUCTE // DO' ~~ ~ PCC~~ ~ ~ a ~ ~ I U ~ EST METHOD IGNATUREOF PLICANT ATE _0~ PPROVED BY ~ __ _ / ~ ~ ~,~I ATE ~r /tt tJJ FD2106 . _ ~ _. MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6J 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 preaared 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 Facility Name: Site Address: _ Facility Contact Person: _~/~~ Make/Model of Monitoring System: B. Inventory of Equipment Tested/Certified [`hartr tha gnmm~rinta Mrac to Sndir~fa enariFr nm.inmonf inctwrfwl/eeivtroll~ ~/ _" Tank ID: Tank ID: - - - Q~In-Tank uging Probe. _ ~ Model: ^ -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: ^ ar Space or Vault Sensor. Model: 'ping Sump /Trench Sensor(s). Model: O- ^ Pipin ump /Trench Sensor(s). Model: Fill Sump Sensor(s). Model: ~ ^ Fill S ensor(s). Model: Mechanical Line Leak Detector. Model: /_ ^ Mechanical a Leak Detector. Model: ^ ElecRnnic Line Leak Detector. Model: ^ Electronic Line Detector. Model: ^ Tank Overfill !High-Level Sensor. Model: ^ Tank Overfill /High- vel Sensor, Model: ^ Other (s ui ment an model in Section E on Pa a 2). ^ Other (s ui men and model in Section E on Pa a 2). Tank ID• Tank ID• In-Tank Gauging Probe. Model: O- ^ In-Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: ^ Annular Space or Vault Sensor. odes: iping Sump /Trench Sensor(s). Model: ^ Piping Sump /Trench Sensor(s). I: Fill Sump Sensor(s). Model: O" ^ Fill Sump Sensor(s). Mode . ~MechanicaT Line Leak~Detector. Model: ^ 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: ' ^ Other (s eci ui ment t and model in Section E on Pa a 2). ^ Other (s i ui ment t and model in Section E on Pa a 2). Dispenser ID: #" Dis user ID: Dispenser Containn~nt Sensor(s). Model: ~ ^ Di nser Containna'nt Sensor(s). Model: hear Valve(s). ^ Shear e(s). ^ Dis enser Con nt at(s) and Chain(s). ^Dis ser Co 'nment Floats} and Chain(s). penser ID: Dispenser ID: ispenser Containment Sensor(s). Model: ^ Dispenser Containment Se s). Model: .Shear Valve(s). ^ Shear Valve(s). ^ Dis nser Containment Float(s) and Chain(s). , ^Dis user Containment Float(s) and (s}. Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: ~ ^ Dispenser Containment Sensor(s). Model: hear Valve(s). ^ Shear Valve(s). ^Dis user Containment Floats and Chain s). D Dis user Containment Float(s) and Chains . 'lt the facility contains more tanks or dispensers, copy this form. Include infotmarion for every tank and dispenser at the facility. C. C@rt1f1C8tioII - I certify that the equipment identified in this document was impected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (eg. manufacturers' checklists) necessary to verify that information is correct and a Plot Plan showing the layout of monitoring equipmant. For any agar pable f generating ports, I have also attached a copy of the rt; (check all that )• ^ System set-up ^ ' to report Technician Name (print): ~~-{-~dt/~t~ {+ ~'-g '~ Signature: Certification No.:11U(L Testing Company. Name: Site Address: l Monitoring System Certification e. License. No.: ~j~ ~ Page 1 of 3 City: /Bld/g. No.: ~ ~p~ Contact Phone No.: (} Date of Testing/Servicing: ~/f~/~ w Phone No.:(lD~/D / ~~~'° -Date of Testing/Servicing: ~/~ 03/01 ,` ~,. D. Results of Testing/Servicing Software Version Installed: Co lets the followin checklist: Yes ^ No* Is the audible alarm o rational? Yes ^ No* Is the visual alarm o rational? Yes ^ No* Were all sensors visuall ins led, functionall tested, and confirmed o erational? D~ es ^ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ro r o ration? ^ 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 di~Q~nnected? If yes: which sensors initiate positive shut-dawn? (Check all that apply) J~Sump(Trench Sensors;ispenser Containment Sensors. Did ou confirm sitive shut-down due to leaks and tensor failure/disconnection? es; ^ No. ^ Yes ^ No* For tank systems that utilize the monitoring system as the grimary tank overfill warning device (i.e. no ~N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill int(s) and o ratin ra rl ? If so, at what rcent of tank ca aci does the alarm tri er? % ^ Yes* No Was any monitoring equipment replaced? Tf yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement 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 es, describe causes in Section E, below. Yes ^ No* Was monitorin s stem set-u reviewed to ensure ro r settin s? Attach set u re rts, if a licable Yes ^ No* Is all monitorin ui ment ational manufacturer's s ecifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 03/01 r• 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. ( mm~lete the fnllnwinv rherkiictr 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 manufacturer's maintenance checklist completed? * )n the Section H, below, describe how and when these deSciencies were or will be corrected. G. Line Leak Detectors (LLD): C'mm~lete the fnllnwin4 eherkiict~ ^ Check this box if LLDs are not installed. 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: ,J~ 3 g.p.h.; O 0.1 g.p.h ; ^ 0.2 g.p.h. Yes ^ No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ^ No* Was the testing apparatus properly calibrated? Yes ^ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N!A ^ 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 Jfi~' N/A or disconnected? ^ Yes ^ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ~N/A or fails a test? ^ Yes ^ No* For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Yes ^ No* Were all items on the equipment manufacturer's maintenance checklist completed? In me ~ectioa ti, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 03!01 onitoring System Certification Site Address: Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . t .. . . . G'''". . ~ . . . _ i . . _ . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . _ . f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . - - .~ .~ . . ~ ~=/. . ---~._. .---. .. ..,.. ::::::: ::::: ~ ~ :::::Q ::::::~ : :::::: ::::::::::: ~~. Date map was drawn: ~~~~ Instructions ff 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 prepazed. Page ~ of ~ 05/00 r ALARM HISTORY REPORT 'ALARM HISTC>RY REP(7RT ----- SENSOR ALARM ----- L. 58?SFILLR ALARM ----- L i:l-2 DISP OTHER SENSORS DISPENSER PA,1V FUEL A1-ARM FUEL ALARM - SEP 16. SEP 16. 2005 9 4f1 AM 2005 9:43 AtH FUEL ALARM SEP 14. 2005 3:4? PM --- FUEL ALARM _- - - -~ - ` ~- SEP 14, 2005 3:45 FM ' ALARM HISTOR'1 REPORT -' ALARM HISTOk'1.REPt}kT ----- SENSOR ALARM ----- '. L 9; 87 ANN -' - --- SENSOk ALARM ----- ANNULAR SFRCE ALARM HISTOR'1 REPORT ----- SEIVS~SR .:ALARM - -- L 2:3-4 DISP -- DISPENSER PAN FUEL ALARM SEP 16, 2005 9:42 AM FUEL ALARM SEP 14, 2005 ;~:49 PM , ALARM HISTORY REPORT -'--- SENSOR ALARM ---- L 3:5-6 DISP - DISP£NSER PAN FUEL ALARM SEF 16, 2005 9:44 AM FUEL ALARM SEP 14, 2005 3:50 FM ALARM HISTOk'f REPVRT - -- SENSi7R ALARM -- L 4:91 FILL OTHER SENSORS FUEL ALARM SEF 16. 2005 9::39 AM L 6:91 STP FUEL ALARM - STF SUMP SEP 16. 2005 10:49 AM FUEL AE.ARM SEP 16. 200p: g;3?AM FUEL ALARM -= SEP 14. 2005 12:10 PM FUEL ALARM JAN 1. 1996 8:47AM SENSOR OUT ALARt°i JAN 1 . 1996 8:313 ANt ALARM HISTORY REPORT ----` SENSOR ALARM =--- L 7:91 ANtV ANNULAR SPACE ..FUEL ALARM SEP 16, 2005 10:4? Al°1 ;. SENSOR OUT ALARM JAN 1. 1996 $:40 AM ALARM HISTORY REPORT -- `- SENSOR ALARM -- `L 8:B? STF STP SUMP FUEL ALARM SEP 16. 2005 9:36 Ah1 FUEL ALARM ' SEP 14, 2005 12:09 Phl` :~;ti . 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'gin i ~~~~~~ ~ ~ - ~ ~ ~ e66 T~~~tun ~~ve., Sze. ~, ~+;; i • ~ t3akers~eld. ~A ~33C? 1 ~-~ ~>_~~©~~€ ~~~; ~ i~~ TEST{i~€ia ~~~.: ~66~? i 326-39?3 i 51399 ~~C`J6VtjH'.~ ~ T't?~ ~.~,1~~-~iE~ T TEST9i~G Fes: (66? ~ 852-2 ~ r' r ~.~a~t2C TfCz~Ta~~SS 7'ES [ fAt~t-~'3 T~ r~E~'s=G:%€~ E€iE~ I t ~E~;v,1 T No. ECJHf1NCED LEAK CE T EC T IvCN ~ UNE T ES I ;NG ~ SB-9E3 SECQNuARY CON I A!!VNiEiJ I T~STI(`~;G ~~ TANK TIGuTNESS TEST ~ TO ~E^f=0Riv7 FL•ti_ ~~tJPtiTORINi; CE~I"i=C~.TiO,d ' +~`~~ `i~G Cf,~,~pdAdY ~AsV.IE r~TEST,'~iN~ CCtUlt~Ai~lY Q~?!!'vz-~ ~s.~.e~r x r1t~A,t.X.PO.o E ": FHC?J?a °;[.i~v ~rE ~~! t}F¢-2~ ~~k~b~~~~ ~ ~.at[~. ~.o~e~- ;: q ~'l ~ ~~-~~ J "1" nA H.Li~^A}}S7CEi~+=-S~.S/ ) {'' J ^''~ ~ /p} ,,~ / ~ (~ a sJ~ti~~ & ~otJt= ~~~,~~~~ C~ r srE~ C~ sect ~tJS~EC say cE? T I~tcaTio~; -: ~~~~~ ~ ~ta~~t ~i=sr T o st= cot~~uc T =~ i;cc ~: ;f ~s T ~t~=~ofl s;:a~H ~ ~~~;= c€ ~pt_tc~~z 'eATF 1t-~~~~ 'AP°~OVE'J 5`t ~~>ATE ,=D21 v5 ,~ ~~ Nov c"'3 05 10:53a F/Itl ~Rrr RONALD J. FRAZE FIRE CHIEF Gary I4afton, Senior Deputy Chief Administration 326-3650 Deputy Chief Dean Clason OperationsrlYaining 326.3652 Deputy Chief Kirk Blair Fire Safety/Preveniion Services 326653 2101 "H" Stree# Bakersfield, CA 93301 OFFICE: (661) 326941 FAX: (661) 852-2170 RALPH E. HLTEX, DIRECTOR PREVENTION SERVICES rx+~ a+u~err sertnces • ewvroorixexrn~ assnc~ 900 Tn.octun Avenue, Surte 21D Bakersfield, CA 93301 OFFICE (661)328-3979 FAX: (681) 852 2171 David Weirather Fire Plans Examiner 326-3706 Howard H. Wines, fil Hazardous Materials Specialist 326-3849 DIRIVR EDIT IIYC October 21, 2005 Mr. Igbal Singh La Barata Meat Market 430 E. Califorrva Avenue Bakersfield. CA 93304 ss1-835-o27s REtHIAiDER NOTICE RE: Necessary Secondary Containment Testing Requirements try December 31, 2005 of Undergnxind Storage Tank (s} Located at the Above Stated Address Dear Mr. Singh, p.2 if you are receivingithis letter, you have n..4L yet completed the necessary seaor-dary containment testing required forall secondary containment c~nponents for your underground storage tank (s). Senate Bill 988 became effective January 1,2002, section 25284.1 (Carifomia Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and every 36 months, thereafter, to insure that the systems are capable of containing releases from the primary containment until they are detecfed and r~noved. This office wr11 continue to send you monthly reminders of this necessary testing. This is a very specialized test and very few contractors are 6cerrsed to perform this test_ Contractors conducting this test are scheduling approramately 6-7 weeks out. The purpose of this~letter is to advise you that under code, failure to perform this test, by the necessary deadline; December 31, 2005, will result in the revocation of your permit to operate. This oftk~e does nat,want to be forked to take such action, which is will begin to send monthly reminders.. ~ Should you have any questions, please feel free to call me at 661)326-319 Sincerery, n ,, 1 ~C Steve Underwood Fire Prevention Offioe~-'~ , su:db J.ertiir~ ~~vi~aisusass~ ~ / e,~aary .s!~oi~i v ~~^ r Hov 23 05 1O:54a DIRIVR EI`IT II`IC 661-835-0279 p.4 11/16/2005 11:43 6618363177 REDWINE TESTING SVGS PAGE 03/04 a~~'~ - ' •~ ~~ .. FAQL ~ ~ 1~i9I6~' Lc'~~D . Fsc~cr~rsr B~Q~1~ ~ ~, _~ . ~~~~ Y.. ~: k'. ~* '~ .;• ~..: . t• "!~ K tD' ~~ i ~. ;. ~6Mnp ~ ::: 2 f ~P 3 Sa~fR 4 . / -~ , ~MI^1 f~a/~t if ~DaA~e . , . _ , '~~~ lr ire 'i i. Q miler BM~t / `• . 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