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Home My WebLink AboutBUSINESS PLAN (2)\." ,~ ~=7c~111O10/Ogy 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 KERN CTY - ENVIROMENTAL HEALTH 2700 M STREET SUITE 300 BAKERSFIELD, CA. 93301 Test Date: 01 /25/2005 Order Number: 3138486 Date Printed and Mailed: 02/01/2005 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: CIRCLE K#2708825, CO. 123 2222 F ST. @23RD ST. BAKERSFIELD, CA. 93301 Testing performed: Leak detector tests Monitor Certification Secondary Containment-Spill Container Stage II pressure decay tests Sincerely, Dawn Kohlmeyer Manager, Field Reporting ;- TanY PURPOSE: COMPLIANCE TEST DATE: 01!25!05 CLIENT: CIRCLE K STORES 495 E. RINCON, STE.150 CORONA, CA 92879 MICHELLE WILSON (909)270-5193 TANKNOLOGY CERTIFICATE OF TESTING 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451-6334 FAX (512) 459-1459 TEST RESULT SUMMARY REPORT WORK ORDER NUMBER: 3138488 CUSTOMER PO: 100139 SITE: CIRCLE K#2708825, CO. 123 2222 F ST. @23RD ST. BAKERSFIELD, CA 93301 MANAGER-RANDY (661)324-1758 TEST TYPE: TLD-1 Prnrlnrt Pina Tinhtnacc Tact Racultc IMPACT LINE LINE LINE DELIVERY TEST RESULT FINAL LEAK RATE (gph) VALVE ID - _ PRODUCT - - MATERIAL _ __ - _ TYPE _ _ _ ___. _ A B C D _ _ A B C D _ _ _- - - - -- __ FUNCTION u Tl: 91 1 SIIPER FIBERGLASS PRESSURE T2: 89 2 PLUS FIBERGLASS PRESSURE T3: 87 3 UNLEADED FIBERGLASS PRESSURE ne Leak LINE ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESU Cl: 91 1 VEEDERROOT ELECTRONI 204905 P C2: 89 2 VEEDERROOT ELECTRONI 011662 P C3: 87 3 VEEDERROOT ELECTRONI 012171 P Npw Rpnlarpmpnt L inp Lpak 1)ptpr_tnr Tact EP ED LE' DETE T 1 E i EL) EAK D ~#2 LINE MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # 5ERtAL # RESUL ID T2: 89 2 VEEDERROOT SLECTRONI 119080 P ror owner aetauea report mtortnanon, VlSlt WWW.tan KilOIO~.COm 8nU select VP-L1nC KCpOrtS-WKAY, Oi CO17t8Ct yOlli IOC81 1811K0010~! OIIICC. Tester Name: DAVID LASKY Technician Certification Number:ggg Printed 02/01!2005 08:30 SBOWERS INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tanlv~otogy TEST DATE:01/25/05 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3138486 CLIENT:CIRCLB K STORES AUSTIN, TEXAS 78759 (512) 451-6334 SITE:CIRCLE K#2708825, CO. 123 TANK`INFORMATtON Tank ID: T7: 91 1 Tank manifolded: No Bottom to top fill in inches: 89.0 Product: SUPER Vent manifolded: No Bottom to grade in inches: Capacity in gallons: 9, 684 Vapor recovery manifolded: YES Fill pipe length in inches: Diameter in inches: 89.00 Overfill protection: YES Fill pipe diameter in inches: 4. o Length in inches: 364 Overspill protection: YES Stage I vapor recovery: DUAL Material: Dw FIBERG Installed: ATG Stage II vapor recovery: AssIST CP installed on: / / COMMENTS TANK TEST RESULTS Test DAethod:vacuTect LEAK DETECTOR TEST RESULTS Test method: FTA' Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: vsaDSxxooT Ingress Detected: Water Bubble Ullage Model: sLSCTaoxxc Test time: SIN: aotsos Open time in sec: .Inclinometer reading: Holding psi: 24 ~ VacuTect Test Type: xoT NoT ReS111ency CC: TESTED VacuTect Probe Entry Point: Test leak rate ml/m: ia9 . o TESTED Pressure Set Point: Meterin g psi. Tank water level in inches: Calib. leak in gph: s . 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type; T~-1 LINE A B - C D Material: FIBERGLASS Diameter (in): 2.0 Length (ft): 125.0 Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE Pump make: Fs PETRO COMMENTS Impact Valves Operational: UNKNOWN Printed 02/01/2005 08:30 . INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan/atology TEST DATE:O1/25/05 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3138486 CLIENT:CIRCLE K STORES AUSTIN, TEXAS 78759 (512) 451-6334 SITE:CIRCLE K#2708825, CO. 123 TANK INFORMATION Tank ID: T2 : e9 2 Tank manifolded: No Bottom to top fill in inches: s9. o Product: PLUS Vent manifolded: No Bottom to grade in inches: Capacity in gallons: 9, 684 Vapor recovery manifolded: YES Fill pipe length in inches: Diameter in inches: 89.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 364 Overspill protection: Yss Stage I vapor recovery: DUAL Material: Dw FIBERG Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS TANKTEST RESULTS Test Method;vacuTect LEAK DETECTOR TEST RESULTS Tesf`method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: vssnERROOT vEEnERROOT Ingress Detected: Water Bubble Ullage Model: ELECTROxic ELECTRONIC Test time: SIN: ii9oao oiieea Open time in sec: Inclinometer reading: Holding psi: 2a VacuTect Test Type: NoT NoT Resiliency cc: VacuTect Probe Entry Point: TESTED Test leak rate ml/m: la9.o TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: a.oo 3.00 Water table depth in inches: Results: PASS PASS Determined by {method}: Result: COMMENTS COMMENTS LINE TESTREStlLTS Test type: TLD-i `LINE A B C D Material: FIBERGLASS Diameter (in}: 2.0 Length (ft}: 125.0 Test psi: Bleedback cc: Test time (min}: NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSIIRE Pump make: FE PETRO COMMENTS Impact Valves Operational: UNKNOFTN Printed 02/01/2005 08:30 . INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan TEST DATE:O1/25/05 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3138486 CLIENT:CIRCLE K STORES AUSTIN, TEXAS 78759 (512)451-6334 SITE:CIRCLB K#2708825, CO: 123 TANK INFORMATION Tank ID: T3 : 87 3 Tank manifolded: No Bottom to top fill in inches: 89.0 Product: UNLEADED Vent manifolded: NO Bottom to grade in inches: Capacity in gallons: 9, 684 Vapor recovery manifolded: YES Fill pipe length in inches: Diameter in inches: 89. oo Overfill protection: YES Fill pipe diameter in inches: 4 • o Length in inches: 364 Overspill protection: YES Stage I vapor recovery: DUAL Material: Dw FIBERG Installed: ATG Stage II vapor recovery: Ass=sT CP installed on: / / COMMENTS TANK-TEST RESULTS Test Method: VacuTect LEAKDETECTOR TEST RESULTS, Test method: FTA ~' Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: vasnERROOT Ingress Detected: Water Bubble Ullage MOdel: ELECTRONIC Test time: S/N: 01'1'1 Open time in sec: Inclinometer reading: Holding psi: 22 VacuTect Test Type: NoT NOT Resiliency cc: ~-y T VacuTect Probe Ent Point: ESTED Test teak rate ml/m: 1a9. o TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: a . o0 Water table depth in inches: Results: Pass Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: zLD-i L1NE - A B C D Material: FIBERGLASS Diameter (in): 2 . o Length (ft): 125. o Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: UNKNOWN Printed 02/01/2005 08:30 SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS r- TanKnotogy TEST DATE:O1/25/2005 CLIENT: cIRCLS R STORES 495 E. RINCON, STS. 150 CORONA CA 92879 MICHELLE WILSON 909-270-5193 Tank Interstital Tests TANK PRODUCT MANUFACTURER RESULTS SUPER PLUS UNLEADED WORK ORDER NO.: 3138486 SITE: CIRCLE R#2708825, CO. 123 2222 F ST. ®23RD ST. BARERSFIELD CA 93301 Piping Interstital Tests LINE PRODUCT MANUFACTURER RESULTS SUmD &Under-Dispenser Containment Tests Sump/ DISP.# MANUFACTURER P/F 89 FILL OPW Pass 87 FILL OPW Pass 91 FILL OPW Pass Tanknology representative: JERRY BELLOLI Services conducted by: DAVID LASKY r~~ C7~~~~~~ ~~ Test Date: 01/25/2005 Work Order: 3138486 SECONDARY CONTAINMENT TEST RESULTS SUMP TESTS Type Tank or Disp Manufacturer Model or Diam./Width/Length " Depth " Test Method Start Initial Level Finish Final Pass/ F il # Material ( ) ( ) Time Level Change Time Result a Spill Container 89 FILL OPW Plastic 12 13 1240 6 0 1340 6 Pass Spill Container 87 FILL OPW Plastic 12 13 1240 4 0 1340 4 Pass Spi11 Container 91 FILL OPW Plastic 12 13 1240 4 0 1340 4 Pass Comments: ALL TESTS WERE PERFORMED VISUALLY, NO VISUAL LEVEL CHANGES. MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of Califomia 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 dowment testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or resort 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: CIRCLE K#2708825, CO. 123 Site Address: 2222 F ST. City: BAKERSFIELD CA Zip: 93301 Contact Phone No: 324-1758 @23RD ST. Date of Testing/Service: 01/25/2005 Facility Contact Person: MANAGER -RANDY Make/Model of Monitoring System:V/R TLS 350 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced Tank ID: T1:91 Tank ID: T2:89 X In-Tank Gauging Probe. Model: MAG 1 X In-Tank Gauging Probe. Model: MAG 1 X Annular Space or Vault Sensor. Model: 409 Annular Space or Vault Sensor. Model: 409 X Piping Sump/Trench Sensor(s). Model: 208 Piping Sump/Trench Sensor(s). Model: 208 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: PLLD #204905 X Electronic Line Leak Detector. Modef: PLLD #119080 Tank Overfill/High-Level Sensor. .Model: FLAPPER/ATG X Tank OverfilUHigh-Level Sensor. Model: FLAPPER/ATG 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: X In-Tank Gauging Probe. Model: MAG 1 In-Tank Gauging Probe. Model: X Annular Space or Vault Sensor. Model: 409 Annular Space or Vault Sensor. Model: )( Piping Sump/Trench Sensors} Model: 208 Piping Sump/Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector. Model: pLLD #012171 Electronic Line Leak Detector. Model: X Tank OvefilUHigh-Level Sensor. Model: FLAPPER/ATG Tank OverfilUHigh-Level Sensor. 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). ispenser 1/2 Dispenser ID: 3/4 Dispenser Containment Sensor(s) Model: BRAVO FLOAT Dispenser Containment Sensor(s) Model: BRAVO FLOAT XO Shear Valve(s). X Shear Valve(s) DX Dispenser Containment Float(s) and Chain(s). X Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Q Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(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): X^ System set-up X^ Alarm history report Technician Name (print): DAVID LASKY Certification No.: 8766 Work Order Number: 3138486 ~~~~ Signature: ~~~ License. No.: Testing Company Name: Tanknology Phone No.: (800) 800-4633 Site Address: 8900 Shoal Creek, Bldg. 200 Austin, TX 78757 Date of Testing/Servicing: 01/25/2005 Page 1 of 3 Based on CA form dated 03/01 Monitoring System Certification Monitoring System Certification Site Address: 2222 F ST. Date of Testing/Service: 01 /25/2005 @23RD ST. D. Results of Testing/Servicing Software Version Installed: 16.02 Complete the following checklist: x Yes [] No ` Is the audible alarm operational? O Yes ~ No ` Is the visual alarm operational? O Yes No ` Were all sensors visually inspected, functionally tested, and confirmed operational? 0 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 ` x NlA 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 leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive' shut-down? (check all that apply) ^x SumplTrench Sensors; ^ Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks aIId sensor failure/disconnection? ^x Yes ^ No Yes Q No ` ^x NtA 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) antl operating properly? If so,, at what percent of tank capacity does the alarm trigger? FLAPPER Yes' ^x 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' x^ 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. Qx Yes ~ No ~ Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. ^X Yes [] No ` Is all monitoring equipment operational per manufacturers' specifications? ' to 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: ~~~~ ~ eT Date of Testing/Service: 01 /25/2005 @23RD ST. F. In-Tank Gauging /SIR Equipment a 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: Q Yes ^ No • Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ^x Yes ~No * Were all tank gauging probes visually inspected for damage and residue buildup? ^x Yes ^ No * Was. accuracy of system product level readings tested? QYes ~No * Was accuracy of system water level readings tested? X Yes ~ No * Were all probes reinstalled properly? x^ 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 LLDs are not installed. Complete the following checklist: ^ Yes ^ No * ^ NIA For equipment start-up or annual equipment certification, was'a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: Q 3 g.p.h ^ 0.1 g.p.h ~0.2 g.p.h x Yes ^ No • - Were all LLDs confirmed operational and accurate within regulatory requirements? 0 Yes ^No • Was the testing apparatus properly calibrated? Yes ^ No • ~ NtA For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Yes ^No • ^ NtA For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Q Yes ^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 • ^ NIA For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ^x Yes ^No • ^ NtA For electronic LLDs, have all accessible wiring connections been visually inspected? 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. H. Comments: 89 PLLD FAILED PRESSURE WAS OFF. REPLACED WITH NEW PLLD RETESTED PASS. Page 3 of 3 Based on CA form dated 03/01 ~ 7ankr~ology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512) 451-6334 FAX (512) 459-1459 TEST DATE:O1/25/05 WORK ORDER NUMBER3138486 CLIENT:CIRCLL R STORES SITE:CIRCLF3 R#2708825, CO. 123 COMMENTS Vapor Recovery Testing, Monitor Certification & Spill Bucket Testing. Performed decay, a/1, dry blockage, moat cert and spill bucket testing, all passed, had trouble with the 89 leak detector, it was reading 7 psi with 0 psi on th eline, replaced aad tested ok, also replaced weeder root power indicator lamp aad dispenser 2 and 3 nozzles with V34's. Parts billed on WO # 3138610 PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 02/01/2005 08:30 SBOWERS ITE DIAGRAM ~ Tanla>tology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512) 451-6334 FAX (5121459-1459 TEST DATE: 01/25/05 WORK ORDER NUMBER3138486 CLIENT:CIRCLS R STORES SITE: CIRCLE R#2708825, CO. 123 i,~Q VENTS L5 A L2 v 409 ~ STP 208 PLUS O 10K L3 a L6 v 409 ~ STP 208 REG O 10K L1 A L4 v 409 ~ STP 208 SUP O 10K #Z ~/ #1 #4 #3 BRAVO FLOATS IN UDC'S Printed 02/01!2005 08:30 SBOWERS Work Order: 3138486 Cali`bratian Sheet Ft~r Pressure Measuring D~uice Dade: +~ - Z 3 - c7 Equipment; ~_] MechanicalDigital Ser'raI Number.: N ~~ ~ ~~1~_~ .c: ~i~a ni~K-iii. ~~a~0 Qf $~~~~ ~•. n. _--- (incline) : ~°~ (aCfual) 50% O~ S~a~"~ ~.C1C~ incline ~ ~ ~~ . (, l ~ (ectual)~ $;d Q~0 ~~ $~a I e ~ ' ~° Q .,.., ti neiine) r. • ~ . , (actual) Galibraiinn rh~;ck. can he done .using a, ~° irtickne mar~orneter: For pressure; . measuring; devices great than 2", use. a' 2" .scale. Pressure measuring iicvices` b~lbw 2".shall 6e t~asecl ~n the- scale of fhe ~resst~re=measuring deice. Coiri~any Name: ~.aL~~ Y _... _~~ Person candu tin~,calipfation; ~~:~ p,~L. ~: i. /~. /• Signature: CSPMO (rev. tor'l7lR4j Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 313 84 8 6 Circle t CotnpllancE Pr~:isPar+ • And Stags 11 Ti3.tinc~ RAP Aitai:hrnent:F-f UST FAQILlTY INSPECTIC3N/AUDI.T SHEET ~ • Facility: c~S•~t t.~G~ Faclitr ~ .~ 7p ~ ~ ~ ~ Test Date: I ~ . S ~ °' Adiiress: 2 2 Z 2 ~ ~" County ~A'~~1.4'S•'E L~~ . Cross Street: +~ •~ ~~ c3t Wnrk ~ ~ r ~ .~1~ a' ~. ca~r..~ r.._e wr..:.-c....-s N"== NoC,F'ressnt nr Abccrvud $ = t?r1LSIflCtDtY . U'= Vrim6sr~atrny. Fi1F Cover: ~~ • FIII Cep: $ Fii1 Cep $bal: _~ Drop Tube: ,~ StElka Pfate: V/R Cwer: S Y/R Cap: .Ci V1RSee1: VlR Dry, Bresk: ' g 'Sub Pump: Sub Pump Cover: 9 Overfill: S OverFdl Mfgr: ~~~ ovsrfULTypei .~~~~ Dvertllt:5et at: Q ~a~~ eE:oaldaJ <Po'Prvseurc r=_Rex r=f7riaf A=11ng1cCliesk M~Metallic = h4,Stage I ; ; V e Vgrp~.if.Gheck • KiI1 Type:. PradttM Llne Typa: Tank Swing Juinf~Type: ~~isoenser Swine Joinf.Tbuo~~l!C'~+'~ ' N =Nor PrnSent S - SeEisfectery; U = Ungatisfacfory impact V--pave: •:S, Vertical Ehaek'Valve FilWapor SpIU Buckets $, , Fill Spill Mfgr QQV~ Fill Sump Presetyt I~JQ Dispenser Gontalnmeinf: hub pump Contalrrmeirt: Si h?'E Uiap. Z- .Hosea, ~`' ,Regu~ar:..~ Plus; d1- hrsmiui~'r ~~ DleseL• 4 tCeresene: k'ot Gas Nozzles;, Stage:ll B = lsatenee A_.a:air. ~Systep'I:TYI~=~~• ,~,p~ Aslst M1gr: ~4~'~+Y` "~~ ~iquld Remvl Regd: /till'' • Comments: Cor~plianoe Detail: (List;rte'hethai ruie}ii imrned+ate attention): " Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 313 8 4 8 6 F'YSTEP1 al;"1'OF - _ .. .. r :~~~~:~ • THERhIFiL. COEI'I' :.000'(itu_ F•""~-232 ENL~ OF M1::7.iAGE TANK DIAMETER 89.00 1 PTS ' '` ~ ' ' D I SAH1.1-iD 1F 1.1.E . 'TANK. PRi 1;ctL FIJLL 9f~f14 t 5 9 UNITS ." fIJ U' S : 6E:.>i 11vt:M 'vt:;1 9£lcf . . SYSTEM LANGUr~GE 4q.5 INCH Vt)L : : 49G~J' 1 tiy8 I:NGLlSFI 22._3 LNCH VOL SYBTEhI DATEiT I hIE 1=0k1°ir'ti f Fl,t)AT 1;1`~)r: cI.O 1N: E~t•~i, . t: l l+'CLfi ,K 222 REST Wr1TER twIARN t NG : 2.A ' 8t F"IELD CA.Q3.34.1 KS~:N.~.1:aFEF. 1 lh1E'r; ~ .1.L t:Ll :124-.1'Iht1 I N-TANI': ::I`'+'1'[1P MA'r: OR LABEL VOI:: 9164 SrIfFT TIe~I: l 6:110- AM - - - - - - -. _ - oVER1=IL:L L,IM1T ~ 9px 87cti ktHIFT TII•IE S plStiBLED I11GH kRf>DUi°r ,H1FT T[r,~~r:. ~ DESABI:Et+ T 1s6UPER y1y9 5t~ E F ~ 7,.i•!£..~ [~ I IJiFIC Ftc, PFt)UU%'T t;OPE ' 1 7 PELiillE:h'Y LIMIT 9~ F 0 THERMAE. f`ftE:E ~1u 1]0 • 3 ~rHNK PEFJta 1~. L~;;:frla' t; 'f•NIC CtIArIE:TER a..u b1:Af11:EIr: ` 7•knl' FP~F.:LE ' a r7s ~ L4W Fk0>1Ur"f .ri99 TANK taIdIYUAL WHFtN1W~:r~ >- iila. VGL : ir:1:4 LIMIT I-EAi: ALAFa'~ DISABLED 66. 8 I Fly ~H VUI. 7861 ` , 6UUUEIV 1.Ui~S'L11'11'7~ 5Q 1.INL: PEF;dt11+Ji: Wi~F3NIIih:S 4A.5 fNfal VOL : ~L14 4 TANK `I' L'E' 30+'~` DISABLED.; 22.3 IN~::N VOl`. 1898 -LINE ANNUAL WARIVIIdI~: `~ ' ~ ~ ~ THt~i•: 19HIV1~1'uLIiEL D`ISAPI.E:U i'LQaT `iI.E : .{ . t l [ N . 6i?c , T;e•:. NANE F`F: t N~f Tt• -uctLUMES- ~ , ENai6~EL WATER WNRIVI Nt: ' ' 2.11 :.. P/1N PEF:IUI~lG; LEt~K ;IL` WATER LIMIT: HIGIi 3.G. . 0: TEI'IF 1 GMFEIV$HT10N VAI,I q tDl:f: F ) : , t,u. u' ' MA)':. OR LABEL VOl.: 9oSa ' 1 LA},: MI MI nNNUHI • ~~'^ , ' 1' 13TIi.K HEIGHT:OF'1':~L- OV)RFiI.L; I:aMIT •lU% • . 0 p1SABLEIt~~~ ~~~~~ ~dilg~ F:E('[:IfUN'.lL~a'1`; DtJRi'iTION P N1t;ni'RviiWT: `~'~~ ' , HOURS 1 p; C~tYtl ~fiT``~~ttit'i'.•~.; :'a°E:: t DELIVER,: Iahll'1' ' 1199. 10!o ~ PLk' LOL PtC 1°>rST TYF>l; tit?::NLIaRC~ EIVfaBI.ED 9aE3. START `D,A'f,E E'iPR, liF:EK: t `SUN: C.uW F'RC'L~th:T ~ ~ • flL ANNUAL: 1'E: ~1' FhIII: taRM Lil: ~1l ir1BL:EL' START TIME ~ i;EhK r•+LHkI.1. L 1 I t; 7 : 55 , 2:gll;AM S[1ADEIV LOS:: L1MIT~ 5U PEhIODIf: PEST FAIL ENLI , DATF. TFiNK T LLT L' • bCt At.r1P.~1 L I : ~:1BG:1=D -END T.IMI~ M+i;NiFOLDEA 'fAMKS - TFSI' FitIL GF:t>SS '2':'00' HM TP: tt :Nf . nI:MR11 Li ::NBI.£~+. ftNN'•'fEST PVl.Rtt3tNG : ~Fk ;;'lSTEI°I.caEGURI'I';'. LaiAK NII,N. P.EI•:IUPiL: 0. ' 1-'ER TI.~+T riVF.F'r-tblNG: CFF` CODE 2~}7253 L " '(t~Nh Tt"ST NUT:IFY.: Ol'!•' E.+K MIN HNNIdH : L ~ •~ . LI TNr; TST~ ~ S PPhION iIREAK:OFf • ' IiE1.1 V]~k i' liELF+'Y : (``-•' ~f [1, TYPE I PER l OP I V TES `3T.,t~Lr+F•G 7E~T I'~+11. r-IVNI~+L . ALHRM ilI BFiBI.J a COCIIhU N 1 CAT I QIVS : sh"TUP k'ER Lt7D l r 'PE57 FH l L Gf10~ TEST FA I L 'r::k'1' SETT1l.~::i; ALARM L~ISWNLET.1 NONE FOUIVI) ANN TEST F1VIiF:FV:ING: OFF 1 3:I:INLFstDFti 1;F;GUUt+7 !:.'1LtE ., ' PER TEt3T AVERt~t+ENt.t: itFF TH£RC'IAL l,OEiFF : .UUI17U0 RS=x'33 BE~UkIT> ': Liui:GGL ~:LL~E TAIVK TEST NOT11•'Y: t)F1= THrafi: DIHrIF.T£f•`.' TF1NK PROFILE 89:IS~`. d..PTS. . ' FULL :++~~~- ~ TP1K 'fST :SIE'4t:'ti >r£A1•.:GFr B INCH Vttl: : E,6 7861 DL'LIVT±R1' UL:LAY l5 I.1IN ._ A~J.S ley%11 ~;JI. : 22.:1 I N~:H VOL '11ti3-. 18'8 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 313 84 8 6 ~ ~LGi~'i' S l;?F.: d • G 1 N . 8496 - - - - -- - - - - - - FNF: i::UkC [. [ Ni ` i:1.~1' ::r"'i uF• Wi iTER lJf 1RN [ by _ .:i - - - - - - - - L 1 : £iUAER HIGH- WAT.E':R L:tr1tT: :3.1) TkI-STATE- (:~TNra,~ I'I,CrH'I'> CATEGORY : AIVIVULAR SPACE hir't:(:OR. LABEL VOL: 96ti4 G 1 :PLUS OVERFII:L l:FP91•f 9f1Y, 8715 PlE'k: 'f'il•'E F'ItIt:F:~:Lr~:'~`3 HIGH- PR011111:7'~ y,~iY LI,IVE .LEN~:TH;; ?5 IEET' L 'c''i'1.US q1 q9 ;H1Cl'I;OWN h'A'Cl:: ..1 r0 i:FH Z"r~ i ~ 1`.+T~: ~ I F•.;t.6: E'i: ,r+l' ~ ~ i•EL1'~fiR'i' Lll•11'1` lUr: T 2:PLUS CaTEGJRi'' : cTi• ::UhIF. SF .F DISPENSEMODE: . 1'HNDHR~ :LOW=F'ROI~UCT. 500 SENSOR: HIGH F'REti:'+iikL: L.3:"I:1NC~fiADED' LEAK • `AL:AkP1, L1 M I.T : 99 TR I -STATE (13 I IVY: LE FLOAT ) EUDD&N LOSS ZIMIT: 50 CATEGORY HNNlh.nk SPACE `l'ANk : 'f<11:T 2.74, MAN.I FOLI)L•'U 'T'ANK:' Tli:. NUNI+. j„ ~} : SUPER TRP-BTATE (SINGLE FLOAT) L>•:NP;..M 1: N ' P1=R I OD 1 G : 0'r: ~ L 5:FLIL~ cE~st: •1•~11V.' r,I~F~Lir-L 0`•: •~~ Y: ~UT'El•: TR1:=h7F~TE ~ ~il•A;LE FLOfi`fJ ` ,, . r f.'r.T1•:GC:kY : i.NNULi,F. SPF~i'E • ' .. P I F•E TYPE : F I 8)^Rf3LASS l:1 N1: LENf;I'fi: . '75 FEET. 1•`~:k1yDIC"TF':~'[' 'I^~F•a` SHUTDOWN RATE. :~:il GYH 3TANDFIRD T 1 :l3UF'ER r d,:)JNl,t<AC![:I! . - DISI'1:Nak: Maul:. TkI;+~7~iFE` :$IN~:~1:~ FLU.+i'~ F'tIVNUFiL.TEST FF'iIL STAIVDfiRD i%~TEi::)k\? t :iCl••`$UhIF' At.fih•h1' li'l`y+ABL.ED SENti(11+': filcal k%RESSURE I'ER T 4I~ I ~ ;TEST; FF1I L HI:.AI T1. I11:;iiHLf:L) GROSS- TE;;; C F'A I L .FaLFaRM. i11E'iG1At.ED _, F•1NN '1'1:5'1' AVI-;h'-a(ia Nu: OFF ` F'>;R` TEST`ttV)rRAGING: nFI' TANI'; 'I'k.Y.iT Nl?T1k"~': UE'F ra 3:IINl;tHT~I:U :>:LLL ],1,NF. UINtiSLE SETUP TNK 'l~~+l' St'FHUN k11tE:AK:OFF piPE '["'~r'E: !•tf.•ckyLh~.`: - - - - - - AEL°IVEF2'i ;DEL:A'i' : l5 I'11N l'tl'1S ,LEt,li,Tl.,; 75 Fl-1~1' Q 1 :PLUS SrluTbc~wN l•i;TE: 3.U GPH T 3:UNLEHAF:D IN-THNh'.Ht.ARMS p 1 SPENBE MOE~1= : T. 2 : PRABE .; n l,l*l'. STANUHFU SENfiOR: HIGH F'f:F~SiSURE Lif~lilll SENSOR'F:tL:MS L :•?,:-Fi.1F.;L ALARM. `],e::5t:ld~ !~k JUT iii-r1(?I`! ~.L 5:>r>~IVSGR,{;IJ'>- ~L~kl1 L ~' t SHORT FtLARM = L 5:EN11RT 'ALARM ' A ~ ~ SUt!ER I:F.AK TE:3T; hIETHbD raLARF~1:: i N=Tf-NK `'`~1 :T OI•~ Lr;TE :- n1_]- ; AWl'; ,,~ : F R HE -OUT T l JHN 1 . 195E7` . , START_TINI)e" : DISHFIIdiU LFNl: LEAK LOVKOIfI' :iETUP' ];1rdU1L t~EN?tiR.H1.~~1a~ TE:rI; RATE :0,.,20 GALiHR _ _ _ _ _ .- _ L. t :rUEl: AL~IRIN DURHTION, ,' HOUR6 LOCKOUT SCHF.1riJLE L 4:I?lI1:L: HLARM DA[t•Y L 1_:F~ENSOR {)Irl' ALr1Rl~l 'TriRT T11`1E: b15r;bLED L 4:SENSOR OUT HIHRM LEr~C TEST kEFK~1cT : Fvkl"Ir tT 9TOF' 'F I M& D I SHI ILED L C : SHnRT iiLARri 1: 4:5HORT HLr.kl4 NOFr'~1A1. l~ 3:UNLEADFh I N-THNK ALARI'I£s T 3:PT:UAE: OUT Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 313 8 4 8 6 ~I. ivu I L °L•"N~~GFc f-ti1.1fi L ~ :FUEL F,LHF:f I L d : r U£L hLr;kl•1 i L +Etr::i)k :)UT rjLtiRM L 6:fii:N34F. tiUT Hl.HIaM l 's : SHO>d'f ALNRI I L t:SH~iRT L+1.W7,'M • • - :I N-TANK F;LFIRM -- - ~' _:fi the SF.1'U!~'DA'1'H WARIVIIVi; t7V1:kFILL ALARPI J~ ~'3-U~ a : GG sUItLEN 1,OSS A1.HRNI 06-23=Q2 12::1:1 flu-: ,;-r:? 1c' 12 HIGI~I P120I)L1C'I' ALARM 06-23-02 X1:04 Iiv-ir+1~1I+ FUFi. LEVEL OB=03-03 17.::'3 CIE,-20 03 14:37 Ob-:?3=n:r i 2:3a FROHI= UU`I` 11-02-0,1 11:02 t39-12-0t y:,20 HIi;H PROLUCT ALARM 1'1-27-03 8:05 o7-nt-n~ t:r:l Ob-05-0$ 1.1 :3t INVHLID f:U1:L LEVEL_ 10-01-04 l h ::I'/ 09-07=0d 2G.G6 FF'ltllil; au't oq- ~ 7-n:, d:ua 11-02-01 1 1 : rir l a -oz-o1 10;: aG St)I'ltidaP.E a<:£'.' i c i •?'i LE'`--ifi :~Jf'TidriR£tt 3atGlo-lful.~i: CREH'1'k:L' 9B . 05.1 a .13 . nrl Ntl SOFTWARE IYIODUL6 SY6TEM 1'f:H1'I'Ik13a: !•`RRI41)IC IN-TANK :1'L~fS ANIVUAL I N-THNk; TEST$ --- SYSTI=M Al.fihh1: ----_ l3Y'S~ ~II:CUN!1.TY WftRNINC:. 01-25-05 'i:39 ALARM HISTORt REFOk:c -° IW-TPtIVK A1,Ah7~1 ----- T 1:~tUPFR S>;T t.1I' LHTFi t;Ii;kN I hlr,i U'/=0:~=98 16:1'1 St_t11C1'.;'1, L.`.~,y tdlif.lt 04-ii6-na 1:37 09-17-03 1.1:08 0'-2~1-ao 10:1:1 1 i:dF+L 1 T+ 1.115E L~;IEI. 09-17-03 .'1;'15 12-•.t]B U2 .1,1:51 09-07-0? 'i;26 09=17-G3 li: C8 11 • Il'e' ^ 1 1 1 : 0::' i l -02-01 l Il : 40 UEL I ~J1;1~Y NEELED 07-:JO-u4 8:10 04-13-04 10:39 11:-1's-v's 1 f :[ :DELI V1;RY,~_NEFuI:b y1t=tJo~='U5-~~1'6 C 1 U- ~09=`9U:=f14~ 18:05 ~a-2s-0d 2:i:OZ. MHM "~ PR4LUt;T: - R1~:HRM pF,-2a-0~ 4,:hf, AI,FiRM; .HI~aTi)hY' REPt~RT . _~ LN THNK .AL•HkM --. -. ;:ETUP ISA`l'A WARN1N~r 6^,'132-~sk's lc:l'i I:kiA]G AI:F;Rh1 03-17-tSa 1~ ~'t; OVERFII.I. AIARNI 07-2~i-fl!3 u:n1 t3~-06-FJ4 '_'3':50 5UI)I)EIV LOS:i ALARM ny-1 ?-03 8 : f13 ti'3-17 uu 15::13 l'13=17-OU 14:20 DEI•IVERY NEEPEIt t 0-0 t -0a 1:' ::57 G3-1'3-01 t~:._'it, UB-U'I-04 163E • MFt?~. PRO.DUt;T HT.H1+M. 11'-27-03 8:07 ~ :~i,l Tilh1P lJrtkN I IW U9-17+U:+ '7:_1.2 * n ,~ ,~ x EraL ~ ~ r. R ~, aLARhr FIIST"~kY F.EI''~?RT ----~ SEI+ISOR ALAT,h1 .----- L 1:SUPk:R ANNULFIR SPAt`E SEhdSO}: iiuT. t tk.Hkl•'t 03-29rOrt 1.1:59 f ti£L. Hi.w,k11 03-~29-r14 10 :`Fi i SEIVSOk Or1T i1LARM 613-98-i:;i - s ~.1'C,. Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 313 84 8 6 F 1LARM H I STUk`; kEPORT -- • :.&:N:'Ji'•li r'iLARM -~--- L 2:Pi~US ~t'P -~rlf• 3£:= c:k Vu'1' ALARI'1 G3-2y-04 ll:`,j FUEL ALARI`1 1111=•2'1 U4. 10:9 :~FNSOR' OUT riL:iR:'1" uls lif, Lia 1.3: 1 G. Jy1:r+kM NI'f;TORY'Fila?URT --- SEN$C1R AGARI°I -- - L' :3:,UNLEAL~EL~ rnNJVULHk . SPAi:I BENSt1R OUT F~LARM p3-29-n~1 1.1: 59 FUEL. F1:A}tl'I 03-29..-0~ 1Ot4E :;ENS4R OUT At~RP1 U8-Ofs-03 i3:liJ Ai.ARI°I HIST;)ti'p` REF'Ok'I' 1: G : SUPER ST1;. SUMP ~;k:NSOR OUT AI.ARNI U3-29-OJ 11:59 EU£1-. HLMR91 p3-r 9-.1J4 1 p ~ 38 SENSOR OUT ALt+RM HLAkM H I$TURY REPORT `~- 1:PLU:;: YL1.~ SHUTDOWN ALARM GROSS t I NL-' FA I L 03-~ 9-p:1 11.:34 }'[:[:G SnuTLvwN riL.,RrI `08-OR-03 13:28 .+i.'++~1•: ri1:;::;J<'Y REI":1F:T ----- SEN84R ALARM 1. ~:YLUS ANNUI.AF' SPAt;r SENSOR :OUT FaLriRM 03 :~9-il,l i l :59 it M ~E if A ENr1 M it 3t x .t FI:II:I: ALARM .F. h~::.:k v'J 1' ALtiRl1 06..-08-U3 13:10 3i k 3E * * EIVL~ * 3E :S 'i % ALARM HISTORY f+f:PORT ---- S8IVSOR. AI.ARhI. --=-- L S::uNLEaDEB ,.~ ~Llh1I~ •:•,J:1'UP Z~ATH WHRNI Nl, Ilt -O:J •U5 8:13 Oi~-~f13~-115- ~:=0~ SE.v ~'-~fc .~U7 hLARM 03-e9-G4 1 I :;;9 AL:ARF'I N I aT[~k r Rai ~?&T. ---^ „BENSUh' AG.ARM °----- Q- 2:SUB1:R PLLD SHUTI)GWIV hl:MJ2r9 HIGH: PRESSURE tit.plr1 [)9-2y 11r1, .23::47 .F'1.LL :fi+1UTI;QI.JIV . ~:1:i;1.:~': 08=27-u•1 htir5a ..: .- ~•ENG ~.~~,~~.,,~. A: ALARM HISTORY REPC)R'1' ~ 3:UNLEHDFD PI.I.D SHUTUOWIV 1'fLItRM 11-03-04 4: U2 HIGH .PRESSURE ' HL:ARrf 11-03-04 4:02 PLLU SHU7')•itil,JN ALARhI ~7.7s-~9-u.{. L1 :55 Tanlrnology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3138486 ALr';l,T1 H1STcJr•.•r 1?!_Fv1.'t ALARM HISTU}:`; .F:I;F?ORT -°-~ itv •i, IruK~~i..,;R!~. --- -- -- S:`?'1'!.'r7 A: ARM ----- PA]?E at ' ' T =':F-Lt1'~; ~+~%EkF1LL. HLr1kr'f 06" 1 g-Oa k , l j . D1-D5-05 l i : SEi `'ETUP DATA WARNING - 23: 2h t17-3j O~t O: X71 PRINTER k:I;f:nR O'J•~~":.-98 .1x:;1.5 06-OF;-D4 ~:i:50 U1'115-05 11:59 HATTERY IS OFF rrt•,n Ef~~,.1.R ALf~RM SULIDEN LOS:; AL.Akr9 01-0] 'rF. $:00 01-~'5-05 1;1:36 uy-1'("-U3 r3:03 a3:, ~,E~_itR1T: evNFJUE:k:: 03-17-UU 15::"13 0'1'=25 'Uh .l E+:.32" OVERI'ILt. riLrjRFf t73-1'/ -00 1-•3:20 CEtic:h [:~ INuORRE~-;T uF-23-U:' "4:02 04-p4-04 3.:11 1 HIuH YRODUt:T raLHRhI " SUDDEN .i03>:r HL~,hr1 nl ''~=f~. f^^>:~3 u[,-23-02. t?_:33 11"-27-03 ,8:05 " 06-_`t" •02 (2; 18 0'7 IT: -•11? , i ~3:.f 4. . 06-F'3-02 .1:::.12 TNVAJ.ID FUEI" "~.SVE.',, Nii::ri F'ki;t~Jl'7 N?_RRM° O1-25 :05 1;1;5 D1-.2.~.~-05. 13:21. 1'0-01-04 1ri:37 ut,-23-n2 ~t:o4 u~-a7-1~a au:ob } Pi;:i,l. i'C+ "FUEL .LI`.VEL l: ~;i?BE OUT ~":!E k..« ' *" END : ~ * : ~ .. h ,.. : 01-25'. O5' 1 J ~ ~i5 'Ud=03-03 17:'?3 01-25• n5 14: 2s U1-25-05 1 3:22 : 06-28-0;3 10:37' . 0'x-17-1i3 -8:114 f'RJBE vuT ~ HIGH WATER. WHRIVING Ol -25-u5 1 ~': _~:! u1-25- 175 F3::32 11-02=01 '11:02; I~~Lt.4'EJ:tY'`hiEEGEFi HIGH WATER WFRNT.Nt:. 01-25-05 13::x4 ul-~~-05; 13:~e l o=Oia • F14 12:'57 08-.13-1]4 1 Y.: 2t7 .ALARM HISTORY, REPtiRT III:LTVERY WEEDED J•~w~"' TRGr1a^T nL:kJ•r Ol-2a-0G 13"45 01-2R-05,13:"l - -- I N.-TANK A1.:-aLT1 •--.--- Q }-06-U5 1.6: t u 1.1 ;27-03- ti : q7 T : 1::~::F•ER 09-•30-OA "18:05 ~f+%' PkUIiUCT ALARM LOW !l'EMP WAk'fyING~ _fsETUP DATA bJAF:N1tVu . G1 -25x05 13:.29 01-.2r,-05 14 a;J 02-02-98 16::19 Ob-?;i n? d : ('JF fJ~ "1"7-D's e: i H I C H"' WATER; ~ ALARr7 `01-25-b5 13:37 3.iL,i,Fly. 'L(r.;, fiL.rnitl•1 0~-116"::-1j~; l :: rr rrr• I v >03• a : ca • Fi1GFl p`R~rnlac~['•"a Li-1RC'I u1;:-25-G5 1_s::•.1 * * x :'t :r END ~ >: s 1NVAI:.IL FUEL. I-EV1~1: ~ '~ M " * END ~ * * ~ « 01-:~5=f15 1.3:x6 OQ-17-~73 ~`i5 s'>-vis-u~ 31:~r 1?k013]: OU7 II1-25=-05 1 A": 57 01-25-05 t'4:5b H I rl 1 WATER Wt 1R N I NC: ALHkI`1 H 1 STs:1~^; kEF~OR'F O l -• 25 • U5 13::.36 ALHkI`1 H I f;TGRY kEPORT N1iEUEL L~EL 1 VEF", • .- 1N-7'HNI: %•Lr~;RM ----- L E :9ei[~ER HNFiUl.fiR ~'prJi:E . 01-25 05 1. L: 45 T 3: UIVLEADEI) SEN 7t)R'OUT ;faL:~l:hl 07-:30 "1l4 '$: 1'0 01-2g .05 1Ei~12 04-13"~; '"~s^33 SETUP UtiTA WARIVIN~;~ ' ' FLI)rL'-F1LF1kM MAiC PROPUCT, til_ARI'1 IJ r -O'•'•'IlJ 10:19 O1 °15=05 I3: 02 Of-25-05 1:.1:19 LEA}C iJLHRM SENSOR-OUT FLHRM U3-1'/••:UU 1.3:28 • 03=2J f14 I1.:Ci4 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 313 84 8 6 F~I:ARM '1lTSTORY 121:i'`UR'f -- SENSt)R ALARI°I --- . - L 2:]?LUS STF SUMP sEiV>sSOR c)UT r;LARM fJl'-25-Gti f6:42 FUEL AI.ARi"I O1-p,5-1.ih 1.3:09 SEN:iUJi OUT. ALAh'pt U3-2' J-04 1' 1`':59 ALARM HISTORY REPUt,''f ----- BEN:10R ALF'tRIW ---- ~ 2::;Iq=ER, PLLIi f311U'f1iI11:1N AI:ARI'I • cRJ$$ 1, f NE E'r1 [ C' O 1'=25-05 lri ::'2t1 PL:1;D BHUTIit?WN ALARI°I tiLARM H I : ;TORY- ,R£I<ORT_ - --- SENOR ALARhI ----- ANNULHR SPHCI fsEN80R OI Y[' :.AL,ARM . r FUt~I, HLAkM I'llk:L ALARM.., 01-25-05 L:3` l5 NLaRrJ Ha:';'r,,:;i: kt:i••:'~~-f W: ~3::Uli:'F:i~EIEe:-,, F LLCM: ~rtt11'C~~t;tr :,'.L.iF.s~l +~;c+~9S~,.i.1;wE ~,F++i.~ , F1:LL+" SHUTLGWN °+~LHRI1 J 1 `UCH-U4 ~ : f,12 * ~ .•~ : *. x ran x _;~ x ~ h. r;1:ARl°I H I S1'Ul,'Y . 4: J :}'i>RT --- :ENIit)R HLARM -~ L 4:SUl;T~R S7I' SUM]? F,'1?Nt:C1R OUT ALARM 01-25 115 16:42 ]= UEI_ ALARM 01=2!i 'n5 i 2~:~59 k;t:N:'+OR OUT ALARM 03-2y• 114 11 :59 ALHRIh HI:;T~RY •REI~ORT -- SENSOR HI.HRM - L 5:PL1J57 ANNULAR SFAt:I: SENSOR tiUT f+LJtRI•I O 1-25-05 10 : ~1;' FUEL AL.WRPI 01-25-05 13: t.: :JE:N:iJP, :~i'i +,tiLn~Cl•1 Js-~'~ lid 11::59 ~ iF A R M; It ~l_Rl~. ~ 'r. t. u r HLARM lIISTOP.ti P.Ef~JJr~: L ~ lJN1.FHUEL STP:SUMP £~ENSOR Ou't' AI:AFP1 .FUEL FtLt'aRM U1 ~'S-05 1:3:15. J3f"TUP J:~riJr+ wAF•wING lit u3-uB $ ~ 13 ~~IC::;fEND~x«+c~ ~iL.ft;rl I { 1 STORY R1=i•ORT ----- SENai~J,' AI.AhTA FLLI! SHUTDOWN AC::;RM u1.-25-05 15:54 ~::ROi33 L J NE F'.: S'E tl t -'d j-e]F i 5:54 i•cLL FHUTI;UWIV HLARI'I U3-29-04 1.1:34 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 7875? Work Order: 3138486 .~ 9. SPILLl©VERFII.L C4N~'eUNMENT BOXES lo tesiing,,+~,d recommended follow-un for fatle~f, tests) Comments - (include infor,-ration'ori repairs`riiade prior (~ Facility is Not Equipped. WitirSpilUO'v~fi11 Containment Boxes SpilUOv~erf ll Containmcat Boxes arc Present, but weie Not Tested Tesf Method Developed By: Spill l3ucket Manufacturer Industry Standard. Professional Engineer. Other (5}~ecify) Test Method [Jsed: Pressure Vaeuum Hydrostatic, t er peC~} .,,~ y . Vf4l~ Test Equipment Used: Equipment ]tesoiutian :Spit! Box ~'$•Q Spill:.l3o# ~~ . Spiil"Boii # ~" Spi1l,Box,# Bucket Diametiet•: (7 +~ /2 " /~ ,~ Bucket Depth: /'?j ~' 1 +' ~ 3 `~ Wait~iime between _ applying pressurelvaeuum/water and starting test .~ Test Start'1'imc: r~ +~~ !. Z l/~ 12 initial Reading (R~: ~' ~ " ti/ Test:End Time: f~T,L/(G f 3 3 j d /, Finat Reath#B (RF} ~ r r ~ ~ ;~ 3 E ~ Ttst~Dw'ation:_ /""i/~ I L/,d~ / Change in Reading (RF= .P,asslFail.Thresholdor Criteria: C` >'t?cs~E,itesiliEd' :t ', .~?~,' .Cfl~ail~;~ =~-. ;'r ,:.:;:, (~1?;ui>'-`: ass'°:::Q~!aiE _ .O.Pass ^Fail Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 .. ~; ~ ~ b 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 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 Test Date: 01/12/2006 Order Number: 3144551 Dear Regulator, Date Printed and Mailed: 01/30/2006 Enclosed are the results of recent testing performed at the following facility: CIRCLE K#2708825, CO. 123 2222 F ST. @23RD.ST. BAKERSFIELD, CA. 93301 Testing performed: Leak detector tests Monitor Certification Secondary Containment-Spill Container Sincerely, Oar ~a~~ Dawn Kohlmeyer Manager, Field Reporting ~~ ~n~~ TANKNOLOGY CERTIFICATE OF TESTING 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451-6334 FAX (512) 459-1459 PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT TEST DATE: 01/12/06 WORK ORDER NUMBER: 3144551 CUSTOMER PO: 100543 CLIENT: CIRCLE K STORES SITE: CIRCLE K#2708825, CO. 123 495 E. RINCON, STE. 150 2222 F ST. CORONA, CA 92879 @23RD ST. BAKERSFIELD, CA 93301 LORRAINE SOFFE MANAGER -RANDY (951)270-5193 (661)324-1758 TEST TYPE: TLD-1 Prnrlnct Pina Tinhtnacc Tact Racultc LINE LINE LINE DELIVERY lMPACT- TEST RESULT FINAL LEAK RATE (gph) VALVE ID PRODUCT MATERIAL TYPE A B C D A B C D FUNCTIO __ --- lOk 1 SIIPER FIBERGLASS PRESSIIRE lOk 2 PLIIS FIBERGLASS PRESSIIRE lOk 3 IINLEADED FIBERGLASS PRESSIIRE Existin Line Leak Detector Test EXISTING LEAK DETECTOR #1 EXfST1NG~tiEtiK DETECTOR'#2 LINE ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESULT lOk 1 VEEDERROOT SLECTRONI 204905 P lOk 2 VEEDERROOT ELECTRONI 119018 P lOk 3 VEEDERROOT ELECTRONI 012171 P Npw Rantar_amant 1 ina I aak rlatartnr Tact __ ~Q LACED LEAK DETE T #1 D L A T E LINE Ib MANUFACTURER MODEL # 5ERlAL # RESULT MANUFACTURER MODEL # SERIAL # RESUL rur owner ue~aueu repun mcormanon, visas www.tanKnoiogy.com ana se~ect vas-Lme xepons-wxAr, or contact your local tanxnoiogy orrice. Tester Name: STEVEN GALLARDO Technician Certification Number: Printed 01/30/2006 08:35 SBOWERS INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan TEST DATE:O1/12/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3144551 CLIENT:CIRCLE K STORES AUSTIN, TEXAS 78759 (512) 451-6334 SITE:CIRCLE K#2708825, CO. 123 TANK INFORMATION Tank ID: 1ok i Tank manifolded: No Bottom to top fill in inches: 89 . o Product: SUPER Vent manifolded: No Bottom to grade in inches: Capacity in gallons: 9, 684 Vapor recovery manifolded: YES Fill pipe length in inches: Diameter in inches: 89 . oo Overfill protection: YES Fill pipe diameter in inches: 4. o Length in inches: 364 Overspill protection: YES Stage I vapor recovery: DUAL Material: Dw FIBERG Installed: ATG Stage II vapor recovery: BALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test Method:vacuTect LEAK.DETECTOR TEST RESULTS Test method LT-1 Start (in) End (in) Dipped Water Level: New/passed Failed/replaced Newlpassed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: vEEDERROOT Ingress Detected: Water subble Ullage MOdeI: ELECTRONIC Test time: SlN: aoesos Open time in sec: Inclinometer reading: Holding psi: VacuTect Test Type: NoT Resiliency cc: NoT VacuTect Probe Entry Point: TESTED Test leak rate ml/m: la9.o TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: s.oo Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type:';TZn-i LINE A B C D Material: FIBERGLASS Diameter (in): 2.0 Length (ft): 125. o Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: PUmp type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: UNKNOWN Printed 01/30/2006 08:35 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tanlv~ology TEST DATE:O1/12/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3144551 CLIENT:CIRCLE K STORES AUSTIN, TEXAS 78759 (512) 451-6334 SITE:CIRCLE K#2708825, CO. 123 TANS INFORMATION Tank ID: iok 2 Tank manifolded: No Bottom to top fill in inches: 89. o Product: PLUS Vent manifolded: No Bottom to grade in inches: Capacity in gallons: 9, 684 Vapor recovery manifolded: YES Fill pipe length in inches: Diameter in inches: 89 . oo Overfill protection: YES Fill pipe diameter in inches: 4. o Length in inches: 364 Overspill protection: YES Stage I vapor recovery: nuAL Material: Dw FIBERG Installed: ATG Stage II vapor recovery: BALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Ter>t Method:VacuTect LEAK DETECTOR TEST RESULTS Test method: LT-1 Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: vssDERROOT Ingress Detected: Water Bubble Ullage Model: ELECTRONIC Test time: SIN: ii9ois ' Open time in sec: Inclinometer reading: Holding psi: VacuTect Test Type: NOT NoT Resiliency cc: VacuTect Probe Entry Point: T ESTED Test leak rate ml/m: ia9. o TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: 3.00 Water table depth in inches: Results: pASs Determined by {method): Result: COMMENTS COMMENTS LINE TEST RES ULTS Test type: TLn-i ..LINE A B - C D Material: FIBERGLASS Diameter (in): 2.0 Length (ft): 125. o Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURs Pump make: FE PETRO COMMENTS Impact Valves Operational: UNKNOWN Printed 01/30/2006 08:35 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan TEST DATE:O1/12/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER9144551 CLIENT:CIRCLE K STORES AUSTIN, TEXAS 78759 (512) 451-6334 SITE:CIRCLE K#2708825, CO. 123 TANK INFORME4T10N Tank ID: 1ok 3 Tank manifolded: No Bottom to top fill in inches: 89. o Product: UNLEADED Vent manifo-ded: No Bottom to grade in inches: Capacity in gallons: 9, 684 Vapor recovery manifolded: YES Fill pipe length in inches: Diameter in inches: 89.00 Overfill protection: YES Fill pipe diameter in inches: 4. o Length in inches: 364 Overspill protection: YES Stage I vapor recovery: DUAL Material: Dw FIBERG Installed: ATG Stage II vapor recovery: BALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test h~-letho~~:vacuTect LEAK DETECTOR TEST RESULTS Test method;LT-1 Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: vEEnERROOT Ingress Detected: water Bubble Ullage MOdeI: ELECTRONIC Test time: S/N: oiain Open time in sec: Inclinometer reading: Holding psi: VacuTect Test Type: NoT Resiliency cc: xoT VacuTect Probe Entry Point: T ESTED Test leak rate ml/m: 1a9. o TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: s . 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LIME TEST RESULTS Test h/pe: TLS-i LINE A B C D Material: FIBERGLASS Diameter (in): 2 . o Length (ft}: 125. o Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: UNKNOWN Printed 01/30/2006 08:35 SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS `i- Tan~Crtt~l0~gy TEST DATE:O1/12/2006 CLIENT: CIRCLE R STORES 495 E. RINCON, STE. 150 CORONA CA 92879 LORRAINE SOFFE 951-270-5193 Tank Interstital Tests TANK PRODUCT MANUFACTURER RESULTS SUPER PLUS UNLEADED WORK ORDER NO.: 3144551 SITE: CIRCLE K#2708825, CO. 123 2222 F ST. ®23RD ST. BAKERSFIELD CA 93301 Piping Interstital Tests LINE PRODUCT MANUFACTURER RESULTS. Sumo &Under-Dispenser Containment Tests Sump/ DISP.# MANUFACTURER P/F 87 OPW Pass 89 OPW Pass 91 OPW Pass Tanknology representative: BRIAN DERGE Services conducted by: STEVEN GALLARDO y' ,,,,,, Test Date: 01/12/2006 Work Order: 3144551 SECONDARY CONTAINMENT TEST RESULTS SUMP TESTS Type Tank or Disp Manufacturer Model or Diam./Width/Length Depth Test Method Start Initial Level Finish Final Pass/ # Material ~'~) ~") Time Level Change Time Result Fail Spill Container 87 OPW Plastic 12 13 0900 3 1/4 0 0930 31/4 Pass Spill Container 89 OPW Plastic 12 13 0900 6 1/2 0 0930 6 1/2 Pass Spill Container 91 OPW Plastic 12 13 0900 3 1/4 0 0930 3 1/4 Pass Corriments: Hydrostatic test. 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 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: CIRCLE K#2708825, CO. 123 Site Address: 2222 F ST. City: BAKERSFIELD CA Zip: 93301 Contact Phone No: 324-1758 @23RD ST. Date of Testing/Service: 01/12/2006 Facility Contact Person: MANAGER -RANDY Make/Model of Monitoring System:TLS-350 Work Order Number: 3144551 B. Inventory of Equipment TestedlCertified Check the appropriate boxes to indicate specific equipment inspected/serviced Tank ID: 1-91 Tank ID: 2-89 X In-Tank Gauging Probe. Model: MAG X In-Tank Gauging Probe. Model: MAG X Annular Space or Vault Sensor. Model: VR 409 Annular Space or Vault Sensor. Model: VR 409 X Piping Sumprfrench Sensor(s). Model: VR 208 piping Sump/Trench Sensor(s). Model: VR 208 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: VR PLLD X Electronic Line Leak Detector. Model: VR PLLD Tank Overfill/High-Level Sensor. Model: ATG/FLAPPER X Tank Overfill/High-Level Sensor. Model: ATG/FLAPPER Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). TanklD: - TanklD: X In-Tank Gauging Probe. Model: MAG In-Tank Gauging Probe. Model: X Annular Space or Vault Sensor. Model: VR 409 Annular Space or Vault Sensor. Model: X Piping Sump/Trench Sensor(s). Model: VR 208 Piping Sumprfrench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector. Model: VR PLLD Electronic Line Leak Detector. Model: X Tank Overfill/High-Level Sensor. Model: ATG/FLAPPER Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other s eci a ui ment (p fy q p type and model in Section E on page 2). ispenser 1/2 Dispenser ID: 3/4 Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s) Model: X^ Shear Valve(s). X Shear Valve(s) QX Dispenser Containment Float(s) and Chain(s). X Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(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 X^ Alarm history report Technician Name (print): STEVEN GALLARDO Certification No.: 006-05-1226 Signature: License. No.: Testing Company Name: Tanknology Phone No.: (800) 800-4633 Site Address: 8501 N. MoPac Expressway, suite 400, Austin, TX 78759 Date of Testing/Servicing: 01/12/2006 Page 1 of 3 Based on CA form dated 03/01 Monitoring System Certification Monitoring System Certification Site Address: 2222 F ST. Date of Testing/Service: 01 /12/2006 @23RD ST. D. Results of Testing/Servicing Software Version Installed: 16 Complete the following checklist: 0 Yes ^ No' Is the audible alarm operational? Q Yes ^ No * Is the visual alarm operational? ^X Yes No' Were all sensors visually inspected, functionally tested, and confirmed operational? ^x 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' X 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 leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) ^x Sump/Trench Sensors; ^ Dispenser Containment Sensors. Did you confirm positive shut-down due to Teaks and sensor failure/disconnection? ^x Yes ^ No ^Yes ^ No ' ^x N1A 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? ^ Yes' ^x 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. ^x Yes• ^ No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ^ Product; ^Q Water. If yes, describe causes in Section E, below. ^X Yes ^ No' Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. ^X 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: Liquid found in 91 STP sump. Console power light inoperable. Page 2 of 3 Based on CA form dated 03/01 Monitoring System Certification Site Address: 2222 F ST. Date of Testing/Service: 01 /12/2006 @23RD ST. 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? QYes ^No' Was accuracy of system water level readings tested? x Yes ~No • Were all probes reinstalled properly? Q 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 LLDs are not installed. Complete the following checklist: 0 Yes ^ No' ^N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Check all that apply) Simulated leak rate: Q 3 g.p.h ~ 0.1 g.p.h ~0.2 g:p.h x Yes ~ No' Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ^No • Was the testing apparatus properly calibrated? Yes ^ No * 0 N/q For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Q Yes ^No * ^ N/q For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Yes ^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 LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? O Yes ^No' ^ N/A For electronic LLDs, have all accessible wiring connections been visually inspected? 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. H. Comments: Page 3 of 3 Based on CA form dated 03/01 ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512) 451-6334 FAX (512) 459-1459 TEST DATE:O1/12/06 WORK ORDER NUMBER3144551 CLIENT:CIRCLE R STORES SITE:CIRCLE K#2708825, CO. 123 COMMENTS Monitor Certification, Spill Bucket Testing & PV Maintenance. Monitor System passes, liquid found in the 91 STP sump and weeder root light bulb needs to be replaced, Was Coulter notified. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 01/30/2006 08:35 SBOWERS ITE DIAGRAM ~ Tanlv>tologY 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: O1/12/06 WORK ORDER NUMBER3144551 CLIENT:CIRCLE R STORES SITE: CIRCLE R#2708825, CO. 123 t C-Store 000 VENT DUMP- STER Q A PLUS V OI S 10K O A REG QV #2 O S 10K A O CANOPY #1 O S SUP V #4 10K O #3 P~~O -~ Printed 01/30/2006 08:35 SBOWERS Work Order: 314 4 5 51 ~" r `•" ' i '3:uNi Fr~Qlai . ~i:l.i IIF~r:L'k:iF'iEL[:`Cri.ya3111 T ^'F! il:~: F'kG1tUC`T :''~'IE ~ . PRODUCT' CtsnF -3 ti51--."1:A 1758 11.;1 :EF"r •.[I. ~~~1 THEF u . THfJ}: L' []t:' . ~t:'zr 9 TANK. I,l,;r~~;L-T•. ~, U LI 1'=-.".: :l-:' .. n . Tkli}': ~1:~i=:LE •t i::l•5 T;.,Ij;; ~ R~ r I Lr l. 1rUl. Fi'll ~ PTS i1t,H~1 FULL `:<:L 9684 co :H Vt)L '1861• $ 1 N: . E,L,.• l l INCH VOL.: 7$b 1. . ' ' . . ~l•1.5. 1NCI1 Ifat. .4904 44.5 INCH VGL 32':3 1 NCN a9Qs l z=" ?K i SY: 1'L- f~l. ST;,7+.:' ?2:3 I IVi'H VOL 1 H~lll - ... = HJ..1.. FUI'd::'TInNR N:sT!f'9HL. F'LOHT SI$E: tL:~J ITV ts4tiE FLOAT S 1 ~E ~ 4.0 I N: I Irr7F, . WH'1'l;h WriRNI N[; 2;0 41A.TEk I•:r,~;•,;`ra':: ' ~;~7 HTC:H IJATER I JMl'1'.i :1'.L 1:C "•~•-~'~"t~r!iC}•; Llhll J.II r7:~?S Ok LHI:I ! '• ~;;:; N1A.! OR LriBEf- 'lOl. ~ yb84 7U`•,, G,rEFF ? L'~ : ; : '~I,+ERF I LL 1..11 1 ?' ,c+.. ~ . . il`/ i 5 8715 ••~~;•, rR•~tit~li'' G0; . C n[i;ll F'F2UDUCT ~ 95% lr•1•-7'HN}" tel:*I . .- +I Val li1:L1VLa:Y T-Ir7JT ~y199 1~~`~: '- - -• - - - - - L~EL1~•'kFt: LIMIT 1034 X09 • 468. T 1 tSUY~R 1~kOpU~T : ,I,r 1 LQ6~J I~ROL~uCT '~ 5nn L•;i~J PROUIIC°f ' 50[1 ''r 1= :-Ir+i-- 'JIFF ::in' u;'IUU L!~HK ALHRM I1M1.1~~: '~9 I. &AK ALARM LIhIIT: ~ 99 . TANF: uIHMFTER s5.nti - ' _ :71111UrN L;i.;i I.Tr'111'.c 50 ,LIT1r,IiN l ~.oSS L1M1T• IfiN>C TILT 5L '~ ~-} I AN}: TR~F 11:1: . 4 !/T~: Ti 11VK T I I:7 3 . b~' . rnr} ~rL 5061 LC-.. 'ti .„ dJL 7FiE1 MHN1'1'OLllF n THNr:F; Mr~NtFOLLED TANk$ , 41,5 INCH VOI. a`1Fl~i . T>z: NONF. T1s: NONE '?3.3 i1Vr:a1' ut}I. : isye I _F.HY I!! ~ '•V ; i:~ ,:: Gr [ i:• t]'•• `~i+t: :`l i r+ F k:h I Uli P~ : ui: FL.~irtl' :~~1ZE: ~t__li'~I~N~. ~849E- I i • n; LIATEk WHRNING LF..HK MIN ~iIVNUHL II"_ LEAK,'IhfIV i;rJrJUAI. -~ 0 ~. MHx nb! irti; : y6r~a I :AB>;i. , . 0`dEkFILL L:1M1'1' ':,_ PERIOLIi: TE°T TYPE F'I:h.'I(1111t: -TEST .TYPE, _ . tli n F'R:i; r :'t' i+~": ' rsiiPiVriL TEST FAIL y,l'J'y i ° ANNUHL rE,S'T rr,~:. , ALARM--DISAbLF>_i f F.i.IVERY 1:1 Mia ; f); • :.' ,w C•,F _-iEE~C~ 968 i i:i.l;,l i:• TL?: I' I'Nll. 7~1kIULIr 717 'ti:i. l•:iW F'RODU~T hL'IU ~ riL:'1RI'l I+t,-•f38LED ,yLr~kri DaSaBLEL' L):HK ~+f NRM k.I M I1' : g9 , SUnfJEIV Lc L1h91?' w GROSS TEt~I' I`HII: i;h't~;J~i f}::ST .FAIL. - • . T ... '! . hl I f1I-r tRl"I D I SHNLEPi MAN11'OLliED TAIVKw ANN '1'1::.1' AVEr~Hi:l!V4': 01'1' P[!•r~r -c~T r;'t~1:friiulNi,i:: "' ' ' U['[' '1'B' Ni1NT` PER TEST r:;..j=.t'r-u~1'7,;: :r t'f;k 1 1:1 HVF.RAt:Flur..: nRF ': r+.: L•. 'f E: ;T -NOT [.F'Y: tsk't' 7ftIV}(-.'TEST NOT.LF:l: UF.F LEi~I}: M1N 1:`E1;lOlllC: U?. ' * ' ' IN1~ TaT SIF'h101V BkEfIY:OFF . I+i . .3T :7i4•tt:'N FlF'F.tilr' ' :OFE' E.`~1: ~ I : i~i r1NNUHL i Is; DELI VERY X:ELHY t ~ Ih r N L~l:LIVER: DELAY E. 15 Ml N ' fl ~+!-~-' =':'I .: , i 3 rC~R'i REF'Uk l' I•Fr;:=,r,:'•: 'FEf ;•rF•l: VETCSIiiIV l0.17~ `•---- S`='::TEr1.4L,PL• ' --- S'THrJDRRA s~rrlaHl,L:# 34,u1 E--l uu-•~. Ek c ; !•'Hl :RIATF.A - 58. Cis. 14 : ; %. E.; 1 ~-20-u5 1 ~ : fl3 ANIJUAI. 'TEST Fs:1 L FRI N'1'l;k ERROR r,;.hnr•I irI H131,E[: a'r'hsllULEls 33C}l til ~ Ui,U-A Ic ~-rf-.i5 : i :ii9 SYSI'f'M FEATIJI?r..::` AFiTTERY IS OFF rr•r!:'•..:. -..~.. ~F':~T F~il-L 'i:RIJLI~:"IN-Trill}: '1'l-::i-1':: C:-•vi-~,r, 8:di] ALraRM 1, I f :HBLI:[' ANNI1gi. 11V•-TAN1? 'T'ESTS ~~'~ SECT IRLTY WAR1d 1 NG ~R~':i.i TEST FhIL t).10 rIANU[•iL80.20 [~ON'1' ~'L•~+'=k 1S INCt)kRECT ALi1RM ksl:.;HBLEr, WPLLfi ilr;-0:1-Oa •'±'•01. 0.10 1"wr1•'_>!,:.A:;._;,1 ~~JNT r;NN TEST :;IiF'k•HI:IIVr~: (YFF Yr:R TEf3'i' AIrF.kr~i t N[ :: ^•FT: : THIVK T1',T NOTII'Y: r)1'1• TNk: T:'~l' F'I)/HtsN BREf;Kail'F F,£i.IV)rlti"i hFa AY I is min, ~i Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 Work Order: 3144551 ' A1;H4:M HI:;7Gk ri'~.•y'-• .'i kEPUH'I' r•_••Pf' riitil•;`N H1:HF?M • -__.. - i N-TtiIV}C i'r''•~'i~: -~Lr'~RI°I -; --- . ..-- :N''l'~NF: yf.~F?E1 :UtJ'EAL'EP `1' 1:SUI'lsk T3;I-C.UC3 ' d3 wr.F.': •: $)=T Ur TtAT~ SETI I}' 1)ATH 4JflHIV 1 hIC ' da°rliF' UpTA WHkNINr, ~_ 07-p2=m 16; 15 a G7-U2-ya tf,: t u7-U2-98 16:14 LEt1K HL,FRr1 HIi;II WHTF.R HLr;RM ' ' ,. HIGH. hT] '} .+ ~;JI ET3r(.7-0u 1;.!:28 :1 7 D1-~~-u5 ]3 _ :: ~-~~ 13:3e H3Cai WRTEk r;Lrb:It SUUDEN i.GSR AE.AkM ~~i:F_hE'Il.l. HI HF:M O1 '1h •U5 13:4Fi 0.1-19=05 17:^:1 u-E-06-0~4 1::37 , 06-?3-0'2 a:i~2 ~ ILLf•tLflR~9 Citi.E:RF ii-i^-L!;~~ ~tl;'08 _ :;U11UI:N LOSS raLAkM . ~ ~l :; U-05 '-10: stll 06-2:J •fl;~ 1 ?b a3 i ::-•~:''i~-' 12 :35 i~11 F'k~~I~~:'T ~ ~~.iFt~9 li} 06-23-D2 ] L'' ] Ft 1'?•.'I•iL• i~5 .: f ''' fiE,-23•-CI'r ' 1::' : ] :' . gUI~D1=N I .US'+.`:~ ALNRM IIVVH1..lU F'I1LL. 1:EV>:L HIS:H I'kpL~Ui'7 il :-:I~E•: 09-17-03 k3:03 O1-?5-itF 13' 46 ' . (JI-'c°• ':• i !::'l u5-!•7-i)~J 1,5:33 - h 09-17-Q3 :9'.1 ' ~0-3'3-u'. z;:iJ.1 ii 0•`i .17 -ul. i ~: S1 -UE3•-u~' 11 12 [NVHLIb FIIEi. LFti>;I: HIl'.'H F'k(tllll%T E•tl.Akr1 F•r,.:rt. :.Jr L]1-25~O r, 13-:45 l?=2n-05 1U:50 . ^i=25-U5 ! a : mac. D6-28-03 1u:37 6~F,,-E3,~•-.;]5 `.::'l:t . ni ,5: u5 1a:~ F'1~C1IiE: C1 U]• I NvaL I FJ' FUEI LEIfEI:. H 1 GE 1 I~IATfiR WARN I NG O1-2D-D~ 1:23 u1-oEi-ob l.E~:1U Ul -?5-f15 13:;i~ 01-•25-p5 13: 2U ! ^-:?A- 115 0>1.'+ . Y1-02-U1 11 ,U2 u';-~a-~F. 1 ~.1 . 1'IELIvEk ~1.1_i:.E• . 03 F 2' Hl1H WAT1:7t WAFN1Ni~ Fft~7BE GUT Y~ E -35-G5 `1 a:23. . 07-d1 1I 01-25-U5 1•.~13E. uti-31-03 6 : uy f.14-17-.US e : G'+ rl ;•. Fh':~DUtT tI:FtRr,.' ` ` = HIi;H CJFI'I'ER'IJAkIVLND' . . i:.::9' ui-_5-u5 1': 11 n5 G rc _~ . ~, ., - `OC-35-U5't3:3 . . ;Ga os-~ - •u~• _~ :ai'<":1 a-. 5 hl i~,i•, C~F JC~UCT HLE,iP UILIVF.`h7 NEEI?E17 . . . . C11--2F tl9 1'.1J:2y 17 Gl-Q6=~li, 10: 06-23-02 4:06 1^-~7-ii5 -::ai Nl-t,': F?kciDl{rT, Fil.flkrl ^1-25-05 13:24 lh~'?a D3 t3; 0'i LOW TEh1•' L.ir.klYrl~:> I;L.rkl., r;:.-.s. ~~'r~:kT U9-17 •f13 y:.1.2 - -.. FSEIVkiVR ALHF:I•I --- * ~ * I:NI1 t ! : ?~ IE'ER HIJIJUi_Hl•: :::•nf= ;iI:NSGR OUT NI,Hki9. HLHRM H1ST~>F~: F.EPc11TC U1 -2-O.ri 16:1'? --- SENSOk fli-flkrl •• ---- ~_E'.ti R GUT ~1I.Hkt"I SEN:3UK O~JI' HLAL:M _. -~ ~-.i~ t';' ~^ - 3E 'a. aE ie •~ 1_I~Fi ~ ~ ' .: -''_?-Oa l l ' b9 FUEL ALr+kl•1 ak"1 HIST~'R`': REF'!%I?T` : 01-25-D ~ 13: u'~ H - - - - :;E~'rr~_ 19ENSUk QU'1" Fi].flRIN 1r1LE:HAEU '3:I n3-2'i • n4 11 : 9 . HwNULHk F;b•rii:k. O1-25-UF 16:42 ~ r t w• ~^IU t~* 3E w FUFiI, HLNh'M t'3: 1 ~~ G Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 Work Order: 314 4 5 51 ALHkM N1 ~T(iTt`: kE]''~~~:';' ~;t'IV::r:T ~~ .,;:; : faLr;kr~ n , . i:.. r£F:'k'I' 1 :7 ::'•Ul~c': =Ti =iUNIF' ---- :EIVtit)R F;L"kM ---- :,~^+Rr! Hf T:iR?r b'f;E`t)t,"G. EiUF LA'l'M LIr;hhdLNi; SI 1 :1?LU3 1~-03=95 10:1:1 i'<~N'['INUt1US F'UMF',HLh1 ' ' -•---• .~k:Nti:>k' r+LHkM -- -- r i'-0`l-Oo E3: i :.~ - :'iLE't1GELl :~f~l'lll•• IiHT'H WHhNLNc+ i:(ih~ i'.. ~!U~ F'Ihl4' iaLJ9 1'~-03-OG 1U:01 GGIVTIIVIIUII:; kUl°II' HI J•1 " Ul..r,.;_;~~ g; t.~' '~I:UF 01-07-OF T?I IGL . ALfiRM i:OIVT] IJI~GI,~: kUhli i ~:;". , 12=O:i-Or 2;45 t~GIV11IVU~UB r~1•;i' "aL^'I ' 01-07=CiE.. :'I:UY s ~ G3 05-19=•U5 CON1`I NI IUJ: ~ PUMF° .,f ILi9 05-1.7-G5 '3slrl' M * :t .3E 3f..pNll,7Err~k r s ~ 3E Y ~EIVD * :i e ~ sr ..~,.~" tII•.;i~~t:Y REPORT ~ pC;IRM HISTUT2l' REPV}.'f --- Sla:r,;_.... -~Fih~l - -. SI:Nk;oR A1:ARI'1 -- - CI1'tCLi= 1; id Sl IP>rR 2..,. ~ 1•. s'PRE>. HNhJULflI" SJ'F+i~I: ` :til~l I~.i~,3 'r '.""P HLh! i BAN;1-kS~jELI).~:H.9,'i5U1 HL(~kl~ SF.N:~ort G111 . U1-05 UE E3:1c 651 32'~ 'k'156 U1'2~-0~'ft:a' c^IJTI NI IUUS PUM6' ALI°I 01 -d ~'-06 8::19 FUEL A1.HRh1 i:S -:Z'; -i!i; ~ t :0:' SENtttT Cilif, 1 rl<.I': ('QNT.1NUOfP ~ .r'UMF` HLI r Cll 02-06.20:46 ~ ~! 3'r'wi;IS h6FOF:'C G3_2~-Uq ;, ; ~ ,.- _ _ w w M*~ ENL~ +~ w w w~ ~. x r x K ENti ~ k it 3f, .i :i::, +krl H I r~TtsR :' k>rP^RT - ESN: or iil.Hf,~l•1 --- T: t.:IINI,L'AIIF.D r~Tr' SUMP I"IIT'.I. ALAl;h9 0'~-'22-05 ..: a4 FUEL t=;i:~4F.''7 aEyaiiR OUT F1.HRM , Ol-25-05 If,:4~ {~ 5 Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 Work Order: 3144551 ~lf,+lE r~ ~. ~" :.T klrCT E ~ FF~F [ [ ' T `"' ' FROPl1~l Y•nL'L•' ~. '1'. 3:I INT F t[~EI~ PRC17U T +70E : r F i~ + a~.?3301 6t, s~-r- t ; htl THT;}~'MAL t:Ul'FF :. UI ICi7fi0 ' ' TH£AI1r,I. + •aa l ' - ;~5u ~ I kNK L+.IAF1E'1°ER ~g,~;; TANK lilr+hl):T?'F; 3.3•u0 F u'. -:l ~~-06 10;.7 7.~t;: 1•'k::FI LE 4 1?TEs TANY. I•>/ur• I; is -1 PTS . FULL VtsL 961:1,T .::..L ~: ~•i:. 9e84 G6:8 INCH Vt71 7861 t,t•,$ 1;•;..'r v•_L `/ut:t. ~4d ; 5 1 N(~H VUL a 9pg a a , F l fl~-•rl ,;.;[; 490a 21,:_:1 IIV~:H '.lt;. ;~..;;_ __. ~ iW~Fi VUL 1898 ItLL F"Ulr~'Tii+r '._h~~l-1L FLOHT ::1~E; ~1:i) IIV. 843r+ ELVH"(' ~;I2Ec 4.0 LN. 8496 WA:I}?H" WAkrd1 NG ;~:, I, ' ulrftEh WHRNING ?_.0 H1 I~H LJr;7~L-Y LIi+!''•': 3.;.( HIi;H La„TER LlhI1T: 3:0 .'%~ '•k'tAbEl. 1/ciL: ~bti~r hl:;+; Oh LAT'iFi: Ih'1T:: 9r,Fl4 ;7~+EkFiLL .I [MLT ')i.l% ;7::EF?F[LT. CIhILT 50`r. 871 r, ~ 8'15 IIfGH F'~t~I1711GT h~,~, IIlt;ll I•'RIlpUCT, 35% ' ' ~ 9 9 [N= l HrIF:"SETUP- TL? i•::r~;~., ~I;a[!: lllu DEL.IVF.1?Y LIMIT 10 - - - -. ._. .. __-.._ qb8., 568 T r`~ t 6w rP.0ui1cT gun i.nid PRO1iU'T : GuG [~e 1 ' _ L.Er,} ALrkl ! L I I ~ ^ ~ '; ; LEf•i},' f iLf iRM L I Ih 1 T : :+5 qtr '_~EFF. .Q007.Op ' ~~; . ~l.]i;:L'•. I,JSC;'i.IhilT: 5U lilllil)FN LOSE ! Ir9i?': 5U '_ „~~.,: ; .-,tI~TER Ei~:uu ._. TnN}: TiI.T J.172 Tf01VY•. T1 L7. = r.l ~ ~'!:;(. VGI. - 9t$4 MAtll t'ii1.DEU T'AN!~::: h'k''a Fv~C~E:[? l':;NA'^'. L-t.b :r.:~ VJk '7Fi51. Tlli L1~'i~lE : F::7VB ':;n . a~r.~. .., ~~.Y~tl 'w,}L.. JRS9 L1:AI{ MIN PEklgllTC: 0', Lt.'iK r'F1N PERIODTt^.: 0% Fl:::r;'; ,.. _... ~ :!7- I N : X3496 ~ p. LErsK MIN AIVI'JUAI. Oi~ LEAK I°II N /iNNIIAI. (1%: hlf,l (>Fi'L±F :•.i..: :3eEa ,FE.~;[,iutl': '1'E:i-t..fYPE k}:klt'+:il+' TE6T T`:i•'c 4VERF11_L ~,,:'. 90. i3TANDARU f+'C~tNL+AkD rJ'11 5 ftI{:H' T~k0in1+;% QFV: RIVNURL TL'EZ': p„ ] L r::;!1+~:• :EST FA! L al':+g' ' iyi.AR(1 l;~Iiii'1BI'.EIi . ALARM DISABLEU3 1;1:1.11/1 .M."r L l l'1; T ! : i'. . • ark 1•'L"Rr(iI)Il': 'F't:k,1' T'HIL E'F;F'I+si~lr' Tlr3T FAIL -LOW PRODuu'1` uu yLAFt!•1,7,i~aF1:_L• fiLf~Rhl DI BriBL:E1? 1:1 Hli h1~HRM L 1 r'I l r : ~ `' nv5i ; TEtiT F!~11 f. GkU:;I; "1'k:ST FA I L SUL~I~EhI LO°S Llh1r+% -:+ . HLHRI"f L~ISAfjIJa HLNRM LISf113L>;L :TANK .f.1 l.T -_ . c1 , IhilN I FOLUETi Tr'1NKa f11VFa TEF1 ~:.F-~:,~.V.:: OFF.: ' AfJN TEST. hlll:f;lic;lr',Ic,: c)F}': Tti: NONE ~ r, ! EST .;I11;kHt, I N~; : OFF PER TEST .r jVERt=t~~ 1 IvC~ c OFf TE)h!K '1'L::;;T NG7:1 r•Y : GFF .rHwx. •rtsT Ni;T I >•"~ : i.F•} LEAK MhN.P~R1i1L1C~: u ,I: :., :E•it+jN E3REr~Ka11''I' ';11•'HGI1 Ek£ r'•'+~FF TNK TS7 fl . 'Lt:HK r'I1 N ANNUAL 0%. Al~L f I!)rRY DL"Lf,"r 1 ~. r1 I hJ UEL I ~JEi?•.< i.;:i., ~ . t ~ hl i ra 0 `:':'ItiJAkF. kL]t11:;lcily i.EVEL ' VER~IUN 1L +1~ 5U1"1'41ARFit a:~LU+ r.= 1 Gi:!-+'• .q;;gFr-I Hl~T,~k"~ kEI:Ul~fl' FfiP.[UC,(C l EST`TYPE ' ' i.1..r:r.+TEL. .;;~: ia.'13.ua ~.~ _ :; ---- YL~1'EI•i r,1.ti;a1 -... - :~I ll ANUAk ` c; , r1c;DiJLF.tI : I;}ul ~o-ob(7-A PHb''E12 VUT 1 •~:. ~Ll •os I l : ns ANNUAL PEST FAIL - t ' SYSTLr1 FEATIJRF'':: pftllv7i~rc EkRG'r. ,. 1 1;1!::; :+H..r;kr ll.ta r•rk i ~~L•': f N-Tyi~K 'I'!:::ti Pti 1 ~-10- 115 1 1 c i I~+ PEkIuLli: TEST FAIL ANNIJAL I N `i"r1Nl: TE8'fM T:TI PT L~aTTFk`! t8 OFI' . ~ i HLHKM L'+ItiF;ti_.1-:L . O,1D IHraNIIr.L:'.G .,N7 r . -~' ~ ~ ., U;~u1t+c ..~ r•++~ WARN,1NCt +,S 13&CURI'fY i;h'ci:;:. '1'1;51' FHI[. ~, ;LLL; •~U.10 MANIIHI.&0',20 ~_~ON1' t?-0305 t0:t71. "~Pt?i'+'T : .'ti r ai.ARM iil.;rtlll.lai . i;Lv+:i: ~; un-Ua-04 3:01 ~;Nr4 'I'I ; I' HVERAG I NG t OFF PFR TEST ,1vERraQ I N~ = OFF Y•.;N}; TEFi'f NO'1'll'':: Ul'1' 'l'NL '[':.+'C SIPFION &kEr'i}.-~SFF .i:)=i i_ EF.'. :+EL~'. t 5 M i N ~.~i Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 Work Order: 314 4 5 51 AT .ARt'1 1i l ~7'?)K1` 1~1:}•'t iF:T •" ,Li : n i ti i +iR'~ F2E1~C'RT `+Lnki l r c l ,~ i .tkY 6; E!'•.:TZT 'Ii;lvt: r,t !~; ---•" IIJ _r;F.. - ., - , .,. .i.e _. --•- lil rr,N)<'" r-1Hf:,. •-- -~ •. "1',V=,I'raNK itLF;l•!P1 -•'--- 'i ._i;F£k _;.(.,[_~l:i 7. •~:ufVLtti11ED o-~F~fUP, DATiI WARNING r, :.;L''l'Uk' lltiTA tAIARN T N ' ?Ei~!('' UHT'n hiARIVINr~ 0?-02 ~ yu .1r.:19 ?i'~-t,2-yY t .: t ~ 0'1-0 qf: t E : 1 :~ HIGII Wri'I'1R f~Lf;Rh! HIGH .I,JATI:F: AI,MI+'I.1 LEFT};'- AI:AR:•1 01-17.:..nr. '+:; 01-1'3-Ot3 `.i:;?1 ~i3-!'/-Ill7 13; c8 Q1-'~E-05 ? %: -:' n~ ~a5-~u5 1J::JE, rii.;ii ~~rITEN HLARI°I ~i::~F1LL ..;rF'hl OVl'!d}'11.1.. ALkfi;''. . OIr..12-0G" '9;'7' j.-,; c' `a:00 . •. - liY-i.-t:- :i1G :~i 325,-,db I:%74#3 SWL~EN TOSS hiLAkM un-:'.~s-U1 '1: U2 '~'F.rc't i Li.. HLr~tkrl .. n1` 1.2-06 8:3~ SIJPAI;N LGGS r-lI:F1RM O1- 12-06.. y:nr_ ,~ . o~-i~; ua 1•i:'~u ' r!i~ '-t:~~, o1-l _^ • ~l°Uh 1t7:~$ oa-uE,:•nn t ::1~ , OI-L2-~E s's i2-n9=u5 12•:Ih ' (Jc• .a=.0_:: _:.~.i • SUI~C~EN L`'C~$ fiLAkM HIGH PROttlu"I HL:HhT1 • tti--] :•aL C;:y~ Ol-l2•-06 3:18 rri.:ri 1•'kUpIJC' f raLA1,T1 ' - . Ul-25-U5 1.3:24 n1 t 06 9:1i! 2 03-] '? •q6 ! ~: 3': r71~-25-07 =13:21_ , i.NVHi:ID FUEh hlnVEl. ' ' D6-2;L",ll:? `A :04 N1i;H'PRGIiUt"I: Fil Ft°1'1 m -i'~ uc ~, 4 ~ ~ _ ~~( '1`1•-06- '1':tB i'; at-. 01-2~ ,~ " 1:Nt~-+1:_. F~~~t LEvF:L. ` = ! 2-2f!-05 j 0:: 5rt 09-1:?-Gs ~ ~ 1 a2`iib 3:-17 •::' t75 01:08 +''•`•' t7- x11.12=05 8:35 ' ; Yl?C+1J• L: UUT O1 -2i"Or .13 ~ 4!i . I Nt+~ it *?` 'FEEL -tEVtL fll ]2-•f,6 5:'i' 01-1. Uo ~ _» I-'kuBE OUT U1-•12-06' '.1.:5G Ot~-25 l.~"_ :~; -'r 01-.1:2=C't: 4. G: U1. Ch'rr~ io:1t) HIFH :1r•.?>F. •.,lF.iv(fi~: ' J1-25~t]5 1.1:'?3 E>z~'Al; i7U1' - :, is t!c,. •t:'.•!l ~?.-=rrt:'~ b'2::3ti ~Hf~1W WF9TI;R WRitN1NG D1~li?•OE 4,: 5t' UI-1^_-I.1t,, cJ:~'1 = tJi ~i2-V'b 3::J1. l.lh^li-U6 Il:'~5 U1 .25 U5 1~~t3E ll(:, 1 +1 >' r E i.•. H! t,N WH I');k Wr-iRN 1 NC; U1 )_ r i:d6 u^ ,.1 ?;67 C~ECIUCkY NEEDED. 01 -e5-Ga 13:5:', , 11-01:-05 '14:x0 M,;:. r"~ _:•~ _•r .+!c: iRPI ae-i;~/-un z'~: uy P£1:1 VI RY"r,tE£l;r:n F,1 -; . do 9.18 i=. ilr '= ia:"i :; S'- ""• eF.;tGuC~T HLr9krl , '-'( iG'.tln 9: 5 . . , 0~1~-12-170 ~ 5;~TE1 01-U6-06 !15:-1'•> 06-2;;•-J~ d:Uf MHX Pk~L±f.i::'I'•'ni.r!R(•1 ~ ul=i 2-n~; 9:~1i3 01-15-0~ :.3:3rf d l--2?-il:l 8:07 L11W TEMP" 1,1H1dNING ~ :+: iE ~ s i'''ii w - s r 09-1</-03 4:12 i !::SUPER iiLr3f,'r1 H1`ii'+iF.'v G:I:(~:+,;7- tiNNIJI:.AI. SYAI:E SENSOR "OfIT A(.ARM - • • L:L'IV'GR hLH1•'h7 G1-12-Ot El~a' L 2:PLUS FI li'1, HI ARL1 S'_`~::: is '''UT HLr•!Rht . ni-~12=!h E. ~:.:, O1-i~ ub s:47 ~ * x ~. ~rlr~ R :. ;;1.~V:;,}:-';:;[ rj+.,j.,p•I • FUEL ALARI°I ' ..yl-,r~r:rl N1::1'i+k"! RFP7R7 .I'i- <5-t75-16:2 01-1~! Ilia i 1:43 -~ SEN:ic)b: S!UT ALHF'f1 L ~~:~INI.EFiL~EI! 01-~5•~U5 16:4 t'jIVIVU.LAR SFACE U1-i2-o6 r1:4~ u$[, ~ ILtiTr'I ~ x :.: ;K iE F.NU ~ a r .. : iI;NS~R OI~IT+ H1.faRM i ~;~ Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 ~ f Work Order: 3144551 ALAI-'M N[~;i~k1' REPi11R`l: L 4::3UI~ER $T~ '..?i Ih1P frl -1'2"C1F, 6 ~ 4'~ I I1'=12-UO 8: a' 12-63-•i~5 I u: Hl-Akh! HI::I't,h"! R.I=r'piC7 f. E;:UNL:EACIFD :37r' 6UMY U1-1 ~• lhr, H:47 1'UEL ALARM. FUEL ALARM U: ^I-0: ..:..la ~ ~ . ~. - Ci,tn t `~_R~ ~ ~ r II_HFrr9 H I S7{i1<' ;' . xEf:t Mfr -• -- =E!JSt~R ~iLAPr9 -- 1. 5:YL.US ANNULAR sr-ncL: sk:NS~?R ~>U1' ALi5RN1 FUEL ALARM Ol-1.: uo d:>Ia ~a$NSUk. UUT ~l.r,kl l PLHRr1 H 1'I:Ti>F.~'; F'£I ::R? to 1 :!_`1.US_` c~~t.r.:::iI~iTL~>t~ri rlLraRrl, U1=1'?'sllrr v::313 i~'i :IQ...: ii.J~ 'r'ur'li: ri(.hl o1=ri9=or, 13:12 w• K! s FI:T, R e w w R ALARI'1 Hl'~TvTs"~ 8'EI°:."r.': 43 2:SUT•Ek i.: .~-ih~ y:.t4 :.~.:.:::: i.(Nf' FA.IC. ,iCrl3-fie 9:44 :~C~tiT [ Ni-1~yUS PI ir1E` AI .r1 G l ^t)9-0E 8' 1 .. . . ENU .i * * s M H1 JaAF4 H 1:::1'Ul•."; RI:Yt?k.7' •• 4;%tia L [ iVE FH I L OC-l2-UE 9:54 ~=ufVTIlVUOIJfs I'UI°IP ALM. O1-0'J I IL 13:12 i :1 k~: L>= Y. . :_i-._-tied ! ~ :U5 ~; :.r ~'c_"i , 'iJa NCIRNIF;I. Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 ~ a Work Order: 314 4 5 51 Gommentn - (inr"Dude i~forrr~crtran aft'repriirs rnr~delirtnr to testts~,R•,,dnrl pt~cumrnertdect foldo~+••up;{oi'.fcrilert tes~sJ Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 9. SpiT.i,I~YERF7LI;.CdNTAINMEN~' BaXES m w w ri M it N b f•. ~' .~G O 7 -~ E~VR Equipment lnspection:& Maintenance Form Station No. 2 ~a~~~z5 DPW VR-1 a2 Requilred Maintenance {Place checks irrl the boxes when c~lrnplett?dj r-or reference, GARB Phase (Executive OMerfVR-102-A,.6,;G, Of. D) ~R'ernove tap Cover screws; renove~deFirisin loweroo~~er ,Check d^ain Foes in larver crn~er for blockage Qan"t remove sc-een"s; reinstall top, tighteraCrews. utJ}~GI is 4iGC~l •- ] Remove vent oop by depressing tabs, lift top upward, slip screen up and ou: ] Clean or replace iiF9e- screen (OPW Hid895A4) as needed; end: reinstall ~ Reinstall app, .make sire tabs aro inside valve body; rote un:it::abs seat. LowerSafBen • yieave pipe adaptor an riser to seriice lower flier G:raenj ^ Remcve valve from p!pe adaptor ay grippi^g lcwerflat above pipe adaptor ] L!ft filtecscreert(C05086fv1}cut; clean or replace as needed and rriinstaU !] ReinstaF valve an pipe adapto- 8 tighten (•u~~ench on vvilir C05102tv1 hol cn!y'} .. ~ ^ Ensure balk •naves freely in cage ^ Ensure bleed hde allows tee and p!oper air Flrnir nsure assembl isn't Jana ed. cormded.pr conlam~nated: and ref stall ^E y g n { ,•''{•r~•, ^ Jnspect adaptors for large dents, cracks. or dalortriatians, replpce if needed ~ ^ L~Spec1 and Clean interior oFcontainer Inspe:.1 and clean drain vahre sc-een [i Remove-dirt aril grf; if'screeri is clogged remove the• ralvle and soak, in water `iis,ng h,gh'-pressure air to chain, ~einstatfdrairi ~.a•ve i. [~,Tesl cra n va ve, using apcropriate TP-2[)1:1C x D ^ If.'a~l, txoceed to:next stew , ^ Replace drain.vslve (1OK-2100-EVR) and retest i. _. • ^'Ensure flapper is open ay, looking down through ape~ling D Test seals using TP=201,.9 t} ^ if fail; proceed tc>^!ext staJi ~] Replace seal'{OPW H11g31M}and retest ^ li su'I failing, replace drop t..bc and retest b.4~ti~ jiiid ~ ,v.•S~~.r.~ ~.rgii:.. ~t '{,; {} ti: Inspec' o-ring-for nicks or :ears; repiace iF seeded ^ Vis~agy inspeol soal in cap: replace if needed ::C;~~ii•~}~;{• y:•y~N'..yi..{7.'~ t~.ti ~, .~. ~.ri'•:aCvti.~ ~..i:i :':a'..`~.:~ t}.n y;.~~.:' •~Vf?' Y^. ~'`.~}:~~.ig ~n2f, „~J,_F SAS ~ ^ Visually in"spECf seal in cap'For ri(c'cs, {ears or defvrmati0ns, ^eplace it needec I Certify Lhat the at,ave.information is.accurate: t,7aintenariceoonductedoy: ''~rt;1v ~L_S~It.i^O t7abe _ fi< aC ~'naany~ ~s+~.<..--oar ~, r` H t~ Y .~ 3 ~: X" W U P, 0 z 0 o~ip 0 0 h ~,. .~ Spill Bucket Testing Report Form This form is irrrerrded for• use b}~ c•ontr•actors perforrrring annual testing of UST spill corztainrnertt structures. The completed form gnu! printouts fi•an less (if applicable), should be proi~ided to the facilit}~ owner/operator for su6mitrnl /o the !o~ a1 rr~rulnmra~ avers: 1. t_ FA('ILITY INFORMATION Facility Name: C,1,S~-C LL O ~~2 S' Date of Testing: Z ~ ` ~ "} Facility Address: 2`~-2`L `~ S ~ ~ T~~.~LS ~~ ~ ~_'.~ _ 3~C~ Facility Contact: M~'~ ~ ~ ~- Phone: ~~, Ct? ~ 2 ~- Date Local Agency Was Notified of Testing Name of Local Agency Inspector (if present during testing: ~~ tJ "~ 2. TF.STiNG CONTRACTOR INFORMATION Company Name: ~_ . ~ . Z' , Technician Conducting Test: ~ji 1,L, ~ '~ Credentials ;~SLB Contractor ~'fCC Service Tech. i:r SWRCB Tank Tester ^ Other (Spec;h r License Number(s): 3. SPILL BUCKET TESTING INFORMATION Test Method Used: '~ Hydrostatic ~ Vacuum ~ Other Test Equipment Used: ~ ~. S ~ o Equipment Resolution: ~ ~~ ~ < . Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 C~i q v iS l 2 ~ ~ 3 Q~ ~ v 4 Bucket Installation Type: Direct Bury 0 Contained in Sum Direct Bury ^ Contained in Sum ^ Direct Bury 0 Contained in Sum .Direct Bury .Contained in S Bucket Diameter: 2 '' 2 " 2 ' ~ Zz Bucket Depth: Q ~ ~ Z ` Z" ~" Wait time between applying vacuumlwater and start of test: ~ 2 `~ ~ ~. 2 ~~ ~ Z ,~ ~ ~ ~ - `~ Test Start Time (T,): t '. 2 ~ ~ ~ ~ '• 2 $' l~ `• 3 '. Z ~ ~' 3 , '. 2 ~ ~ t ~ 3 Initial Reading (R,): ~ . `,~ ~ ~~ ~ . ~ ~ 3, (n1 ~ 3 = ~/0 3 , '~ , 3 . ~~j Test End Time (TF)~ '• 3 ~. FJ (~ ~ ~ ~ ' • S S ~ ~'. ~3 ~ ~ '. ~ $ t ~'• y ~ ~` ~ ~ ~ Final Reading(RF): `~j.`3`-E3 ~.2.SC~ ~'r3S~n .'3S ~.100~ j'. b©3 3:`~b~ 3, ~ Test Duration (TF - T,): Sww . , S ~.:.,~_ ~ ~ . (S v~.`.. ~ S w."`., S .r'~... ~ S ,~ . }~~,~„~.._ Change in Reading (RF-R,): C? ,© ~ ,p '3 - o ,oo ~ _ a , v~ 1 -O ,005-• O . ~O (P •~- o ,moo - v , o0 PasslFail Threshold or Criteria: ~' O ,~t7 2 __.. ~ , p~ 2 - ~ O O 2 - p . ~p 'Z ~Te~t Rc ult: ~ 0 _R,as I'a~l ~ •~'~~ ;~O~P'arl ~ ~7 ~ Pass , - T+~j;.l _ I'-ass . `13:F 1 . Comments - (include information on repairs made prior to testing and recommended_follow-upfor-failed tesuj Spill Bucket Testing Report Form 1 his,/a~tu i,r inlenc/ed for rrse ~y con/rcuYors perrormirtg artntru/ les/ing q~ US%~ spi/1 conlainnten! s/ruclur~es. 77re comttleled ~nrm nncl prinlorrbc ~rotn lea•IS (if applicahle), show/d be proric%d to Ihe_facility Dourer/oper~lor for snbmil[a! to the loco/ re,~alniort~ n~enc.r. 1. FACILITY INFORMATION Facility Name: ~ \ ~ L h ~ ~ ~ s Date of Testing: U ~~ Facility Address: 2 2 2 2- $ \ ~~ 1~--``-~-~ l C ~ ~ C~ ~ ~ 3 Facility Contact: ~1'~ >v ~ ~ ~ 2 Phone: ~ ~ ` _ -- Date Local Agency Was Notified of Testing Name of Local Agency Inspector (if present during testing): N 0 ~ E 2. TESTING CONTRACTOR INFORMATION Company Name: C Z , Technician Conducting Test: \ ~~- D \ ~ ~. Credentials CSLB Contractor ICC Service Tech. SWRCB Tank Tester ! i Other (Specify) License Number(s): 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ydrostatic i ~ Vacuum Li Other Test Equipment Used: ""~~ "~ ~ 0 0 o Equipment Resolution: ~ ~ o ~ Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 ~' 2 ( ~ 1 3 4 Bucket Installation Type: irect Bury ^ Contained in Sum irect Bury ^ Contained in Sum ^ Direct Bury ^ Contained in Sum ^ Direct Bury ^ Contained in Sum Bucket Diameter: ~- ' Z `' Bucket Depth: ~ `' 2 ~ Z Wait time between applying vacuum/water and start of test: ~. 2 ~ ~~ Z ' ~~ Test Start Time (T,): 'z ', .Z O 2 ; 3 S 2 ~. 2 p ~ 2 ', .3S_ Initial Reading (Rt): 3 ~ 2O `~ 3 • ~ 3, 3 S ~ 3 ~ 3 S Test End Time (TF): ~ 2 ', 3S 2 ; 50 2 ! 3S` ~2 ', S O Final Reading (RF): 3. 2.p(o 3. 20 S 3.3 S O 3 < 3 Test Duration (TF - Tr): ~~,,.;,,.,. , ,S`,,,: ,. f ~ ~,.:ti . ~ S v.- ;., , Change in Reading (RF - R,): -o .001 -'o . oo ~ - ~ ~ o o \ -~ .o o L Pass/Fail Threshold or Criteria: ~ Q ~ ~ ~ _ O ' 1~0~ Tesf Result: Pass ^ Fail. Pass- ^ Fail D `Pass ^ Fail ^ `Pass ^ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all t info f co aine in this report ~ue, a nd in full compliance with legal requirements. Technician's Signature: Date: ~ .- ~ ~ ~ ~~ ~ State laws and regulations do not currently require testing to be performe y a u feed contractor. However, local requirements may be more stringent. C:\Documents and Settings\beachd\Desktop\Spill Test 3 7 O6.doc Page 2 ~~ ~ ~ ~ f~ ~ Triangle Environmental, Inc. 730 N. Mariposa St., Burbank, CA 91506-1629 (818) 840-7020 Fax: (818) 840-6929 T.E.I. UST WORKSHEET SUMMARYSHEET Client: Circle K Stores Work #: 20013233 495 E. Rincon St., Suite 150 p ~7 Corona, CA 92879- Test Date: 2~2°~200 / Lorraine Soffe (951)270-5183 Facility: Circle K Store # 2708825 County: KERN 2222 F ST Cross Street: NWC 23RD / F ST BAKERSFIELD, CA 93301 Repairman: Billy Hernandez Labor Hours: Work Description 1: Annulars passed. The 87 turbine sump failed, 89 & 91 passed. Spill buckets passed. The 87 and 91 vapor buckets failed, 91 passed. UDC 1/2 failed & 3/4 passed. Work Description 2: Turbine sump lids need new cam-locks. Parts List Qty. Description Item #1: 11 Annular cover bolts (9/16) Item #2: 1 Hazardous waste label Item #3: 2 Cim-tek fuel filters Item #4: Item #5: Item #6: Item #7: Item #8: Item #9: Item #10: Item #11: Item #12: c `T . i b RECEIVED ~ WORK ACKNOWLEDGMENT MAR Q 2 20Q1 DATE: ~ ~ 2 ~'- ~ ~ AUTI-i#: ~~~ e FACILITY#: Ci! Q C l_~ - ~~~ Z ,g Environmental Inc. ADDRESS: _Z Z- Z- Z ~ S 730 N. MARIPOSA ST. TEL: (818) 840-7020 CITY/STATE: ~ ~ ~ ~~ +2- S ~' ~ ~ L9 ~ ~ 3 ~S ~ BURBANK, CA 91506-1629 FAX: (818) 840-6929 COUNTY -~- ~ TECH: ~ L~~' ~1~ - SERVICE REQUESTED (CHECK) TANK TIGHTNESS TEST ^ MONITOR CERTIFICATION ^ ENVIRONMENTAL REPAIRS ^ PRODUCT LINE TEST ^ FACILITY INSPECTION ^ O~HE$, ^ ~ ^ . LEAK DETECTOR TEST ^ VAPOR RECOVERY TEST ^ , ~-~ `~ `/'~ SERVICES PERFORMED ~- ~ ~ ~U `~ ~ J ~-~ ~ ~- t.T vim. ". `~ ~ I L-- r .~- ~ -- ~ 1 ~ Chi -~ E ~v ,~-` ~' ~ - ~S~ ~.- ~ ~ S ~ ~ r~ ~~, p, ~~~~ ~i~ .~,.~,~ . ~1cF n ~v,1--'A v~~E-E~ N c~ ~o~~ ~C~S, PARTS 1."l ~`~ ~ ~~ dr~n%v~orz Cvv~~- `E~~-`~S ~ ~ i .~~ ~~ :-~,;-, ,~~-~.~~~~- ~ _._.. CUSTOMER PRINT NAME CUSTOMER SIGNATURE r DATE: ~ ~~ ~ ~~ c SBD123-WORKAL7IN(3,97) ~~ MJM 12-f14 12/26/2006 II:II AN UNDERGROUND BTQRAOE TANKS APPLICATION TO PERFORAII ELD l LINE TE8TIN6 l Sd98Y SECONDARY arONTA1NMENT 7Lr871NG RANK TIt~FITf1ESS'TEST AND TQ PERFOWIf FUEL MONITORING CERTIFICATION Tanknolagy 9096766061 3/3 BAII<18RSFY~iT,D Y+'IRE D$PT. *«~ Prevcation ServL~es Air 400 Truxtun Ave,, Ste, 210 Baker®a~~a, CA 933ai Tel.: (661 3~5-3974 F'oax: (661 852-2171 Peps 1 of 1 pERMrt NC. ~ ^ ENHANCED LEAK 43ETECTION ^ LINE TESTINl3 ^ 38.989 SECONOA,RY CONTAINMENT TEBTINd ^ TANK TK-HTFIE$8 TEST _ ® TO PERFORM FUEL hM1DNITORING CERTIFICAT-ON _ ~_ _ Circle K#27088Z5 2222 F St. NAME a PHONE NUMBER OF CONTACT PERSON Massser- owN~Re NaMe Clrcia K Stores ~ ~ ~ __.__ . aPeRATOas NAME PERMIT rp OPERA'E NO. - __-__- - MUMBER Of TANKS TO 9E TE$TED I PIpRiQ GOfNp TO EE TESTED C~ YE~_ _ EI NO ~._ - T~.~.. - VOLUME CONTENT8 .. ~~ . 1 9684 Supreme (91~ Z a 9884 Plus (89y 8684 ._ _. . Regular {87) ., l _ ~. ~ . TANK TE8T1N6 CON'ANII _ _ NAME pF T1~TFN9 COMPANY TAnknol inc. NAME i PHONE NUMB2p OF Wpsi>~y CiQ41~tYr 800-BBB-S47B oBY~ CONTACT pER$cN _ _ Nict.12 IMIULiNO ADORE>#5 4'1785 ~nl,erprl*e Circle 3. $ulte D Temecula, CA 93890 NAIIiE • PMDN6 NUMISBR Dror ~ TfRI Coullar - (SB4) A3#-177 CER7lFICATK)N 1t,~ TPATIR OR 3PeCIAL INOPCCTOR: DATE l '[tME TEalT TO 9E 4 14:00 A,~A _ Icc ~: -- CONDUCTBDI 310NATIJRE OF APPLI DATE; W1TE -- ~ TEST METHDE~ ~~ _ ~.~ Fp 2085 (Rev. 081Ca)