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UST-REPORT 7/28/2006
- , ----- - ~ ,~ ~~ ~ 'f "~U1QUE1zG1~601~b STORAGN TANKS) FILE #7 ~` _~ _ ONE STOP MOBIL - ~_ , -- ± ~ 402 S. CHESTED ~ ~ ~ ~ ~ _ ..... _~ _. _ _ ~ ~ Y - - _ S - _ ~ ~ J _ ~~ ~~\ I ~;; °: .' ...~ t _..; ; ,~ . - ----- ---- - ~ -- - - - - _..~-r~ ~3~~~ MONITORING SYSTEM CERTIFICATION ` For Use By AI! Jwisdictions Within the State of Cali ornia Authority Cite& Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Tit a 23, California Code ofRegulations This form must be used to document testing and servicing of monitoring equipment. A separate celpfication or report must be nrenare for each monitorine sv to 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: d/vc TL Bldg. No.: Site Address: C~~a ~, Cl~1ES\~i~ /{V~ City: FAA ~~Fs~ Zip: Facility Contact Person: Contact Phone No.: (~„_„) Make/Model of Monitoring System: 1fif~Gd ~ Date of Testing/Servicing: ~/~/ ~~ B. Inventory of Equipment Tested/Certified _ ti,..._.. ..a;,..,.. a .:r _ .,......,~i~,.r.,:~..a• s.1 tti T"t~\C47~C''_~'!'1~ V Tank IDG ~ L ~ Tank ID: In-Tank Gauging Probe. Model: i~~ [ ~- In-Tank Gauging Probe. Model: _ ®Annular Space or Vault Sensor. Model: ~ ~ ~. Annular Space or Vault Sensor. Model: ~ 5 3 f~ Piping Sump /Trench Sensor(s). Model: L_~ 3 lid Piping Sump /Trench Sensor(s). Model: L S 3 ^ FiII Sump Sensor(s). Model: _ _ ^ Fi11 Stunp Sensor(s), ~ Model: ® Mechanical Line Leak Detector. Model: ~~~ C~ Mechanical Line Leak Detector. Model: ~ ~ r/4~j' © Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Others ci ui ment a and model in Section E on Pa 2 . ^ Other ci a ui ment a and model in Section E on Pa e 2 . Tank ID: Took ID: ^ In-Tank Gauging Probe. Model: ^ In-Tank Gauging Probe. Model: ^ Annular Space or Vault Sensor, Model: ^ Annular Space or Vault Sensor. Model: ^ Piping Sump /Trench Sensor(s). Model: ^ Piping Sump /Trench Sensor{s). Model: ^ Fill Stamp Sensor(s). Model: ^ Fill Sump Sensor(s). Model: O Mechanical Line Leak Detector. Model: ^ Mechanical Line Leak Detector. Model: ^ Electronic Line Leak Detector. Mode[: ^ Electronic Line Leak Detector. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Other (specify equipment type and model in Section E on P e 2). ^ Other (specify a vi meat type and model in Section E on Page 2). Dispenser ID: ~ ~ Dispenser ID: (~ Dispenser Containment Sensor(s). Model: ~"A DUX ®Dispenser Containment Sensor(s). Model: ~A LX ~ Shear Valve(s). (~ Shear Valve(s). D Dis enser Containment Floats and Chains , Dis enser Containment Floats and Chains . Dispenser ID: Dispenser ID: ^ Dispenser Containment Sensor(s). Model: ^ Dispenser Containment Sensor(s ). Model: ^ Shear Valve(s). . (] Shear Valve(s). ^ Dis enser Containment Float(s) and Chain(s). ^Dis enser Containment Floats and Chains . Dispenser ID: Dispenser ID: ^ Dispenser Containment Sensor(s). Model: D Dispenser Containment 5ensor(s). Model: ^ Shear Valve(s). ^ Shear Valve(s). OD15 enser Containment Floats and Chains ^Dis enser Containment Floats and Chains . *tt the faculty contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at fire facility. C. Cartl~CatiOri - I certify that the equipment identified In this document was Inspected/serviced to accordance with the manufacturers' guidelines. Attached to this Certification !s information (e.g. manufacturers' checklists) necessary to verity that this Information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check all that apply): System set-up `Alarm history report Technician Name (print): S7'EU~N~"t-~L Signature: CertificationNo.: ~C f~t~~S3~ ~Sa(olc~~f(~ 4~' License. No.: Testing Company Naine: RICH ENVIRONMENTAL Phone No.: ~~~ 3g2_gb$2 Site Address: j~Q ( S• ~y~'t~FQ ~yE '3rlk>rr2aflEL'I~ ~r ~~ Date of Testing/Servicing: ? /o~S/-~ Page I of 3 03101 Monitoring System Certification 4~~~~ D. Results of Testing/Servicing Software Version Installed: D.gg ~D (:omolete the tollowinp checklist: Yes ^ o Is the audible alarm o erational? ® Yes ^ o Is the visual alarm o erational? ~ Yes ^ o Were all sensors visual! ins ected, functional] tested, and confin-ned o erationa!? !~ Yes O o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment wi1J not interfere with their ro er o eration? ^ Yes ^ o If alarms are relayed to a remote monitoring station, is al! communications equipment (e.g. modem) ~ N/A operational? ~I Yes ^ o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ^ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check a!1 that apply)'l~Sump/Trench Sensors; ^ Dispenser Containment Sensors. Did you confirm ositive shut-down due to leaks and sensor failure/disconnection? ~Y.es; ^ No. ^ Yes ^ o 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 rot(s) and operatin ro rly? If so, at what rceni of tank ca aci does the alarm tri er? ^ es ®No Was any monitoring equipment replaced? Ifyes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. ^ es ~ No Was liquid found inside any secondary containment systems designed as dry systems? (Check al! that apply) ^ Product ^ Water. If es describe causes in Section E below. $1 Yes ^ o Was monitorin s stem set-u reviewed to ensure ro er settin s?Attach set u re orts if a ]icable !~ Yes ^ o Is all monitoring equipment operational per manufacturer's specifications? In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 03!01 «~~ a 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 followine checklist: ^ Yes ^ o Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ^ Yes ^ o Were all tank gauging probes visually inspected for damage and residue buildup? ^ Yes ^ o Was accuracy of system product level readings tested? O Yes Q o Was accuracy of system water level.readings tested? ^ Yos O o Were all probes reinstalled properly? O Yes ^ o Were all items on the equipment manufacturer's maintenance checklist completed? * In the S ection H. below. describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) Complete the foilawinQ checklist: O 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? O N/A (Check all that apply) Simulated leak rate: J~ 3 g.p.h., ^ 0. 1 g.p.h , ^ 0.2 g.p.h. 61 Yes 0 o Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ^ o Was the testing apparatus properly calibrated? ® Yes ^ o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? O N/A ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ~' N/A ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled $ NJA or disconnected? O Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions -® N/A or fails a test? ^ Yes ^ o For electronic LLDs, have all accessible wiring connections been visually inspected? 29 N/A Yes Q o Were all items on the equipment manufacturers maintenance checklist completed? in tae ~ecnon n, oeww, uescrtne liow aaa wtiea tuese deficiencies were or wlll be corrected. H. Comments: Page 3 of 3 03101 Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors I. Results of VacuumlPressure Monitoring Equipment Testing ~~c~~ a LG 163-1, Enc. II This gage should be used to document testing and servicing of vacuum and pressure interstipaI sensors. A copy of this form must be included with. the Monitoring System Certification Form, which must be provided to the tank system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the local agency regulating l'JST systems within 30 days of test date. Model: System Type: [] Pressure; ^~ Vacuum Manufacturer: Sensor ID • Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; ^ Fail Interstitial Communication Tcst Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; ~~] Fail Interstitial Communication Test Result: ^ Pass; ^ Fair Compoaeat(s).Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; .II Fait Interstitial Communication Test Rcsuit: []Pass; ^ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test AesuIt: ~] Pass; ^ Fail Interstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored by thin Sensor: Sensor Funetionelity Test Result: ^ Pass; ^ Fail Intexstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored by this.Sensor. Sensor Functionality Test Result: ^ Pass; ^ Fail Interstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor: • Sensor Functionality Test Result: II Pass; ^ Fail interstitial Communication Test Result: ^ Pass; ^ FaiI Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; [] Fail Interstitial Communication'TestResult: QPass; ^ Fail • Component(s) Monitored by this Sensor: Sensor Functionality Test Result: II Pass; ^ Fail =Interstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor; Sensor Functionality Test Result: ^ Pass; II Fail Interstitial Communication Test Result: ^ Pass; ^ Fail How was interstitial communication verified? . ^ I.cak Introduced •at Far End of Interstitial Space; ~ ^ Gau e; ^ Visual Inspection; .^ Other (Describe in Sec. J, below) Vacuum was restored to operating levels in all interstitial spaces: ^ Yes ^ No (~f no, describe to Sec. J, below) ,I. Comments: /~U N F ~~ f ItESt ~ .y coR 1~RFSLr~r ~4 I _ ~"~Zt - Page of If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor, vacuum/pressura has been d~pnstrated to be communicating rhrougb0ut tbo interstice. 3~=~ Monitoring System Certification UST Monitoring Site Plan Site Address: ---------------- - ~ T -R-a ~---- -------_.__..--- - - - - - - - - - - - - - - - - - - - - ~ r - - - t_ - - - - - - - - - - - - - -------------------- ~~-~--- ~ - ---r-------- M ------------------------------ - -------------------- h - -- •---3---------- ~ _- -----~--... -~ .(~j~ --------------~_.___ o=~ ~.- - -------- ~ --c r -------------------- --- -- ---- ~------- - Date map was drawn: 7 / ~ /~ ~ Instructions Tf you already have a diagram that shows al! 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: CIearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page ~ of. `~ a5,ao r i R ~' CH .~1~l.T.R~ NMF,'NT 5643 BROOKS CT BAKE3RSFIELD,CA.9330$ OFFICE (661)392-8687 & FA% {661)392-0621 1 ' j+i -CAE n~CAL LBAK DBTR_CTQR TEST W/0#s Facility Name:~~C ~ ~ ~ Facility Address: $~I S. GE}~S~E f2 YOU= , ~xc~S~~L_17~C/`} Product Line Type (Fresaura, suction, Gravity)„P~SSU~ PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS SERIAL NUMBER BELOW PSI OR L/D TYpET~~~CC?~1N - ~ PASS. SERIAL #_~ ~~ ~. NO / ( SAIL L/D TYPE 5P-'G V YE9 PASS C~ t SERIAL # ,_,__ L/D TYP}3 YES PASS SERIAL ~ NO FAIR L/D TYPE YES PASS SERIAL # NO FAIL I certify the above tests were conducted on this date according to Red Jacket Pumps field test apparatus testing procedure an limitations. The Mechanical Leak Detector Test pave /tail .is determined by using a low flow threshold trip rate. of 3.gallon per hour or lase at 10, PSI. T acknowledge that all data .collected is. true and correct to the best of my knowledge . ~ag+~3~ ~Sa ~~ a~(o ~~ Tech: ~S:T~~E.v :b3E~t'~ Signature [ Date : ~'o~~- ~~ ti:! 1 . i ONE STOF MOBIL "!ART 401 ~;. CHESTER iAKERSFIELD~ CA, 9,T,304 SITE # 835 835-9544 ~23~205G 03:36 AP1 TANK SETUP REPORT aNK N0. i 36C+0 GRL UNLEAUE D SUF ;aNK Ti'PE DOOR TANKS aNK DIMS 111,5 ,~ 191 ANY. SIDE 3006. ANY. SHAPE , .. CYLINDE ~.'.' ENGTH 191.06~~ RODUCT U NLEADED SUP FFSET P 0.91 FFSET W 0.91 ANIFOLD NONE ROB£ STD 113 LOATS ^c LORI TYPE GASOLINE RADIENT 3.503'; ENSOR LEN"uTH 113 IGH LIMIT 95.00 OW LIMIT 35C:.66 IGH HIGH 96.06 OW LO~i Ir8.66 ATER LIMIT 4.66 EMP COMP API 66~54B PI GRAVIT4 51.36 LPHA :26.66 0. RIDS 5 RTD LOC 1 11.99 RTD LOC 2 34.80 RTD LOC 3 51,60 RTU LOC 4 oCG.10 R.TU LOC .5 3b.90 "' ONE STOP MC+BIL "1RRT. 4t32 S, CHESTER BAKERSFI£L D, CA. 9,384 SITE # 3+3 5 835-9544 ?~1~.1a66 68:37 RM TANK SETUP REPORT TANK. NO. 2 11606 rAL UNLEADED REG TANK TYPE JOOR TANKS TANK DIMS 111.5X 253 5 TANK SIDE , 12096 TANK SHAPE Ci'LINDER ' . DIAriETEP, - 111.56 LENGTH 25Ci.56 PRODUCT tJyLEADED REG OFFSET P 1.25 OFFSET W 1.15 MANIFOLD NONE PROBE STD 113 FLOATS FLOAT 7YFE ~ GASOLINE GRAGTENT g.97~1 SENSOR LENGTH 113 HIGH LIt9IT 99,60 LOW LIMIT 535.06 HIGH HIGH 101.66 LOW LOW 22,06 WRIER LIMIT 4,66 P API 6B 54B API GRAVITi' T 6~•• S6 ALPHA 326.00 N0, RIDS 5 RTD LOC 1 + 2,9~ RTD LOC 2 34,byi RTD LOC g 51•b6 RTD LOG 4 3.1E3 . RTD LOC 5 ~ ~•b. 96. . ~~~~a ONE STOP MOBIL MART. 402 S. L•HESTER BRKERSFIELD~ CA. 933ks4 SITE # ri65 835-9544 ?~2'~•~2fiC7~, 08:4© Art ALARM REPORT ?i28i2005 98:46 AM :,.U.AN•SPACE ONE STOP MOBIL r1AR.T. 402 :~. CHESTERT~n BAKERSFIELD. CA. ~JJ64 SITE # 605 835-9544 7j23i200b 03:43 AM ALARt9 P.E?ORT ?i28i2~i0b gg:43 AM S.U.AN.SPACE ONE :•TOP MO@IL MART. 402 S. CHESTER BRKEP.SFIELD~ L"R. 93394 SITE # 805 335-`'544 ?~28~2066 k18:45 AM S`rSTEM SET!IP REPORT '~t7F7WARE VERSION ~-~~3'310 LOCATION 1 Oh1E STOP MOB LOCATION 2 It MART. STREET 1 462 S, CHEST STREET 1 ER. CIT4 1 gAKERSFIELD CITY 1 CA. STATE ZIP CODE 93304.. SITE # 805 835-9544 - -- - .... _... _ - - ~~ "~ F~ vOL UNITS SALLONB S~:{iD INUTRY NONE 12:$$ AM RELAY TIMEOUT LEVEL UNITS IiJCHES H TIMEi INUTR. iNUTR 12'0$ RM HIGH LIM TE(4P UNITS FA RENHEIT TIME2 11:$0 AP1 LOW LIM C TIP1E STYLE 12 HOUR 11ME~ INUTR NONE GH H DATE STYLE MMiDD~YY yCND INURC 12;pp AM LOW LOW e DAYLIGHT SAU ENABLED TIMEI INURC INURC 12;©$ AM WATER lIM SET TIME 3:45 AM TIP1E2 INURC 12s$$ AM LEAK LIM SET DATE 07~28f2tiJ65 TIMES NONE SYSFAIL N0. TANKS SCHD DLHST TIt1E1 DLHST 12:$@ AM THEFT 4 LEAK LIt9IT 2.~7p TIME2 ULHST DLHST 1;60 AM STD ALARM THEFT LIMIT Id.i+d TIMES NONE DELIU LiMTT ^c$d.$$ SCHD ALHST 12:$$ RM ALARM i SNTNL MODE OFF TIME1 ALHST 12:$0 AM ALARM 2 i ^a TART SNTNL 22:0$ AM TIME2 ALHST 11'5$ Apt ALAR19 3 i. ENG SNTNL 1[:$$ AM TIMES ALHST NONE ALARM 4 E UELTU DELAY 15 gCHp ACT AL 12:1$ AM ALARM 5 OF REPORT DELIU ENABLED TIME1 ACTAL 12~$$ AM RLARM 6 OF REPORT ALRRS ENABLED TIME2 Ar,TAL 12:$$ AM ALARM 7 OF REr^URT TESTY ENABLED TIMES ACTAL NONE RLARM 8 O NO. OF ALARMS P T U T 1d ;CHD ALST ALST 12:U0 pM STD RELR~ ER RIN IN RL 5.0$ TIME1 AM 12:$0 ALARM 1 Oi MODE CHRN 1 NATIVE TIME2 ALST TIMES ALST 12'09 APt . ALARM 2 OI BAUD CHAN 1 12$d $ 99 ALARM 3 Ot DATA 6IT5 1 3 CONFIDENCE . Ci lkf ALARM ~ OP ::TOP BITS 1 1 LEAK TEST . ALARM 5 OP PARITY 1 NONE gCHD TEST LAST DAY ALARM o - Oh ~ECURITV 1 LAST DA~r ALAk.M 7 ON ACCESS 1 TANK 2 ALARM 3 ON F'Hi)NE 1 TI11E TEST 1it99 PM ETD REDIAL 1 DISABLED TRNK 1 11°9$ PM ' RCCcSS 2 TANK 2 ALARM 1 : . U. SUMP PHONE '1 ALARN t S,U.RN.SPRCE REDIAL 2 DISABLED ALARM -rp ALARM 3 R.U. SUMP ACCESS 3 TIMEOU7 ON RLARM 4 R,~J.AN.SPACE PHONE ;;, HIGH LIM OFF ALARM 5 NONE REGiAL 3 DISABLED LOW LIM ON flLARM 5 NONE AC'C'ESS 4 HIGH NI~SN ON RLAP.M 7 NONE PHONE 4 LUIJ LO~.d ON ALARM 6 NONE REDIAL 4 DISABLED WATER LIM ON GIRL DELIU LEAK LIM ON DIAL RLARM SYSFAIL ON DIAL LEAK THEFT SENSOP, TOPE :~ENSOR 1 STD SENSOR c STD SENSOR 3 STD SENSOR 4 STD SENSOR 5 STD SENSOR 6 STD SENSOR 7 STp SENSOR ~ TD CONTROL OUTPUT GRACE PERIOD 0 LUW LOW 1 NONE LOW LOW 2 NONE LOW 1 NONE LO4r ~ NONE HIGH WTR i NONE HIGH WTR c" NONE HIGH ! NGNE HIGH ~ NON£ HFG.H HIGH 1 NONE HIGH HIGH 2 NONE SYSTEM FRIL NONE STG 1 ALL STG 2 ALL STD 3 ALL STD 4 ALL STD 5 ALL STD 6 ALL STD 7 ALL STD 8 RLL • G,T,j. Nc T PRGD LE~,EL ULLAGE rE!'1P_kgTUkr &~ IER LEUE~ TER UGl a~,, ~c ;~: ~~ ~~~AL ~'=.I?E IN 59; c, ~? UArL a ~~ ~ r ~'~'`~ f `' 8y? ItJ r`•1 GAL GNE STOP `I02 .g, 4HES ~AR7'. SAKERSFIELD, TER SITE # 805 83.S-G ~¢ c4 INUENTGR,~, PEP AT 9 +~:~ G'fs.'[15~. r?14,5 GAL i1LLyGE -L !_7.5" SAL ~-t~T PEkA1'G.RE 68~ q, d SAL WATER UGL EL 1 47~j 2 F ~6' 4 GAL ~ 3c~~a ~- ONE STOP MOBIL MART. 402 5. CHESTER BAKERSFIELD: CA. 33'x%34 SITE # 805 535-9544 7~28i2G~s6 09:ict AM INUENTGR4~ REPORT TANK N0. 2 i'26~]0 GAL UNLEADED REG GP,OSS 4940.8 GAL NET 4787.7 GAL ULLAGE 5910.6 GAL TEi1PERATURE 103.735 F WATER LEUEL 2.897 IN ~dATER UOL 77.1 GAL ONE STOP MOBIL MART. 402 S. CHESTER BAKERSFIELG~ CA. 9304 SITE # 805 835-9544 7~28i2006 09:19 AM ALARM HISTUP,V REPORT 6~29i200b 05:50 aM POWER UP 7ii5i2006 05:31 AM LOW LIMIT TANK N0. 1 7i15i2006 08:55 Ph' LUlJ U)W ; TANK N0. 1 7f2?~2006 12:29 PP LOW LIMIT TANK NO. i 7i28i2006 08:40 AI S.U.AN.SPACE 7i28i2905 08:43 A SrU.RN.SPACE 7i2B~200b 08:50 A R.U.AN.SPACE 7i28i2506 0$:50 F R. U. Atd, SFACE 7~25i~096 09:51 E R.U. SUMP 7.2812006 08:51 E S.U. SUMP l 3~c ~ MONITOR CERT. FAILURE REPORT SITE NAME: ~u % ~- DATE: - 0 ~ . ADDRESS ~a i ~~, cN ~,~r Fig, At~f TECHIVicIAN• ~'~ fit; E..u o~E___ RT -_ THE. FOLLOWING COMPONENTS WERE REPLACED/REPAII2ED TO COMPLETE TESTING. REPAIRS ~r~ .~/ ~ LABOR• itJC~N E PARTS INTALLED: ~/G ,vE NAME: TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTiFYIIV'G TAE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR TAE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIItONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENAI:TIES OCCURING FROM NON-COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON-SITE FOR YOUR CONVIENENCE. t a ~a~ -~ SWRCB, January 200b Spill Buckef Testing Reporf Form This form is intended for use by contractors performing annual testing of UST spU/ containment structures. The completed form aril. printouts from,tests (if applicable), should be provided to the facility.owner/operatarfor submittal.to the local regulatory agency. ~ ~ r•rr .rrv TNRnRMeTT[)11T Facility Name: ~v~ +~ C~~ -- - ----- DateofTesting: $-C)• Facility Address: o` G 1{ E T E U E • Facility Contact: Phone: Date Local Agency Was Notified of Testing ; : ~ • Name of Local Agency Inspector (tfpresent during testfngj: TTe'CTINr C''nNTR A ('T[1R INFORMATION Com any Name; LGH ~ E .v UI aN - L .Technician Conducting Test: S I r J 1r'N O ~R ! Credentisis~: CSLB Contractor ICC Service Tech. WRCB ester Other ( ecify) License Number(s): CERTIFICATION OF' TECHNICIAN RX;SPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all tha information contained in this report is true, accurate; and in full compliance with legal requirements Technician's Signature: Date:_ 7 ` p1 8 ^~to 'State laws and reguiations do not ctureatly require testing to be performed by a qualified contractor. However, Focal requiretaeats may ag tnOrC atrinECnt. ~-u~untears _ (tnctuae tnlormatton on repairs made prior to testing and recommended follow~up for ailed tests) l v iC~ /o~ `~-~-~ SB989 TESTING FAIL SITE NAIL: ~L REPORT DATE: -~~* F5'fE~ AuE TEC •H ADDRESS; $G I s, c zclArr: Tr vE'.~ c~8£~° ~ h CITY: ~?4 E F~~LY• sI NATURE: SITE CONTACT: THE FOLLOWING COMPONENT3 WERE REPLACED/REPAI TESTING, LIST OF PARTS REPLACED/REPAIRED: REPAIRS: ~D ~ D TO COMPLETE THE 58989 LABOR: ~ E PARTS INSTALLED; r. ~~~~~ UNDERGROUND STORAGE TANKS APPLICATION 70 PERFORM ELD! LINE TESTING ! SB989 SECONDARY CONTAINMENT TESTINQ IFANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAKERSFIELD FARE DEPT. . ~f~~ Prevention Services A1~TI ! 9001Yuxtun Ave., Ste. 210 ~- Bakersfield, CA 93301 Tel.: (661) 32b-3979 Fax: (661j 852-2171 Pale 1 of 1 PERMlr NO. ^^ ENHANCED LEAK DETECTION ~{ ~.,_ ^ SB-B89 SECONDARY CONigINMEN7 TESTING 1 1 TA NIf TIR4RNFGC TC~ iN TA DFRCARSR FI ICI AAA NfTARINC~ f`FRTIFII".IIT14N FACILITY NAME 8 PHONE NUMBER Of CONTACT PERSON ADDRESS OWNERS NAME OPERATORS NAME ~ PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED ~ ~ ~ o -~INZ ~ - TANF(.,E871N0 COM?ANY ,. ... NAME OF RTING COMPANY NAME b PHONE NUMBER OF CONTACT AERSON f'o MAILING ADDRESS ~~ NAME ~ PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR C TIFICATION /: DATE ~ TIME TEST TO BE CONDUCTED • C7 C1~ ICC q: TEST METHOD SIGNATURE OF APPLICAN ~-U~ DATE -APPROVED BY DATE FD 2095 (Rev. 08/Ob) BILLING & PERMIT STATEMENT r~~s PERMIT NO.: ARrM r :.r~._ ~~ BAKERSFIELD FIRE Preaention Services 900 'Tn~xcun Avenue, Suite a I0 $ekersHeld, CA 93301 T.1 • Irftl Q7(wA070 R 1^iar rfirill f2K7-7171 e ' • LOCATION OF PROPErtrY 01AINER . srARTNpOATE, oA (/ NAMe Dv~IL 5 i Y'? PROJECT NAME A~oRESS S. PHONeNa PROJECraooRess ~~~ ~ . cnY ~ ware zlPcooe 3~Q • e• •- • C.ONrRACTOR NAME CA LICENSE N0. TYPE OF LICOlSE EXPRATI(?N DATE PHONE NQ OONTRACTOR ANY r ~ FA7t N0. ~ -a~~ mss ~ ~ (~ f ~ ~ r3 G ~ ^ Alarms -New & Modifications - (IVGnlmum Charge} $2fi2 50 e ~ . 98 • p Over 20 000 Sq FL Sq 013125 = Permit fi3e FL x ~ , . . . 98 ^ Sprinklers -New 8 Modifications - (Minimum Char e) $210 00 ~ . g . 98 ^ Over 5 FL S FL x 042 =Permit fee 000 Sq ~ . , . q. 98 ^ Minor Sprinkler Modifications (< 70 heads) $ 93 00 pnspedion Onty] ~ . 98 ^ Commercial Hoods -New & Modifications $ 398 26 ~ . 98 ^ AddTtloga! Hoods S 36 00 ~ . 98 ^ Spray Booths -New & Modifications $458 00 ~ . 98 ^ round Store a Tanks (lrutalAatfonAnsp.-1' Time) $165.00 ~ ^ Addltlona! Tanks 2 26.00 82 ^ Aboveground Storage Tanks (RemovaNnspedJon) $109.00 ~ ^ Underground Storage Tanks (lnsta/latlorlllnspecUonj $878.00 (pertank) ~ ^ Underground Storage Tanks {Modfication) $878.00 (per site) ~ ^ Underground Storage Tanks (MinorModificaHpn) $155.00 ~ ^ Underground Storage Tanks (Removal} $675.00 (pertank} 84 ^ OiiweU pnstaliatlon) $72.00 ~ Mandated Leak Detection esGng) I Fuel Mond. ~ $ 81.00 (perslte) ~ O Tents $93.00 (pertenfj ~ ^ After hours inspection fee X122.00 ~ ^ technic - {Per event, Pius Insp. Fee ~ $90 per hour) $ 60.00 + (5 tire. min, stand -by fee AnspeWon} _ $510.00 84 ^ RL~INSPECTlON{S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) ~ ^ Portable LPG (Propane): NO.OF CAGES? ~ $66.00 ~ ^ ive Storage $249.00 ~ ^ Cop ' & File Research (F8e Research Fee x33.00 per hr) 25¢ per page ~ ^ Miscellaneous , ~ FD 2021 (Rev. 09!05) a 1 - OR101NA1. YVFttT'E (to Traasaury) 1-1'HLLOw (to Flle) i•AINK (to customer, . _ .~ L i ~~_~" MONITOI~NG S'YSTE1`~I CERTIFICATION _ For Use By.4ll Jurisdictions Yf~ithin the State of California Authority Cite& Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations This form must be used to document testing and servicing oflnonitoring equipment. A separate certification or report must be prepare for each monitorin s~ysteim 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 muse submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: O~~ v"~UP ma3~Tt_ Bidg. No.: Site Address: ~U~ S r" NF~T~ 2 F1vE, _ City: = Zlp: Facility Contact Person: Contact Phone No.: ( ) Make/Model. of Monitoring System: ~^~ ~ "~ Date of Testing/Servicing: ~/.~~/~ B. Inventory of equipment Tested/Certified INSPECTOR ON-SITE Ea NO NAME:ST~yi/ ~~'~"~(z~o (`6..rL r!.^ •. :ar^ F.....,.. rn A,rtiratP mPrifir ern~inment imnecYeri/serviced• Tank IU: _ ~~~ Tank ID ' QED ~, (n-Tank Gauging Probe. Model: ~./~Ct- r• , ^ In-Tank Gauging Probe. Model: ,_ ~ Ct~ ~l Annular Space or Vault Sensor. Model: Lj^ ,~ - ^ Annular Space or Vault Sensor. Model: j,~- 3 Z `~'-,~ ® Piping Sump /Trench Sensor(s). Model: ^ Piping Sump /Trench Sensor(s). Model: LS - ,~ ^ Fill SLUnp Sensor(s). Model: ^ Fill Sump Sensor(s). Model: __ ~. Mechanical Line Leak Detector. Model: ~~i~WG1eE.T ^ Mechanical Line Leak Detector. Model: ~E~ L2~-KE,T ^ Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ^ Tank Overf Il /High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: O Other (s ecif e ui ment a and mode! in Section E on Pa e 2). ^ Other (s ecif a ui ment a and model in Section E on Pa a 2). Tauk [1): Tarok ID: ^ In-Tank Cauging Probe. Model: CI In-Tank Gauging Probe. Model; O Annular Space or Vault Sensor. Model: ^ Annular Space or Vault Sensor. Model: ^ Piping Sump/ Trench Sensor(s). Model: ^ Piping Sump /Trench Sensor(s). Model: O Fiil Sump Sensor(s). Model: ^ Fill Suntp Sensor(s). Model: t7 Mechanical Line Leak Detector. Model: ^ Mechanical Line Leak Detector, Model: ^ Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector, Model: ^ Tank Overfill /High-Level Sensor. Moc}el: ^ Tank Ove~l1 /High-Level Sensor. Model: ^ Other (specify equipment type and model in Section E on Page 2). ^ Other (specify equipment type and mode! in Section E on Page 2). Dispenser 1D: ! - Dispenser ID; L~- L1 ~ Dispenser Containment Sensor(s). Model: _ E~"~ I?_EAJ ~ Dispenser Containment Sensor(s). Model; ,~~~ UA i2~y L~l Shear Valve(s). ~ Shear Valve(s). ' ^ Dis enser Containment Floats and Chain s). ^Dis enser Containment Floats and Chains . DispenserlD: DispenserlD: _ Dispenser Containtnent Sensor(s). tvfodel: Q Dispenser Containment Sensor(s). Model: fl Shear valve(s). [I Shear Valve(s). ^ Dispenser Containment Float(s) and Chain(s). ^Dis enser Containment Floats and Chains . ~ Dispenser 1D: Dispenser [D: i ^ Dispenser Containment Sensor(s). Model: ^ Dispenser Contaimnent Sensor(s). Model: ~ Shear Valve(s). ^ Shear Valves}. ^Dis enser Containment Float(s) and Chain(s). D Dis enser Containment Floats and Chain(s). tt the rtctlity contains more tanks or dispensers, copy this form. include information for every tank and dispenser at the facility. C. Certification - t certify that the equipment identiCed in tltIs document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to ibis Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, t have also attached a copy of the report; (check all that apply): ~ System set-up ~ Alarm Itistory report Technician Name {print):~j(Z[a.J'p~.~) /J'~P4~,c.~..1 ~ Signature: =----- Ccrtitication No_: ' aq~~'7o1~ 7 (p0 License. No.: ~~3~o}~p - y~ ~` ^ Testing Company Name: RICH ENVIRONMENTAL Phone No.:.~ 661 ~ 392-86~ Site Address: r-(U~ ~, ..r 1-lE,~i E,Q At/ F ~~lc~g~,F~r~a~y Date of Testing/Servicing; ~/~/~ Page I of 3 03101 Monitoring System Certification D. Resu]ts of Testing/Servicing Software Version installed: O 9 41U ~.. ..1~.., .~~ ~„~~„ „tio,.Uic~,. ~,. V 111 I G l l~ 111 4~ ~ Yes ^ o is the audible alarm o erational? ~ Yes O o Is the visual alarm operational? ~- Yes ^ ° Were all sensors visually ins ected, functionally tested, and confn-ned a erational? ~ Yes O o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ^ Yes . ^ o If alarms are relayed to a remote monitoring station, is al] communications equipment (e.g. modem) ~J. N/A operational? ~- Yes ^ o For pressurized piping systeiros, does the turbine automatically shut down if the piping secondary containment ^ N/A monitoringsystein detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) jt~-Sump/Trench Sensors; ^ Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ~ Yes; O No. CI Yes ^ o 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 alatTn visible and audible at the tank fill point(s) and operatin properly? If so, at what percent of tank capacity does the alarm tri ger? ^ es ~No Was any monitoring equipment replaced? Ifyes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. ^ es ~-No Was liquid found inside any secondary.containment systems designed as dry systems? (Check al! that apply) ^ Product; d Water. If es, describe causes in Section E below. Yes D o 1~/as monitorin s stein set-u reviewed to ensure ro er settin s?Attach set u re oris, if a licable ,S~--Yes ^ o Is all monitoring equipment operational per manufacturer's specifications? '~ In Section C below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 oF3 03101 ~~ ..In= I'~rik Gauging /SIR Equipment: ~ Check this bax 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. • ~-1~- ~V111 Il.l{ O Yes . l1JY 1VIlV. d o Has al! input wiring been inspected for proper entry and termination, including testing for ground faults? O Yes © o Were all tank gauging probes visually inspected for damage and residue buildup? O Yes ^ ° Was accuracy of system product level readings tested? G Yes ^ o Was accuracy of system water level readings tested? O Ycs ^ o Were all probes reinstalled properly? O Yes O o Were all items on the equipment manufacturer's maintenance checklist completed? In i1,e Jeer,oa h, DC10W, Q0SCr1Ue JIOWsl,lU lYl,ru u1CSC UC„cJCUC,e~,rvc+c ~/ wn, vc w~JCa.~a-a+. G. Line Leak Detectors (LLD): O Check this box if LLDs are not installed. ('nnJnlntn ,hn fnllnwina rhnrl[licf• -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: ~; g,p.h., 0 0. I g,p.h , 0 0.2 g.p.h. >~ Yes ^ o Were all LLDs confirmed operatioria! and accurate within regulatory requirements? ~l Yes ^ o Was the testing apparatus properly calibrated? ~ Yes ^ o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? o wA ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if the LLD detects a Leak? .~. N/A O Yes O ° For electrol~ic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled $~ N/A or disconnected? O Yes O o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfi,nctions ~ N/A or faits a test? O Yes O o For electronic LLDs, have ail accessible wiring connections been visually inspected? N/A ,~- Ycs ^ o Were all items on the equipment manufacturer's maintenance checklist completed? .,, 1,11: JGCLIVH ~, ue,~w, uesc,,ue „vw t,na tv„eu ulese ae~,c,enc,es were or wui ue correcrea. I~. Comments: Page 3 of 3 Q3101 •Monitoring System Cerfificaitlon Farm: Addendum for VacuuinlPressure Interstitial Sensors Y, Results of Vacuum/Pressure Monitoring Equipment Testing LG 163-1, Enc. D This page should be used to document testing and servicing of vacuum and pressure interstitaal sensors. A copy of this form must be included with the Monitoring System Certification Force, whichmust be••provided to the tank system owner/operator. The owner/operator must,subtnit a copy of the Monitoring System Certification Form to the local agency regulating U'ST systems within 30 days of test date: Model: System Type: Pressure; ~ Vacuum Manufacturer: •Sensor ID • Component(i) Monitored by this Senror: Scasor Functionality Test Result: ^ Pass; ,^ Fail Intcretitial Communication Test Result: ^ Pass; ^ Fail Compozlent(c) Monitored by this Sensor:• ScnsorFunctianality Test Result: ^ Pass;' ~^ Fail Intrxstitial Cotnanunicatiosz TestRcsult: ^ Pass; ^ Fait Componettt(s)Monitored by this Sensor: • Sensor Functionality Test Result: (~ Pass; ^ Fail 7ntcrstitial Communication Test Result: ^ Pasr, ^ Fail Component(s) Monitored by this Sensor: • ScasorFunetiona3ity Test Result: ^ Pass; ^ Fail Xnte,Fatitial Communication TestRcsult: ^ Pass; ^ Fail ' Components} 31-Ionitored by thlr Senror: Sensor Functionality Test Rcsu]t; ^ Pass; ^ Fai! Tuferstitial Communication Test Result: []Pass; [J Fail Corttponent(s) Monitored by tbir.Sensor: ~ • Sensor Functionality Test Result: ^ Pass; ^ Fail Interstitial Commuzticstion Test Result: ^ Pass; ^ Fail Component(s) Monitored by~this Sensor: • Sensor Functionality Test Result: ^ Pass; ^ Fail Xntesstitial Communication Test Result: ^ Pass; [,~ Fail Component(s) Monitored by tblr Sensor: • SensarFunctionaIity Test Result: ^ Pass; ^ Fail .Interstitial Goznmuuieat~ionTest Result: ^ Pass; ^ Fail Component(s) Monitored by this Seuror: ' Sensor Functionality Test Result: ^ Pass; ^ Fail ~ Interstitial Coznrnunicatzon Test Result: [,]Pass; ^ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; [~ Fail Interstitial Couu7aunication Test Result: ^ Pass; ^ Fail IIow war fntersfttial communicaffon verified? .^ I,eaklntroduced•atFarEndofIntcrstitialSpace;i ^ Gauge; ^ Visuallus ection• p .^ Otbcr (Describe ~ Sec. /, below) 'Vacuum war rertored to operating levels in ull interstitial spacer: ^ yes. ^ No (~f'nn, describe in Sec. J, below) J. Comments: ~ ~ G • .~,J Page of • ~ If the Sensor successfully detects a simulated. vaeuum/pressure Ieuk introduced in the interstitial space at tho furthest paint from the sensor, vacuutn/pressurc bas been demonstrated to be conununicating throughout the interstice. onitoring System Certification UST Monitoring Site Plan Site Address: ------- tl -- ----- -------- -- ---------------- - ------ -O -- -----'---------- --- ---------------- ----- -~--Z --- -~ ------------------------------ fi Date map was drawn; 7 /~/~ Inr'~uctions -.~ If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. 4n 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 Iuie leak detectors; and in-tank liquid Ieve) probes (if used for leak detection). In the space provided, note the date this Site Pian was prepared. Page Ll of ~ osioo ~/ 5s~3 a~,aa~s etr ,GEk~Sk'~$.~D,CA.s3~48 OFk'~C~ (561} 392-86$7 & ~`A~ {6b1) 3A~~fl6a3 &IEGFLz~NrCAZ L~'h~ 'fL'n~`CTOR ~'E~T W/0#t Fae:(.~.i~y' ~Tam~ ~ ©~' E. ScoP I`-'~U~TL Faa J.J.Q. ~~ ,A.ddr~~s : ~-1ca Px'gc;luc~ ~,3rxe Tie tFxessuxe, Suct.iozz, Qx~av~.~y7y~ -~ ~'R(:-AUCT T,E.AK p~TECTI~R T~'.~'R 'SE''$T TR2$ PASS. B~.RI.A~ ~IC3z~a~R ~~IaOW PSG QR x.fA x'"~°.PR ,QED uf}CK-~~ C ,as ~ ~ 7 . s~z~zA.~ # y ?.i ~ z~a 'a JAZZ; . _. L/.A `x'XF,EJ~EI~ s~AC.k-~T 8A Q I !. ST~tT~~ #, .,.-._7! ~ ~ ,. APO 1 `1 C~ FATLY _ L/D TY'P~_ ,~ YPS PASS' S~R~.F L, ~„_. _ , kIQ FAIL Z,,/J~ TY'B~__,___~._._.~ 'aC~S PASS' S~F~.T.~1..L #~,. bT4 F.A.IL; Z ::ertify tl~.e abova tests wexe aonductec3 on this da~o aaaoxdix~g ~p Red ,;taaket k~umps field teat apps.xatus Cest9.ng pxo.cedttz~e axa limitaZlQnA, ~tt~:s Mechanical I,eaJc APtect.ar. .Vest pass / fa.~l is detexmined bx u~~,ng a lcr~a flew thxesl~.aJ.~l trip rate of 3 ga.llox~-per k~eur ar ~,ess at 1A ~SZ. I •~cknawledr~e Lhat a].I data eo].leo>=ed ire .true a.xlc4 QoxxAoC ~a the bent o:f rrf~ knowledge . xech : ~_^f ~ ^f _.~~~ sigz~.e~ture : `~ ---~-_-_._ pat®: 7„~~ - ~~ ~. SWRCB, January 20~ Spill~Sucket Testing Report Form 'This form is fntended for use by contractors perfornFing annual testi~ig of UST spill containment structures. •The completed fornr a~ pn~etoutsfrom.tests (:fapplicableJ, should be provided to thefacilty~o~mer/operatorforsubmittal.to the local regulatory agency. • 't _ ~ FA CrLI'I'Y Il~'ORMAfiIO1V Facility Name: p,-1~ a - -- ---- Date ofTtsting: -- - . Facility Address: Gtv ~ ~ ti EiZ - - Facility Contact: hone: Date Local Agency Was Notified of Testing :: Name oflocal ggencyinspectar (4fpresent during testing}: ~- ~ . U~ D 2. TESTING CON'iRACTOR INFORMATION Company Name: i2- K ~T ~- .. . .Technician ConductingTest:3/--~"f~~ fi u^l - Credentialst; CSLB Contractor„ ICC Service ec ~ SWRCB TankTesier. Othac ( ec~) License Number(s): ~,3.g ~ g -g3 G - v_ % -__ ' 3. SPILL BUCKET TESTING INFORMATION Test dviethod Used: 9 Vacuum Other Test Equipment Used: ~(-~~~~l-Al,.. ~. Fquipment Resolution: Identify Spill Bucket (ByTank Number, Stored Product, etc. Y ~ ~ 2 7 ~ 3 4 Bucket Installation Type: D'u. eet B ~ Containe in Svm irect . ury ' - Contained in Sum Direct. Bury. Contained in Sum Direet gory Contained in Sum J3uckct Diameter. ~ ' ~ ~ " ~ . Bucket Depth: ~,,. /~y`~ Wait time between applying vacuumlwaicr and start of test: ~U ~T' n.1 ~ ~~ Test Start Time (T~: / "3 o PM ~ /' C7 ~ M Initial Reading (R~; 9 ~~ ~ „ . e s T t EndT e {TF): 's m UPM ~: o P~ ~ ~ ~ t y~ _ / p Fuial Reading {Rtr). 9 r ~ t r Test Duration (Tp - T~: y'(L. '. Chnngc in lteadiag ('Rr - RI): d ~ ` ~ < < Pass/Fad Threshold or Criteria: ~ ~~ ~ Gg ~ ` . • Comments - include Information on repairs made prior to testing, and recommended follo~o~ailed tests1 .,, CERTIFICATION OF TJECIBNICL4.N RESPONSIBLE FOR CONDUCTIN G THIS TESTIIVG I hereby certify that all [he tnformatson contained in this report u true, accurati; and In full compliance with legal requirements. Technician's Signature: ~ Date' ~'c~~ 7 ,-- :~ 'State laws and regulations do not currently require testing to be performed by a qualiSca contr%ctor. However, locnt requirements maybe mOrG stringent. t ~CNi~ it•{UT;~' hauNE STJ Kt_"t~__. _.--- - - -- -- - • -•;?Ey Ihal~Ta 1 t: {J~ APi ALH~i'? 1 _I rd _~.?E '_~-,rl.. n?ilE.iL rnA4~. _IP?t2 I~UTn i`';el~J AP1 n ~_ `'-rn_,4~ ~' ~!~ ~• !~. i i!'IEJ INUTR LL: ~~ A19 ' !IF•a 3'~" ALAR~'1 'H.-, f L ~1 5_`J'J '7':j-~~~I '~•>~ `T JCHIi ii''URC !~Q~aE ~ ~ ALAI?P? ~k IJrti .Ii'tEl. I~vURG' '!2:6~`~ Ar9 A'~A^~~? 5 UrJ TI(1ci i!tiURC 22: 0~3 AM ~ ,? ~ ~,'I d h ~ :__iV_1i' t_ij: c~:~,..pl,i t r ~ r ~I-H'~~ .. _f. r . !,^E;; aNE1R!: 11, ~~Fj AM ALAR'ri ? u~l =''i°= .._.. ~T.L.j G' ~~~li~ f~a'IV 41L' ST ~ -: -f ~#OIJE ALARi'1 ;; IJN TIt9Ei ~! NST i2: F7Ei AM i;'-,i,q}.~;_ ;~r_ ~!J~J ~:'. ~~-,1~'" .j Ti,ME: i~! H$T 2:~L? Ai? -..•~ i ~ I ial , Ilu + ~;~ 1 ~~ ahl~ H'~WRP? 1 ~. L . 'F _ H _ - :! r-,'I_'+J HL~1~T F•a[ff'~ I !' _ ~ ~. 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CH EAY,Er`tSFIELfr, ESTER GA 9394 eAKERC'~FIELD~ CA . 9339 4 ~;~i};Fr^^,S~iEL~~~ CA. 933~:i4 SITE # 9Q5 v . 35-9544 SITE # 2si5 '~35 -`?5~#~r giTE' ~ tj5 'c'.~5-9544 7`23/2997 Gt4: i_sS Phl 7.: __ 7rit,7 :'':,.. 114:92 Pt'1 7:23r2t7C+7 ,~,- TAP?K o°T'1.4P ~J4: Fi3 Pt4 r RcPURT ALAt2P1 HIST+~R4` ~:EF'iJFT T~i~; SETIIF' ,°- i_T h_~~;E TAN'f. f>iC+. 2 i2Q00 GAL ?/3/2+3C17 [18:15 P~^t yr.;t-: .;~.i, 8ciyt0 GRL UNLEADEf~ PEG PUGIER DOb1h,' UNL Eui;ED SUP TANK T~~PE 3O11R TANKS 7%3i213G37 Et9:41 F'f~ T ih?~:. i'•;'i'E 370R Tflt•?Y:S i fl tti Y. D?f4L~ i # 1, 5}~ 255. S P04?ER UP j FlrY i'Tr'iC, 111.5 ~ 191 ~tL L TANf~ "IZC 120E~9 ;A4?r''. :~~i7E SQQF7 TANK SHAPE GVLINGER 7i 13%2UQ7 Cs8:9~# Af4 'iNiy}; ~~HAPE C~'LI!~DER DIAMETER 111 59 LO4! LIf4IT I Af'tE''En: 111 • SG LENGTH , 2S° 5© v TAt•?K N+J. 2 ~ci,8`H :"i•!s0 PRODUC'T Uh? LEflDED FtEG -'H:~I~ii~l: _~ i`!LCADiC.D SUP r. OFr3ET P - ~} ~c ! f~`23/2ti997 U2: s31 Pi't ~~~ ` ='t T ~' 1 `~' y - UFFSET lu .L. 2.25 N.U. $Uh1P ~~r ~ =~E i bi t~' y l ~tAr'? I FC!LD NIIP?E h[A;diP~:i'~G NONE PROBE STP 113 '23~'2CsCt' tj2:Y~' F'i4 pR.iaF;r STii 1;.3 FLOATg 2 S.U. SUt9P ~LOAT~=~ ~ FLOAT T'•fPE GASOLIP?E i T T,;~PE r%__'~Fi +~ASGLItiE Ij~(~DIkNT r x.9731 r/2~{/2UFJZ '~2:~53 Gi^ i~Rr-ti,IFtCT 8.9G33 C;- ~~ T 11' L.U.AN.~PA+~E _~~:a_OR L"c:J6TH 113 HIGH Lit'1IT 99,!313 K~uN. !.1"i:iT 9a.t_s6 Luo1 LIMIT 535.QQ 7,23r20~:i7 132:133 ~'1 L;j;,} i_if~tlT 358.ks0 HIGH HIGH 1ki2.QF} R. U.At•?.'PAC'E -;I+~ri HIi~`? '~Q=~~~ LGW i_UW 252.Q4~ L~~~td Li~I!I 163. G9 I,}ATER LIf9IT 4.99 7/23/2007 ~~2:~:1 PM ':tiHTtR L iliiT ~.~~ TEt4P CUt9P RPI 6B/546 s{. U. ~:LIfAG TEr1P. CCIC'1P API 66/`46 API GRA!)IT4' 63,54 . API +~Rfl«I T `,' 51.30 ALPHA 320, c~j w"' 7/23/2997 92:28 PM ALr'H`i 32Ci. 0Q" tti(]. RTDS ~ ~. il. UIJi~~ ttCi, ~?TC:~3 5 RTD LDC 1 12, 9Q -"~Tp ~_+~~' 1 ' 2.90 RTD LOC: 2 34, 80 7f;23/2:9Ci7 ©: S2 FM RTC LO+: ~~ 34.86 RTD ua+~ 3 51,6C+ R. U. SUMP RTD LOG ti, ;1.60 RTC} LDC 4 68,10 ,:;T{; L!iC a 68.13 RTD Li]C 5 86,90 f•'7; LOC 5 86.90 STRAPPIhtG DATA '=~?RAPPI^?i~ ~~ATA ItarHE., rf~LLC!N5 0.0 y~, j S, ct+_iri 128,4 IQ,Qiti~ 484.7 1.r , x1.11.1 .58,.1 15.00b `877.b 1_ .~, i~s1.1:_1 r4,~' 4 'c'Q. ~9~ta 7T( 9 1~~ a . 213. Ci1j11 yl?~. ~ 25. C~01.~ 1831.4 ~~. ~tLiks :~.;. 1353.2 39.00@ 2359 9 3~1, ~~ksri 1 ZS'3:4 ...s~ 35. G39€t . 2935 9 .-_VG4..,4s;+_r+~,-,a+...+,- - ~ ......t~.1~a„y:::- 4N.t~C~9 . ) X525 1 4Ci, CtCiCj ::604.7' 45. 6F~0 . 4131 1 Y5,13;.16 30152.4 SO,I'390 , 4748 9 _,~.i , a.i_it_r 35[18: 2 55.60313 . 5376 7 .;5, CsCi~=t 3968.3 60.006 . 5994 I r~~i. L_sl_i11 442$.9 65. QriQ . 6E13 3 „__,, ,_ii~ci 4Y85.4 7"•060 . 7'?23 Q l_t . l~><i l_1 5335.9 7 5 . Q l~ ~j . 7817 9 7 5ti b3C'y?. 5776.5 80.0CiE~ , ~~? 83 _~F~.1~r!~i 62~i8.8 85. a0~i , ~{ 8939 4 ~,5. Ea~30 ~ 6br5. I 90.9013 . 9451 9 913, +_ss:sCi -' 5983.8 y5.0Es0 . 9920 b '?5., Ct%iK3 7330.1 190.9 66 . 19.,3? 4 1 Csi3, inlia 7b35, 1 1Es5,9C~Q , 10572 0 lc;,:_~1;+1.1 1S +_ , 13410 78x5.3 8Gi53.6 i 10.0G.}(3 . 1Q899, 7 Oh{E STOF h106IL MAkT. ONE STOF MOE~IL .MART. 46:' :;. CHESTEP, 462 S. C:HESTEk BAKERSFIELD ~ CA. 93364 BAKEkSFIELD, CA. 9?,3~=+4 SITE # 365 C~s35-4544 SITE # 265 035-9544 7i23f24]67 64: rjb Ptq 7~23i2667 64: 67 PM LEAK TEST REPORT LEAK TE'?,T REPOkT TAh{K NO. 1 86G~Cr C;qL TANK NO. 2 12666 GAL Ilfsl EARED SUP ~ UNLEADED kEG BEAK TEST 6. 1G~6 G.fH LEAK TEST Q. 1536 G•'H LEAK THRESHOL ` D 6.656 GfH LEAK THRESHOLD ©.656 G•'H ~ CONFIDENCE LE F.rEL 99,43 CONFICENCE LEVEL 99.6': _.-.. TEST STARTED 11:66 PM TEST STARTED 1i~66 PM TEST STARTED 6b~36f2667 TEST STARTED 6b~36i2667 LAST DELIrrERY ;: 4b pM LAST DELIVERS' 5:45 PM LAST DELIVERY 66~29~2667 LAST DELIVERY 66i29f2667 GROSS CAPAC ITY 18 82 ~. GROSS CAPAC ITY 53.92 BEGIN GROSS . 1519.3 GAL BEGIhf GROSS 5393.6 GAL BEr,IN NET 1491.3 GAL GE6IN NET 5756.2 GAL BEGIN LEVEL 27.459 IN BEGIN LEVEL 59,865 IN BEGIN TEMP gg,572 F SEGIfd TE"1P 94.256 F BEGIN WATEk 2b.1 9AL `~~'BEGih{ WATER 7b.9 GAL BEGIN (dATER 1.726 IN BEGIN MATER 2.393 IN END TFME 1:59 Af9 END TIt9E b:59 AM END DATE y+7:~61f2667 END DATE 6761:266' END GROSS 1519.5 C,pL END GROSS 5295.4 GAL END NET 141,4 r;AL END NET 5749.6 CpL .. EtJD LEVEL '~7, 451 Ih{ END LEr.+EL J9.225 IN END TEMP $9,55F F END TEMP 95.697 F ENG WATER 26.1 r;AL END WATER 77.6 GAL ENG .IdATEk 1.726 IN END MATER 2.893 IN HOURLY DATA TIP1E GEG F GAL 11:59 Pt4 59.561 151?. 42 12:59 iahi $9.558 1517.52 1:59 AM 39,55b 1517: 5b SLOPE k~.67 GALfHR SLOPE LOW 0.06 GALjHR '.' SLOPE HIGH 0.67 GALIHR .~~~ TEST kESULT$ INCREASE SLOPE Er~LfALS CALCULATED LEAK RATE HOURLY DATA TIh1E DEG F l 1 ~ 59 Pt4 54.376 12.59 At4 54.476 159 AM 94.554 2:59 At9 94. b87 359 AM 94.792 4:59 At9 94.393 5:59 At9 94.99b 659 AM 95.697 GAL 5227.64 582b.92 522f~. 91 522b.35 522b.S1 5226. Q4 5325.66 5825.'9 SLOPE -~3~:16 GAL rHF' SIOFE LOW -E~.16 GAL~HR ~':. SLOPE HIGH -6.1b GALJHF.' TEST RESULTS FAILED SLOPE E!~UALS; CALCULATED LEAK RATE y=~;~: ~S;•~'!, .. ;QN~TOR CERT: Q..,L;fRE REPORT SI'Z'E 1VAME: O ~ C- 5~ P rn o 8~- ~- DATE: 7- ~ -U~ ADDRESS- `'1 G S 5 c N E ~. ~ ~ A~ E TECHI~IICTAN: ~ ~Anl ~ ~_ AEG ^~ CITY ~3H ~ ~ G ~ E~~ SIGN~TURE~ ~----~" .-~---~__ - THE~ROLLOWING COMPONENTS WERE REPLACEDIREPAIRED TO COMPLETE TESTING. REPAIRS: NU N" ~ LABOR: ~ U~~ PARTS'FNTALLED: /~ C~ ~1 c . NAME:. TITLE: THE ABOVE NAMED PERSON TAKES FITLL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR T$E AIlOVE LISTED PROBLEMS AND NOT'IF'YING RICH ENVIIZONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURTNG FROM NON-COMPLIANCE. A COPY'OF THIS DOCUMENT H,A5 BEEN LEFT ON-SITE FOR YOUR CONVIENENCE. . e , ~'^ BAKERSFIELD FIRE DEPT. BILLING & PERMIT STATEMENT -~- e~ ~' E R S F~ ~~~. D Prevention Services f. .~- _ -~srars -- '' °' ~"`_ ~~- 1600 Truxtun Ave Ste 401 D~rIPAR TMET PERMIT NO.: T T -0571 'tl°,Ep;, =, , ~ Bakersfield CA 93301 r` Tel.: (661) 326-3979 • Fax: (661) 852-2171 • LOCATfONOFPROJECT 402 S CHESTER AVE - ~ • PROPERTY OWNER ONE STOP MOBIL STARTING DATE COMPLETION DATE G/1907 1 OAM NAME GIL PROJECT NAME ADDRESS PHONE NO. 835-9544 PROJECT ADDRESS CITY BAKERSFIELD STATE CA zlPCODE 93301 •• CONTRACTOR NAME JAMES RICH CA LICENSE NO. 809850 •- • TYPE OF LICENSE. EXPIRATION DATE PHONE NO. 392-8687 CONTRACTORCOMPANYNAME RICH ENVIRONMENTAL FAXNO.392-0621 ADDRESS 5643 BROOKS CT CITY BAKERSFIELD ZIP CODE 93308 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. ^ u ^ 00 , ^ e) $280 ^ Alarms -New & Modifications - (Minimum Char • • 84 • g . ^ 98 Over 10 000 Sq Ft Ft x 028 =Permit fee Sq se ^ , . . . . ~ ^ Sprinklers -New & Modifications - (Minimum Char e) $280 00 ^ 84 g . ^ 98 ^ Over 10 Ft 000 Sq Ft x 028 =Permit fee Sq ^ 8a , . . . . ^ 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 96.00 [Inspection Only] ^ 84 ^ 98 ^ Commercial Hoods -New & Modifications $ 470 00 8a . ^ ^ 98 ^ Additional Hoods $ 58.00 ; 84 ss ^ Spray Booths -New & Modifications $470 00 : 84 . ^ 98 ^ Aboveground Storage Tanks (Installationllnsp.-t~ Time) $180.00 : 82 ^ Additional Tanks $ 96.00 ^ 82 ^ Aboveground Storage Tanks (RemovaUlnspection) $109.00 ^ 82 ^ Underground Storage Tanks (Installation./Inspection) $878.00 (per tank) ^ 82 ^ Underground Storage Tanks (Modification) $878.00 (per site) ^ 82 ^ Underground Storage Tanks (Minor Modification) $167.00 ; e2 ^ Underground Storage Tanks (Removal $573.00 (per tank) ; 8a ^ Oilwell (Installation) $ 96.00 ^ 84 ^ Mandated Leak Detection (Testing) /Fuel Monit.Cert/SB989. Note: $96.00 for each type of test /per site (even if scheduled at the same time) $ 96.00 (per site) CK# 1775 $96 ^ ^ 82 ^ ents $ 96.00 (per tent) ; 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $96 per hour) $ 96.00 + (5 hrs. min. standby fee /Inspection}=$576..00 ^ 84 ^ After hours inspection fee $121.00 ^ 84 ^ RE-INSPECTION(S)lFOLLOW-UP INSPECTION(S) $ 96.00 (per hour) ~ 84 ^ Portable LPG (Propane): NO.OF CAGES? _ $ 96.00 ~ 84 ^ Explosive Storage $266.00 : a4 ^ Copying & File Research (File Research Fee $50.00 per hr) 25¢ per page . 84 ^ Miscellaneous 84 FD 2021 (Rev. 06/07) 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to File) 1-PINK (to Customer) UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING I SB989 SECONDARY CONTAINMENT TESTING (TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAKERSFIELD FIRE DEPT. fiR~ Prevention Services AJ~Tr1r f 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 PERMIT N0. ~^ -~ ~~~ 1 J ^ ENHANCED LEAK DETECTION /~^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING n TANK TIQHTNFSS TFST l~ l~ TCLP FnRM FI IFl Mil INr CFRTIFICATInN .SIT INFORMATI N ` .. FACILITY ~~~ ,^ _ NAME 8 PHONE NUMBER OF CONTACT PERSON C Y1 ADDRESS - OWNERS NAME OPERATORS NAME PERMIT TO OPERATE N0. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO TANK # VOLUME CONTENTS U n . TANK,TESTING COMPANY . NAME OF STING COMPANY (/ NAME 8 PHONE NUMBER CONTACT PERSON /~ (D MAILING ADDRESS _ NAME 8 PHONE NUM ER OF TESTER OR SPECIAL INSPECTOR CERTIFICATION #: DATE & TIME TEST TO BE CONDUCTED SIGNATURE OF APPLIC~ - .; Ov ~ ~` ICC #: ~ ~ DATE Q _ ~ TEST METHOD APPROVED BY DATE C f ~.. FD 2095 (Rev. 09/05) ~, ,: .f;~ ' .UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / S8989 SECONDARY CONTAINMENT TESTING. /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAKERSFIELD FIRE DEPT. P~R~ Prevention Services wRTAI f 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 PERMIT N0. ~~ ~ ~~ ^ ENHANCED LEAK DETECTION p~ ^ SB-989 SECONDARY CONTAINMENT TESTING TANK TIrHTNFSS TFS .fit TO PFRF(~RM Fl1FL MnNITORING CFRTIFI-/iTIAN FACILITY ~~ NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS _ OWNERS NAME OPERATORS NAME PERMIT TO OPERATE N0. NUMBER OF TANKS TO BE TESTED IS PIPING OING TO BE TESTED ^ YES ^ NO TA K V ME CONTENTS Q ~ I LI' I ~ ~ ~ / . TANK,.TESTING COMPANY ' . ` . NAME OF FcrING COMPANY 1r NAME &PH~OjNE-NUMBER OF CONTACT PERSON p~ LJ ~ O ~O MAILING ADDRESS 5 ~ ~o - d CG- NAME & PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR C TIFICATION #: DATE 8 TIME TEST TO BE CONDUCTED -a -o ~ : oc~Q ICC #: TEST METHOD SIGNATURE OF APPLIC ~^l DATE APPROVED BY DATE FD 2095 (Rev. 09/05) . ~ d ~u ; BIa~LING & PERMIT STATEMENT PERMIT NO.: BAKERSFIELD FIRE DEPT. Prevention Services PIRA 900 Truxtun Avenue, Suite 210 AI~TM T Bakersfield, CA 93301 Tel.: (6611 326-3979 S Eax: (6611 852-217] • - ~ • LOCATION OF PROJ T ~ ~ PROPERTY OWNER STARTING DATE ~ + ~ OMPLETION DATE O ~ NAME D~ ~ ,^ ^ ^\ ~' ~/ , PROJECT NAME ' ADDRESS c PHONE NO. Q . J PROJECT ADDRESS ~ a ~ ~ CrrY ~, , ^ ~ STATE ZIP CODE ~~O CONTRACTOR NAME CA LICENSE NO. TYPE OF LICENSE. EXPIRATION DATE PHONE NO. ^~~ ' !/•( CONTRACTOR CO ANY E FAX NO. ADDRESS ~ CffY ~ ~~ I ~ ZIP COD ~, J • • ~ ^ Alarms -New & Modfications - (Minimum Charge) $262 50 • ~ • . 98 Over 20 000 Sq FL 013125 =Permit fee FL x Sq ~ ~ . , . . 98 ^ Sprinklers -New & Modifications - (Minimum Charge) $210 00 ~ . 98 ^ Over 5 000 Sg Ft Ft x 042 =Permit fee Sq ~ . , . . 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93.00 [Inspection Only] ~ 98 ^ Commercial Hoods -New & Modifications $ 398 26 ~ . 98 ^ Additional Hoods $ 36.00 ~ 98 ^ Spray Booths -New & Mod cations $458 00 ~ . 98 ^ Aboveground Storage Tanks (Installatan/Insp: 1" Time) $165.00 82 ^ AddiSonal Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (Insta/laGonJlnspedion) $878.00 (pertank) 82 ^ Underground Storage Tanks (Modification) $878.00 (persite) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (RemovaQ $675.00 (per tank) 84 ^ Oilwell (Installation) $ 72.00 ~ ~ Mandated Leak Detection esfing) I Fuel Monit. Cert $ 81.00 (per site) 82 ^ Tents $ 93.00 (per Pent) ~ ^ After hours inspection fee $122.00 ~ 84 ^ PyrOteChniC - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. min. stand -by fee /Inspection) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 ~ ^ Explosive Storage $249.00 ' ~ ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page ; 84 ^ Miscellaneous ; ~ FD 2021 (Rev. 09105) 1 -ORIGINAL WHITE (to Treasury) 1•YELLOW (to Flle) 1-PINK (to Customer) UNDERGROUND STORAGE TANKS _..._...-• I3A.KERSFIELD FIRE DEY'1'. " _~...x._,~_.N-1. ~`" Prevention Services ABTM ~ ~1iJ(J'll~uxtutl I~~~c., Slt+.210 APPL{CATION i3~lr~~t~~;t~~~`~~i, ~:1~ <,~3>~~1 TO PERFORM ELD /LINE TESTING "I ~•!,: ((:i61) ~32G-34i7~3 ! S6989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL 1'tit~:: {661) 85`L-2 1'71 MONITORING CERTIFICATION Fra!,,e , of i PERMIT NO. 1 l O~o~ ^ ENHANCED LEAK DETECTION ^ LINE TESTING ~ .SB-929 Sf~CONDARY CCNTAIfJMEtJT TESTING ^ TANK TIGHTNESS TEST ^ TO PFRFORh.4 FUEL MONffORING CERTIFICATIChd ._--~. _-_____.---.____ _ ---..------, SITE INFORMATION __- __. !FACIL4TY 'n^ ~ 'NAME 8: PHONE PJUhABER OF GO NT ACT PERSON ADDRESS _ __._.. - C=~.. ~.u~~.ue_~ - -- --. __~-- ~ 9 3 3 ~~ Va/NERS NAME - ---t------ ------- - - _ - -- - PERATORS NAME i X _ PERMIT 70 OPERATE N0. UMBER OF TANKS TO BE TESTED ~ $ f !h i,•JG aJItJG CO BE TESTED? '(E ~ ~ NO -.._~ -- , ___,__.____^ TANK # ___,_. „_._., i VOLUME CONTENTS t _ iL- TANK TESTIN4 COMPANY - .. _ . _-.. _... __._ ---- --.. w M OF TESTING COMPANY ,NAM & PHONE NUMFSEFi pi CON'TAC7 PERSO J N U M I'Il Q ADDRESS -" 1 A__. ~, NAM & PHONE NUMBER OF TEST i OR3 ECfAT~~pECTOR -T T~ CERTIF~ATfOtJ `~(~1-~~,',"_' (o __J__Q,L _d' a ~_.__ a.~ 0 3 S l a R- o S o 3~ i 3 a___ _------ --- -_ _.___.. ~- DA E_ TIME TEST T0,',BE CONDUCTED aCC JJ: I EST METHOD ed•,~,~a _y ,, , /l.o~w.~,~Y~~ 9; oo/4r'` __ I Sa~~ o? ~ b- uT _ __ _ !~.~~-- - SI NATO Ey OF iAP ANT _ DATE' F ~________~ _._ .. _. - ~, _- _ .. _ - ._ ~ ~ __ ____- ~ ______ r 4 -a''~ ~o S' -_ ,~ P~RM.tT NlH ~~p~~~~~~ APPROVED BY >~ HIS Q4?P~.~CA.TIUt`l ~~GON~ES ;DATE ,(Q a$ O.S -.. - FJ~'06 ,i UNDERGROUND STORAGE TANttS ~~F~L~~AT`t~?N TO PERFORM ELD (LINE TESTING ! SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION -:~xs,. PERMIT NO. ~ 1 ~-~ ^ ENHANCE D _EAK DETEC.TIC~^' ^ LiCJE f ~ ~ lP:~; :~/.~ _ _ . t ~:~.'~ ~ .. , . ,..._ ~ . S ~ ~ ~~.. ^ TANK TIGHTNESS TEST ^ TO f~ ~ ~- ~? ". ~.:: r?lidtl ~.~.:;'~ _ _ ~ • ~~ SITE INFORPaAT10N ~AC!LIlY ~~~ ~' V`^'l. -NAME « GN~rJ_ ,, - r ~,.: _ -- _- -_. - _ _. f\DL~RESS ;OWNERS NA(v1E _~_ _.. OPERATORS NAME PERfvi1T TO OPERATE iViJ. U~48ER OF TANKS TO BE TESTED ;S , ~ !3E TES1 `r D? ~ ' sf't ~! _. _ .___.__.... __ ___._ _~_..... ., ., r --.-._-_-_-TANK # _. _- dOLUME ~,ON7ENTS Y~- TArdK TESTING COMPANY NAPlI OF TESTING COMPANY NAt~- c r'i ;;i~ ;r1~3 ;, ~::r"~ I ~.'- ~ PCHSO?; M~lILI G ADDFESS NAM & PHONc NUMBER OF TESTER OR EGIAL~iNSPECfOR GERTI !i~ra,"P_~Pt DA~E TIME TEST T0. BE CONDUCTED ICC ;, ~ TES ~ PlE ~ NOD SI ATU~tEyCE~P NT _ _„--- ~. _ DATE ~~`aC i `~~ ~7 .-} - . 1. APpLIG~TIQN. E3 ~EiQ~1~~ ~ ~~~l1(1,l-!" ~N,E°~=l-rr-' F~C?`,/~.C) '7 ;` ; ~, ~~~ ~ ,r GATE Iakersfield Fire Dept. PREVENTION SERVICES Fire Safety Services • Environmental Services 900 Truxtun Ave., Suite 210 ' Bakersfield, CA 93301 Tel: (661) 326-3979 UST/AST PE~MI]', TANK TESTING ~~ ~ 82 STATE SURCHARGE 86 TENTS. LPG, FIREWORKS. POWDER/OTHER PERMITS 84 COPIESIREPORTS 89 FOLLOW-UP INSPECTION INSPECTOR: DATE TIME SPENT: CHARGES: ~ CHARGES CODE: REASON and DATE t FOR INSPECTION: @ "` LOCATION OF WSPECiTION: ~` . tt BUSINESS NAME: r~ ;{ _ , i 1~h. f ,E TELEPHONE NUMBER(S): // ~p ~} "°~,, ~ BILL TO: ~,-_r3 PAY BY: ,„.--. (," G ~ ~~'r. x'7"`(1, a. 8 ~ (,~ NOTES: ""- .m... 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S IN~TL-L ~IGAT OF WATER . . 7i..~: ~ ~D~/ ~ '30 WATER ~~ ~y •y~ vl+~r~R ~EIGRT . ~ ~ ' . ~a ~~= ~ , ~ , ~ ~oo,.~ t~tT~ennox (~YGNATURL~ . . ~~ ,~~s s D~BN~$; ; I3ISPEI~SER DISPENSER ~ DLSPENSER Sf`I'ART TOME Il~tl'FIAL HEIGRT OF WATER .:~.. . ~~ WATER I#$IGAT V1'ATER . HEIGHT c~~rlFlca-Ttorr c~cN~-~ Page of _ 1 L33~ ~.. E R S F I F'/RE ARTM RONALD J. FRAZE FIRE CHIEF Gary Hutton, Senior Deputy Chief Administration 326-3650 D Deputy Chief Dean Clason Operations/Training 326-3652 Deputy Chief Kirk Blair Fire Safety/Prevention Services 326-3653 2101 "H" Street Bakersfield, CA 93301 OFFICE: (661) 326-3941 FAX: (661) 852-2170 RALPH E. HUEY, DIRECTOR PREVENTION SERVICES flRE SAFETY SERVICES • ENVIRONMENTAL SERVICES j 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 OFFICE: (661) 326-3979 j FAX: (661) 852-2171 David Weirather Fire Plans Examiner 326-3706 Howard H. Wines, 111 Hazardous Materials Specialist 326-3649 December 1, 2005 One Stop Mobil 402 S. Chester Avenue Bakersfield, CA 93304 FINAL REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirements by December 31, 2005 of Underground Storage Tank (s) Located at the Above Stated Address Dear Valued Customer, Over the last six months this office has continued to send reminder notices regarding secondary containment testing. Code requires that all secondary containment systems must be tested 6 months post construction and every 36 months there after. Senate Bill 989 became effective January 1, 2002, section 25284.1 (California 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 detected and removed. Our records indicate that your facility is due prior to December 31, 2005. Those sites that have not been tested and have not pulled a permit prior to December 31, 2005, will have their permit to operate revoked. This office does not wish to take such action, which is why we will continue to send monthly reminders. Contractors are already booked several weeks in advance. I urge you to schedule your testing date as soon as possible to avoid possible revocation of your permit to operate. Should you have any questions, please feel free to call me at (661) 326-3190. Sincerely, RALPH .HUEY, Director of Prevention Services /, Steve Underwood Fire Prevention Officer SU:db