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i (UNDERGROUND STORAGE TANK) FILE #2
_ _ ~ FASTRIP FOOD STORE #6 cFAC #562
. ~ 1640 S. CHESTER AVENUE
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4i~NIFIED PROGRAM INSPECTION CHECKLIST Prevention Services
,( 8....... E_R 5 F_._ __0 900 Truxtun Ave., Suite 210
___._ _ _ _ _ .~ ~. _._ . ---~_---- _..- -.-. ~~, F~Re Bakersfield, CA 93301
SECTION 1: Business Plan and Inventory Program ~` ARTM r Tel.: (661) 326-3979
u ~ Fax: (661) 872-2171
FACILITY NAME
° ~ ~
~ INSPE ION D TE INSPECTION TIME
ct
f"ZI,S 3 0
ADDRESS PHO ~ NO. NO OF EMPLOYEES
~ ~ `~ ~~~~
FACILITY CONTACT BUSINESS ID NUMBER
15-021-
section 1: Business Plan-and Inventory Programs
^ ROUTINE MBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V ~ C=Compliance OPERATION
V=Violation COMMENTS
^ ^ APPROPRIATE PERMIT ON HAND
^ BUSI11@SS PLAN CONTACT INFORMATION ACCURATE
^ VISIBLE ADDRESS ~. ~UO
U
Y /
LAY ^ CORRECT OCCUPANCY
u
J/
^ VERIFICATION OF INVENTORY MATERIALS
-
/
LW ^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
^ PROPER SEGREGATION OF MATERIAL
~,/
IS ^ VERIFICATION OF MSDS AVAILABILITY
^ VERIFICATION OF HAZ MAT TRAINING
^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
VVV
~^ EMERGENCY PROCEDURES ADEQUATE
^ CONTAINERS PROPERLY LABELED
^ I-IOUSEKEEPING
^ FIRE PROTECTION
^ SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN:
QUESTIOJ1~6fREGARI}1NC~I'~HIS INSPECTION? PLEASE CALL US AT (661) 326-3979
(Please Print) Fire Prevention / 1" In /Shift of SitelStation #
^ YES L~pO
White -Prevention Services Yellow -Station Copy Pink -Business Copy ~ FD 2155 (Rev. 09105
INSPECTIONS
B ~~~ E R S F I L D
BUSINESS PLAN & ~ rM r
INVENTORY PROGRAM y
UNIFIED PROGRAM INSPECTION CHECKLIST
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tei.: (661) 326-3979
Fax: (661) 852-2171
Page 1 of 1
FACILITY NAME: -~'Q S`T~~n
Section 2: Underground Storage Tanks Program
INSPECTION DATE: / .30 ®~
^ Routine /Combined ^ J int Agency ^ Multi-Agency ^ ~omplaint ^ Re-Inspection
Type of Tank Number of Tanks
Type of Monitoring ~1~(_ W~ Type of Piping j~ul '~
OPERATION C V COMMENTS
Proper tank data on file
Proper owner /operator data on file
Permit fees current
Certification of Financial Responsibility
Monitoring record adequate and current
Maintenance records adequate and current
Failure to correct prior UST violations
Has there been an unauthorized release? ^ Yes ^ No
Section 3: Aboveground Storage Tanks Program
Tank Size(s)
Type of Tank
OPERATION Y N COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?)
If yes, does tank have overfill /overspill protection?
C =Compliance V =Violation Y =Yes N = No
Inspector:
Questions regarding this inspection? Please call us at (661) 326-3979
ess Site Responsible Party
White -Prevention Services Pink -Business Copy
F-7335
Aggregate Capacity
Number of Tanks
FD 2156 (Rev. 09/05)
T`~~6~3~
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. 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 this date.
A. General Information
Facility Name:: #562 Fastrip #6
Site Address: 1640 South Chester Avenue
Bldg. No.:
City: Bakersfield
Zip: 93304
Facility Contact Person: Omero Garcia ~ - - Contact' Phone No.: 661-393-7000
Make/Model of Monitoring System: Veeder-Root TLS 350 Date of Testing/Servicing: 9/7/2006
B. Inventory of Equipment Tested/Certified
Check the appropriate 6ozes to iu ~cate speck equipuu:ut inspected/servited:
Tank ID: 12000 gal. Regular 1
[X] In-Tank Gauging Probe. Mode1:847390-107
U Annular Space or-Vault Probe. Mode1:794390.420
[x] Piping Sump /Trench Sensor(s). Mode1:794380-208
^ Fill Sump Sensor(s);; . ~ . „ Model:
[J Mechanical Line Leak Detector. Model: FX1y
^ Electronic Line Leak Detector. Model:
U Tank Overfill /High Level Sensor. Model: 8473so-107
^ Other (specify equip. type and model in Sec. E on Pg. 2)
Tank ID: 12000 gal. Super
[x] In-Tank Gauging Probe. Mode1:847390-107
L] Annular Space or Vault Sensor. Mode1:847380~d20
[X] Piping Sump /Trench Sensor(s). Mode1:794380-208
^ Fill Sump Sensors(s). Model:
[x, Mechanical Line Leak Decector. Model:FX1y
^ Electronic Line Leak Detector. Model:
U Tank Overfill /High Level Sensor. Mode1:847390-107
^ Other (specify equip. type and model in Sec. E on Pg. 2)
Dispenser ID: 1 ~ 2
~] Dispenser Containment Sensor(s). Model: 794380-208
[X] Shear Valve(s).
^ Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 5 & 6
[~ Dispenser Containment Sensor(s). Model: 794380-208
Lx] Shear Valve(s).
^ Dispenser Containment Float(s) and Chains(s).
Tank ID: 12000 gal. Regular 2
[X] In-Tank Gauging Probe. Model: 847390-107
[X] Annular Space or Vault Sensor. Model: 794390-420
[X] Piping Sump /Trench Sensor(s). Model: 794380-208
^ Fill Sump Sensor(s). Model:
^ Mechanical Line Leak Detector.- Model: FX1y
^ Electronic Line Leak Detector. Model:
(~ Tank Overfill /High Leval Sensor. Model: X7390-107
^ Other (specify equip. type and model in Sec. E on Pg. 2)
Tank ID: 12000 gal. Diesel
~x] In-Tank Gauging Probe. Model: 847390-107
[>~ Annular Space or Vault Sensor. Model: 84738020
U Piping Sump /Trench Sensor(s). Model: 794380-208
^ Fill Sump Sensor(s). Model:
L] Mechanical Line Leak Detector. Model:.Fx1~y .
^ Electronic Line Leak Detector. Model:
Lx] Tank Overfill /High Level Sensor. Model: 847390-107
^ Other (specify equip. typs and model in Sec. E on Pg. 2)
Dispenser ID: 3 & 4
[X] Dispenser Containment Sehsor(s). Model: 794380-208
U Shear Valve(s). ,
^ Dispenser Containment Float(s) and Chain(s)
Dispenser ID: 7 8t 8
(~ Dispenser Containment Sensor(s). Model: 794380-208
U Shear Valve(s).
^ Dispenser Containment Float(s) and Chain(s).
Dispenser ID: Dispenser ID:
^ 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).
the facility contains more tanks or dispensers, copy
every
at
C. Certification - I certify that the equipment identified in this document was inspected/services in accordance with the
manufacturers' guidlines. Attached to this Certification is information (e.g. manufacturers' checklist) necessary to varify that
this information is correct and a plot plan showing the layout of monitoring equipment. For equipment capable of generating
such reports, I have attached a copy of the report; (check aU that apply) Q Syst Set-u x ~ ` tory report
Technician Name (print): Joseph Stroope Signature:
Certification No: A31228 Licens o: 804904 "
Testing Company Name: Confidence UST Services, Inc. Phone No: 800-339-9930
Site Address: 1840 South Chester Avenue ,Bakersfield, CA 93304 Date of Testing/Servicing; 9/7/2008
D. Results of Testing/Servicing
Software Version Installed: 8.~2
Complete the following checklist:
[~ Yes ^ No* Is the audible alarm operational?
x 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 the lowest point of secondary containment and positioned so that other
equipment will not interfere with their proper operation?
Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem)
x N/A operational?
x Yes ^ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary
^ NIA containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes:
which sensors irritate positive shut-down? Lx] Sump/Trench Sensors [~ Dispenser Containment Sensors
Did you confnm positive shut-down due to leaks and sensor failure/disconnected? [X] Yes; ^ No;
^ Yes ^ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no
^ N/A mechanical overFll prevention valve is installed), is the overfill warning alarm visual and audible at
the tank fill point(s) and operating properly? If so, at what percent of tank capasity does the alarm
trigger? 90
^ Yes* ^ No Was any monitoring equipment replaced? If Yes, identify specific sensors, probes, or other equipment
replaced and list the manufacturer name and model for all replacement parts in Section E, below.
^ Yes* ^ No Was liquid found inside any secondary containment systems designed as dry systems?
^ Product; ^ Water. If yes, describe causes in Section E, below.
x 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 manufacturer's specifications?
* In Section E below, discribe how and when these deficiencies were or will be rnrrected.
E. Comments:
F. In-Tank Guaging /SIR Equipment: ~] Check this box if tank guaging is used only for inventory control.
^ Check this box if tank guaging or SIR equipment is installed.
This section must be completed if in-tank guaging equipment is used to perform leak detection monitoring.
Comalete the followin¢ checklist:
Cx] Yes ^ No* Has all input wiring been inspected for proper enter and termination,including testing for ground faults?
x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
x Yes No* Was accuracy of system product level readings tested?
x Yes No* Was accuracy of system water level readings tested?
x Yes No* Were all probes reinstalled properly?
^ Yes ^ No* Were all items on the equipment manufacturer's 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 LLD's are not installed.
Com fete the followin checklist:
[~ Yes ^ No* For equip. start-up or annual equipment certification, was a leak simulated to varify LLD performance?
(Check all that apply) Simulated leak rate: (X]3 g.p.h.: ^0.1 g.p.h.; ^0.2 g.p.h.;
Yes ^ No* Were all LLD's confnmed operational and accurate within regulatory requirments?
x Yes No* Was the testing apparatus properly calibrated?
^ Yes No* For machanical LLD's, does the LLD restrict product flow if it detects a leak?
N/A
^ Yes No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak?
[~ N/A
^ Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is
[x] N/A disabled or disconnected?
^ Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system
[X] N/A malfunction or fails a test?
^ Yes [] No* For electronic LLD's, have all accessible wiring connections been visually inspected?
[~ N/A
[~ Yes No Were all items on the equipment manufacturer's maintenance checklist completed?
* In the section H, below, describe how and when these defciencies were or will be corrected.
H. Comments:
.
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STP EUt"iP
FUEL HLHRhI
HUG '~9 . ~iJD6 I Q :46 Hf"1
FUEL. HLHRt°t
EEP ?1 '<OU5 1:U1 F't°t
FUEL HLHRt"1
HUG ;JI. ''<i]U5 ~:'2a3 Pt'•1
HLHRf"1 H I STuR`.' REPS R'I'
----- SEtV UR HLHRt"t -----
L t : 91 HNt'JULHk
HNNULHR ~PHt~E
FUEL HLHRf°1
HUG 29. '?UG6 I U : 4y Ht"1
FUEL HLHRhI
NEP 7 . 2UU5 1 : iJe F't•'1
FUEL HLARM
HUG :~ 1 . 20175 A : ?U PI°1
HLHRt°1 H 15T(iR! REPO%RT
L :s : Gy L~`CF'
~'ri=> ~uhii;
rI JE L FLHRhI
f ii.l 'ti , 'GLJUE, I Q : ~ r Fit"i
I/'+Jt.L. iLHRt l
f°1Hk '~. 'IIiJF~ '~: ~a FiP'J
J= UEL HI_F;RP~I
::.EP .. ~OU5 i 2: 5y pr.)
F;Lr;PI'1 H I ~T~JR't` REF't 5RT
L 4 : >;y F;NNULHk
HrJtVUL.HR ti:PH%E
FUEL F=tLHRf"1
HUG~'9, 2UGb IU:4G Hhl
FUEI. HLHRP9
F;EP ?.~U05 1 : U6 Pt"i
~:ETUF' DHTH IJF;RPJI NJ:~
F;LF~kf°l H I Tt~RY REF's !kT
-- SENSiiR
- r=JI.NRt"i -----
L
5:8? STP
5TF' SU1hP
FUEL HLr~Rt°t
HUG 29. ?UUE 1 U : 48 Fit°l
FUEL. HLHRhJ
CEP ?, '~UU5 1:58 Pr9
FUEL HLHRI°1
FiUG G1 r 2UD5 ~:'~'5 Phl
---
""~LA]?t"1 H I S'I'~~iR`f REF ~fRT AL~~RNI H I :TURY REPtyRT
--~'--- SEhJSuR i=iLAR("1 ----- ----- '`-'ENSCJR i=3LARt"t -----
L 6 : 8? AtVNULAR L 9 : Li I SF' 1
ArJPJULAR 6:PACE UIS PF.NSER PAPJ ALARM HISTtiR4' REPiJkT
FUEL. ALARt"1 FUEL AL~Rh9
,:Ui; - y+
'~- 20+7F,, iC1:49 Afh AUG '?9.. 2006 I D : 56 i=if"i ------ ~,..-'ENtiOR ALARM -----
L1'?:UISP 7-l3
f.•'UEL AI_ARf°1 FUEL HLARNI L~ISF'ENSER F'AN
'EF'
-~ ? • 'UU"~ 1 : 0'? Pt°1 FIEF' 7, ~[]U5 1 ~ : 5~} F't°I
ETUP 1'iATA I~IARtV I hdG
MAR 2~. :~U05 fi:5y AM
FUEL ALAF'r.i F111;L ;LARt"I
Alti~; I , '?i ti05 :! : 17 Pt"1 f°iryR 23, 2UU5 3:31 Ph'1 ;~ETUF' DATA I,~ARhJ I Nia
NEP 7, 2004 11:42 ANl
ALAf?t°i H I S'1'<_~};'y REF'ti>RT AJ.ARr'~ H I ~;TvR'! REF'ti1R'I'
'
il-.ARI"I H I ~~TU~R
'.' REPUSRT
_ ___ _ J~t'JSi1k ALARh9 ---___
L ": U I E~.'EL STF; L.1 G : L~ I 5P 3--4 - ...--- SEPJtiUR ALARM -----
:~T`l=' SUMP l~~I,PErJSER PAN I.t:3:C~IS1' 4-1u
FUEL ALARM FilEL ALARi"I L:~1;~PEPJSER F'AN
AUG
<.y, '.-,-
_
'' -llOG 10:44 ANl A1JC: '?9, 2UU6 10:54 Fit"1
Fi.JLL ALARr'i
- AUi:; 25, 20U6 11:01 AM
FUEL ALARM F UEI.: ALARh~1
N1AR '2UUE, 1
b.. :40 F'i~9 '~,EP ?. 2005 12: ~0 F'Nl FUEL AI_ARt"1
i~;EI' ,?~. X105 1 ~.b7 F'P'I
FtJEL ALARM 2=UEI_ AI..ARNi
SEP ~ . 2005 1:03 Pt°1 AUG 31 ~ 21105 4:55 Pf'1 ;:;E`CUP L+I~'1'A WA RP) I N
t°!AR '~~'. 2005 3:40 PP9
ALARf°l HISTCiR~,' REF•'UR'!` HLARt°! HI:3Tt1R`f REF'ukT
ALARh'1 H I:~Tt~R1' kEPUk'T
----- SENSi~R ALAR("I -----
L S:LiIE~;EL AtUlVULAR ----- SE1'JSf~R ALARt°1 -----
c-~ ,
L11:UI.~F 5-6
_____ SEN:~iiR ALARt~i --------
APJhJULAR SPADE U I SPEiVSER PAN L 14
FUEL ALARM FUEL. ALARi°1 uTHER ;~EhJSC>kS
AUG ~'9,~UU6 10:4~~ At°1 AUG 29, 2006 10:59 At°i
FUEL ALARM FUEI. ALARi"i
SEP 7.='005 1 :IJS F'h,l SEP 7, 2005 12:55 FM
FUEL ALARM SETUP DATA tdARNI NG
AUi_; ;jl ,
2'005 4:21 pi"t MAR '~'?. 2uu5 3:06 F'I~I
ALARI"1 H I ST'C'+R`~' REF'Uk'T'
----- SENNtSR ALARM -~-----
15:
~"°R SEN:~C)RS
}
i
1. '; : i i I FEEL STP
-i °.1"F' ~Uh'IF'
FUEL ~;L~F<t°I
:CEP 7~ '~UU6 10:15 rit°t
i~LHRNi H I E'1'UR'f REP~~RT
---•-- SENSi~R HLF;Rt°t ----- -
L1E: •- '
UTHER SENSGkS
HT.r~RM H1S'fC~R`. REFURT
----- - SEt'diiiiR HLnRhI ------
L. 1 :91 STP
;TP SUt°1F'
FIiEL FiL(=iRM
r=;uG 29 . 200E 10 : aE F,r~t
1=,,i1_L r~LHRrvt
SEF' ?. 20U5 1:01 Ft~'1
!= i_i!L ~I_HRNt
t',f IG 31 0005 4 :''3 Pr1
------ SEh4SrJR €~LtiRhl -----
L 1:91 STP
STP SUt°iF'
FUEL riLFlkt°]
CEP 7. '?OOE 10:1'3 F,t°l
-- --- SEh•JSUR ~LaRt°l -----
L 3 : ~i9 STP
STF SUN1P
FUEL HLARt°i
SEF' 7. 200E 10:19 r=~(°I
-- SENSt]R i~LtiRM -----
L 5:87 STP
STP SUiNP
FUEL r~t.€~RNt
5EP 7. '0006 1 U : 20 rat°t
t'9I lVia-CHESTEk
k,~}:ER.SF I ELU i:r;933L1~}
GE } -397-sb06
SEF' '~ • :'006 10:20 rat°1
---- SEtVSUR NLr;RM -------
L11:UISP 5--b
ti I ~F'EtVSER FHN
FUEL ~LFIRt°1
SEP ?, 2006 lU:'?0 HNI
------ SEtVSt~R FtLHRt°i _____
L1=~:DItiF' 9-10
L, I.SF'EfV SER PHP•J
FUEL ~L€~Rth
SEF' '7, '~'OOE 10:03 tit°t
F' -
S'~`.'I'EM N1'ATUS REPORT
ALL F'Ur~cTT~tVS tVCsRt°1~L
- - _ _ „_.4---
"
8r'i}':ER~.',F I EL.r} C:A9'~ "G4 _ ^~..••. = ~
"- -F,~`!'F,' I F'
~~
661-357-86uE, . P't I idt_ -GHE ,,TER
t `
IA?:ERF~F I ELU ~•A9 33U4
~~EF' 7, 2UU6 lU:'~'Q Al'1 661--~~`?7-C3606
+
- SE[VSCrk ALt~Ri°1 -
-
I. B:UIE:~EL AtVNULAR ti:EF~ 7. 2CiU6 10:''4 hh1
ANNULAR SPACE
S'fSTEt`1 :7TATU~i REF'CrRT FUEL €;Lt~R[°i
-
• ALL FUNC:TIt+PJS-i'JORNIAL - SEE' 7. '~fJUb 1 U : '~7 r`=tt`'1
_'.;~TEM STATt_ty REF'i~RT
F;LL FUNt:`1' I ui'1S i'J+~RMAL
[ i'11.~EN'T'~k4` F'EF'CrRT
"i' 1 : LNVLEAUEU 1
`~st>I_.t1t`•1E - 15176 GALS
--.--_. SEIVSCiR r";L~',Rt°1 -_.._._- tJLL:;GE = 113156 C~r`iLt3
----- SEiVS~1k F;LF-iRl°t ----- (, C':91 FiNNULr~iR ~~it'~ iJLLP=iC>E= o9~Jy Li~L:=%
L10:):~I:F' 3-4 F~hJIVI_ILAk SF'r'=itE Tt:.'• 11i~'.LUI°1E = 18F~'~' ~at'tL3
UISF'EtVSER F'Ai'J FUEL. riL.ARf`9 HEIGHT = 23.94 IN+~HES
FIJEL ALARt"i SI?F> '7. 20ll6 10:27 A{~1 t;J~TER I.risL = 0 [;AL;~
SEE' 7. ' 2uU6 1 C1: 21 Ai°l 1..[ATER = 0 . QO I tVt_•[•IES
TEMP = 92.8 DE~a F
7' ' ~ : It I ESEL
Vi ~UJihE - ''x'74 GALS
ULhAGE = 5788 GALS
ap."•a ULLi=1t3E= 8501 GALS
T~' ~v'+~LUME = 1927 GALS
HEI+"BHT = :7.17 I fVCHES
- SEi'dS'vR ~,LARi°I ----- Wr`-TER ~:rjL = Ct t;,L~a•'
---.-- SEl'JSUR ALhRt°I - ---- I.. ~ : 8y rahJtVULAR WATER - 0 . CiU I tdC:HE s
L 5: U I SF l -'~ t=;l'•JNUL~,k SF"r`iCE T'Ei°iF' = 9~j . 9 17EG' F
U 1 SPEPJSER PAI'J FUEL hLAkt°i
FUEL ALARI°i SEE' 7. '?006 1 G : 28
~ Fih'1 `I' ~ : AREt°tI Ut°i
SEA 7, 2U06 1D:'~'~ At°t ~lt?LUh'lE = 2595 GALS
ULLAGE = 4467 GALS
90>~ ULLAGE= 8260 ~:ALS
'I'~_ 4~ULUh'lE = 25;33 ~.;ALS
HEIGHT = 29.83 I t'Ji~HE
t.JATEk VCyL = U GALS
WATER = L . 00 I iVGHE S
'GENE' = 9:3.6 UEG F
•-~---- :~Ehd~.;uR ALARr°i ------ T 4 : UPdLEPtUEU 2-;.~ I AHvPJ
Fi=;'.~;TR I I~' L E : 87 A[VhdULAR t;ULUthE = 1965 GAL:
M l tVG-~~HE: TER AJ'•1NULhR SPr;ivE UL,LAtyE = 10097 C;;;LS
xt~~};EF'SF I LLI± CA93:3U4 FUEL riL€=;RtH 9U?d ULLAGE= 88917 GHLS
t^~61 -:7~~7--86U6 SEE' 7 . '?OD6 1 U: •2'8 i;NJ T~ VULUME = 19'23 ~_.HLS
HEI GHT = 24.51 I i'JC;HES
:_:EF' '?,x'006 10:22r";i"I WATER !~i~L - '?1 GALS
I,IATER = 1.16 I PlC:HES
TEt°1F' = 85 , y UEe F
:;r,',.,'TEt"1 ~~T'ATUS REFukT
- ~ x ri ~ ~ EtVU x * * f
I_ '3 : FUI=.1.:
~,LAI2P'1
FASTRIF'
N1I Nu-C:HESTEk '
BAk:ER~]F I ELU C.ti93:3174
661-397°8606
SEE' 7 ~ 2U06 10 : 2S ih'I
S.'STEM aTni'U° REP uRT
h•1 [ Nita-•~..:'HF:~T'EF'. L 2 : FUEL ALARM
BAi:EF,'~:F1E1_L`r t:r-;y;33u4
E.61--3~=r7-86rt L 4:FUEL ALhkf°i
;REF'' '~', `.'U06 117 : ~~'= ri°1 L 6 : FUEL AL.HRt'1
L 8 : FUEL ALr~R[°I
;~`f T'Eh1 STATUS REF~.:,'RT
L S:FUFL ALARM
SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and
printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: #562 Fastrip #6 Date of Testing: 9/7/2006
Facility Address: 1640 South Chester Avenue ,Bakersfield, CA 93304
Facility Contact: Omero Garcia Phone: 661-393-7000
Date Local Agency Was Notified of Testing : 8/16/2006
Name of Local Agency Inspector (fpresent during testing):
2. TESTING CONTRACTOR IlVFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Joseph Stroope
Credentials': X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester ^ Other (Specify)
License Number(s): CSLB #804904 ICC #5258844-UT #061720
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic ^ Vacuum ^ Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (By Tank
Number, Stored Product, etc. 1 Regular #I 2 Regular #2 3 Super 4 Diesel
Bucket Installation Type: ^ Direct Bury
x Contained in Sum ^ Direct Bury
x Contained in Sum ^ Direct Bury
x Contained in Sum ^ Direct Bury
x Contained in Sum
Bucket Diameter: 12.00" 12.00" 12.00" 12.00"
Bucket Depth: 13.00" 13.50" 12.50" 13.00"
Wait time between applying
vacuum/water and start of test: 30 min. 30 min. 30 min. 30 min.
Test Start Time (TI): 9:30am 9:30am 9:30am 9:30am
Initial Reading (RI): 13.00" 13.50" 12.50" 13.00"
Test End Time (TF): 10:30am 10:30am 10:30am 10:30am
Final Reading (RF): 13.00" 13.50" 12.50" 13.00"
Test Duration (TF - TI): 1 hour 1 hour 1 hour 1 hour
Change in Reading (RF - R~): 2.00" 0.00" 0.00" 0.00"
Pass/Fail Threshold or
Criteria: 0.0625" 0.0625" 0.0625" 0.0625"
Test Result: X Pass ^ Fail X Pass ^ Fail X Pass ^ Fail X Pass ^ Fail
COmmeIItS - (include information on repairs made prior to testing, and recommended follow-up for failed tests)
CERTIFICATION OF TECIINICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contain~j in this report Is true, accurate, and in full compliance with legal requirements.
Technician's
Date: 9/7/2006
' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
UNDERGROUND STORAGE TANKS ~~ -~ ~_~
s p I~,'E,L D
`
E h
B BAKERSFIELD FIRE DEPT.
_
_
`". Prevention Services
.... -- -- -- - - - - _ . _- ------ -- . _. _ _. _. ~ .. _. _ .___ .
- _. __ . FrRQ
~
~ of
PA/tTA/IIf 900 Tru~un Ave., Ste. 210
APPL~CAT~~N -.L` Bakersfield, CA 93301
TO PERFORM ELD /LINE TESTING Tel.: {661) 326-3979
SB989 SECONDARY CONTAINMENT TESTING Fax: (661) 852-2171
!TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION page 1 of 1
t
q~
PERMIT N0. ~~`~ (] 3 1
LINE TESTING
.25 ENHANCED LEAK DEFECTION
.ES .eS SB-989 SECONDARY CONTAINMENT TESTING
~
~,
PS TANKTIGHTNFSSTFST / .PS" TO PERFORM Fl1FL MONITORING CERTIFICATION
SITE INFORMATION
FACILRY_
' NAt`aE 8 PHONE RfUCaBER OF CONTACT PERSON
0 ar ~ 3Q3-1
ADDRESS
ll~ u C
o,ke,• ~
OWNERS NAME
a
OPERATORS NAI'SIE PERL'31T TO OPERATE PoO.
NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ci YES ~ NO
TANK # VOLUME CONTENTS
TANK TESTING COMPANY
NAME OF TESTING COMPANY
r
' ~ RIA~IE 8 PHOPIE A1UCaBER OF CORITACT PERSOPo
~ U 33 - qq U
MAILING ADDRESs
,r 3 09
NAME & PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR
OSfZ C 2 - 22 CERTIFICATION #:
- 2Z
DATE & ME TEST TO BE CONDUCTED
-i OU
~-~ m , ICC #:
2 $ - U-C- TEST METHOD
SIGNA LIRE OF APPUCA ~..1 DATE ~ ~ ~ ~
PL i - EQ -3 A -~R tT H AR OV D
APPROVED BY DATE ~ ~ ~~
FD 2095 (Rev. 09/05j