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HomeMy WebLinkAboutUNDERGROUND STORAGE TANKi~ NNDERGROUND STORAGE TANKS) FILE # _ - _ I HOWARDS MINI MART #4 -I =' -- _ ~.- . _ _ _ ._ .. _ _ _ 'i ' 13200 PANAMA LANE ~ ~' ~. , ~ ~._. ~ . - r-- - -- --- -- - - --- ----- --- r r _. _ . _ _ _ _ I,, ~_ ~ _ . ... _ ~~ ~i ~~ ~~, ~., ~,~ ~ ~ ~:~ ~ ~ ~ ~ ~~a~~ , ~~~~ I I ~ ~ - ~1 c~\`~ n v~~,r ~ ~' ~`~ ~ ' ~ "~~. - -- r ~J '/~ ~~ _. I~ ,~ i + ;, ~"~~ ~ r~ '~ ~~~v Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Howard's #4 (Exxon) Facility ID #: 46941 Facility Address: 3200 Panama Lane, Bakersfield, CA 93312 (City) Reason for Submitting this Form (Check One) X Addition of Designated Operator Facility Phone #: 661-833-1561 ^ Update Certificate Expiration Date Designated UST Operator(s) for this Facility ALTERNATE 3 (Optional) Designated Operator's Name: Jessica L. Meyers Relation to UST Facility (Check One) Business Name {If different from above): Confidence UST Services, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 5313857-UC Expiration Date: June 30, 2009 ALTERNATE 4 (Optional) Designated Operator's Name: Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: ALTERNATE 5 (Optional) Designated Operator's Name: Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please Print): loco Hill Co. SIGNATURE OF TANK OWNER: DATE: August 9, 2007 OWNER'S PHONE #: 661-393-7000 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ca.gov/ust/contacts/curia a~vs.html. ' , 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 m35~ ,, Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Howard's #4 (Exxon) Facility ID #: 46941 Facility Address: 3200 Panama Lane, Bakersfield, CA 93312 (City) Reason for.Submitting this Form (Check.One) ^ Change of Designated Operator Facility Phone #: 661-833-1561 X Update Certificate Expiration Date Designated UST Operator(s) for this Facili PRIMARY Designated Operator's Name: Douglas M. Young III Relation to UST Facility (Check One) Business Name (If d~erent from above): Confidence UST Services, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 0878646-UC Expiration Date: September 22, 2008 Designated Operator's Narae: Jennifer Davis Relation to UST Facility (Check One) Business Name (If d~erent from above): Confidence USTServices, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 5252886-UC Expiration Date: March 15, 2009 ALTERNATE 1 oval Designated .Operator's Name: Edward Mitchell Relation to UST Facility (Check One) Business Name (If d~erent from above): Confidence UST Services, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 5258845-UC Expiration Date: May 15, 2008 ALTERNATE 2 (Optional) I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee traitming, in accordance with California Code of Regulations, title 23, section 2715(c) - (f}. Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please Print): JaCO Hill Co. SIGNATURE OF TANK OWNER: ('~~~ _~~' DATE: March 23.2007 `'`v OWNER'S PHONE #: 661-393-7000 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: wwvv.waterboards.ca.Qov/ust/contacts/cups a~ys.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF'['HE CHANGE. November 2004 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD! LINE TESTING ! S6989 SECONDARY CONTAINMENT TESTING ~ANK TIGHTNESS TEST AND TO PERFORtIfl UEL MONITORIAIG CERTIFlCATIOAi PERMIT NO. ~- ~ ~I ~~ _ - ~ BAKERSFIELD FIRE DEPT. . $ A, ICY H_F 9_P_1K~.. L D Prevention Services FlRI B~>~ARTAI~11frT 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 J .ES ENHANCED LEAK DETECTION ~ NE TESTING .ES SB•989 SECONDARY CONTAINMENT TESTING PS TANK TIGHTNESS TEST PS T~i PERFORM FUEL MONITORING CERTIFICATION SITE INFORMATION FACILITY ~5 =~ 4 NAL'7E 8 PHORiE NUC9BER OF CONTACT PERSON Q,r~ 9 -~Ob ADDRESS 2©d ~ ~ r 93 OWNERS NAME CO OPERATORS NAN7E PERC~71T TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? .es YES ~ NO TANK ~ VOLUME CONTENTS TANK TESTING COMPANY NA E OF TESTING COMPANY ~on ~ 1 NAC.7E 8 PHONE NUC78ER OF CONTACT PERSON I un oo y -993 MAILING ADDRESS -4c a~ r ~c~kexs-~ie.1c1 C~A 93301 NAME & PHONE NUMBER OF TESTER OR cS'r ~ SPECIAL INSPECTOR - CERTIFICATION #: -1322 DATE & ME TEST TO CONDUCTED ~ 8 ~ ooa. m , ICC #: 25 ~ - UT TEST METHOD SIGNATURE OF APPLIC DATE ' / ., ~Y RLI Q CQM S A T RJR DYED APPROVED BY DATE FD 2095 (Rev. 09/05) ~~- ay~b 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 sepazate certification or report must be Qrenared 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: #351 Howards #4: Site Address: 3200 Panama Lane ~ City:. Bakersfield Bldg. No.: Zip: 93312 Facility Contact Person: Omero Garcia Contact Phone No.: 661-393-7000 Make/Model of Monitoring System: Gilbarco EMC B. Inventory of Equipment Tested/Certified Check the appropriate bones to in ~eate spec equipment inspected/serviced: Date of Testing/Servicing: 9/7/2006 Tank ID: 12000 gal. Regular 1 U In-Tank Gauging Probe. Mode1:847390-107 ^ Annular Space or Vault Probe. Model: ^ Piping Sump /Trench Sensor(s). Model: ^ Fill Sump Sensor(s)' ~ Model: ~: [] Mechanical Line Leak Detector... Model: [X] Electronic Line Leak Detector. Model: WPLLD U Tank Overfill /High Level Sensor. Model: ea73so-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 ^ Annular Space or Vault Sensor. Model: ^ Piping Sump /Trench Sensor(s). Model: ^ Fi11 Sump Sensors(s). Model: ^ .Mechanical Line Leak Decector. Model: U Electronic Line Leak Detector. Model:wPLLD U Tank Overfill /High Level Sensor. Mode1:847390-107 ^ Other (specify equip. type and model in Sec. E on Pg. 2) Dispenser ID: 1 8t 2 n Dispenser Containment Sensor(s). Model: 79a38o-208 [X] Shear Valve(s). ^ Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5 & 6 Lx] Dispenser Containment Sensor(s). Model: 794380-208 ~x] Shear Valve(s). ^ Dispenser Containment Float(s) and Chains(s). Dispenser ID: ^ Dispenser Containment Sensor(s). Model: ^ Shear Valve(s). ' ^ Dispenser Containment Float(s) and Chain(s) 'the facility contains more tanks or dispensers, copy this forn Tank ID: 12000 gal. Regular 2 [X] In-Tank Gauging Probe. Model: 847390-107 ^ Annular Space or Vault Sensor. Mode]: ^ Piping Sump /Trench Sensor(s). Model: ^ Fill Sump Sensor(s). Model: ^ Mechanical Line Leak Detector. Model: U Electronic Line Leak Detector. Model: WPLLD U Tank Overfill /High Leval Sensor. Model: 847390-107 ^ Other (specify equip. type and model in Sec. E on Pg. 2) Tank ID: 12000 gal. Diesel U In-Tank Gauging Probe. Model'. 847390-107 ^ Annular Space or Vault Sensor. Model: ^ Piping Sump /Trench Sensor(s). Model: ^ Fill Sump Sensor(s). Model: ^ Mechanical Line Leak Detector. ivlodel: ~x] Electronic Line Leak Detector. Model:, WPLLD L] 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 Sensor(s). Model: 794380-208 U Shear Valve(s). ^ Dispenser Containment Float(s) and Chain(s) Dispenser ID: 7 & 8 [~ Dispenser Containment Sensor(s). Model: 794380-208 U Shear Valve(s). ^ Dispenser Containment Float(s) and Chain(s). Dispenser ID: ^ Dispenser Containment Sensor(s). Model: ^ Sheaz Valve(s). ^ Dispenser Containment Float(s) and Chain(s). 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 all that apply) x^ Sys m p ~ Ala history report Technician Name (print): Joseph Stroope Signature: Certification No: A31226 License o: 804904 Testing Company Name: confidence usT Services, inc. Phone No: 800339-9930 Site Address: 3200 Panama Lane ,Bakersfield, CA 93312 Date of Testlrig/Servicing: 917/2006 D. Results of Testing/Servicing Software Version Installed: 15.01 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 ^ N/A containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initate positive shut-down? ~ Sump/Trench Sensors~Dispenser Containment Sensors Did you confirm positive shut-down due to leaks and sensor failure/disconnected? [~ Yes; ^ No; Yes ~ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ^ N/A mechanical overfill prevention valve is installed), is the overfill warning alarm 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? I 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 corrected. E. Comments: F. In-Tank Guaging /SIR Equipment: U 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. Complete the following 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 II, 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. Complete the following checklist: Lx] 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: Cx]3 g.p.h.: ^0.1 g.p.h.; ^0.2 g.p.h.; x Yes ^ No* Were all LLD's confirmed 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? x N/A Lx] 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 ^ N/A disabled or disconnected? (~ Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system ^ N/A malfunction or fails a test? ^ Yes ^ No* For electronic LLD's, have all accessible wiring connections been visually inspected? ^ N/A [x] Yes No Were all items on the equipment manufacturer's maintenance checklist completed? * In the section It, below, describe how and when these deficiencies were or will be corrected. H. Comments: HOWARDS MINI-MART 3200 PANAMA LN.93312 BAKERSFIELD CA. 805-833-1561 SEP 7. 2006 8:39 AM SYSTEM STATUS REPORT ALL FU(VCTIONS NORMAL INVENTORY REPORT T 1:PREMIUM VOLUME = 27?8 GALS ULLAGE = 9222 GALS 90°r; ULLAGE= t3022 GALS TC VOLUME = 2722 GALS HEIGHT = 2b.93 INGHES WATER VGL = 0 GALS WATER = 0.00 INCHES TEMP = 88.7 DEG F T 2:UNLEADED 1 VOLUME = 6517 GALS ULLAGE = 5483 GALS 90o ULLAGE= 4283 GALS TC VOLUME = 6378 GALS HEIGHT = 50.98 INCHES WATER Vt?L = 0 GALS WATER = 0.00 INCHES TEMP = 90.3 DEG F T 3:DIESEL VOLUME = 5325 GALS ULLAGE = 6675 GALS 90% ULLAGE= 5475 GALS TC VOLUME = 5244 GALS HEIGHT = 43,53 INGHES WATER VOL = 0 GALS WATER = 0.00 11VCHES TEMP = 93.8 DEG F T 4:UNLEADED 2 VOLUME = 6204 GHLS ULLAGE = 5796 GALS 90% ULLAGE= 4596 GALS TC VOLUME = 6069 GALS HEIGHT = 49.03 INCHES WATER VOL = 0 GALS WATER = 0.00 I tVCHES TEMP = 91.0 DEG F ~ * ~€ ~ ~ END ~ ~ * * ~ SYSTEM SETUP SEP ?. 2006 8:39 AM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE~TIME FORMAT MON DD YYYY HH : NiM : SS xl°1 HOWARDS h1INI-MART 3200 PANAMA LN.93312 BAKERSFIELD CA. 805-833-1561 SHIFT TIME 1 6:00 AM SHIFT TIME 2 DISABLED ` SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED TANK PERIODIC WARNINGS DISABLED _- TANK ANIVUAL WARPJI NGS DISABLED LINE PER I OD I C WFtR1V I NGS DISABLED LINE ANNUAL WARNINGS DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE tDEG F 7: 60.0 STICK HEIGHT OFFSET DISABLED H-PROTGCOL DATA FORMAT HEIGHT PRECISION TEST DURATIO(V HOURS: 12 DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK 1 SUN E START TIME 2:00 AM END DATE OCT WEEK 6 SUfV END TIME 2:00 AM RE-DIRECT LOCAL PRINTOUT DISABLED SYSTEM SECURITY CODE OOOOOD COMMUNICATIONS SETUP PORT SETTINGS: COMM BOARD : 1 (RS-232) BAUD RATE : 5600 PARITY NONE STOP HIT i STOP DATA LENGTH: 8 DATA AUTO TRANSMIT SETTINGS: AUTO LEAK ALARM LIMIT DISABLED AUTO HIGH WATER LIMIT DISABLED AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT DISABLED AUTO THEFT LIMIT DISABLED AUTO DELIVERY START DISABLED AUTO DELIVERY END DISABLED AUTO EXTERNAL INPUT OIV DISABLED AUTO EXTERNAL INPUT OFF DISABLED AUTO SENSOR FUEL ALARM DISABLED AUTO SENSOR WATER ALARM DISABLED AUTO SENSOR 4UT ALARM DISABLED RS-232 SECURITY CODE 000000 RS-232 END OF MESSAGE DISABLED IN-TANK SETUP T 1:PREMIUM PRODUCT CODE 1 THERMAL COEFF :.000700 TANK DIAMETER 95.50 TANK PROFILE i PT FULL VOL 12000 FLOAT SIZE: 4.0 IiV. 8496 WATER WAR1V I NG 2.0 HIGH WATER L I I°l I T: 3.0 MAX OR LABEL VOL: 12000 OVERFILL LIMIT 90% 10800 HIGH FRODUCT 95% 11400 DELIVERY LIMIT 5% 600 LOW PRODUCT 500 LEAK ALARM L I N1I T : 99 SUDDEN LOSS LIMIT: 50 TANK TILT 2.71 MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 10% . 1200 LEAK MIN ANNUAL 10% . 1200 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY i MIN T 2:UNLEADED PRODUCT CODE 2 THERMAL COEFF :.000700 TANK DIAMETER 95.50 TANK. PROFILE 1 PT FULL VOL 12000 T 3:DIESEL PRODUCT CODE 3 THERMAL COEFF :.000450 ; TANK DIAMETER 95.50 TANK PROFILE 1 PT FULL VOL 12000 T 4:UNLEADED 2 PRODUCT CdDE 4 THERMAL COEFF :.000700 _TANK DIAMETER 95.50 TANK PROFILE 1 PT FULL VOL 12000 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING 2.0 HIGH WATER LIt°1IT: 3.0 MAX dR LABEL VOL: 12000 OVERFILL LIMIT 90i . 10800 HIGH PRODUCT. 95% . 11400 DELIVERY LIMIT 5% 600 LOW FRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 2.16 MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC:. 10~ 1200 LEAK h1I N ANNUAL 10% . 1200 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERHG I tVG : OFF TANK TEST NOTIFY: - OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 1 MIN FLOAT SIZE: 4.0 IN. 8496 WATER WARNING 2.0 ' HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 12000 dVERFILL LIMIT 90a 10800 HIGH PRODUCT 95% 11400 DELIVERY' L I hi I T 5 600 , LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LdSS LIMIT: 50 TANK TILT 2.54 MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 10°~ 1200 LEAK MIN ANNUAL l0i 1200 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL HLARM D I SABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: dFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 1 MIN FLOAT SIZE: 4.0 IN. 8496 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL tIOL: 12000 OVERFILL LIMIT 90~ 10800 HIGH PRODUCT 95% 11400 DELIVERY LIMIT 5r 600 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 2.58 MANIFdLDED TANKS T#: NONE LEAK MIN PERIODIC: IOo 1200 LEAK MIN ANNUAL 10%0 1200 FERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF FER TEST AVEPAGING: OFF TANK TEST NOTIFY: dFF TNK TST SIPHON BREAK:dFF DELIVER`! DELAY 1 MIN -.-~.., LI6IUID SENSOR SETUP L 1:DISP 1-2 NORMALLY CLOSED CATEGORY DISPENSER PAN , LEAK TEST METHOD TEST ON PATE ALL TANK JAN 3. 200b START TIME 2:00 AM TEST RATE :0.20 GAL!HR DURATION 2 HOURS L 2:UISP 3-4 , NORMALLY CLOSED CATEGORY DISPENSER PAN L 3:DISP 5-6 NORMALLY CLOSED CATEGORY DISPENSER PAN L 4:UISP 7-8 NORMALLY CLOSED CATEGORY DISPENSER PAN LEAK TEST REPORT FORMAT NORMAL WPLLU L I tVE LEAK SETUP W 1:PREMIUM PIPE TYPE: STEEL LINE LENGTH: 100 FEET 0.20 GPH TEST: DISABLED SHUTDOWN RATE: 3.0 GPH 0.10 GPH TEST MMrDD DATE ??? 0 T 1:PREMIUM DISPENSE MODE: STANDARD W 3:DIESEL PIPE TYPE: STEEL LINE LENGTH: '?00 FEET 0.20 GPH TEST: DISABLED SHUTDOWN RATE: 3.0 GPH 0.10 GPH TEST MMiDD DATE ?'?? 0 T 3:DIESEL DISPENSE MODE: STANDARD W 4:UNLEADEU 2 PIPE TYPE: STEEL LINE LENGTH: 200 FEET 0.20 GPH TEST: DISABLED SHUTAOWiV RATE: 3.0 GPH 0.10 GFH TEST N1h1~DD DATE ??ter 0 T Q:UNLEADED 2 DISPENSE MODE: STANDARD LINE LEAK LOCKOUT SETUP W 2 : UNLEADED 1 PIPE TYPE: STEEL LINE LENGTH: 200 FEET 0.20 GPH TEST: DISABLED SHUTDOWN RATE: 3.0 GPH 0.10 GPH TEST Mh1~DD DATE ?'?? 0 T 2:UNLEADED 1 DISPENSE MODE: STANDARD LOCKOUT SCHEDULE DAILY START TIME: DISABLED STOP TIME : DISABLED :, ,. OUTPUT RELAY SETUP R i:OVERFILL ALARM TYPE: STANDARD NORMALLY OPEN IN-TANK ALARMS ALL:OUERFILL ALARNI ALL:HIGH PRODUCT ALARM ALL:MAX PRODUCT ALARh1 WPLLD LINE DISABLE SETUP . ~ W 1:FREMIUM I N-TANK ALARNIS T i:LEAK ALARM LIQUID SENSOR ALh1S ALL:FUEL ALARNI W 2:UNLEADED 1 IN-TANK ALARMS T 2:LEAK ALARM LIQUID SENSOR ALMS ALL:FUEL ALARM W 3:DIESEL IN-TANK ALARMS T 3:LEAK ALARM LIQUID SENSOR ALMS ALL:FUEL ALARM W 4:UNLEADED 2' IN-TANK ALARMS T 4:LEAK ALARM LIQUID SENSOR ALMS ALL:FUEL ALARM SOFTWARE REVISION LEVEL VERSION 15.01 SOFTWARE;Z 346015-100-B CREATED - 97.10.23.08.56 S-MODULEit 330160-010-A SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS PRECISION PLLD ALARM HISTORY REPORT ----- SENSOR ALARM -- L 1:DISP 1-2 DISPENSER PAN FUEL ALARM AUG 29. 2006 9:06 AM FUEL ALARM SEP 7, 2005 10:22 AM FUEL ALARM AUG 31. 2005 8:35 AM ~ ~ * ~ ~ END ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 2:DISP 3-4 DISPENSER PAN FUEL ALARM AUG 29, 2006 9:04 AM FUEL ALARM SEP 7, 2005 10:20 AM FUEL ALARNI SEP 7. 2005 10:15 AM * ~ ~ * * END ~ ~ * ~ ~ ALARM HISTORY REPORT ----- SEhdSOR ALARM ----- L 3:DISP 5-6 DISPENSER PAN FUEL ALARM AUG 29, 2006 8:59 AN1 FUEL ALARM ' SEP 7, 2005 10:24 AM FUEL ALARM AUG 31, 2005 8:35 AM * * * ~ ~ END ALARM HISTORY REPORT SENSOR ALARM L 4:DISP 7-8 DISPENSER PAN FUEL ALARM AUG 29, 2006 5:03 AM FUEL ALARM AUG 29, 2006 9:01 AM SETUP DATA WARNING SEP 11, 2005 9:27 PM ~ * ~ * END ~ ~ ~ ~ ALAS ;~.: r>2MaH I STORY REPORT ~ WPLLD L I NE LEAK ALARM ----- SENSOR ALARM ----- W 2:UNLEADED 1 L 5:UNL WPLLD SHUTDOWN ALM DISPENSER PAN WPLLD LINE LEAK ALARM SEP 7. 2006 9:09 Arl SENSOR OUT ALARM W 3:DIESEL APR 26, 2005 8:15 AM GROSS LINE FAIL SEP 7, 2006 8:54 Arl ` SETUF DATA WARNING FEH 15. 2005 B:12 AM FUEL ALARM AUG 11. 2004 10:28 AM UJPI:LD L I NE LEAK ALARM W ~i:DIESEL WPLLD SHUTDOWN ALM WPLLD LINE LEAK. ALARM SEP 7. 2006 9:09 AM W 3:DIESEL WPLLD SHUTDOWN ALM SEP 7. 2006 8:54 AM * * ~ ~ ~ END ~€ ~€ ~ ~€ ~ WPLLD LINE LEAK ALARM W 4:UNLEADED 2 _ WPLLD SHUTDOWN ALrI • WPLLD LINE LEAK ALARr1 SEP 7. 2006 9:09 AM W 2:UNLEADED 1 GROSS LINE FAIL SEP 7. 2006 8:59 AM ----- SENSOR ALARM ----- L 1:DISP 1-2 DISPENSER FAN WPLLD LINE LEAK ALARM FUEL ALARM W 2:UNLEADED 1 SEF 7. 2006 9:09 Arl WPLLD SHUTDOWN ALrI SEP 7. 2006 8:59 AM ----- SENSOR ALARM ----- L 2:DISP 3-4 ----- SENSOR ALARM ----- DISPENSER PAN L I:UISP 1-2 FUEL ALARM DISPENSER PAN SEP 7. 2006 9:10 Art FUEL ALARM SEP 7. 2006 9:09 Art ----- SENSOR ALARM ----- WPLLD LINE LEAK ALARM ~ DISPENSER3PAN W 1:PREMIUM FUEL ALARM WPLLD SHUTDOWN ALM SEP 7. 2006 9:11 At°1 SEP 7. 2006 9:09 AM HOWARDS MINI-MART `~ HOWARDS MINI-MART 3200 PANAMA LN.93 312 ----- SENSOR ALARt°1 ----- 3200 PANAMA LN 93312 BAKERSFIELD CA. ' L 4:DISP 7-8 . BAKERSFIELD CA. 805-833-1561 DISPENSER PAN 805-833-1561 FUEL ALARM SEP 7. 2006 9:1 8 HM SEP 7.- 2006 9:11 AM SEP 7. 2006 9:15 AM SYSTEM STATUS kEFORT - SYSTEM-STATUS_REFORT ALL FUNCTIONS NORMAL - W 1:WPLLU SHUTDOWN ALM INVENTORY REPORT W 2:WPLLD SHUTDOWN ALM ' -- SENSOR ALARM ----- - W 3:WPLLD SHUTDOWN ALM T 1:PREMIUM 4:DISP 7-8 L _ VOLUME = 2778 GALS DISPENSER PAN W 4:WPLLD SHUTDOWN ALM ULLAGE = 9222 GALS FUEL ALARM 901 ULLAGE= 8022 GALS SEF 7. 2006 9:12 AM TC VOLUME = 2721 GALS HEIGHT = 26.93 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 88.7 DEG..€.....~. T 2:UNLEADED 1 VOLUME = 6517 GALS . A ULLAGE = 5483 GALS ----- SENSOR ALARM ----- ---= IN-TANK ALARM ----- 90%d ULLAGE= 4283 GALS L 3:DISP 5-6 T I:PREMIUM TC VOLUME = 6378 GALS DISPENSER FAN HIGH PRODUCT ALARM HEIu^HT = 50.99 INCHES FUEL ALARM SEF 7. 2006 9:18 AM WATER VOL = 0 GALS SEP 7. 2006 9:12 AM WATER = 0.00 INCHES TEMP = 90.4 DEG F T 3:DIESEL VOLUME = 5325 GALS ULLAGE = 6675 GALS 90/ ULLAGE= 5475 GALS TC VOLUME = 5243 GALS HOWARDS MINI-t°1ART HEIGHT = 43.52 INCHES -- SENSOR ALARM ----- 3200 PANAMA LN 93312 1 WATER LOL = 0 GALS L 3:DISP 5-6 , BAKERSFIELD CA WATER = 0.00 INCHES DISPENSER PAtV . 805-833-1561 TEMP = 93.8 DEG F FUEL ALARhI SEP 7. 2006 9:12 AM SEP 7. 2006 9:18 AM T 4:UNLEADED 2 VOLUME = 6205 GALS ULLAGE = 5795 GALS SYSTEM STATUS REPORT 90~ ULLAu^E= 4595 GALS _ _ _ _ _ _ _ TC VOLUME = 6070 GALS ALL FUNCTIONS NORMAL - HEIGHT = 49.03 INCHES WATER VOL = 0 GALS _ WATER = 0.00 INCHES TEMP = 91.0 DEG F HOWARDS MINI-MART 3200 PANAMA LN.9331'L BAKERSFIELD CA. ~ ~ ~ ~ ~ END * # 805-833-1561 SEP 7. 2006 9:15 AM SYSTEM STATUS REPORT W 1:WPLLD SHUTDOWN ALM W 2:WFLLD SHUTDOWN ALM W 3:WFLLD SHUTDOWN ALM W 4:WPLLD SHUTDOWNV ALM 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 (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: #351 Howard's #4 Date of Testing: 9/7/2006 Facility Address: 3200 Panama Lane ,Bakersfield, CA 93312 Facility Contact: Omero Garcia Phone: 661-393-7000 Date Local Agency Was Notified of Testing : 8/16/2006 Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. ~~"^^ Technician Conducting Test: Joseph Stroope Credentials': X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester ^ Other (Sped) License Number(s): CSLB #804904 ICC #5258844-UT Tester #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 #1 2 Regular #2 3 Super 4 Diesel Bucket Installation Type: ^ Direct Bury x Contained in Sum ^ Direct Bury x Contained in Sump ^ Direct Bury x Contained in Sump ^ Direct Bury x Contained in Sump Bucket Diameter: 12.00" 12.00" 12.00" 12.00" Bucket Depth: 13.50" 13.00" 13.00" 13.00" Wait time between applying vacuum/water and start of test: 5 min. 5 min. 5 min. 5 min. Test Start Time (TI): 8:15am 8:15am 8:15am 8:15am Initial Reading (RI): 13.50" 13.00" 13.00" 13.00" Test End Time (TF): 9:15am 9:15am 9:15am 9:15am Final Reading (RF): 13.50" 13.00" 13.00" 13.00" Test Duration (TF - TI): 1 hour 1 hour 1 hour 1 hour Change in Reading (RF - RI): 0.50" 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 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 the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature. /~f!~/ Date: 9/7/2006 'State laws and r~lations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. - SWRCB, January 2 02 Page d of ~ Secondary Containment Testing Report Form This form is inten ed for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tes (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Howard's #351 Date of Testing: -3 - t - v S' Facility Address: 3200 Panama Lane, Bakersfield, Ca. 93312 Facility Contact: Jaco Oil Phone: t-~y~. ~~;; _ PS~~ 1 Date Local Agen y Was Notified of Testing : ~._~ s_.~~; Name of Local gency Inspector (tf present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Sunset Mechanical Technician Con ucting Test: Ken Brus Credentials: ~ CSLB Licensed Contractor ^SWRCB Licensed Tank Tester License Type: C-36 C-10 License Number: 53~.~'I-/ Manufacturer Manufacturer Training Com onent s) Date Trainin Ex fires Incon TS-STS Ins ection E ui ment 1/12/08 Veeder Root Monitoring System .6/12/06 AO Smith Secondary Piping 6/19/06 ICC Cal. UST Service Tech 12/21/06 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made it ~ L ~ ^ ^ ~ 'cr ~ ^ ^ ^ ~ _ ~' ~ ® ^ ^ ^ ~ Q ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: i,.r c~f.~ty ~ E '1-~ ~,' : t Pa =. t`j_a ~ Y'~, M ~~t~ ~i t`r cy ~~ r~ r~ C, r l~ c:. r d_ ~~ ~t "+ ftr~ ;~ ~=/')~ I2t-tll5"r" ~4M.:iu'~/bt` ~r~'~l~`^ty~~[~,-. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To t/:e best of my knowledge, t/ie facts stated in t/:is document are accurate and in full compliance with legal requirements Technician's Signature: ~~..~=-"~-~ ~ Date: 'j - i - ~ ~ SWRCB, January 2002 4. TANK ANNULAR TESTING Page 2 of ~ Test Method Developed By: ^ Tank Manufacturer ^ Industry Standard ^ Professional Engineer ^ Other (Sped) Test Method Used: ^ Pressure ^ Vacuum ^ Hydrostatic ^ Other (Sped) Test Equipment Used: Equipment Resolution: - _ ___ ,- __ - - -- -- - - - - - - - ~I, Tank # I Tank # `~ Tank # ~ Tank # ~} Is Tank Exempt From Testing?~ ~l Yes ^ No ~ Yes ^ No ~ Yes ^ No lKl Yes ^ No Tank Capacity: 1"~. ~;~-, (Z, n~^e~s 1 Z f~i' ~ '~ ,'~~, Tank Material: S n ~~ ` .~ ~~ ~.~ ~.. E Tank Manufacturer: Product Stored: ~. ~ ~,r ~ i n~A Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R,): ~: Test End Time: Final Reading (Rr): Test Duration: Change in Reading (Rr-R~): Pass/Fail Threshold or Criteria: Test Result: ^ Pass ^ Fail ^ Pass ^ Fail ^ Pass ^ Fail ^ Pass ^ Fail Was sensor removed for testing? ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA Was sensor properly replaced and verified functional after testin ? ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA ^ Yes ^ No ^ NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) .Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} SWRCB, January 2002 7. UNDER-DISPENSER CONTAINMENT UDC TESTING Page ~ of _~ Test Method Developed By: p UDC Manufacturer 17' Industry Standard ^ Professional Engineer ^ Other (Sped) Test Method Used: ^ Pressure ^ Vacuum ~ Hydrostatic ^ Other (Sped) Test Equipment Used: 7~~N 'e'~° - ~i ~ - Equipment Resolution: "•~c~°~ _ ~ UDC # 1 UDC # ~~ UDC # ~ UDC # i _ _ ____- _- - - UDC Manufacturer: Tip ; r~ c. c+n ~V ti • e~ '*" ""s`«a ° n UDC Material: ~ ~ ~:<~ ~ ,~ .-<~ far ~ . UDC De the • Height from UDC Bottom to Top of Hi hest Pi in Penetration: ~f~.ti~~ a.~. -' r~ ~. ~~~'.'. "' ~-~ ,. Height from UDC Bottom to Lowest Electrical Penetration: 6' r ~ ~ l~,cs Condition of UDC prior to testin ~ ~ Portion of UDC Tested ~i„ ,- ,~ Does turbine shut down when UDC sensor detects liquid (both ,p Yes ^ No ^ NA @ Yes ^ No ^ NA ~d Yes ^ No ^ NA ,~ Yes ^ No ^ NA roduct and water)? Turbine shutdown response time -+• . ~ <•- ~-~°= • ~ -~ .-. c, + -t' ' c. Is system programmed for fail- safe shutdown?+ ~ yes ^ No ^ NA Gd Yes ^ No ^ NA ®. Yes ^ No ^ NA .~ Yes ^ No ^ NA Was fail-safe verified to be o erational?~ ~ yes ^ No ^ NA ~ Yes ^ No ^ NA .B Yes ^ No ^ NA ~ Yes ^ No ^ NA Wait time between applying pressure/vacuum/water and 1 ~ ~ ~ ~ ~ ~ ~ '~ ~ a~ • 1 ~ ~ ~ ~ • y 5 ,~ , ~, startin test Test Start Time: o : 4 ~ ~':'^ f : rle7 ~`°'~ - ;'-1 CJ `'~"' 1; ~{ ~ F'e`•~ Initial Reading (RI): ~. -• : ~• ~ "' y 1 i-1 • ~C~ • ~ -> Test End Time: ~'~'~+ F ~ek~ ~9~ • ~ ~.~ Final Reading (RF): , o ; ~• ~. .. ~ rl . ,~~ ~• Test Duration: 15 .•K ~ ,av . i `.a i~ , ~v . i e, ~•.~, , .v i F; r-a ~ ev . Change in Reading (RF-R~): -1°. ~~ •~ ~ • ~~.~? •• ,p' Pass/Fail Threshold or Criteria: -+~ . ~, ~ ~ ~ ± • c~ c~ ~. -" • p c; ~ -- ~ '~ • ~ ~ ^ ' ' Test Result: •~ Pass ^ Fail .C~ Pass ^ Fail ^ Fail I~ Pass 13 Pass ^ Fail Was sensor removed. for testing? ~ Yes ^ No ^ NA ~ Yes ^ No ^ NA ~ Yes ^ No ^ NA .E~.Yes ^ No ^ NA Was sensor properly replaced and verified functional a8er testing? ~ Yes ^ No ^ NA ~d'Yes ^ No ^ NA ($ Yes ^ No ^ NA ,~ Yes ^ No ^ NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ If the entire depth of the UDC is not tested, specify how much was tested. If the answer to a~ of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) SWRCB, January 2002 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Page ~{ of ii Test Method Developed By: ~ UDC Manufacturer (~ Industry Standard ^ Professional Engineer ^ Other (Specify) Test Method Used: ^ Pressure ^ Vacuum ~ Hydrostatic ^ Other (Sped) Test Equipment Used: ~`,~r~e~ av '~`~.~' ~T 5 Equipment Resolution: 'T . fac~s~ IL__ _ ~j UDC # UDC #F„~ TUDC # °~ UDC # UDC Manufacturer: -ray-- > -•~ . UDC Material: ~-• ~<°c ~ K~-~ !: .~' ~'<~ UDC Depth: ~ ^ •~~ Height from UDC Bottom to Top of Hi hest Pi in Penetration: ,ra-• ~ ca -« ,,,i n c ~ , z~ Height from UDC Bottom to Lowest Electrical Penetration: ~ c3 ~ ~ c~, Condition of UDC prior to testin -, C9nC, Portion of UDC Tested ~. 4•,L ~ ~ Does turbine shut down when UDC sensor detects liquid (both roduct and water)?* ~7 Yes ^ No ^ NA .fl Yes ^ No ^ NA .IKII Yes ^ No ^ NA ~1 Yes ^ No ^ NA Turbine shutdown response time -±" ~, ~<.. -* jc-s '~~~_ . °r' . ~, ~•,CZ.. -+~ ~, rF c° , Is system programmed for fail- safe shutdown? ®,yes ^ No ^ NA ~ Yes ^ No ^ NA ~ Yes ^ No ^ NA ~ Yes ^ No ^ NA Was fail-safe verifted to be o erational?~ .El Yes ^ No ^ NA l~ Yes ^ No ^ NA J~ Yes ^ No ^ NA ~ Yes ^ No ^ NA Wait time between applying pressure/vacuum/water and startin test ~~~ avt' u... • ,~~`~ a'.~! , w ~ ~ c~ .mot , .~a. ~ ~~ ~ , ~ - Test Start Time: ~: aa; ~'~`'~ ~ :~, prn •~?,; t~ ~ ~'.~ c ::~ ' >'~'~ Initial Reading (R,): ~ e ~, ° la - ~ ~~ ~i .'l~„ ~•, `3 ? -~ Test End Time: t^~a ~~,~ ~ ~.~• ; ~ - ~~ Final Reading (RF): ~~ .. t , l r ~; .~ . ~ Z ~ ~ - ~ . '~ ~~.~= Test Duration: ~ S ~:., ,,,,., . ! . ,,,•, ~„~ , -~, . ~ w . Change in Reading (RF-Ri): -b ty~c~ i • • +. ~e'~n~; -- - • ;~ ~~•> '• - ~, p Pass/Fail Threshold or Criteria: -~ . oe~ ^ - ~r , ~,, ^. t . ~p'~•. ~ ~' • ~? • Test Result: .17 Pass ^ Fail ~] Pass ^ Fail ~l Pass ^ Fail ~ Pass ^ Fail Was sensor removed for testing? 8' Yes ^ No ^ NA ~l Yes ^ No ^ NA kl Yes ^ No ^ NA frl• Yes ^ No ^ NA Was sensor properly replaced and verified functional after testing? ~ yes ^ No ^ NA .® Yes ^ No ^ NA ®Yes ^ No ^ NA Yes ^ No ^ NA '~ COmmerits - (include information on repairs made prior to testing, and recommended follow-up for failed tests) If the entire depth of the UDC is not tested, specify how much was tested. If the answer to ~ of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) SWRCB, January 2002 Page ~_ of 'T I 7. UNDER-DISPENSER CONTAINMENT UDC TESTING Test Method Developed~By: ~ UDC Manufacturer 'Industry Standard D Professional Engineer j ^ Other (Sped) Test Method Used: ~ ^ Pressure ^ Vacuum 'Hydrostatic ^ Other (Sped) Test Equipment Used: ~ ~c;,~1 ~, -~ ~, - ~ Ti's Equipment Resolution: -t' . ~,~ ' ' _ ___ ~ UDC # UDC # r UDC # ` I UDC # I ~• ~__ _ _ - _ UDC Manufacturer: Tyr` ^~ ~ ..~,R # ~ a ~s, ~. UDC Material: ~ - ~< cr ,~'s r UDC Depth: Height from UDC Bottom to Top of Highest Pi ing Penetration: t~~~!"0'c»a ~~~•-~~~ pc~-~-~~^,;r,.~ •e~ Height from UDC Bottom to Lowest Electrical Penetration: ~~~,~ ~~ o-; 0 ~ ~p~;p ~ ca'~ ,U Condition of UDC prior~to testin ~ rte, ~, .~ Portion of UDC Tested ~ ~Lr_ ~ ;~ Does turbine shut down when UDC sensor detects liquid (both Yes ^ No ^ NA ~@ Yes ^ No ^ NA .~ Yes ^ No ^ NA gYes ^ No DNA roduct and water)?f j Turbine shutdown res onse time -F ~ c4„ -r ~ ~- -t ~ ~- - -} ~~~ , Is system programmed 1'or fail- safe shutdown?~ .~ Yes ^ No ^ NA ~ Yes ^ No ^ NA ~Sl Yes ^ No DNA ~ Yes ^ No ^ NA Was fail-safe verified to' be o erational?~ .E~1 Yes ^ No ^ NA ~ Yes ^ No ^ NA l~ Yes ^ No ^ NA ~ Yes ^ No ^ NA Wait time between applying pressure/vacuum/water and startin test Test'Start Time: ~; 2.C~ ~`~ ~~ : ? O Fey- ~'`'~ `~ ' '' ~`^ Initial Reading (R,): j i ~'"~ '- sl. y ~ ~• _ ~ c° p~ -~ Test End Time: j -=•~.•~ ~~ • ~• ~~N~ ~°~ - ~ r~ r^ :~~• ~ ~_ • ~r ~>u.n • Final Reading (RF): . ~ i c,tc ~ -~~~ i~. •' .`' '~ .C~ `' ' C 1 CJ ~ ` Test Duration: ~ 1'j r~,a.y • 'cs r~ Irv " 1 r• /~ i ai i cj i'vi ~ N . Change in Reading (RF-R,): ' • Ot~G." "' -- • Cs ~+ C~ 3 "` '~' - Z> a~ + . ~~ c> ~ . . Pass/Fail Threshold or Criteria: -?- . ~~ -t" • ~ ~ '- '~'". • ~~c~'2_ ' • i" . ~,~ ~ r Test Result: fa Pass ^ Fail ®Pass ^ Fail ®Pass ^ Fail p Pass ^ Fail Was sensor removed for testing? ~ Yes D No ^ NA ~ Yes D No DNA Yes ^ No DNA ~ Yes ^ No ^ NA Was sensor properly replaced and verified functional after testing? ~ Yes ^ No ^ NA E~ Yes ^ No ^ NA (~ Yes ^ No ^ NA E~ Yes ^ No ^ NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ If the entire depth of the UDC is not tested, specify how much was tested. If the answer to a_y of the questions indicated with,an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) ~ SWRCB, January 2002 8. FILL RISER CONTAINMENT SUMP TESTING Page rr of °~ Facility is Not Equipped With Fill Riser Containment Sumps ^ Fill Riser Containment Sumps are Present, but were Not Tested ^ . Test Method Developed By: I~ Sump Manufacturer ~ Industry Standard ^ Professional Engineer j^ Other (Sped) Test Method Used: iG Pressure ^ Vacuum ~ Hydrostatic ^ Other /Sped) Test Equipment Used: y:e.~.~~ ~ "I ~ - ~ ~; ~ Equipment Resolution: •± ,~p~-~ ~• -- --- - - - _ _-: - r - _- _ __ Fill Sump # Fill Sump #~? Fill Sump # 3 Fill Sump # ~` Sump Diameter: - - -- - ~` f- ~` -~ 4~ ""` Lt ~ ,< Sump Depth: ~ e~ ~ r Height from Tank Top to Top of Hi hest Pi in Penetration: N/ '~ ~~'~ r0~e''~ ~`~~~ Height from Tank Top to Lowest Electrical Penetration: ~ r _ ~ r '~ • ~ < Condition of sump prior to testin C~ey.':~d~ ~C~.~'. ~~~,CS~ C~c1C;~ Portion of Sump Tested -r- `~ -- + Zt~ ~- ~:. `~ - •+ '> n ~- Sump Material: ~t k`?C1rE~t~Rti:.; ~t ~~~C.~S~' 't ~ ..~~n~~4' 'f~i~ ~ `' Wait time between applying pressure/vacuum/water and startin test: :~ J~ ="''}~-. ~ ~~' t+n,w ~ ~~ ~•~,,,~ .~, ~~ 1~r.~, • Test Start Time: I"-~ ,.°~- ., .~ ~=.~ ~: ~ ~•'"~ ~:~ Initial Reading (R,): t- ~ ~, . 7 ~; • - E~ •- _ Test End Time: ~ •+ ~.~ ~•~- ~ • _'- ~F'.~n •a " r- raa, Final Reading (RF): ~'~ ~ ~;, ,-~ •~ -Z ,~ • • •~ Test Duration: 1 S r~1 ~w ~ ' ,~ , „~ ~ +~ Change in Reading (Rr-R,): - . ~o,c' y -• -r<- .dam •-~, •• -!• Q <• Pass/Fail Threshold or Criteria: ~+ -b~"~ °• '~' - ~~'G- '~ • ~c~'~ '• "~` •c~c 2 '• Test Result: ~ Pass ^ Fail <~ Pass ^ Fail J>~ Pass ^ Fail ®Pass ^ Fail Is there a sensor in the sump? ~ Yes ^ No ~ Yes ^ No .Esl Yes ^ No l~ Yes ^ No Does the sensor alarm when either product or water is detected? ~ Yes ^ No ^ NA l~ Yes ^ No ^ NA ~ Yes ^ No ^ NA ~ Yes ^ No ^ NA - Was.sensor removed for testing? ,~ Yes ^ No ^.NA ~ Yes ^ No ^ NA ~ Yes ^ No ^ NA .Yes ^ No ^ NA Was sensor properly replaced and verified functional after testing? •Q Yes ^ No ^ NA t~ Yes ^ No ^ NA .~ Yes ^ No - ^ NA ~1 Yes ^ No ^ NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB, January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page '? of Facility i"s Not Equipped With Spill/Overfill Containment Boxes ^ Spill/Overfill Containment Boxes are Present, but were Not Tested ^ Test Method Developed By: l~ Spill Bucket Manufacturer ~ Industry Standard ^ Professional Engineer ^ Other (Sped) Test Method Used: ^ Pressure ^ Vacuu ^ Other (Sped) m C~3•Hydrostatic Test Equipment Used: 1ti~ i~ Bucket Diameter: ;,,~ ~ g-~~ Spill Box # f Spill Box # ~ ~.Z '~ 12 • ~ Equipment Resolution: Spill Box # ~ I'2 "" '~` -dam Spill Box # ca 1 ~' Bucket Depth: 1 ~ ~- I '~ • - ! ~ ' • t •L ' Wait time between applying pressure/vacuum/water and startin test: ~~ ~ ~ ~, , °~ ~ ~ ~ w , `~ ~ ~ ~ W ~ ~~ ~~ t~ Test Start Time: ~ : ~y . ~,:et . i=ra •~ : ~ i t'e,z - ;~ F~ Initial Reading (Ri): ~,.~ : ~ -- .. -* • ~ 1. ~ -~ , .r~-A t •- c? , ~~ Test End Time: ~~ . N d<~ F'.u ; ` ~' ~ ~ •, • I F' ~~-~- Final Reading (RF): y • ~ ,, ~.~ .. ~ . ~ r ~ - ~~ a 1 •~ Test Duration: ~ ~ +'vt r ~, ~ I ~ t,,t , ~,~, , ~,~, , Change in Reading (RF-R,): -- . ~~ c.,,3 "- -1- . ~ ~~ ~ •• 't'- . ~< oo - - cs acs ~ '° Pass/Fail Threshold or Criteria: '~ - e~C' :. -" ~ • ~~ ~ -,l. ~ , , .... • aC~... „~, ,., _ •e7O'2.. Test Result: ~ Pass ^ Fail ~I Pass ^ Fail ~ Pass ^ Fail ~ Pass ^ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) i_ X41 ` Y y ~. r: ... t1{~C,' ,.1;` tY. i ,::,;. ' t I . r `I t t_ti . ' ufsi, ; I ~;; 7 -_ -' 1; ~ i I, i =---~--~--~~__.:..:.w. ~ i ~ ~ 1 '~ n ~ ~- ~~tr /~'~~ aw t ''~t~GI rFf•3i~Mi'i i~h;; ~ _ j v' _ ;.,. _~i fir. .i i i _,, ".~.h_ i i :,1;J A..1"•.C. `, 5~ iii Tti'' i. ,ter 4 ~ °I~t"'~EC:' i r,; Y' ~ E_pt;?Fy ~~ill~ _ , a;, _ It; _ ~' _ ' ! 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