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HomeMy WebLinkAboutUNDERGROUND STORAGE TANK ~~ '~t / ' ~, ~i`~ (UNDO:ItI~'1tOUNllS1'vitAG~:lANKb') 'p1L~;# ~.~ COSTCO - _ _ _ - - -- - r ~ •~ •3800 ROSEDALE FIWY. RightFax 8/15/2006 2:27 PAGE 002/003 Fax Server • UNDERGROUND STORAGE TANK gAKERSFIELD FIRE DEPT. PERMIT APPLICATION ~~ B A ~-~ s P 1 g~ n Prevention Services TOCONSTRUCT-INSTALL NEW TANK (NEW FACILITY) / .~ ` ~XR')r ~ 900 TnTxtun Ave., Ste. 210 NEW TANK INSTALLATION (EXISTING FACILITY) / ~ DE~~ ~ Bakersfield, CA 93301 MODIFlCATION / & MINOR MODIFICATION - FACIUTY Tel.: (661) 326-3979 Fax: (661) 852-2171 PERMIT NO. ~/yl _ ~ Page 1 of 7 TYPE OF APPLICAT~~I--O1IN: 0 NEW TANK INSTALL /NEW FACILITY ^ NEW TANK INSTALLATION /EXISTING FACILITY (Check ene item onlvl ^ MODIFICATION OF FACILITY ^ MINOR MODIFICATION OF FACILITY ARTING DATE ~r i ] YD ~ / ROPO~~D COMPLETION DATE ~} ~/~ O~ / ACILt]~NAME ISCING FACILITY PERMIT N0. ACIL A ~~ ~~o~~ ~ 'C ITY . ~ ( (/,Iy IP PE OF BUSINESS s N# ~-f U~ D©E33 lit' S c ~ IP Dal ONTRAGTOR LICENSE NO. 5 CC NO, 0 SS P OOE I~,- ~~ ~ RSFIEIDCRYBUSINESSLICENSENO. IQtAANSCOM N0. ~~ SURER BRIEFLY DESCRIBE THE WOR TO BE DONE WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO.OF TANKS TO EE INSTALLED ARE THEY FOR MOTOR FUEL ^ VES ^ NO SP1L PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ^ YES ^ NO Tuic cernnu ~c rno nnn~rno eue~ TANKNO. OLUME NLEADED GULAR REMIUM IESEL VIATION ~ v v o vv~ Tole ccr•nnel Ic ene unl~ nnnrne euel eTnewr_e rn~wc TANK NO. OLUME NLEADED ULAR REMIUM IESEL VIA710N FOR OFFICIAL USE ONLY APPLICATK)NOATE FACILITVNO. N .OF TANKS FEES$ The applicant has received, understands, and will comply with the attached conditioitS of Jre permit and any other state, local and federal regulations. Thisfo»n has been completed under penalty of perjury, and to the best of my 1molvtedge, is hue and correct APPROVED BY: APPLICANT NAME (ARINT) APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FD 2086 (Rev. os/off RightFax 8/15!2006 2:27 PAGE 003/003 Fax Server ` BILLING & PERMIT STATEMENT ~ '~~?'` BAKERSFIELD FIRE DEPT. B tiR SP l D Prevention Services ' F/RE 900 Truxtun'Avenue, Suite 210 PERMIT NO.: wl[rM r sakersfieid, CA 93301 ' ~ ~~~'~ Tel.: (6611 326-3979 0 Fax: (6611 852-2171 STARTING DATE U CCMPLE(iONDATE ~- NAME -1 _ 1 1-f1(n '7 - I ~ --/`j(:, ~ X11 ~ ~l`,~ ~ , STATE 21P CONTRAO OR OM NAME ~ I I i/Y1nI Y P ~ t~-5a3 -~W AySnriFl ~nmYYYI/ml~IDn ~'I A~,QD. ~~'~~-.enl~°~~.~.~~v~l~~_ zIP~~~In~~1 .. ~ t ^ Alarms -New & Modifications - (Minimum Charge) $262.50 • ~ • 98 Over 20 000 Sq. Ft. Sq. Ff. x .013125 =Permit fee ~ t1 , 98 ^ Sprinklers -New & Modifications - (Minimum Charge! $210.00 ~ 98 ^ Over 5 000 Sq Ff Sq Ft: x 042 =Permit fee ~ . , - . . 98 ^ Minor Sprinkler Modifications (< 10 heads) 00 [Inspection Only] S 43 ~ . 98 ^ Commercial Hoods-New ~ Modifications $ 39626 ~ 98 ^ Additional Hoods 00 $ 36 ~ . 98 84 ^ Spray Booths -New & Modifications $458.00 98 ^ Aboveground Storage Tanks (lnsta!lation/lnsp: i° Time) $165.00 82 ^ Additional Tanks $ 2t%QO 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (Instal/atlon./Inspection) $878.00 (per tank) ~ 82 ^ Underground Storage Tanks (Modification) $878.00 (persite) 82 ~ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (Removaq $675.00 (per fank) ~ ^ Oilwell (Installation) $ 72.00 84 fl Mandated Leak Detection (Testing) /Fuel Mon)tCert1SB989. $ 81.00 (per site) 82 ^ Tents $ 93.00 (pertent) ~ ^ After hoots inspection fee $122.00 ~ ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 62.00 + (5 hrs. min. starve -by fse Ilnspectlon) _ $527'.00 ~ ~ ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) S 93.00 (per hour) ~ ^ Portable LPG (Propane): NO.OF CAGES? $ 66.00 84 ^ Explosive Storage $249.00 84 ^ Copying & File Research (File Research Fee $34.00 per hr) 25¢ per page ~ ^ Miscellaneous ~ 84 FD 2021(Rev. 09105) 7 . nkIplNGI WHITF (tn Troasnrvl 1xF11.OW (tn Filwl 'LPWK (fe Cuafamarl Client: 12574 WAYNEPER - .ACORD,~ .CERTIFICATE OF LIABILITY INSURANCE 12/30/05Dmrn '~R PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ~~ 949-250-7172 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE IlivanCurtisMonroe-#OE836~0 - HOLDER. THIS.CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 100 Main Street, Suite 350 Irvine; CA 92614 INSURED Wayne Perry, Inc 8281 Commonwealth Ave Buena Park, CA 90621 COVERAGES INSURERS AFFORDING COVERAGE NAIC # INSURER Ai American Int'I Specialty Lines Ins C wsuRER B: Commerce 8~ Industry iNSURERC: Golden Bear Insurance Company INSURER D: American Home Assurance INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER PppL7EYMM~DM'E PDATE MMlDD/Y`f N LIMITS A GENERAL LIABILITY PROP1665078 12/31/05 12/31/06 EACH OCCURRENCE $5 OOQ OOO X ~ COMMERCIAL GENERAL LIABILITY DAMMG ETOE oNTED n S1 OO OOO . CLAIMS MADE ~ OCCUR MED EXP (Any one person) $5 OOO X BI/PD Ded:25000. PERSONAL & ADV INJURY $5 OOO OOO ~ GENERAL AGGREGATE $S OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $5 OOO OOO POLICY jEa Loc Professional Liabilit Included B AUTOMOBILE LIABILITY _ X ANY AUTO CA6691454 12/31/O5 ~ 12/31/O6 COMBINED SINGLE LIMIT (Ea accident) $1,000,UUO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-0WNEDAUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ C EXCESS/UMBRELLA LIABILITY .. GBX266O4 '12/31/O5 12/31/06 EACH OCCURRENCE $4 OLIO OOO X OCCUR ~ CLAIMS MADE AGGREGATE $4 O.OO OOO $Excess DEDUCTIBLE $AUtO RETENTION $ $Llablllt b WORKERS COMPENSATION AND WC3421147 O1/O1/O6 01101 /07 X wC STATU- 0TH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTNE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $1,000,OQO It yes, describe under . SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS! LOCATIONS !VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENiI SPECIAL PROVISIONS Re: All California operations of the named insured. 'i. CERTIFICATE HOLDER Wayne Perry, Inc. 8281 Commonwealth Avenue Buena Park, CA 90621 CANCELLATION Ten Day Notice for Non-Payjnent of Premium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~_ DAYS WRITTEN NOTICE TO THE CERTIFlCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABILTTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2005!08) 1 of 2 #M9624 CTN O ACORD CORPORATION 1988 ~ - - .%t FASTECH, INC. Construction, Compliance Testing, Engineering, & Station Maintenance August 25, 2006 Mr. Steve Underwood SB 989 POST REPAIR TESTING Bakersfield Fire Department 1715 Chester Avenue, 3rd Floor Bakersfield, CA 93301 SUBJECT: SB 989 COMPLIANCE TESTING AT COSTCO STATION - 3800 ROSEDALE HIGHWAY & GIBSON, BAKERSFIELD, CA 93308 SITE # 688 Dear Mr.Underwood: Attached, please find the secondary containment testing results for the above-referenced site. These results are being sent to you per the requirement of SB 989. CONTRACTOR: FASTECH; License No: 794519 TECHNICIAN: Jim Simeone • SB 989 Testing Results If you have any questions regarding the attached results, please contact the undersigned at (714) 523-0194. Sincerely, FASTECH, Inc. t'le-`" Glen A. Ragle Program Manager Attachments Cc: Caroline Dollemore, Wayne Perry, Inc. -Buena Park 7050 Village Drive, Suite D Buena Park, California 90621 Phone (714) 523-0194 Fax (714) 523-4235 ,~ Secondary Containment Testing Report Form This form is intended 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 tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Costco Date of Testing: 08/17/06 Facility Address: 3800 Rosedale Hwy & Gibson, Bakersfield, CA 93308 Facility Contact: Bill Phone: 661-852-2643 Date Local Agency Was Notified of Testing Name of Local Agency Inspector (fpresent during testinp~: 2. TESTING CONTRACTOR INFORMATION Company Name: Fueling & Service Technologies, Inc. (FASTECH) Technician Conducting Test: Jim Simeone Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester License Type: A, HAZ, C21 License Number: 794519 Manufacturer Training Manufacturer Com onent(s) Date Trainin Ex fires Furnished on request 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Re M pa ad irs e Vapor Recovery Line ® ^ ^ ^ ^ ^ UDC 91 10 ® ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: See attached testing procedures. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: Date:_08/17/06 4. SECONDARY PIPE TESTING Test Method Developed By: ^ Piping Manufacturer ®Industry Standard ^ Professional Engineer Other (Sped) Test Method Used: ®Pressure ^ Vacuum ^ Hydrostatic ^ Other (Sped) Test Equipment Used: See attached testing procedures Equipment Resolution: Piping Run # Sta e II va or piping Run # Piping Run # Piping Run # Piping Material: fiberglass Piping Manufacturer: AO Smith Piping Diameter: 4" Length of Piping Run: n/a Product Stored: vapors Method and location of piping-run isolation: Wait time between applying pressure/vacuum/water and starting test: 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: 12:00 Initial Reading (RI): 5 psi Test End Time: 1:00 Final Reading (RF): 5 psi Test Duration: 1 hour 1 hour 1 hour 1 hour Change in Reading (RF-RI): 0 Pass/Fail Threshold or Criteria: 0.00 0.00 0.00 0.00 Test Result: ®Pass ^ Fail ^ Pass ^ Fail ^ Pass ^ Fail ^ Pass ^ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) 5. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: ^ UDC Manufacturer ®Industry Standard ^ Professional Engineer ^ Other (Sped) Test Method Used: ^ Pressure ^ Vacuum ®Hydrostatic ^ Other (Specify) Test Equipment Used: See attached testing procedures. Equipment Resolution: ~~ __ ~ ~ ~~~.~~ Y~ ~:_ _ . ~ ~ :.~~' UDC #91 10 UDC #9 J 10 UDC # UDC # UDC Manufacturer: Environ Environ UDC Material: lastic lastic UDC Depth: 29" 29" Height from UDC Bottom to Top of Highest Piping Penetration: 11" 11" Height from UDC Bottom to Lowest Electrical Penetration: 11" 11" Condition of UDC prior to testing: good good Portion of UDC Tested Above highest enetration Above highest enetration Above highest enetration Above highest enetration Does turbine shut down when UDC sensor detects liquid (both product and water)?' ^Yes ^ No ®NA ^Yes ^ No ®NA ^Yes ^ No ^ NA ^Yes ^ No ^ NA Turbine shutdown response time Is system programmed for fail- safe shutdown?' ^Yes ^ No ®NA ^Yes ^ No ®NA ^Yes ^ No ^ NA ^Yes ^ No ^ NA Was fail-safe verified to be operational?* ^ yes ^ No ®NA ^Yes ^ No ®NA ^Yes ^ No ^ NA ^Yes ^ No ^ NA Wait time between applying pressure/vacuum/water and starting test 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: 12:56 1:15 Initial Reading (RI): 0.5889 0.5892 Test End Time: 1:11 1:30 Final Reading (RF}: 0.5890 0.5893 Test Duration: 15 min 15 min Change in Reading (RF-RI): 0.00012 0.00011 Pass/Fail Threshold or Criteria: 0.002 0.002 0.002 0.002 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 testing? ®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) ' 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) E S Hydro .T/te,Te~st~Psne/ teve/Pfnbe 2 -~ ~ ~ ~:4 ~ ~ ' ; ~. w Imo.,'.... ~ ,:. ~; r ~ ~' a t ,~ ^t.. - ~ z ,r z.u~-c. y ''. ~ _' ~','~.s ' ^4:,4 3' _ y Test Parameterts T;e~st S~taftus ~~~ ~~ ~~ Fun.ct~onE M'e,nu ~.~'<: h~:~. Test Site Status pass/Fail ~~~ ~ Restart;, Abort Costco Saving... .~~-~ ~~~ ~..: 3800 Rosedale Hwy Change Bakersfield, CA 93308-XXXX 0.00012;Return . .,i ~~,i __ _ _ _ Product UDC ~ ~` _ _. ~ ._ ,s _ ~ ~~ -~.~~~I >r _ I ~~~ TYpe 0.589 !~~~~~~ Dispenser 9-10 ~. Test Start Time ,~.~..._..,_ ~..~..____._~..~.~..u 77II Thu, Aug 17, 2006 12:56 PM~~ ' 7 0.5891 I Test End Time ~ ,.: ~: Thu, Aug 17, 2006 1:11 PM 0.589 ~, Length (min) Limit (in) ~ ~ 15 0.0020 ~ ~{ Test Result 0.588 ' Test passed Comments 0 588 - I I I 1 1 1 1 1 1 I I I I I I I I I I I I I I I I ' - - ~ ~ I + ; - - I I I I I -- - _ _ _ _ ~ I - - I ~ _ _-- ~ r ~ ~ - - I I I I - -- - _ - - - - _ - I I I - - - I I I _ - - - - - - -I - - - - - - f- - { - I I I I I I I I I I I I I I I I I I - I - -- I I - - I i -=~ - _ - - - I I - I I I - - I I I I I I I I I I I I I I I I I I I ( I I I I I I I I - I I I I I - - - ; - - I - I I - I ~ I I - i i' ~ i i i i i i i ~ i i 2 0 9 8 i 12:56:09 PM 01:00:00 PM 01:03:00 PM 01:06:00 PM 01:11:09 PM '~ J 08/17/2006 08/17/2006 08/1712006 08/17/2006 08/1712006 q ~` Test Time ~. ' E S R` Nydre T~t~ Fest~P.~~e%- Le~eP~obe-~ ~ . ,_, y - ~ _ - A`~ a ~ , ~ + : ~ ~ ~_ r ~. II_ Test Par..arnete~rs t ~Tes,~t~~S~tafus . ~`~ ~ ~ F'u~ntc~tio~nMe~n~u~,~ ~~ x _ ~ ~._.~ ~ - . _~~-~..~.. .___ . a ~3--~. ... .. _v_~.~.~>. ~ Test SiteStatus ~', - -- ` Pass/Fair Saving... Restart; I Abort ?~ ~ Costco i. ~ ~__ i i ~`~ 3800 Rosedale Hwy Change Bakersfield, CA 93308-XXXX .Return.; 0.00011 ,,._.. ._.,,w..,r-..Y-,- ~~ ~,~ Product ., . ~;,~~ . .. ,;-r'h . ~ , ',',:. UDC __ - ~ _ ~ ~ ~ ~ . ___ _ __ __a_~ ~ ____ _,_-_-- '~ Type 0.5894- i' . Dispenser 9-10 1 ' Test Start Time ...~~~..~..,.~.....~..._W_~..._ m._.~_.w_. ~ ~~~~~~ Thu, Aug 17, 2006 1:15 PM :; 0.5893- ~ : ' Test End Time ~ _ ' Thu, Aug 17, 2006 1:30 PM °i _ o.58sz- '' ' Length (min) Limit (in) ~ 15 0.0020 ~ 'Test Result o 5ss1- '11: Nest passed . r I~~ Comments 0.5890- - i - i ~ __~ i - } i i - i i i 'i ~ ~ ~ ~ - - - - I - ~ ~ ~ + I - - -~ - - -+ - - ~ ~ - - ~ ~ ~ - - - ~ ~ ~ ~ ~ - ~ - _ ~ - L _ _ ' - ~ ~ ~ f - - - + - - ~ _ - - - - - - - ~ -L ~ -+ - =~ _+- - - ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ - ~ ~ ~ - i i i i i i ii i i i i i i ~.~;~ i ~ i i i i ii ' 01:15:13 PM 01:18:00 PM 01:21:00 PM 01:24:00 PM 01:27:00 PM 01:30:13 PM 08/17/2006 08/17/2006 08/17/2006 08/17/2006 08/17/2006 08117/2006 Test Time ,, FASTECH, INC. Construction, Compliance Testing, Engineering, & Station Maintenance August 25, 2006 Mr. Steve Underwood SB 989 POST REPAIl2 TESTING Bakersfield Fire Department 1715 Chester Avenue, 3rd Floor Bakersfield, CA 93301 SUBJECT: SB 989 COMPLIANCE TESTING AT SHELL SERVICE STATION - 3800 ROSEDALE HIGHWAY & GIBSON, BAKERSFIELD, CA 93308 SITE # 688 Dear Mr.Underwood: Attached, please find the~secondary containment testing results for the above-referenced site. These results are being sent to you per the requirement of SB 989. CONTRACTOR: FASTECH; License No: 794519 TECHNICIAN: Jim Simeone • SB 989 Testing Results If you have any questions regarding the attached results, please contact the undersigned at (714) 523-0194. Sincerely, FASTECH, Inc. ~~~-~ Glen A. Ragle Program Manager Attachments Cc: Caroline Dollemore, Wayne Perry, Inc. -Buena Park 7050 Village Drive, Suite D Buena Park, California 90621 Phone (714) 523-0194 Fax (714) 523-4235 Secondary Containment Testing Report Form This form is intended 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 tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Costco Date of Testing: 08/17/06 Facility Address: 3800 Rosedale Hwy & Gibson, Bakersfield, CA 93308 Facility Contact: Bill Phone: 661-852-2643 Date Local Agency Was Notified of Testing Name of Local Agency Inspector (ifpresent during testing: 2. TESTING CONTRACTOR INFORMATION Company Name: Fueling & Service Technologies, Inc. (FASTECH) Technician Conducting Test: Jim Simeone Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester License Type: A, HAZ, C21 License Number: 794519 Manufacturer Training Manufacturer Com onent(s) Date Training Ex fires Furnished on request 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repa Mad irs e Component Pass Fail Not Tested Repa Mad irs e Vapor Recovery Line ® ^ ^ ^ ^ ^ ^ ^ UDC9/10 ® ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: See attached testing procedures. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: Date: 08/17/06 4. SECONDARY PIPE TESTING Test Method Developed By: ^ Piping Manufacturer ®Industry Standard ^ Professional Engineer Other (Sped) Test Method Used: ®Pressure ^ Vacuum ^ Hydrostatic ^ Other (Sped) Test E{{ quipment Used: See attached testing procedures - ~ Equipment Resolution: _ o - ' ~ ~ ~ i~ ~ °,.°~ I Piping Run # Sta a II va or Piping Run # Piping Run # Piping Run # Piping Material: fiberglass Piping Manufacturer: AO Smith Piping Diameter: 4" Length of Piping Run: n/a Product Stored: vapors Method and location of piping-run isolation: Wait time between applying pressure/vacuum/water and starting test: 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: 12:00 Initial Reading (RI): 5 psi Test End Time: 1:00 Final Reading (RF): 5 psi Test Duration: 1 hour 1 hour 1 hour 1 hour Change in Reading (RF-RI): 0 Pass/Fail Threshold or Criteria: 0.00 0.00 0.00 0.00 Test Result: ®Pass ^ Fail ^Pass ^ Fail ^Pass ^ Fail ^Pass_ ^ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) 5. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: ^ UDC Manufacturer ®Industry Standard ^ Professional Engineer ^ Other (Sped) Test Method Used: ^ Pressure ^ Vacuum ®Hydrostatic ^ Other (Sped) Test Equipment Used: See attached testing procedures. Equipment Resolution: -_ ~~ ~~"' 'r-'~^.~~ v ;• ~-, ~ ~ `` r ~ ~ UDC #9 ~ 10 UDC #9 / lU ~ _ UDC # UDC # UDC Manufacturer: Environ Environ UDC Material: lastic lastic UDC Depth: 29" 29" Height from UDC Bottom to Top of Highest Piping Penetration: 11" 11" Height from UDC Bottom to Lowest Electrical Penetration: 11" 11" Condition of UDC prior to testing: good good Portion of UDC Tested Above highest enetration Above highest netration Above highest enetration Above highest enetration Does turbine shut down when UDC sensor detects liquid (both product and water)?` ^Yes ^ No ®NA ^Yes ^ No ®NA ^Yes ^ No ^ NA ^Yes ^ No ^ NA Turbine shutdown response time Is system programmed for fail- safe shutdown?` ^Yes ^ No ®NA ^Yes ^ No ®NA ^Yes ^ No ^ NA ^Yes ^ No ^ NA Was fail-safe verified to be operational?` ^Yes ^ No ®NA ^Yes ^ No ®NA ^Yes ^ No ^ NA ^Yes ^ No ^ NA Wait time between applying pressure/vacuum/water and starting test 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: 12:56 1:15 Initial Reading (RI): 0.5889 0.5892 Test End Time: 1:11 1:30 Final Reading (RF): 0.5890 0.5893 Test Duration: 15 min 15 min Change in Reading (RF-RI): 0.00012 0.00011 Pass/Fail Threshold or Criteria: 0.002 0.002 0.002 0.002 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 testing? ®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) ` 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) iL/a = /lyl//!/:: flf~lBS[-~"iQD/ = L8Y8/TIl/OP. L- Test Parameters Test;Status Test Site Status pass/Fail Costco - Saving... 3800 Rosedale Hwy Change Bakersfield, CA 93308-XXXX 00011 0 . Product UDC Type Dispenser 9-10 Test Sta_rt_Time _ _ iT~hu, Aug 17, 2006 1:15 PM Test End Time Thu, Aug 17, 2006 1:30 PM Length (min) Limit (in) 15~ 0.0020 Test Result Test passed Comments ~. a, a~ J Y C c~ 01:15:13 PM 01:18:00 PM 01:21:00 PM 01:24:00 PM 01:27:00 PM 01:30:13 PM 08/17/2006 08/17/2006 08/17/2006 08/17/2006 08/17/2006 08/1712006 Test Time EL~DSNyd~o~T~~e..~T®st~Psne/= Leve/Pi©be 2 - I __ _ i - ~;, , , ,~ .. w Test Para;m~e~te~rs _ ~ _ Tegst:~S#t°atus.. .6~ Function Menu _ _~; { ~. ., 1. Status ~ ~-~ 0.589' d J 0.5891 Y C ({t H 0.588! 0.5888 , ~ 12:56:09 PM 08/17/2006 01:00:00 PM 01:03:00 PM 01:06:00 PM 01:11:09 PM 08/17/2006 08/17/2006 08/17/2006 08/17/2006 Test Time ~- I I ~I I I I I I I - I ~ I I I I I I I f - - - I - I - I - - - I - ~ r I I I - - - - ~} - - - - -{ -~ - - - -I - - I I I I I I I I I I 1 I i- - _ - ~- - - - ~ _ _ _ ~. - - I I I I I I I I I I I I I I I I I_ I I _I ~ I I 1 I I I I I I I I I I I I I I I ~ I I '!• Testing Procedures Secondary Containment Testing, Underground Storage Tank Systems Contractor: Fueling & Service Technologies, Inc. (FASTECH) Testing Technicians: Site Manager, Primary Tester: Alberto Rodriquez, Jose Dethier, Abe Reintord Jim Simeone Steve Acosta (714) 325-9477 (714) 306-3075 (714) 325-7495 (714) 926-3165 (714) 809-6018 Site Safety Officer: Primary Tester Qualifications: • FASTECH currently holds business license number CA 794519 - A, Haz, C21 • Information regarding Worker's Compensation and Employers' Liability (available upon request). • FASTECH provides HAZWOPR training for employees. FASTECH develops aaite-specific Health and Safety Plan w/ Confined Space Permit for each testing location (available on-site, day of testing). Test Equipment: • FASTECH utilizes third party certified hardware and software for all hydrostatic tests (attached). The primary tester is certified, by the manufacturer of the equipment used (Enhanced Leak Detection Systems, Inc.), to test containment sumps, under dispenser containment, and spill buckets. ` • Pressure Gauges, Ametek-U.S. Gauge, 0-15 psi pressure range, 4.5-inch diameter; glycerin- filled, .5% span of scale, calibrated every six months. • Vacuum Gauges, Ametek-U.S. Gauge, 0-30 in-hg vacuum range, 4.5-inch diameter, glycerin filled, .5% span of scale, calibrated every six months. • Vacuum Pump, Gast Model 22866, 120 volt AC. Pump mounted greater than 18-inches (about 3.5-feet) above work surface (surface grade), with outlet tubing terminating outside the work zone. Test Procedures: • Local CUPA will be notified of testing schedule a minimum of 48-hours before the test is scheduled to begin. During testing, station's dispensing equipment may remain in operation providing no health and safety concerns arise for either the public or test crews. Testing will be performed within an exclusion zone. If, at any time, the site safety officer or local CUPA deems any situation unsafe, the site safety officer will shut the station's dispensing equipment down. Testing will only be conducted when all health and safety concerns are met. • Sump Cleaning and Preparation. FASTECH will steam clean all turbine sumps, dispenser pans, and spill buckets. The water and waste generated during the cleaning process will be temporarily stored on-site in a labeled drum (dated, Haz Waste Label). The client will classify the drum, and provide transportation for drum disposal in a timely manner. Once the site has been cleaned, it will be ready for testing. Page 1 of 3 • Use of Test Fluid. FASTECH's testing fluid is comprised mostly of water with low concentrations (<2%) of surfactants and stabilizers. California Regulations allow for the transportation and reuse of water that is used as testing fluid. D.O.T. regulations mandate that the test fluid never contain more than 2% by volume of a hazardous material. Because of the extensive cleaning of the sumps prior to the introduction of the test fluid, the test fluid has never been determined to be hazardous. • Tank Annular Space. For tanks less than 20,000 gallons capacity, apply a vacuum of 10" mercury to annular space. After establishing a stable vacuum, maintain this vacuum for 60 minutes. At the end of the test period, if the vacuum reading has not changed from the established test vacuum, the test is complete and has achieved a "pass". For tanks greater than or equal to 20,000 gallons capacity, apply a vacuum of 10" mercury to annular space. After establishing a stable vacuum, maintain this vacuum for 120 minutes. At the end of the test period, if the vacuum reading has not changed from the established test vacuum, the test is complete and has achieved a °pass". If the tank does not maintain the test vacuum, the contractor may re-test the annular space. If, after the second test the tank does not achieve a "pass", the secondary containment must be considered not liquid tight. Repairs may be made by the tank manufacturer or authorized representative per the requirements of the local CUPA. Product, Vent, and Stage II Vapor Piping Secondary Containment. An inert gas shall be used. The secondary containment shall be made airtight with either the rubber test boot - - or fiberglass- test fitting installed at time of installation. If the -test boot is missing or damaged, an approved replacement test boot or fiberglass test fitting may be installed. - . Pressurize secondary containment piping to 5 psig and allow to stabilize for 10 minutes. Maintain test.pressure_. __ - _ :R-= of 5~ psig for 60 minutes. At the end of the test period, if the pressure reading has not changed ,from .the established test pressure, the test is complete and has achieved a "pass". If the piping does not maintain the test pressure, the contractor may tighten clamps and fittings, if necessary, and re-test the piping. If, after the second test, the piping does not achieve a "pass", the secondary containment must be considered mot liquid tight. Repairs may be made by the piping manufacturer or authorized representative per the requirements of the local CUPA. • Containment Sumps and Under Dispenser Containment. The containment sump shall be free of dirt, debris and residual petroleum product. Place test fluid in the sump a minimum of 2-inches above the highest piping penetration. Electrical penetrations do not need to be included unless located below a product, vapor or vent piping penetration. Piping shall include primary/secondary product piping, vent piping, vapor recovery piping and siphon piping. After test fluid has stabilized for 30 minutes, the liquid level shall be measured using test equipment third party tested to below .0007-inches resolution. The test period shall consist of two 15-minute tests. At the end of each 15-minute test period, the test equipment must confirm a hydrostatic change in level no greater than .002- inches in order to achieve a "pass". If the containment sump does not pass the test, the contractor may re-inspect the sump, tighten penetrations/clamps and fitting, and re-test. If after the second test the containment sump does not achieve a "pass», the secondary containment must be considered not liquid tight. Repairs may be made using the sump manufacturer's procedures per abiding by the requirements of the local CUPA. Page 2 of 3 • Spill Buckets The spill bucket shall be free of dirt, debris and residual petroleum product. Place test fluid in the spill bucket f - inch below the highest portion of the bucket's containment. After test fluid has stabilized for 30 minutes, the liquid level shall be measured using test equipment third party tested to below .0007-inches resolution. The test period shall consist of two 15-minute tests. At the end of each 15-minute test period, the test equipment must confirm a hydrostatic change in level no greater than .002- inches in order to achieve a "pass". If the spill bucket does not pass the test, the contractor may re-inspect the bucket, tighten drain valve fittings and re-test. If after the second test the spill bucket does not achieve a "pass", the spill bucket must be considered not liquid tight. Repairs may be made using the spill bucket's manufacturer's procedures per abiding by the. requirements of the local CUPA. Reporting: A final report documenting secondary containment testing shall be submitted to the local CUPA within 30 days of the completion of the test. The report must include all data collected as part of the testing and indicate any deviation from the approved Work Plan. All reports shall be evaluated for the completeness and accuracy. Failure to submit a satisfactory report will result in test results not being accepted and may require additional testing. The Secondary Containment Testing Report Form shall be used. Page 3 of 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 arP3' of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: Costco Wholesale Bldg. No: 688 Site Address: 3800 Rosedale Hwy. City: Bakersfield Zip: 93308 Facility Contact Person: Josh Beckham Contact Phone Na.: (661j 6360832 Make/Model of Monitoring System: Veeder-Root TLS-350 Date of Testing/Servicing: 10/3/2006 B. Inventory of Equipment Tested/Certified Check the appropriate oozes to indicate specific equipment inspectedlserviced Tank ID: 87A Tank ID: 87B (] In-Tank Gauging Frobe_ Model: 84739tK09 Q In-Tank Ga Probe Model: 847390-109 ~ Annular S ce or Vault Sensor Model: 794380-3(11 ©Amtulaz S or Vault Sensor. Model: 794380-301 ~ Pi ing S /Trench Senso s , Model: 794380-352 ®Pi in Sum /Trench Sensor(s) Model: 794380-352 ~ Fill Sum S s). Model: 794380.352 ®Fill S s). Model: 794380-352 ^D Mechanical Line Leak Detector Model: LLD-99 !~ Mechanical Line Leak Detector Model: FX2 - V ^ Electronic Line Leak Detector Model: D Electronic Line leak Detector Model p Tank Overfill /High-Level Sensor Model: 84?39a-11p1 ®Tank Overfill / Hi Level Sensor Model: 847390-109 ^ other (specify equipment type and model in Section E on Page 2). [} Other ni ent and.model in Section E on P e 2}. Tank ID: 91 auk ID: N/A Q In-Tank Gauging Probe. Model: 847390-1119 ^ in-Tank Ga Probe Model: O Annular S or-Vault Sensor Model: 794380-.301 ^ Annular S ce or Vault Sensor. Model: ~ Piping Sump /Trench Sensors . Model: 794388-352 ^ Pi in Sum !Trench Senso s Model: p Fill Sump Sensor(s). Model: 794380-352 ^ Fill Stun Senso s . Model: D Mechanical Line beak Detector Model: FX2-V ^ Mechanical Line Leak Detector Model: ^ Electronic Line Leak Detector Model: ^ Electronic Line Leak Detector Model: ~ Tank Overfi111 High-Level Sensor Model: 84739t--109 ^ Tank Overfill /High-Level Sensor Model: ^ Other (specify equipment type and model in Section E on Page 2). ^ Other ( ify ui ent and model in Section E on Page 2 ). ispenser ID: 112 ~ Dispenser Containment Sensor(s). Model: D Shear Valve(s). ^ Dispenser Containment Float(s) and Chains . 794380-2(18 Dispenser ID: 314 ©Dispenser Containment Sensor(s). Model: ©Sheaz Valves}. © Containment Floa s and Cha' s . 794380-208 ispenser ID: 516 Q Dispenser Containment Sensors}. Model: ~ Shear Valve(s). ^ Di ser Containment Floa s and G s . 794380-2~ Dispenser ID: 7/8 Dispenser Contairunent Sensor(s). Model: ~ Sheaz Valve(s)_ Di Containment Fl s and C s . 794380-208 ispenser ID: 9110 ^ Dispenser Containment Sensorsj_ Model: ~ Shear Valve(s). ^ Dis user Containment Fl s) and Chains . 794380-2~ Dispenser ID: 11/12 Dispenser Containment Sensor(s). Model: Shear Valve(s). Di Containment Floc s and C s . 794380-208 If the facility contains more tanks or dispensers, copy this form include information for every tank and er at the facility. C. Certification I certify that the equipment identified in this document was iaspected/se a is accordance with the manufacturers' goidelmea Attached to thfs Certification is hrfotmaFion (e.g. marmfactarers' checklists) v rift' that this information is correct and a Plot Plan showing the hryout otmonitormg equipment. For any equipment pabte o raring each reports, I have also attached a copy of the report; (drerh all drat opptyj: (~ System-Setup © Alarm Sistory Report Technician Name(print): Bill Karras Signature: Certification No: 006-05-0734 License, No: Testing Company Name: W.S.K. ~ Sons Mc. Phone No: , Testing Company Address: 34455 Sanlight ©r. ,Yucaipa CA. 92399 Date of Testing/Servicing: Monitoring System Certification 814289 906-3023 1013/2006 Page I of 3 D. Results of Testing/Servicing __ Software Version Installed: 322.00 Comulete t'he following checklist: ~ Yes ^ No* Is the audible alarm rational? D Yes ^ No* Is the visual alarm o rational? O Yes ^ No* Were all sensors ~ ed, functio tested, and confirmed tional? D Yes ^ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ro r o ration? D Yes ^ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) ^ N/A rational? ~ Yes ^ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ^ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? ff yes: which sensors initiate positive shut{iown? {heck all that apply) D SumplTrench Sensors; ®Dispenser Containment Sensors. Did ou confirm sitive shut-down due to leaks and sensor failure/disconnection? ~ Yes ^ No ~ Yes ^ No* For tank stems that utilize the monitorin stem as the ri tank overfill warnin device (i.e. no ^ N/A mechanical overf it prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill int s and o ratire r ,?_ If so, at what nt of tank ca does.the alarm tri er? 90% ^ Yes* ^ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment laced and list the manufacturer name and model for all r lacement arts in Section E, below. ^ Yes* ~ No Was liquid found inside any secondary containtent systems designed as dry systems? (Check all that apply) ^ Pmduct^ Water If es, describe causes in Section E, below. ^ Yes ^ No* Was monitorin stem set- reviewed to ensure m r settin ?Attach set u re rts, if a licable ~ Yes No* Is all monitorin ent rational r manufacturer's 'cations? R in section ~; below, describe how and when these deficiencies were or will be corrected: E. Comments: 1 ~I~ .~~..11~/11 1~ ~~I Ir~Il~~lr11 ~~ ~~~r~l 1 I I~1111 I~~\~~I~~~~^-I ~!•~~I~~I~Ir1~~ rr~ I~~ II~~1111~r~f1~~~~1~ I~I~~I~I~ ~~~Ir1 ~~Irrl~rl~l~~ ^~wln~I~nl1 Agency: Bakersfield Fire Dept. _- -- - ax ..~~ I Inspector: Steve Underwood rIItl1~.l 111~/~I~~I~~III~MA~~I~~~ ~~I~I~ I~~I/1111~1~ ~ I~~ ~~~ ~w_~~r ~I 11~~~I^ I I I n w I~rrY~~l1~ ~~~I Page 2 of 3 F. In-Tank Gauging /SIR Equipment: © Check this box if tank gauging is used only for inventory control ^ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. ('.mm~lete the following checklist: ~ Yes No* Has all in ut wirin been ' ed for ro en and termination, includin testin for ound faults? '' Yes No* Were all tank au ~n robes vi ed for dams a and residue buildu ? '' Yes No* Was accura of stem roduct level readin s tested? '' Yes No* Was accura of stem water level readin tested? '' Yes No* Were all robes reinstalled ro rl ? '' Yes No* Were all items on the ui ment manufacturer's maintenance checklist com feted? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ~ Check this box if LLDs are not installed Complete the following checklist: Yes No* For ui ment start- or annual mem certification, was a leak simulated to v LLD rformance? N/A (Check all that a 1) Simulated leak rate: ° 3 .h.; 01 .h ; 0.2 .h. '' Yes No* Were all LLDs confirmed tional and accurate within re at eats? Yes No* Was the testin a tus calibrated? Yes No* For mechanical LLDs, does the LLD restrict roduct flow if it detects a leak? NIA Yes No* For electronic LLDs, does the turbine automaticall shut off if the LLD detects a leak? N/A Yes No* For electronic LLDs, does the turbine automati shut off if rtion of the monitorin stem is disabled N/A or disoonnected7 Yes No* For electronic LLDs, does the turbine autotnaticail shut off if an rtion of the monitorin stem N/A malfunctions or fails a test? Yes No* For electronic LLDs, have ali accessible wirin connections been visuall ins ed? ~ N/A Yes No* Were all items on the ~ ment manufacturer's maintenance checklist com feted? * In the Section H, below, describe how and when these deficiencies were or wilt be corrected. H. Comments: .~~II~ ~ I~~I~~I~~~.~~I I`~III.~~~ !11 I ~~~^ ~II~~r llrl~l~~l Page 3 oj3 Secondary Containment Testing Report Form ~ ~ ~ 3 This form is intended 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 tests (if applicable), should be provided to the facility owner/operator jor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: .+ C:W ho to ~ t~ ~ (a~ • Date ofTesting [O l~ ~ Facility Address:. ~ p ~ ~ d t - F-t .a v(, r-s , Q i ~ C ~ Facility Contact: ~"ps ~ Phone: ~, 3 O LZ Date Local Agency Was Notified'of Testing : `i ~ Zz i o ~ Name of Local Agency inspector Ctf present during testin~: ins ~c-{~ ~ r~ r , 2. TESTING CONTRACTOR INFORMATION CompaayName: ~.5, 6C : -.~ ~5ns Technician Conducting Test: c e G..r fc. Credentials: SLB Licensed Cortrador License Tyne: • ~} _ /+ to _ r , c .. Y . ^ SWRCB Licensed Tank Tester License Number. $ .(r-(2 R Manafactnrer Training ~ h.~ ~ Tc -r t; ~ n ~ c c ~e. r it io -~~ t-o /:~ r / o ce 1 3. SUMMARY OF TEST RESULTS Component Pass Fart TNat~ed ~ Component ~ Pus Farb Not Toted Repairs Made Q~ ~ ~~ll -lC 4 ~-~- ^ ^ ^ ^ ^ ^ ^ ~'1 ~ ~.lc - b~ ~ ~ ^ ^ ^ ^ ^ ^ ~~~ w v~,~ ter. ^ ^ ^ ~ ^ ^ o ^ ~7 U~. ~,e. ^ ^ ^ ~ ^ ^ ^ ^ ~. ~ ^ ^ ^ ~ a ^ .a ^ • o~ ^ ^ ^ ^ ^ ^ o i ^ o o ^ o a ^ ^ - ~^ ^ o ~ ^ ~ ~ ^ .^ ^ ^ . ^^ o o ~ o ^ o o =. ~ ^ ^ ^ o o ^ ^ ^ . ^ ^ a o ^ ^ ^ o ~ • If hydrostatic testing was performed, descn-be what was done with the wafer after completion of tests: GL~~ ~~ S I ~E' in ~~~ ~C~C('OL<~. ~~ CERT To the best of my Technician's Sign ~ ;'TEC1HiICIAN RESPONSIBLE FOR CONDUCTIl`IG THIS TESTING - owledge, th cls stated in this document are accurate and hr full compliance with legal requirements e: ~ - Date: 1 ~ a SWIZCB, January 2002 Page 2. of ~ ~'4 9_ ~PTI:TJCIVT,RFIT,L CONTAINMENT BOXE5 Facility is Not E uip ed With Spi7]/Overfill Containment Boxes ^ SpilUOverfill Containment Boxes are Present, but were Not Tested ^ Test Method Developed By: ^ Spill Bucket Manufacturer du try Standard ^ Professional Engineer ^ Other (Sped) Test Method Used: ^ Pressure ^ Vacuum ydrostatic ^ Other (Specify) Test Equipment Used: 4 5 ~ G~ ( Equipment Resolution: spin Boa # $ 7 d Spill Boz # /~ spill Bog # ~~ Spill Bos # Bucket Diameter: (~ , (~, r p ,, p Bucket Depth: ~ 3 , ~ S 13 ~ z S t • SCa Wait time between applying -pressure/vacuum/water and startin test; t S {~. - ~ i S w. ,y,; f ~" v. , N . Test Start Time: g : `3 © ~ „r. g : 3 U ~,,,~ ~ 3 0 a Initial Reading (R~: 1 ~ , O l Z , p (Z, c~ Test End Time: ~ ', ~ O ~ nn. S '. 3 p e ~• t7 ~. n Final Reading (RF): 1 Z ~ 0 12. O : (3 Test Duration: l Nvi l Nr2 N Change in Reading (R~R~: .~- ,~" -PS Pass/Fai1 Threshold or Criteria: ~~.~ p_-osa ~~ J !o /t.e~ RSS b ~toJ S ~TestR'esvlt~ =- S ~ -E~ -;CI Earl; ,.:1?".i'as Quail Il~=.Tails ^~-Pass QF~iI - Comments -('include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRGB, January 2002 9. SPILL/OVERFILL CONTAIN1v7ENT BOXES Page -,~ of _~ Facility is Not E ui ed With Spill/Overfill Containment Boxes ^ SpilUOverfill ~ontainmeat Boxes aze Present, but were Not Tested ^ Test Method Deveioped By: ^ Spill Bucket Manufacturer ^ Industry Standard ^ Prof ssionai Engineer ^ Other (Specify) Test Method Used: ^ Pressure ^ V acuum ^ Hydrostatic ^ Other (Specify) Test Equipment Used: ~ Equipment Resolution: SpiII Boz # g7 ~ Spill Boz ? Spill Boz Spill Boz # Bucket Diameter: ~ (j p ~ p (Q ~ p Bucket Depth: IS ~ O 15 • "~ S 4 , ~.. 5 Wait time between applying -pressure/vacuum/water and startin test: t S jn. • ,o t S i-~-• ~ ~ 5 h .r+- - Test Start Time: G~ `. p ~,r,.~ C~ `. ~ erg Initial Reading (Ril: ~ f. O 14 • o c.t Test End Time: p - : ~ o ~,.~ ©~ 0 6 ~ Final Reading (RF): I ~-I , fJ 1 ~ ~ ~i ~ ~^ Test Duration: Change in Reading (R~-R~: -~j" „~--- . Pass/Fa11 Threshold or Crite ria: ~~~ (o i 'L .oS ~S g ~~ (~ I Q - b ~ ~~~ ~o/1 y yam, ~7 '~y~p~} {~q- J ~ -y ~ ]~ ~~ ~ . ^ ~~~f p~4 qq~~~~c ~Testrltesnlfi:: ~ ~ ~ L s+..T .YW , L~ AIL-, Y f~~~aJJI U C'~)I ~ aJJ ~~{Ll1 ~ T }~ t L1 L YJJri ~ J:..+~ ~ _COnlments - (urclude information on repairs made prior to testing and recommended follow-up for failed tests) LEAK DETECTOR TEST FORM DATE { ~ 3 f p CO FACILITY NAME ~ ~ ~ 5 ~ t ~ (.~~ o ~E'~.5= ~ / F FACILITY # ~' ~ ~ ~ ~ ADDRESS ....* ~ g ©~ ~Se ~ G I e.. ~~ ~ c ~ c~ ~ y LEAK DETECTQR TEST RESULTS:. ALL LEAK DETECTORS ARE TESTED 1N-L.INE. INDICATE TYPE OF LEAK DETECTOR WiTN SERIAL NUMBER (XI.D, xLP, LD-2000, ETC.}. . MAKEJMODFa. - SERIAL # LEAK_ RATE TESTED (GPH~ PASS OR FAtL CHECK VALVE PSl METERING PS! Lo #1 ~ eZ~ 2 F 33 y 3.., cam. ,~..~ ~S_ ~ ? 3 y NEw LD #2 ~ ~ ~cke.F- !o S 7 (~ 3 . ~ :~S I ~ 3 ~ NEW NEW . LD #4 NEw - .~ LEAK DETECTORS ARE TESTED JN ACCORDANCE •W/7"H THE MANUFACTURER`S SP FJCATJONS. CERTIFIED TES'fER'$ iD # ~ Q (p _ Q S - O ? .~ ~ r` • SIGNATURE OF CERTIFIED TECHNICIAN 4 PRINTED NAME OF CERTIFlEO TECHNICIAN ~ L L l,~"~ ~, ~, TESTING COMPANY NAME 8c 7ELEPiiONE # (~ ~. ~;, ~ ~'' S'l ~ O L+ 3~ 23 "" IF INITIAL LEAK DETECTOR FAILS, ALL REPLACEMENTS SHALL BE TESTED. C ©.s-c-co c~~oc.Essac,~ ~ ~~~ 3 Leo ~©~ ~ ~:r .~.~w~ t3p--~-Euzs Ft ~.~ a ~ Cto. , ~330'~ .~ pf3~-~ t-(~.R'1' ~ R ~o ,, ~ ~. p , ip ~ ~ ~~ l l ~.......~::. _ .. ~........t ~ I ~ ~ l ~. I _ rw ~ _,w r ~ ~ ~r _ ors VIII t ) a ' i _~~ ~9 0 V '~-~ ~ Il o _~ I ~ I ~ ,L______:._..J ~..._____~L..._...( ~o o ~o~ nl~ I ~ ,~ ~~ _~h ~rw~~ s~i~J ~~ Q ~ _ rrrr _ ~r~_ _. ~r~ _ ~~ ' w. _~ r _ r ~ _ ~~_ r ~ ~ _ ~ _ _ _ _ ~ _ _ r ~1~ W1~ S~ r~ ~~~ i ~~ 1/~ ~r ~ .;_~ jJ; ~o~ 1. ~~~ v 7 ,~,,~' 3 J/~ I t\.y / --~ ~-. 01 c~1 ~~ ~ / ~y ..r~ ~ v / •J ~C~) ~, 9 1~}) ~ .... ~ ,_ / a uN~~, ~ ~N~~~~Q a u~~ ~Z ~ ~I(_L. UtNL ~"t ~ © U N 1., yj'~ I7j ll}W Nt.~L.l~y )Z. Q caws„ ~'v'? T3 F/i~. l.iw~-. ~? F3 S"T p Q P~v-^~u.rn q.n~~vu:L:tkf~ ® 0.t Wl~uw. rl~ ®{~I~~ thi v. W1 STP to p~5p !~-~ 14 l~ -S p 3 ~' `( t3 A~s~ `1 a-°S t~ U~sp S+ to pcs(~ l'1+5~-- SYSTEt°1 SETUP OCT 3. 2006 11:27 AM SYSTENI UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE.iTIME FORMAT N14N DD YYl'Y HH : t°1M : SS kNl Costoo Wholesale 688 3600 Rosedale Hiehwa Baker•~f i el d. CA SHIFT TIME 1 DISABLED SHIFT TIME 2 DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED SHIFT BIR PRINTOUTS DISABLED DAILY BIR PRINTOUTS DISABLED TICKETED DELIVERY DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE RE-ENABLE METHOD PASS LINE TEST LINE PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATI4tV VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET DISABLED H-PROTOCOL DATA FORMAT HEIGHT DAYLIGHT SAVINu^ TIME DISABLED RE-DIRECT LOCAL PRINTOUT DISABLED EURO PROTOCOL PREFIX S SYSTEM SECURITY CODE 000000 COMt°IUNICATIONS SETUP PORT SETTINGS: CONIC°1 BOARD 1 ( ED I t°1 ) RS-232 SECURITY CODE DISABLED COMM BOARD : 2 CRS-'~32? BAUD RATE 9600 PARITY ODD STOP BIT 1 STOP DATA LENGTH: 7 DATA RS-232 SECURITY CODE DISABLED COMM BOARD 3 (FXMOD) BAUD RATE 2400 PARITY ODD STOP BIT 1 STOP DATA LENGTH: 7 DATA RS-232 SECURITY CODE DISABLED DIAL Tl'PE TONE ANSWER ON 1 RING MODEM SETUP STRING DIAL TONE INTERVAL: 32 AUTO TRANSMIT SETTINGS: J AUTO LEAK ALARM LIMIT DISABLED AUTO HIGH WATER LIMIT DISABLED AUTO OVERFILL LINIIT ~ DISABLED AUTO LOW PRODUCT DISABLED - AUTO THEFT LIMIT DISABLED AUTO DELIVERY START DISABLED AUTO DELIVERY END DISABLED AUTO EXTERNAL I tVPUT ON DISABLED AUTO EXTERNAL INPUT OFF DISABLED AUTO SENSOR FUEL ALARM DISABLED AUTO SENSOR WATER ALARhI D I SAfiLEU AUTO SENSOR-OUT ALARf°1 DISABLED' IN-TANK SETUP T 1:Unleaded 1 PRODUCT CODE THERNtAL COEFF .:.000700 TANK DIAMETER 119.50 TANK PROFILE : 4 PTS FULL 1/0L 19951 89.6 INCH VOL 16216 59.8 INCH V4L 10017 29.9 I NCH 114E 3781 METER DATA : NO FLOAT SIZE: 4.0 IN. WATER WARNING 0.5 HIGH WATER LIMIT: 0.7 MAX OR LABEL V4L: 19951 OVERFILL LIMIT 90% 17956 HIGH PRODUCT 18953 DELIVERY LIMIT 496? LOW PRODUCT 600 LEAK ALARM LIMIT: 8 SUDDEN LOSS LIMIT: 25 TANK TILT D.00 PROBE OFFSET 0.00 MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 80% 15960 LEAK t°1I N ANNUAL 80% 15960 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 $REAK:OFF DELIVERY DELAY 2 MIN PUMP THRESHOLD 10.00% t ~ " V T 2 : Ur-~ 1 esde8 PRODUCT CODE 1 THERE°lAL COEFF :.000700 THNK DIAMETER 119.50 TANK PROFILE 4 PTS FULL VOL 19951 89.6 INCH VOL 16216 59.8 INCH VOL 10017 29.9 INCH VOL 3781 METER DATA NO FLOAT SIZE: 4.0 IN. WATER WARNING" U.5 . HIGH WATER LINIIT: 0.7 MAX OR LABEL VOL: 19951 OVERFILL LIMIT 90~ 17956 HIGH PRODUCT 95°~ 18953 DELIVERY LIMIT 25% 49$7 LOW PRODUCT 600 LEAK ALARM LIMIT: 8 SUDDEN LOSS LIMIT: 25 TANK TILT 0.00 PROBE OFFSET 0.00 MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 80~ 15960 LEAK MIN ANNUAL 80% 15960 PERIODIC TEST TYPE STANDARD APJNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FATL ALARM DISABLED GROSS TEST FAIL ALARhI U I SABLED ANfV TEST AVERAG I fVr, : OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TfVK TST SIFHON B1?EAK:OFF DEL I VER4' DELA:' 2 M I N PUMP THRESHOLD 10.00 T 3 : F'r ern i Urri PRODUCT CODE 2 THERMAL COEFF :,000700 TANK DIAMETER 119.50 TAN},'. PROFILE 4 PTS FULL VOL 19951 89.6 INCH VOL 16216 59.8 INCH VOL 10017 29.9 INCH VOL 3?B1 METER DATA NO FLOAT SIZE: 4.0 IN. WATER WARN I tVG 0.5 HIGH WATER LIMIT: 0.7 MAX OR LABEL VOL: 19951 OVERFILL LIMIT 901 17956 HIGH FRODUCT 95% 18953 DELIVERY LIMIT 25'~ 4987 LOW FRODUCT 600 LEAK ALARM LIMIT: 8 SUDDEN LOSS LIh1IT: 25 TANK TILT 0.00 FROBE OFFSET 0.00 MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 80~ 15960 LEAK MIN ANNUAL 80% 15960 PERIODIC TEST T'1PE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAG I fVG : OFF TANK. TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 2 MIN PUMP THRESHOLD 10.001 LEAK TEST h1ETHOD TEST ON DATE ALL TAPIk: JAN 1. 1596 STHRT TIME DISABLED TEST RATE :0.20 GAL.fHR DURATION 2 HOURS TST EARLY STOP:DISABLED LEAK TEST REPORT FORMAT NORhiAL LI~iUID SENSOR SETUP L 1:UNLEAD A ANNULAR TRI-STATE (SINGLE FLOAT} CATEGORYY ANfVULAR SPACE L 2:UNLEAD A FILL DUAL FLT, DISCRIMINATING GATEGORY P I P I fVG SUMP L 3 : UIVLEAD A STP DUAL FLT. DISCRIMINATING CATEGORY STP SUMF L 4:UNLEAD B ANNULAR TRI-STATE (SINGLE FLOAT} CATEGORY ANNULAR SPACE L 5:UNLEAD B FILL DUAL FLT. DISCRIMINATING G'ATEGORY PIPING SUMP L 6:UNLEAD B STP DUAL FLT. DISCRIMINATING CATEGORY STP SUMP L 7:FREMIUM HNNULAR TRI-STATE (SINGLE FLOAT} CATEGORY ANNULAR SPACE L B:PREMIUM FILL DUAL FLT . D I S~'R I t°1 I fVAT I NG CATEGt;R''t' P I F' I fVG SUMP ~~~ L 9: PREt•~l I IJt°t :~TF' R '~' : t°tEh1BERSH I P R E: UtVLEADED 8'~tt DUAL FLT . D I ;~i~:R I t•9 I PJrT I tVG ~ TYPE : TYPE CATEGORY STP SUt°1F' STANDARD STANDARL NORMALLY OPEN NORMALLY CLOSED L10:DISP PAPJ 1.2 'TRI-STATE {SINGLE FLOAT} CATEGORY DISPENSER PAN L11:DISP PAN 3.4 TRI-STATE (SINu^LE FLOAT} CATEGORY DISPENSER PAN L12:DISP PAN 5.6 TRI-STATE (SINGLE FLOAT} CATEGORY DISPENSER PAN L13:UISP PAN 7.8 TRI-STATE (SINGLE FLOAT} f CATEGORY DISPENSER PAN L14:DISF PAN 9.10 TRI-STATE {SINGLE FLOAT? CATEGORY : DISPENSER PAN L15:DISF PAtV 11.12 TRI-STATE (SINGLE FLOAT} CATEGORY D I SPEIVSER PAN OUTFUT RELAY SETUP R 1:OVERFILL ALARM T`!PE STANDARD NORMALLY OFEN I N-TANK ALARh1S ALL:HIGH WATER ALARM ALL:OVERFILL ALARM ALL:LOW PRODUCT ALARM ALL:SUDDEN LOSS ALARM ALL:HIGH PRODUCT ALARM ALL:HIGH WATER WARNING HLL:DELIVERY NEEDED ALL:MAX PRODUCT ALARM LIQUID SENSOR ALMS ALL :FUEL ALARt°1 ALL:SENSOR OUT ALARM ALL:SHORT ALARM ALL:WATER ALARM . ALL:HIGH LIQUID ALARr°t ALL :LOW L I Q U I D ALARt°i ALL : L I uU I Li I:JARIV I tVt=~ IN-TANK ALARMS ALL:LEAK ALARM ALL :HIGH 6JATER ALARh'I ALL:OVERFILL ALARM ALL:LOW PRODUCT ALARM ALL:SUDDEN LOSS ALARht ALL : PR013E OUT LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM ALL:WATER ALARM ALL:HIGH LIQUID ALARhI ALL:LOW LIQUID ALARM ALL:LIQUID WARNItVG R 5 : UtVLEADED B7A TYPE: STANDARD NORMALLY CLOSED IN-TANK ALARMS T 1:HIGH WATER ALARM T 1 :LOW PRODUCT ALARM LIQUID SENSOR ALMS L 1:FUEL ALARM L 2:FUEL ALARM L 3:FUEL ALARM L 6:FUEL ALARM LiO:FUEL ALARM L11:FUEL ALARM L12:FUEL ALARhI L13:FUEL ALARM L14:FUEL ALARM L15:FUEL ALARM L 1:SENSOR OUT ALARM L 2:SENSOR OUT ALARM L 3:SENSOR OUT ALARPI L 6:SENSOR OUT ALARM L10:SENSOR OUT ALARM L11:SENSOR OUT ALARM L12:SENSOR OUT ALARht L13:SENSOR OUT ALARM L14:SENSOR OUT ALARM L15:SENSOR OUT ALARM L 1:SHORT ALARM L 2:SHORT ALARM L 3:SHORT ALARM L 6:SHORT ALARM LIO:SHORT ALARM L11:SHORT ALARM L12:SHORT ALARM L13:SHORT ALARM L14:SHORT ALARM L15:SHORT ALARM L 2:HIGH LIQUID ALARM L 3:HIGH LIQUID ALARM L 6:HIGH LIQUID ALARM L 2:LIQUID WARNING- L 3:LIQUID WARIVIhJG L 6:LIuUID U•lARNING I N-TF-INK ALARMS T 2:HIGH WATER ALARM T 2:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 3:FUEL ALARht L 4:FUEL ALARM L 5:FUEL ALARPI L 6:FUEL ALARM L10:FUEL ALARM L11:FUEL ALARM L12:FUEL ALARM L13:FUEL ALARM L14:FUEL ALARM L15:FUEL ALARM L 3:SENSOR OUT ALARM L 4:SENSOR OUT ALARM L 5:SENSOR OUT ALARM L 6:SENSOR OUT ALARM L10:SENSOR OUT ALARM L11:SENSOR OUT ALARM L12:SENSOR OUT ALARM L13:SENSOR OUT ALARM L14:SENSOR OUT ALARM L15:SENSOR OUT ALARM L 3:SHORT ALARM L 4:SHORT ALARM L 5:SHORT ALARM L 6:SHORT ALARM L10:SHORT ALARM L11:SHORT ALARM L12:SHORT ALARM L13:SHORT ALARM L14:SHORT ALARM L15:SHORT ALARM L 3:HIGH LIQUID ALARM L 5:HIGH LIQUID ALARM L 6:HIGH LIQUID ALARht L 3:LIQUID WARNING L S:LIQUID 6JARNING L 6:LIQUID WARNIfVG ~$~ O R 7 :PREP°t I U(°1 91 TYPE: STA fdDARD NORMALLY CLOSED IN-TANK ALARMS T 3 :HIGH WATER ALAkt°1 T 3 :LOW PRODUCT ALARt°1 LIQUID SENSOR ALMS L 7:FUEL ALARM L B:FUEL ALARNI L 9:FUEL ALARM L10:FUEL ALARM L11:FUEL ALARM L12:FUEL ALARM L13:FUEL ALARM L14:FUEL ALARM L15:FUEL ALARM L 7:SENSOR OUT ALARM L B:SENSOR OUT ALARM L 9:SENSOR OUT ALARM L10:SENSOR OUT ALARM L11:SENSOR OUT ALARM L12:SENSOR OUT ALARM L13:SENSOR OUT ALARM L14:SENSOR OUT ALARM L15:SENSQR OUT ALARM L 7:SHORT ALARM L B:SHORT ALARM L 9:SHORT ALARM L10:SHORT ALARM L11:SHORT ALARM L12:SHORT ALARM L13:SHORT ALARM L14:SHORT ALARM L15:SHORT ALARM L B:HIGH LIQUID ALARM L 9:HIGH LIQUID ALARM L B:LIQUID WARNING L 9:LIQUID WARNIPdG RECONCILIATION SETUP EUIN1 1 AUTOMATIC DAILY CLOSINu^ TIME: 2:00 AM AUTO SHIFT #1 CLOSING TIME: DISABLED AUTO SHIFT #2 CLOSING TIME: DISABLED AUTO SHIFT #3 CLOSING TIME: DISABLED AUTO SHIFT #4 CLOSING TIME: DISABLED PERIODIC RECONCILIATION h10DE : MONTHLI' ALARM: DISABLED TEMP COMPENSATION STANDARD METER CALIBRATION OFFSET : 0.000°. C`.ostco Wt-,olesale 688 3800 Rusedal e Hi ef-,wa Ba4<ersf i e 1 d, i~A OCT 3. 2006 11:29 AM Coskco Wholesale 688 3800 Rosedale Hieh,wa Bakersfield. CA SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL INVENTOR`! REPORT T !:Unleaded VOLUME = 1288? GALS ULLAGE = 7064 GALS 90% ULLAGE= 5068 GALS TC VOLUME = 12715 GALS HEIGHT = ?2.99 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 79.0 DEG F T 2:Unleaded VOLUME = 13285 GALS ULLAGE = 6666 GALS 90% ULLAGE= 4670 GALS TC VOLUME = 13107 GALS HEIGHT = 74.87 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 79.1 DEG F T 3:Premium VOLUME = 11228 GALS ULLAGE = 8723 GALS 90i ULLAGE= 6727 GALS TC VOLUME = 11102 GALS HEIGHT = 65.29 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 76.0 DEG F *~~~~eEND*~~*~ SOFTWARE kEVISION LEVEL VERSION 322.00 SOFTWARE# 346322-100-A CREATED - 01.10.16.09.48 S-PIODULE# 330160-100-a SYSTEM FEATURES: i PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS BIR OCT 3. 2006 11 :29 At°t SERVICE REPORT NONE IN-TANK LEAK DIAGNOSTIC PROBE DIAGNOSTICS T 1 : PROBE T'1PE MAG 1 SERIAL NUMBER 609830 GRADIENT = 349.4000 NUM SAhiPLES = 51521 C00 1314.9 CO1 21775.5 C02 21775.6 C03 21775.6 C04 21775.6 C05 21775.6 C06 24605.2 C07 24605.2 C08 24605.2 C09 24605.2 G10 24605.2 C11 45592.2 C12 13678.6 C13 14132.1 C14 14486.5 C15 14621.8 C16 14595,4 C17 14535.9 i;18 45593.0 IN-TANK LEAK DIAGNOSTIC PROBE DIAGNOSTICS T 2: PROBE TYPE MAG! SERIAL NUMBER 609832 u^RADIENT = 349.2000 NUM SAMPLES = 22813 C00 135$.9 CO1 24131.3 C02 24131.4 C03 24131.4 G04 24131.4 C05 24131.4 C06 24389.6 C07 24389.6 C08 24389.6 C09 24389.6 C10 24389.6 C11 45424.1 C12 13791.4 C13 14021.6 C14 14298.2 C15 14291.7 C16 14502.9 C17 14430.5 C18 45423.5 ~~~ U LIQUID DIAijtVs}:TIC L 1:UNLEAD A ANNULAk IN-TANK LEAK DIAGNOSTIC IN-TANK DIAGNOSTIC SAMFLES= 5 - _ - _ - - _ _ _ _ - - - - - - - - - - _ - _ - LOW REF 1= 184 PROBE DIAGNOSTICS F°RUBE UTAGNc~STICS HIGH REF1= 1098 T 3: PROBE TYFE MAG1 ~ T 2: PROBE TYFE MAG1 VALUEI= 99458 SERIAL NUMBER 602053 I SERIAL NUMBER 609832 GRADIENT = 349.2500 ID CHAN = OxC000 NUM SAMPLES = 27852 GRADIENT = 349.2000 L 2:UNLEAD A FILL ~ SAMPLES= 5 C00 1362.3 G01 23048.0 NUM SAMPLES = 20 LOW REF1= 184 C02 23048.1 C03 23048.0 HIGH REF1= 1098 C04 23048.0 C05 23048.0 C00 1359,0 CO1 26033.9 VALUEI= 146487 C06 23724.0 G07 23724.0 C02 26033.8 C03 26033.8 C08 23724.0 C09 23724.0 G04 26U33.8 G05 26033.8 C10 23724.0 X11 44179.4 r L 3:UtVLEAri A STP C12 14583,9 G13 14989.1 08 2E085.5 G09 26085.3 SAMPLES= 5 C14 16074,7 C15 16384.4 C10 26085.7 C11 45429.9 LOW REF1= 184 C16 16819.4 C17 16855.7 C12 15754.9 C13 15321.1 HIGH REF1= 1099 C18 44179.9 C14 15841.9 G15 15766.8 VALUEI= 147970 G16 16047.3 C17 15950.4 C18 45428.8 L 4:UNLEAD B ANNULAR SAMPLES READ =104603919 SAMPLES= 5 SAMPLES USED =104589486 LOW REF1= 184 HIGH REF1= 1097 VALUEI= 9$978 L 5:UNLEAI'~ B FILL ACCU_CHART D IAGNOSTICS SAMPLES= 5 _ _ _ _ _ _ _ _ _ _. _ _ LOW REF 1= 185 HIGH REF1= 1100 T 1:Unleaded VALUEI= 147959 AGCU DISABLED Ihl-TANK DIAGNOSTIC T 2:Unleaded - - - - - - - - - - - - L 6:UNLEAD B STP AGCU DISABLED PROBE DIAGNOSTICS SAMPLES= 5 T 3: PROBE TYFE MAG1 LOW REF1= 184 T 3:Premium SERIAL NUMBER 602053 HIGH REF1= 1097 AGCU DISABLED ID CHAN = OxC000 VALUEI= 143240 GRADIENT = 349.2500 T 4:Premium AGCU DISABLED NUM SAMPLES = 20 L 7:PREMIUM ANNULAR SAMPLES= 5 I tV-TAtVK D 1 AGPdOST I t.' C00 1362 , 0 CO 1 22706.8 C02 22706.8 C03 22706.8 LOW REF 1= HIGH REF1= 185 1098 _ _ _ - C04 22706.8 C05 22706 6 VALUEI= 99046 PROBE DIAGNOS TICS . C06 22706.8 C07 22706 9 T 1: PROBE TY SERIAL NUMBER PE MAG1 609830 . G08 22706.6 C09 22706.6 C10 22706.8 .CI1 44178 9 L B:PREMIUM FILL ID CHAN = OxC 000 . C12 15480.8 C13 15068 5 SAMPLES= 5 GRADIENT = 3 49.4000 . G14 15794.5 G15 16395.5 LOW REF1= 185 NUM SAMFLES = 20 C16 17052.6 C17 17092.1 C18 44179.1 HIGH REF1= VALUEI= 1100 148016 C00 1315,0 C02 25397.1 GO1 25397.1 G03 25396.9 SAMPLES READ =104603779 SAMPLES USED =104599165 L 9:PREMIUM STP C04 25397.5 G05 25397.5 SAMPLES= 5 C:06 25424.7 C07 25424.7 LOW REF1= 184 C08 25425.1 G09 25424.9 HIGH REF1= 1096 G10 25424.? GI1 45594.4 VALUEI= 147253 C12 15329.9 C13 15239.4 C14 15857.0 C15 15995.8 -- - C16 16043.3 C17 15939.9 L10:DISP FA N 1.2 C18 45595.1 SAMPLES= 5 LOW REF1= 185 SAMPLES READ =104605499 HIGH REF1= -1097- SAMFLES USED =104587978 VALUEI=. 1019'?2 ~~~ L11 :DISP FA(V 3.4 .~ SAMPLES= 5 LOW REF1= 184 ALARM HI STC>R'Y REPORT HIGH kEF1= 1093 i VALUEI= 101504 j I ---- IN- TANK ALARM ----- • T 2: Unle aded L12:DISP PAN 5.6 SAMPLES= 5 ALARM HISTORY REFtiRT HIGH WAT ER A LAkhI LOW REF1= 185 AUG 25. 2006 10:27 Al°1 HIGH REF1= 1097 ----- S'fSTEM ALARM ----- JUL 8. 2006 3:58 PM VALUEI= 101780 pAFER OUT AUG 26. 2003 10:43 Phl SEP 29. 2006 1:40 PM PRIPJTER ERROR OVERFILL ALARM L13:DISP PAN ?.8 SEF 29. 2006 1:40 PM SEF 29. 2006 8:35 AM Sr~MPLES= 5 BATTERY IS OFF SEP 27. 2006 3:09 PM LOW REF1= 185 JAN 1. 1996 S:OO ,AM JUL 24. 2006 3:50 PM HIGH REF1= 1095 VALUEI= 101343 LOW PROD UCT ALARM MAR 2. 2005 10:20 AM ALAkt°1 H ISTORY kEPO RT OCT 10. 2004 3:57 PM L14:DI~P PAN 9.10 AUG 2, 2004 8:14 PM SAIHFLES= 5 ---- IN -TANK ALARM ----- LOW.REF1= 185 HIGH PRO DUCT ALARhi HIGH REF1= 1097 T 1:Unleaded OCT 3. 2006 10:26 AM VALUEI= 101097 ~ SEP 6. 2005 11:43 AM SETUP DATA WARNING JAN 18. 2005 2:25 Phl L15:DISP PAN 11.12 SEP 1. 2004 9:28 PM INVALID FUEL LEVEL SAMPLES= 5 OVERFILL ALARhi APR 29. 2004 4:31 Fhl LOW REF1= 1B4 SEP 27. 2006 3:22 PM AUG 26. 2003 10:43 PM HIGH RE1~-1= 1095 JUL 24. 2006 3:38 PM VALUEI= 102073 APR 24. 2006 3:30 PM PROBE OUT JUN 25. 2004 11:56 AM LOW PRODUCT ALARM JUN 25. 2004 11:41 AM L16: MAR 12. 2005 4:28 PM JUN 25. 2004 10:21 AM SAMPLES= 5 MAR 2. 2005 10:08 AM LOW REF1= 184 OCT 10. 2004 4:03 PM HIGH WAT ER WARNING HIGH REF1= 1096 AUG 25. 2006 10:27 AM VALUEI=999999680 HIGH PRODUCT ALARM JUL 8. 2006 3:58 PM OCT 3. 2006 10:19 AM AUG 26, 2003 10:43 PM SEP 6. 2005 11:43 AM SEP 1. 2004 9:28 PM - DELI VERY NEEDED GROUNUTEMF D IAu^NOSTIC- INVALID FUEL LEVEL AUG 26. 2006 12:32 PM _ _ _ _ _ _ _ _ _ _ AFR 29. 2004 4:37 PM JUL 8. 2006 8:20 AM _ _ AUG 26. 2003 10:53 PM MAY 5. 2006 1:13 FM AUG 26. 2003 10:50 PM e 1. SAMPLES= LOW REF1= 50 185 pROBE OUT LOW TEMP WAR NING • HIGH REF1= 1097 .APR 26. 2004 3:33 PM JUN 25. 2004 11:53 AM VALUEI=999997056 AUG 26. 2003 11:02 PM AUG 26. 2003 11:06 PM AUG 26. 2003 10:42 PM e 2: SAMPLES= 50 DELIVERY NEEDED LOW REF1= 184 JUL 8. 2006 6:46 AM 1 HIGH REF1= . 1096 MAY 5. 2006 1:17 PM VALUEI=99 9997056 APR 12. 2006 8:13 PM LOW TEMP WARN ING I 0~ e 3: SAMPLES= 50 AUG 26, 2003 11.04 PM ~ ~ ~ ~ ~ EMU # ~ * ri ~ `y LOW REF1= 184 HIGH REF1= 1097 VALUEI=99 9997056 !~ e 4: SAMPLES= 50 LOW REF1= 184 HIGH REF1= 1098 VALUEI=99 9997056 ~ ~ ;~ * ~ END ~ * ~ ALARf°1 H I STOR'! REF ORT ---- I N-TA(VK ALAR(°1 - T 3:Prerniurn HIGH WATER ALARM AUG 26. 2003 10:5'3 PM AUU` 26. 2003 10:42 PM OVERFILL ALARM JUN 3. 2006 9:07 AM MA :` 3. 2006 '5:06 PM APR 25. 2006 5:37 PM LOW PRODUCT ALARM AUG 26. 2003 10:54 PM AUG 26. 2003 10:39 PM HIGH PRODUCT ALARM OCT 3. 2006 10:32 At°1 APR 23. 2006 1:09 PNi SEP 6. 2005 11:44 AM INVALID FUEL LEVEL AUG 26. 2003 10:43 FM PROBE OUT SEP 17. 2003 9:17 At°t SEP 17. ,2003 8:58 ANl SEP 17. 2003 8:28 AM HIGH WATER WARNING AUG 26. 2003 10:59 PNi AUG 26. 2003 10:42 PM DELIVER"! NEEDED NOV 22. 2004 8:27 PM MAR 14. 2004 9:04 AM AUG 26, 2003 10:54 PM LOW TEMP WARNING. SEP 17. 2003 x:13 AM AUG 26. 2017;1 11 :08 PM Costco Wholesale 688 3800 Ru_.edale Hi~ahwa Fiakersf. i e-l d. CA OCT 3. 2006 11:30 AM LEA}; TEST REPORT T 1 : Ural coded PROBE SERIAL NUM 609830 NO TEST DATA AVAILABLE * * ~ ~ ~ ENU ~ ~€ x ALARM H I STOR`:` REFt~RT ---- - SENSOR ALARM ----- L 1:UNLEAD A ANNULAR APJNULAR SPACE FUEL ALARM OCT 3. 2006 9:01 ANt FUEL ALARM SEF 6. 2005 9:49 AM FUEL ALARM SEP 1. 2004 8:27 PM x ~ ~ * ENU ~ ALARM HISTORY REPORT ----- SENSOR ALARP't ----- L 2:UNLEAD A FILL PIPING SUMP LIQUID WARNING OCT 3. 2006 8:59 AM LIQUID WARNING FEB ]4. 2006 7:36 FM FUEL ALARM SEP 6. 2D05 9:hi-AM F=1LFiRt°t H I ~TUR'r' REFURT ----- SENSOR ALARh'I. ----- L 4:UNLEAD B ANNULAR ANNULAR SPACE FUEL ALARM OCT 3. 2006 9:01 At°1 FUEL ALARM SEF 6. 2005 9:51 At°i FUEL ALARM SEP 1. 2004 8:27 PM ~ ~€ ~ * ~€ END ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 5:UNLEAD b FILL PIPING SUMF LIQUID WARNING OGT 3. 2006 9:02 AM FUEL ALARM SEP 6. 2005 9:12 AM LIQUID 4JARNING DEC 10. '?004 ';.':15 PNl ALARM HISTORY REPORT ALARhI HISTORY REPORT -~--- SEtVSOR ALARh1 ----- L 3:UNLEAD A STP ----- SENSOR ALARM ----- STP SUMP L 6:UNLEAD B STP STP SUMP LIQUID WARNING LIQUID WARNING OCT 3, 2006 9:00 AM OCT 3. 2006 9:03 AM HIGH LIQUID ALARM SEP 6. 2005 9:17 AM j SETUP DATA WARNIPJG J MAY 11. 2006 10:02 AM HIGH LIQUID ALARM ~ SETUP DATA WARNING SEF 1. 2004 •8:50 PM ~ MAY 11. 2006 9:53 ANi 1 i x * ~ * ~ EhJU :« x ~ x is ~ ~ ~ ~ EhJti k x ~ x n ~~~ ALARf°I H I STOR'! REPORT ----- SENSOR ALARM ----- L 7:FREMIUM ANNULAR ANNULAR SPACE FUEL ALARM dCT 3. 2006 9:06 AM FUEL ALARM SEF 6. 2005 9:51 AM FUEL ALARM SEP 1. 2004 8:26 PM * ~ * ~ ~ END * ~ n ~ ~€ ALARM HISTORY REPdRT ----- SENSOR ALARM ----- ~. L B:PREMIUM FILL PIPING SUMP ' LIQUID WARNING OCT 3. 2006 9:07 AM FUEL ALARM SEP 6. 2005 9:13 At°1 HIGH LIQUID ALARM I SEP 1. 2004 8:25 Ph1 , ~€ ~€ * ~ ~ END ~ ALi=;Rf`9 H I ~Tti~ RY REF'URT ----- SEPJSOR ALARP~i ----- L 9 : PREt°1 I UM STP STF SUMP LIC~UID WARNING dCT 3. 2006 9:08 AM FUEL ALARM dCT 3. 2006 9:08 AM SETUP DATA WARNING N1A'! 11. 2006 9:59 AM ALARM HISTORY REPORT -- SENSOR ALARM ----- i L11:DISP PAN 3.4 DISPENSER PAN FUEL ALARM OCT 3. 2006 9:09 AM FUEL ALARM SEP 6. 2005 9:38 AM FUEL ALARM SEP 1.-2004 9:.41 PM ALARM HISTORY' REPORT -- SENSOR ALARh9 ----- L10:UISP FAN 1.2 DISPENSER FAN FUEL ALARM dCT 3. 2006 9:10 At°i FUEL ALARM SEP 6. 2005 9:39 AM FUEL ALARM SEF 1. 2004 9:43 PN1 ALARNI H I STdR'! REF•dRT ----- SEfJSOR ALARM =---- L11:DISP FAN 3,4 DISPENSER FAN FUEL ALARM OCT 3. 2006 9:09 ANl FUEL ALARM SEP 6. 2005 9:38 ANl FUEL ALARNI SEP 1. 2004 9:41 FM ALARf°t H I TdR.Y REPs?RT ----- SE(VSGR ALARNI ----- L12:DISF PAN 5.6 DISPENSER PAN FUEL ALARM dCT 3. 2006 9:11 At°1 FUEL ALARM SEP 6. 2005 9:43 At°1 FUEL ALARM SEF 1. 2004 9:46 FM r * ~ ~ * END ~€ i~ ~ ALARM HISTORY REPORT ----- SENSOR ALARM ----- L13:DISF FAhJ 7.8 DISPENSER FAN FUEL ALARM dCT 3. 2006 9:12 AM FUEL ALARM SEF 6. 2005 9:42 AM FUEL ALARM SEF 11 2004 9.49 PM ALARNI HISTORY REPdRT ----- SENSOR ALARNI ----- L14:DISF PAN 9.10 DISPENSER PAN FUEL ALARM 4CT 3. 2006 9:13 AN1 'FUEL ALARM SEF 6. 2005 9:46 AM FUEL ALARM SEP 1. x'004 9:56 PM ~: ~ * * END ~ n ~ ~;~ D .- ALARM HISTORY'REPORT SENSOR ALARNI L15:DISF PAN 11.12 DISPENSER PAN FUEL ALARM OCT 3. 2006 9:14 AN1 FUEL ALARM SEP 6. 2005 9:44 AM FUEL ALARM SEP 6. 2005 9:44 Ahl LAST h~IETER EVEhJT OCT 3. 2006 11:29:07 AM FP : 41 f°i : 0 = T U EIVD EVENT 12 GALS OCT 3. 2006 11:29:10 AM FP 44 START EVENT OCT 3. 2006 11:29:26 AM FP 36 START EVENT OCT 3. 2006 11:29:38 ANl FP:39 M:0 = T U END EVENT 21 GALS OCT 3. 2006 11:3D:22 AM FP:35 M:0 = T U END EVENT 21 GALS Custcu WI-,ule~ale 685 3800 Rosedale Hi el-~wa Bakersfield, CA OCT 3. 2006 11:30 AM LAST F'OWER OUTAGE REPORT T 1:Unleaded PROBE SERIAL NUM 609830 POWER REMOVED MAY 3. 2006 5:59 PM VOLUME = 15321 GALS WATER VOL = 0 GALS TEMF = 79.1 DEG F i POWER RESTORED MAY 3. 2006 6:35 FM VOLUfhE = 15321 GALS WATER VOL = 0 GALS TEMP = 79.1 DEG F GROSS VOLUME CHANGE 0 GALS T 2:Unleaded PROBE SERIAL NUM 609832 POWER REMOVED MAY 3. 2006 5:59 PM VOLUME = 15244 GALS WATER VOL = D GALS TEMF = 79.4 DEG F POWER RESTORED MAY 3.2006 6:35 PM VOLUNIE = 15244 GALS WATER VOL = 0 GALS TEMP = 79.4 DEG F 1 GROSS VOLUME CHANGE 0 GALS T 3:Premium PROBE SERIAL NUf1 602053 POWER REI"1OVED MAY. 3. 2006 5:59 PM VOLUME = 18339 GALS WATER VOL = 0 GALS TEMP = 74.3 DEu^ F POWER RESTORED MAY 3. 2006 6:35 PM VOLUME = 18337 GALS WATER VOL = 0 GALS TEMP = 74.2 DEG F GROSS VOLUME CHANGE -2 GALS Castc[~ UJI-~olesale 688 3800 Rosedale Hieh~.~a Bak.ersfi i el d. CA OC:T 3. 2006 11 :30 AN1 LEA}; TEST REPORT T 2:Unleaded PROBE SERIAL NUM 609832 NO TEST DATA AVAILABLE * ~ * ENU ~ ~ ~ ~ ~€ BUS SLOT FUEL METER TAN}; TANK MAP EMPTY . Gostco Wholesale 688 3800 Rosedale Hiehwa Bak.ersf i e 1 d. CA OCT 3. 2006 11:30 AM LEAk: TEST REPORT T 3:Fremium PROBE SERIAL NUM 602053 NO TEST DATA AVAILABLE ~ n ~ ~ * ENU ~ ~ ~ ~ 1~~~ ,fir ~ - ~.= UNDERGROUND STORAGE TANKS APPLtCATiON TO PERFORM ELD !LINE TESTING 1 SB989 SECONDARY CONTAINItiIENT TESTING !TANK TIGHTNESS TEST AND i F}E4~F'~" e`~'st~ k t;-_ ~ ~~;3~€ § vRINCs CEf~'!'DrtC~@ T it3:5 PERMIT NO. ~~--~~_ P~ . ~ ~ -"- ~ _~~ . BAKERSFIELD. FIRE DEPT. , _ ~ Prevention Services ~8;~1- ~t F`L";~;-;+'~ 900 Truxtun Ave., Ste. 210 -_ _ "_, Bakersfield, CA 933Q 1 ~, Tel.: (661} 326-3979 Fax: (661) 852-2171 Page 1 of 1 .2S ENHANCED LEAK DETECTION .~S .eS S&3a9 SECONDARY CONTAINMENT TESTING - ~BC-`TAtJt! TIrLITAiFCC TFCT -.._'_ ~ - DC7 Tft ~~4'.rFftK.'u; F; I~f xR+"TAFfi"7RhC: rFR7Vi-i^1i?ERhF .__ .- SITE INFORMATION FACILITY -~c~ i.Oh~les~(~ ~l~$~i ..r..:. ;:~~. ..:<t=:~.,~~`; ~;~ ,sus:"_Y~.;. ,~,~,~;,,;; (~,~~ t33Y{9;c~$z~.. ADDRESS 3~aa ~e~ ~~~, ~-l. b,...~~. fs~te ~ d ~'xa . 1 33a OWNERS NAME /~ l: ©lS -lt-G C~ 1 r ice; -__:'. .. ~.>. ~.~ :,:_,_3._ : ~:,~s+_.s. "._. ~., ~ .P, .-- _:.~;. 1 NUMBER OF TANKS TO f3E TESTED tS PtPING GOING TO SE TEST ED? .e; YES ,~ NO TANK # YOLiJME _ CONTENTS _ 3 1--- ,^~~ ~ i ~ASo(,Nc ~ __~ - i _ _ .. .r- . ~ _ ~ ____ - -- - - - - - - _ E TANK TESTING COMPANY ~ NApM~E OF TESTING CO PANY ,y, 5 ~ ~ °~- ~E.lll l ~NC ;i s. -- ~=" ~_Y~_ 3 .' :: ?<„ r ~~ iS ~ Ci O ( ~ 2'Z ~ _ , ,~ _ , • ~, ~ i 1 ~'t ~v^{' G ~ MAILING ADDRESS 3 ~[ ~-{ sS S'c,;n i ~ ~ ~ ~ ~- ~ t_.1a ~ a r~- ~" ~ i Z ~ `3 5 NA{M~E 8~ PHONE NUMBER OF TESTER OR SPECIAL tN PECTOR 1~IL.t. ~iulfCS c($1 °YO(y 3p'23 CERTtFtCAT10N #: ~~~ ~~Q~3y DATE & TIME TEST TO 8E CONDUCTED /~~3~D6 ~1.00~nr %CC I TEST METHOD 5a$73i3-yT alt. '~/fsc~o-t l SIGNATURE OF APPLIC T ~'".., C+~.t p DATE / gyp/ - l1CATtf~l~t HECOMES A RERMtT H N A -~PROVECt APPROVED BY DATE G~' S FD 2095 {Rev. 09!05) ftig)iLraX ~ 8/15/204Fi 2:Z7 SAGE 002/00: Fax Server UNDERGROUND STORA~E'CANK ~'] .~~ ~ARERSFIE)f.D FIRE DEPT. P~RIVIIT,gPPLICATION ~~~ ~ ' n 1 P..'~S P 1 H`1 D t1~~e~~X~tp, Sc'rvicies ` . ~ ~ ~ pxjq~ ~ app ~„~n AWe-r stc. 210 TO CONb`"IRUCT INSTAI.I. NL1M1f TANK (NEW FAL:IIJT I L t C (ISTING FACIU EW T K S ! ' Y)! ti ~ . yc~gr~~j~r ~1 ` ~`~Y~~ar ~n q~~01 _ g ] ~ N AN IN tDN ( I A ' ' #~ + / ~ ~ ~'` i' `~~L: {~i6 ] } 326-39'79 •A710N 1 & ININOR MODIFICAT[ON - FAClLm MODIFII ~, 1+ax: {667.) RS2-2171 PcRlu~7no. -. ~ -_ Da TYPE QF' APPLICATION: D NEW TANK INSTALL / Nr'W FACILTY Chock one item Daly) a:7 MOt]IFICAT14N OF FACtLRY At;rlNC Dare- _'- J '. ~ ~ -~ovos~ NU. ~.~~__ .m F•xavu>tD aY Page 7 Of T ^ NCW TANK IN3TALLATIDN ! EX1571NG FACILITY ^ MINaR MODIFICATIpN OF F_ACIItIY (:OMPLCTIDN DATE /~!/P ~QW ~ .,~~ uo. ND. ~~ QE f]cMla ~~ry~.,~_~/ra n ~~Lrj tlT ~1~~, . ~OFI'11i1'OGIYOU 11JATkli ~ IIOILTYI'F,fxWFC7CDA79IfE ilO. p'7ANK,~7'h BHINSIILLILO gRETI{CY hOk KO70R FUCL ~ sYRL WCIICNTrON t;UMlftJL AND GOUMl7't MCA9UfSES P1nN 04J 17L[ O Yla CI NU L7 YC:; ONO 'fAN1S N0. UMnL NLCADCO FCGVI AR kCMUM CLCL VVITgN 7TOS SEG'710N IS FOR NOM MOTOR FUEL StORPIGE TAN7(S_ __ , _, TANCN(b VOLUME LtAUFO ~ GUlAR E6nl,iM at:4fl. VIATION FOR OFFICIA! USE ON~Y__ _ ~APIR7CA7gN nATR .. FAfaLmf NQ .. ^.... N .Of TAN .~. fCE9 T, ..-~ 17ia r~pplAxru nxclveaL r7de7aTands, a„atw!!l crorxply with rhr. eituclred rorroF/loos afOrc prrn~%f ~d rury udrer saitt lxaf anttjr~a+r+~ rcglrludnn. ~ onn ear r1pG:te[tundp-r!~„c! rjury,«adtoifir,bre+l bjnrykrwlvlcr{;rntrrr~eomr~ rorn!r1 AMY UVGO BY_ MPLICANY>AI (PRINT) Al+l+1 f(:AAfT91GNA7UAT ~~ THIS APALICATION FiFCOMFS A f'EI2M1T WHEN APPROVED F42oBG tRrV. o9lOS) z e d ~Q- ~..~. 2" (~'.-~ d E T~ E 0 9 0 9 t e n d -') ll-~ 11151161'Q.1i 1G/ G/ GV VJ G JG YC1V L' VVY/ VVY 1'QA JGl VGl UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING (TANK TIGHTNESS TEST AND TO PERFORM FUEL MON{TORING CERTIFICATION BAKERSFIELD FIRE DEPT. ~~~~ Prevention Services ART1 900 Tnixtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LINE TESTING ~SB-989 SECONDARY CONTAINt~NT TESTING n TANK TIAN'I'NFRR TFRT ^ TCl PFRFARkA FI IFI M(1NIT(1RINQ CFRTIFI(`ATIAN FACILITY ~ 6g,~ Co 5-F ~o ~ ESP S NE NUMCB~ OF CONT2A~ P y ~~ _ ~ ~ S 3 II r p p ADDRESS ~ SDO ~pSC~. ~`''~ L~ ` ~ 1..9 A ,Q0.~ST ~P_ 1~. C 0.. 1 3 3 0 O ~ ©5-~ cJ CG(~ od~~-.b~ OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO 8E TESTED IS PIPING GOING TO E TESTED? ES ^ O TANK # VOL M CONT NT ~ ~© U~ Gad. 87 v~ \ ec.~~. ~.S Z ZO Uoo Goal - `$7 vI~ ~ea~~ GAS. TANK 7E$TING.CpMPAt'lY NAME OF TESTING COMPANY ~ W~ vie ~~~' ._!._/~C, NAME ~ PHONE NUMBER OF CONTACT PERSON C'G,ro t~~-R-- _ -~\\ow`vf'2 goo 583 o3SZ MAItING ADDRESS q~ ~/pp /~ (~ ~ P /~ p / !J 20 ( l.arhw~t~a1 +,1 P~~ /~-v~ a .=~lJ'eN l C.~ ~ lea ~ _l ~ to ~ f NAME 6 PHONE NUdiBER OF TESTER SP CIAL INSPECTOR CERTIFICATION >Y: DATE ~ TifYIE TEST TO BE CONDUCTED - ICC !l: - I ] Q ` ' ''(~ TEST METHOD SIGNATURE OF APPLICANT ~ DATE ~ Z _ 6 , Q APPROVED BY DATE g ~ FD 2095 (Rev_ 09/05) L F/RE ~ARTM RONALD J. FRAZE FIRE CHIEF Gary Hutton, Senior Deputy Chief Administration 326-3650 Deputy Chief Dean Clason Operations/Training 326-3652 Deputy Chief Kirk Blair Fire Safety/Prevention Services 326-3653 December 1, 2005 Costco 3800 Rosedale Hwy. Bakersfield, CA 93308 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. 2101 "H" Street Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Bakersfield, CA 93301 Health & Safety Code) of the new law mandates testing of secondary containment OFFICE: (661) 326-3941 components upon installation and every 36 months, thereafter, to insure that the FAX: (661)852-2170 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. RALPH E. HUEY, DIRECTOR PREVENTION SERVICES FlRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 I Bakersfield, CA 93301 OFFICE: (661) 326-3979 FAX: (661) 852-2171 David Weirather Fire Plans Examiner 326-3706 Howard H. Wines, 111 Hazardous Materials Specialist i 326-3649 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 I/. HUEY, Director of Prevention Services ~~ Steve Underwood Fire Prevention Officer SU:db