Loading...
HomeMy WebLinkAboutUNDERGROUND STORAGE TANK (2) r ~ q Y(UNDERGROUND STORAGE TANKS) FILE # ~. r !~ TEXACO FOOD MART ` -- - i 13004 STOCKDALE HWY. ~~ ~~ 6 -~' .~.' ~~, ~,~ ~~. _ _. W '_y Uw~?E~RGROUND STORAGE TANK Bakersfield Fire Dept. ,.yy-. .,,a~~~,~~, :s ~ ~~ Environmental Servicee APPLICATION TO PERFORM riRr `~f~(~~~'".<:",`~~ -`.` ~`~: `_:; ~ LINE TESTING, TANK TIGHTNESS TEST ~ ~ 't'ee: (66 ~ J32e-'~-~7~~ /SB989 SECONDARY CONTAINMENT TESTING E'a.x; (661) 852-`Z i r i Page 1 of i PERMIT NO. ~S~ ~ i ^ ~ TANK TIGHTNESS TEST ^ LINE TESTING ~ SECONDARY CONTAINMENT TESTING_ _ AGILITY ~' how'd -'Y1,ob~ DDRESS _ ~ ~ I ,~ DO ( J-t-oCk_Gla l e. ~y ~ ~cL.K.~.f S 'f'-I e la ~ t..~-t ~ J J I oC.- OPERATORS NAME __ _ _ ~'ERMiT TO OPERATE NO ~ r. Chou-> ~ _ t ~ 2.. _~^_- OWNERS NAME } ~ mom. C.-~o~, ~ , ___ _ ~ NUMBER OF TANKS TO 8E TESTED; ~ i iI "~ ;IS PfPING GOING TO BE TESTED ~iYES NO T TANK N0 CONTENTS vO~UME v t ~~ U n (c~ I b Do0 a _. ~g.._(-tn ld_ lD~ 000 3 r- _.__~._. _._...__.____.__..._-____.____.__.-.._.~_____ ~1 ~nld - ._.._____-_. _._.___.___._._ _ io 000 /-.---_..~..- `{ psi co 000 ~fANK TESTING COMPANY II ~Redw~~~__`T?es-~~.n~__.Serv~~eS sne~ t---~ - -- __.--.---_________..___ _.._ . .____. _._-._... ---____.------_____.___.. ~AAILING ADDRESS P.b. Bo t~~l (~ keys ~ e.ld Ca a 3 3 0 ~ AME 8~ PHONE NUMBER OF CONTACT PERSON 7 ' _ _ _ _ r.~ an l Ti,~rn e~ Lvlot - 834 - (o ~ q3 EST MET D ~_.___._~ ~_____ _-.-____- -1__n won NAME OF TESTER OR SPECfA~ ~NSPEGTOR. ~bsh~ Oa~iS CEftT+r~CA.T,Orf f;, 0a 1 oa.~q ~_.____-__ ATE & TIME TEST IS TO BE CONDUCTED ~egola anu.t~r ~S ~oo~ q: oo A~m IGNATURE OF A LLG~~NT .~,_ /~ /.rte -__ _ _ . PATE f'l _ ~n n~ -- ,- - -----._.. _....____.._..-_-..___v_...._.______._.._____.__._.,_ _..___.._.__--..__..----.._~_____._~_.__-_._._._ i,4PPROVEO ,DATE ~.__ .~_ _ _.. ____ _ . ____ __ _~-! _.a_ ~1S__._ _ ------- -. . S~2Go4 !' ~ . :~ . ' 'f ' •~ ~r~~. ,~ s,~; ; ;,, ~ .. . ~E~Cf~lD~i1~t?!"=~YSTE1lq CERT~CATION F4fiM .i '~'' ~ DATA f 1 10 -t,. - Fd ~ b~.l ~' , ` ~~ . ' 1 Oft{.; S FdCiLITY ADDRF.~S: QL DA(.F; ~cs 1~ t~ ~~ - - S~~z. ~T ~ /o~~r4~--ui ;~, ~- `. ~'° ,.; i1~T Atraa~lar SpBCe G~ ~:: ~. ~,,, ~ k ~. ~: ~ Tank ~ Tank 3 Tam 4. ~tsrt'L1~e ~ Q ;;- ~~ t~te~t Pr+~re Q / a /0 . ~> , . . .. ~'.nd TYme 0 ;y~ :~ ` ~: ,,; ~~; ,,..: y ~~ ~ ~ . ~dtkatian ~ ~ ~~ ~~ ~~ ASS M :, ~~~f~ ~~~~ ` _ , G•:.~ a.. ~r. .y,.. ~/ C~Aa `371:T7~ 'i3~ei~..!) 7bT14~ Cu.v'Ts.v~i.v~ ~ ~N(,~ , X, :~,~ x.tae g~ ~' Line 2 ~`~ ~,int 3 / Dst 4 , _ +. . ~`, Mart T~ ~,+ ~ l ~ ~ `, 3o j ~ 30 ~ 13e K jz; a. '. ~~ WM4T~/L ~~+~Q.l~i .~3 •92.0 '~ 4Y r. . ~, 4 Time ~ !oa ~ ; 1 ~ 3t 3n r., ,. ' , ~ `Rf~ ~~~ i 1 4 9 2m . S s-- ; ~ s '' (Suture) 1 '. ~.~ .. v ~.cs Ju i~.~7TS `. ~"~ ~~ n a-cif ` l,.t ~J2 ~r~ '~ ~~d ~GUG- ;; '. sci.~w~ .. "~U .., ~ ~s~! '°'" `! +r to ~` ~8' St 0~ ~5 f 3 $~iv ~~LrdtiG ~'': (~trr~ !4 A.~~~"- f~agb l a~ ~N~~ y-v 7G'~L d o p 'fit :r ~ .G,~, ~ ~:;~ . ~.K~F,cs NT~11:.7v . _ /3 ~. t,~ Sra.c.c a,~ t ,a P sOv ~. `~ A !o ~ (J~.ua- tv ~:.: . ~~:. ;~ d `SP #~- ~ ~ _ f~ua p~~ss~ ~. -nom ~~'~`~~ wits ;~ ''~ ~ ult. ~ y~ "~~ k av-~ '-I~ ~~~ l.v .~7~ . ~"sccc~S i ~~~'~.~ 5 `~~ ?• •; ~~ ~r,lr; .~ECO>V~'•!~'~"YSTEM CERTIFICATION FORM ~',. . ~y~`'~ ~ 1 t ~ U ~ S DATE ~'' F+ACII.ITY , >y,`. CACILTTY ADDR>~S ~ ~.~a'~ . ~.• ~~.~ ~'~-,~f~, e, . Ti~riw+e Sumps ~ ' •, i. 1, .. ' 1. `s ~~ . '~ . :~ , ~:: ;, ,; . ,: ~. ~.. 5ui~p 1 ~ : ~ , ~ . Sump Z ~ Sump 3 `~/ Swap 4j~•L. Start T'eme .. ~ ' ~~" y. j YNti~I HNght df Water , ;.~ /,~ a o r 'tlme f ~ ~ ~a -ss- ~ ss- '~vater HeigiK ..9 ~ y ~ ..! . o .~ j.~ ~i ~ ~'ime 1 ~ w /='L..S^ Water Height ~„~~,.~ ~ ,•~,, 0: ~ ~ -~ J ~ films f . ~~ / ~/ 5' /-~.Sr '1~VV~ter Il~ight .~ 3 ~.:~ .o ~ r,~ 1r., ! . l ~r.~ iCcrtincatgon ~~~~ ~ ~. ~, ~ ~ ,- / `:~~~ ~' /R' OrernA Buckets Uw~erEill 1. ~ ~.- . , tl! Z ~ Overtlp 3 Overfiti ~ Mart ~ o Qv • ~ . •-~ Y~ He1gl,t of water . , . ~ ~.~ ~ I ~ ; :~ ~ ~ b~ Time ,~ f l ~ ~ Q~ 'Water Height J J • ~ ,; ~ ,,. ' ~ /,.~ ~61-ater xe:ght p~ , ,, ,:.: ?• ( • ~0 71 ~ ~ a ~%ss '~Ctioa ~(Sfgewtun) ` / ~` / Page 2 of 3 i ~ ~~7 -----~_ •'h ~~ !.. ,. e~:.. ,:,. ~~: ~~.. . ~;; , - , +; n: •. - ' ~!'} S£CONDAIY SY5TEM C1~RTIFICA'I'iC)N FORM ~~; ~'°' DATE ~~ io~b5 ~: FACILITY TD :~`.>~ FACILITY ADD .a ?~~cic7 !-1~: _~~~2~r :I~%-6~~,.~ ._ ~-{ %~~ ~ -- - - A=1 ~. );' UDC 'TESTING ' Fur;. .,,~. ~~~:. . ~:;. , cit. .• ~: ~,: r~; ,, s:: ~~~ DISPENd9,-I~ , ;DIS'I'ENSER x DLSPENSIrR 3 DISPENSER 4 STARTTIME /~ p - ~ ~ /S IYVI'CIAL ~ , HETGIY'~' 4~' 1iVATER t~ETGTiT ;~ .:.:~ ~ -a3 ~ o~.~ . / a ~~«~S! /~~ iL/L/ ~ ~ . c• 'VVATF:tt CERTIFECATION {'SIGNA`T'URE) ~~ START TlMIs r ,~ , ~ : ~NTTIAL : . WATER .. ~~: TIME ~ G . ~~ ~ WATER . ,; ~iEiGAT ~ TIC WATER ~:'; ~, HEIGHT ~ ~'~ . ~: ~C ~~mtnC,-~or . ~, ~o ^I~ DISP'LNSER 6 DISPENSER ~ D-ISPENSER 8 . ,1 Page 3 of //~~7 4 r I UNDEFIGROUND STORAGE TANKS :~.,,. y' APPLICATION TO PERFORM ELD /LINE TESTING / S8989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORWG CERTIFICATION BAKERSFIELD FIRE. DEPT. ~i~s Prevention Services AIR1'r r 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 7 PERMIT NO. ~~~~ ` 8 ^ ENHANCED LEAK DETECTION ~I~t{ E T ^ SB-989 SECONDARY CONTAINMENT TESTING III TANK TIRNTNFCR TFCT 1^L TC1 PFRFnRM FI IFI MC1NITnRIN(, CFRTIFICATInN ' FACILITY ~ ~ i NAME & PHONE NUMBER OF CONTACT PERSON ' ADDRESS ~~ OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED i PIPING GOI TO B T S D? YES ^ NO TAN # V ON T i ~ dOO - ~ ~r 1 ~ ~ 'TANK TESTING COMPANY NAME OF TEST G COMPANY NAME 8 PHONE NUMBER OF CONTACT PERSON a ~ MAILING ADDRESS i ~ ~ _ ~ ~ q "l G~-- I U NAME & PHONE UMBER OF TESTER OR SPECIAL INSPECTOR U CERTIFICATIO , DATE A TIME TEST TO BE CONDUCTED ~n ~ . iCC #: TEST METHOp SIGNATURE OF APPLICA ~ ~~ ~~ DATE - _ ~ _Q APPROVED BY DATE C~~a - FD 2095 (Rev. 09/05) ~1LL~NG & PERMIT STATEMENT saxEitSFiELn Fig DEPT. Prevention Services ~fRe 900 Truxtun Avenue, Suite 210 PE~dIHI7SN0.: ~ ARrx r a, Bakersfield, CA 93301 Tel.: (6611 326-3979 S Fax: (6611 852-2171 • LOCATION OF PROJECT , ~~ - ~ ~ PROPERTY OWNER STARTING DATE OMPLETIO ATE S~ NAME 1 \ ^ ~ ~ PROJECT NAME r\ y~ ~ V l ADD 5 PHONE NO. ~~ PROJECT ADDRESS 4 CnY TE ^ /~ Il~(~ 1" ZIP COD • •' CONTRACTOR NAM CA LICENSE NO. ~ •' ~ ~ TYPE OF LICENSE. EXPIRATION DATE PHONE NO. Q'J~^ Q~i () V U :~ CONTRACTOR COMPAN E ~ ~ ~ FAX NO. ADDRESS ~ CnY ZIP C DE 1 J ~ ~ 50 ^ Alarms -New & Modifications - (Minimum Charge) '$262 ~ ~ . 98 Over 20 Ft 000 Sq Ft x 013125 =Permit fee Sq S'4 ^ , . . ,. . 98 ^ Sprinklers -New & Modifications - (Minimum Charge) $210 00 ~ . 98 ^ Over 5 000 Sq Ft Ft x 042 = Permit fee Sq . , . . 98 ^ Minor Sprinkler Modifications (< 10 heads) 00 [Inspection Onlyj $ 93 . 98 ^ Commercial Hoods - New ~ Modifications $ 398 26 ~ . 9¢ ^ Additional Hoods 00 $ 36 ~ . 98 ^ Spray Booths -New & Modifications 00 $458 ~ . 98 ^ Aboveground Storage Tanks (Installation/insp.-1~' Time) $165.00 - 8 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/lnspedion) $109.00 82 ^ Underground Storage Tanks (Installation.llnspedion) $878.00 (per tank) 8Q ^ Underground Storage Tanks (Modification) $878.00 (per site) 8~ ^ Underground Storage Tanks (Minor Modfcation) $155.00 ^ Underground Storage Tanks (Removai) $675.00 (per tank) 8a ^ Oilwell (Installation) $ 72.00 ~! ^ Mandated Leak Detection (Testin Fuel Mond. Cert. Tents $ 81.00 (persite) er ent) 8~. ^ After hours inspection fee $122.00 ^ Pyrotechnic - (Per event, Ptus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. min. stand -by iee nnspection) _ $510.00 ~ ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 8~ ^ Portable LPG (Propane): NO.OF CAGES? $66.00 84 ^ Explosive Storage $249.00 ' ~ ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page ^ Miscellaneous ~ ; 84 FD 2021 (Rev. 09/05) i 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to File) 1-PINK (to Customer) •? = v fi. s, -.:a ~lLL!!V(~ ~ PERMIT STATEI~EIVi° oaTE ,~r•,~ Bakersfield-Fire Dept. PREVENTI®N SERVICES Fire'Safety Services • Environmental Services 900 Truxtun Ave., Suite 210 Bakersteld, CA 93301 Tel: (661) 326-3979 ~,.. USTIAST PERMI•F,'rA ESTING~ ' , . ~-, ~ ~,`~~ ! 82 ~~~~ ~~ ~ ,: ''STATE SURCHARGE 86 TENTS, LPG, FIREWORKS, POWDER)OTHER PERMITS 84 COPIESlREPORTS 89 FOLLOW-UPiNSPECTION INSPECTOR:' DATE TIME SPENT:' CHARGES ~ f~ ,,~.~"^ ?+ CHARGES CODE: REASON and DATE FOR INSPEGTION: LOCATION OF INSPECTION: y BUSINESS NAME: 3 ' TELEPHO+N~E N«~UMBER(S): fig,.. -,,, Blll TO: <:,3 PAY BY: f ~ ~~£..~'~.q~ ~:^~'"C..~„, fl•, rt M . NOTES:.. __ .,. i _ "'"` CUSTOMER SIGNATLIR£: 4NSPECTORh2ECE1VERSLGNATURE: 9~ ~a9~9 %' .-._ SWl2CB, January 2002 Pagc J of~ Secondary Containment Testing Report Form Tliis form is inrendadfor use by contractors performingpariodic testing of USTsecondary containment systems. Usa the appropriate pages of lhis form 1o report results for all components tested. The completed form, written test procedures, and printouts from tests (;f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agenry. 1. FACILITY INFORMATION Facility Name: Date of Testin : (7 d Facility Address: 6[ Facility Contact: Phone: Date LocaE Agency Was Notified of Testutg Name of Local Agency inspector ~fpresent during testiny~; 2. TF.STiNG CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: Credentials: !H CSL$ Licensed Contractor C SWRCI3 Licensed Tank Tester License Type. C611D40 License Number: 609850 Manufacturer 11~ann~art~rer Trainit~ Com onent s Date Trainin E fires INCON INCON TS-STS 3. SUMMARY OF TEST RESULTS Component Pass sail Not Tested Repairs Made Component pass Fatl Not Tested Repairs Made 2.~C5'Y 0 0 0 ^ 0 0 ^ ^ G 0 ^ ^ ^ ^ 0 Cl c '~• ~ ^ o ^ ^ ^ ^ o ~ ) ', a ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ o ^ a 0 CJ ^ ^ 0 ^ ^ J ~ 0 Q U 0 0 ^ ^ o ^ ^ o ^ ~ ^ ^ ^ o ^ ^ ^ ^ ^ r O ^ ^ ^ 0 0 Q ^ If hydrostatic testing was performed, describe what was done with the water after completion. of tests: RECYCLE AND REUSRD 11 ~_wt~5 or+ was\~~2 ~ wte. ~ CERTIFICATION OF TECHNIG[AN RESPONSIBLE FOR CONDUCTING THIS TESTING 7'o the hest of my knowledge, the acts .stated in this document re accurate and ltt ju[t compliance with legal requirements Technician's Signature; Date: ~ ~ ~ 0 ~ 6 '° /a y~~~ ~;--- .i ` ~a2 6 S WRCB, January 2062 Page of~' c cFrntvnenvi~rviw•TTi'e~-nv[= Test Method Developed By: ^ Piping Manufacturer i7 Industry Standard Q Professional Engineer ^ Qther (Sped) Test Method Used: ~ Pressure Q Vacuum ^ Hydrostatic ~ Other (Spec/jy) ' Test Equipment Used: 4 i n . DIAL GAUGE Equipment Resolution: . 5~ ,: ,a,. ;;~ ~ Piping Ran # Piping Run # Piping Run # Piping Run # Piping Material: ~ J ~L Piping Manufacturer: p ~ in1~1~~ n~kty- Piping Diameter: '• ~~' Length of Piping Run: a Product Stored: ~~ ~} Method and location of i in -run isolation: ~ ~n -~"'"~' ~~-~AS~i~P Wait tithe between applying pressurelvacuum/water and startin test: Q fM • in ~ ~"~ Test Start Time: 1~•,~~pYn ~. lAM Initial Reading (R,): tj ; ~ Test End Time: ~ : p~ -,(~ Final Reading (RF): ~ 2 rj ~ Test Dutation: ~ }jp J~j ~ }~ p ~ 12 Change in Reading (Rr-Its): ~,, ~• Pass!Fail Threshold or Criteria• ~ ~_ Test Result: ass a Fait Pass D Fail U Pass O Fail q Pass Q)trail - ~ - Cotnments - (include Information on repairs made prior to testing and recommended follow-un for failed tests) :•Y•.~ 5 cf~ b1 F 6 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 2101 "H" Street Bakersfield, CA 93301 OFFICE: (661) 326-3941 FAX: (661) 852-2170 RALPH E. HLIEY, DIRECTOR PREVENTION SERVICES FIRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 OFFICE: (661) 326-3979 FAX: (661) 852-2171 David Weirather Fire Plans Examiner 326-3706 Howard H. Wines, III Hazardous Materials Specialist 326-3649 March 31, 2006 Mr. Lonng Chao Stockdale West Texaco 13004 Stockdale Hwy. Re: Failure to Perform /Submit Annual Fuel Monitor Certification NO"1C"tCE OF VIOLATION & SCH~~ULE FOR COMPLIANCE Deaz Lonng Chao, Our records indicate that your` fuel monitor certifications is due/past due on 03-15-06. You are or will be in violatid~ti of Section 2638(a) California Code of Regulations, Title 23, Division 3; Chapter 16. "All monitoring equipment shall be installed, calibrated, operated and maintained in accordance with manufacturers instructions, and certified every 12 rnrtnths for operability, proper operating condition, and proper calibration." Therefore you have 30 days ~Apri127, 2006) to comply. Failure to comply may result in revocation of your ~'ermit to Operate. Should you have any questions, please feel free to contact me at 661- 326-3190. Sincerely yours, Ralph E. Huey, I Director of Preu tion Servi es - By: Steve Underwood Fire Prevention Officer REH/SU/db "Serving tie Community ~~'or.~V[ore 7~ianA Century" :1 ~1:. MGNITC)RING SYSTEM CERTiFICATi4N ~~~ For Use By All./'urisdictions Withtrt the State of California :authority Ci~e& Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations `!'his Fnrtn must be used to document testing and servicing of monitoring eguipmer-t. A sevarate certification or re must ~e,g~nare 1'or each monitoring system control panel by the technician who perfottns the work. A copy of this form must be provided tb the tank ;ystetn owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. Uenerati Infc,rmatio Facility Name: C FtEV'~o~.,,) Bldg. No.: Ji[:, Address: _f 3~`! $ ~~K~7+9'~ ~Y City: $~/1.5~/~~, Zip: ~3%y facility Contact Ferson: r/~~~ Contact Phone No.: (.~J '~-laker Nfodel of Monitoring System: (~ (L13A•>QC.O ~ -~l'l L Date of Testing/Servicing: ~ / /S/ a(9 '~ i ant. I t~: U Vl L-~ Tank 1D: l'Jil - f Ij~tn= l dnh Gauging F'robe. Model: f Yi (T-~ Q~I~n-Tank Gauging Probe. Model: ` :vnnul:u Space or Vault Sensor. Model: o~~ ( ~ [~'Annulsi' Space or Vault Se[>sor. Model: u ~ / I :!~ Yiping Su,np /Trench Sensor(s). ModeL• o O~_ ~ Piping Sump /Trench 5ensm•(s}. ModeL• a II 'i~ Fill pump Sensor(s.). ModeL ^ Fill Sump Season(s). Model: L~Mcchanical Line Leak Detector. Model: ~~~ TJ'}t-ICI'" ~'~vlechenlcal Line Leak Ietector. Model: [Z~? c77~kFT ^ Clectronic Line Leak Detector. Model: ^ Electronic Line Leak Defector. Model: ~;] Ttmk Overfill / Hi,,h-Level Sensor. Model: ^ "Tank Overfill /High-Level Sensor. Model: ^ Uuz4r (specify cSui meet a and model in Section 13 on P a 2 ^ Qther s ee' ui ent and model in Section Fs on P 2 . i "font, t'D: U b') L~ _ S Tank ID: fa~.S~L n-'1'anlc Gauging Probe. Model: i/Yl (Y' ( ~ ` ~ Tank Gaupjgg Probe. Model: - i ~ fi3 ~ruiula[• Space or fault Settsor. Model: ~ E Annular Space or Vault Sensor. Model: o ~ Piping Sutnp / Tt'e:uh Sensor(s). Model: l~ Cd'Piping Sump /Trench Setsor(s). Model: vlt; $ ^ hilt S[unp Sensors}. Model: , ^ Fill Sump Sensor(s). Modet: 1~Nlcchuucal Lnie Leak Detector. Model: g't I~Mechanical Line Leak Detector. Model: ~ ~~--'~` ^ Ll~ctronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: CJ Tank Overfill / Fli;h-Level Sensor. Model: ^ Tank OverJSl! /High-Level Sensor. Mode]: ^ [~thcr (specify equipment type and model in Section E on Page 2). ^ Other ui ent and model in Bastian E on B e 2 . liu enser ID: I '} a D' user IA: '~ Dispenser Containment Sensor(s). Model: J3 A;QtJ l~ Dispenser Containment S~sor(S). Model: u l~til,ear Valve(s). [Shear Valve(s). ~y Dispenser Containment Floa s and Chains . ^Dis enser Contaitment Floats and Chai s . Qi3Peuser iD; '~ Di C i S ' ~~A"R Dig enser ID: ~ ~~ii 1 ` ~' ' ' spenser onta sunent ensor(s). Model: k3 O ~ ~ ( ~ Dispenser Containment Sensor(s). Model: • . l~Shz~u• V:ilve(s). [f'Shear Valve(s). Dispenser Containment Float(s) and Chain(s). ^Dis enser Containment Floats and Chains . his a„ser ID: ~' Co ~ Dispenser ID: Dispcnser Contaiiunent Sensor(s). Model: V ~ ^ Dispenser Corttaritment Sensnr(s). Model: " ~ l~5hear Valve(s). ^ ShearrValve(s). ~ ^Disp~nser Contai[u3.tenr Float(s) and Chain(s). ^Dis enser Containment Floats and Chains . E's. Yluveintory of Equipment Tested/Certified Check [he appropria[e boxes to indicates eeific a ui meet ins ected/setviced: '"If die facility contains more tarilcs or dispensers, copy this farm. Include inftannation for every tatilc and dispenser at the facility. L. CeY11f1Catl0n - I certify that the egnipment identified in this doenmen# was inspectedtserviced in accordance with the tanufacturers' guidelines. Attached to this Certification is information (eg. manufacturers' checklists) necessary to verify that this lnfarmatlou is correct and a Plot Plan showing the layout of monitoring equJiament. FQr any egnipDrent capable of generating such reports, I have also arrached a copy of the report; (check all that apply): ~S_ystem sot-up (~A1a rt . "Cechnicirlrs Name (print): _ ~•~~ ' /~~~ Signa C;Cr[ilii:ation No.: _ C~c:~C,, - t~ - 1 oZ r/ $ License. No.: ~ ~ ~' ~O~ `l'esting, Company Natne: RICH ENVIRONMENTAL Phone No.: ~ 661 _) _322-8687_ S;[~ :address: ~~~~~`~ ~Tc~.K-A,4~ ~;~, Date of Testing/Servicing: ~/ l~/e (o 1~toniusring System Certification Page I of 3 03101 ~S, -ei ~.:i~e~ults of T~esting/Servicing Jy~~l 5~;,'r.~are Version Irstailed: i`ninnlcire the t'nllnwin~ ehecklist~ iZt~g-y' .~` ~.s : ^ a Is the audible alarrn o stational? Yes ^ o _ Is the visual alarm o e1'ational? l.. Yes Q ° Were at! sensors visual ins ected functianall tested and confin-ned o stational? Y;:s ^ o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will ~ not interfere with their ro era station? _ Cl Yes ^ o If alarms are relayed to a remote monitortng station, is all communications equipment (e.g. modem) N/A operational? ~"~s ^ o For pressurized piping systems, does the ttit'bime automatically shut down if the piping secondary Containment ^ NiA monitoring system detects a leak, fails •bo op~e, or is electrically discoua~ected? If yes: which sensors initiate positive shut-down? (Check al! that apply) Its Sump/Trench Sensors; ^ Dispenser Cssntainment Sensors. Did ou conrarm ositive shut-down due to leaks and sensor failure/disconnection? [rrYes; ^ No. _ _ l.~ Yes ^ o For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ~ NIA rnechanicaI overfill E.;evention vaive is installed), is the overfill warning alarm visible and audible at the tank fill oint(s and o ernti iro erly? If so at what ercent of tank capaci does the alarm tri er? [. 1'e~ ^ No Was any monitoring equipment replaced? If yes, identify specific sezlsors, probes, or other equipmem replaced and list the inanufact::rer name and model for all replacement parts in Section E, below. l~' No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apph) CY Product; ~ O Water. if es describe causes in. Section E below. Yea ^ o Was manitorin s stun set-up reviewed to ensure proper settings? Attach set up reports, if applicablC_ ~~ Yes ^ o is all monitoring equipment operational per nyaztulhcturer's specifications? '" In Section E below, describe brow and vc~en these deficiencies were or Will be corrected. ~ . ~ orr>Inents: l~ ~~ V ~-l. -~ 5~ $u-r~^ jJry n .~v 1--~r4~ ~~-ss . .t Paga 2 0£ 3 43 l U t e` t•~. is 5 M F. In-Tank Gauging /SIR Equipment: C!s Check this box if ta~~k gauging is used only for inventory control. ^ Check this box if nc tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. f nn, nlnto t4~a fnllnw9na r6 ar41iCt• ^ Yes ^ ° Has all input wiring been inspected for proper entry and termination, including testing for ground faults?` ^ Yes , D ° Were all tank gauging probes visually inspected for damage and rcgidue buildup? ^ Yes ^ • ° Was accuracy of system product level readings tested? ^ Yes ^ o Was accuracy of system water level readings tested? l~ Yes . ^ ° Were all probes reinstalled properly? ^ Yes ; ^ o Were all items on the equipment manufiaeturet"s mairrtenance chec:klisi camplebed? " Ln thtr section H, below, describe now aqa when tdese aezrctencres were or ww oe correciea. . Ci. L1ne Leak ~eteCtots (LLD): d Check this box if LLDs are not installed. ('nm nlerP tha fnfln~m:na oharirEict• Yes ^ No" For equipment start-up or annual equipment certification, was a leak simulated to verify LLD perfornnance? ^ N/A (Check all that apply} Simulated leak rate: ~3 g,p,h.,, O 0. I g.p.h , ^ 0.2 g.p.h. Yes ^ o Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ^ o Was the testing apparatus properly calibrated? Yes ^ o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N/A p Yes O o For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? f1~N/A O Yes ^ o For electronic LLDs, does the turbine automatically shut off if ayy portion of the monitoring system is disabled L~N/A or disconnected? ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions C>rN/A or fails a test? Yes ^ o For electronic LLDs, have all accessible wiring connections been visually inspected? GY~1/A Yes D o Were all items on the equipment matsufacturet's maintenance checklist completed? { to the Section H, below, describe how antl when these deficiencies were or will be corrected. >Ei. Comments: Page 3 of 3 o~En~ , ~r Z(p sY ~~~ Monitoring Systear Certification UST Monitori Site Address: 1 ~ ~ ~ ~Toe.kbr4-~>r --~ Site ~~~`~~ ~ ~y ~33/5~ ------------------------t-- --------------------------- ---------------------------- uH~--a~ -__--_------..--------------- -- -- ----i~---_-~-- --- d`© Date map was drawn: 3 / .~ Dl~ Instructions If you r~lxeady ha`Je a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. Or. your site plan, Shaw the general layout of tanks and piping. Clearly Ydemtify locatiaiis of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containme: t areas; mechanical or electronic line leak detectdrs; and in-lank liquid level probes {if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page of nsieo 1't.t..Sy 14I CH .EN'~~,g. ; ,,~n~r~2v~rA r. 5643 BROOKS CT $ARERSFI$LA,CA.93308 OFFICl3(661)392=8687 & FAX (661)392-0621 ~~~_'L~ ¢ n fi~icTOR Tgs~ W/0#: Fac~,lity Name• C"Neu~ Faci.litY Address; ~~~~/ S~~D.¢~ ~Y $r4~e~S~lr~cb ~ ~ 9~j~s! PraCluat Line Type (Pressure, suction;, c3ravity) PRC-DUCT LEAK DETECTOR TYPE TEST TRIP PASS s~RIAL NUMSER BELOW PSI OR L/a TYPg ~R~~ i ~ s~~ 9RRIAL # U a$S NO /[~ FAIL vr~~-~s`7 G 1 LID TYPE ~b 7` ~~~~ ~ ~ SRRIAL # y11~ NO / 7 FAIL L/D TXP c ' " 8EI2IAL # ~ NO / FAIL t l ~H7 ~ L/A TYPE _ t~ ~ L ~S SERIAL # ~'$y NO ~~ F + D~ T. c;ertify the above tests were conducted on this date according to R®d bracket Pumps field test apparatus testing procedure an limitations. The: Mechana,cal Leak Detector Test pass / fail is detexmined by using a lour flow threshold trip rate of 3 gallon per hour or less at l0 PSI. I s~cknowledge that all data collected is~ true and oorrect to-the best of my knowledge. Tech: ~'-'4'RBr.1 Kam' ~_. - ~-~~` a~ S igna~ture i -- Date r I ~~F`CLJAhE REL` I S I ON LEVEL VERSION 14.01 SOFTWAREtt 3460!4-100-B C•REA'TED - 97.03.1 '~ .20.41 NO SGF1'6JARE N1ODULE SYSTEhi FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS SYSTEM-SETUP - - - ._ - - MAR 15. 2006 'x:44 PM SY'STEI°1 UIV I TS u.S. SYS TEhI LANuUAGE EPlGL I SH SYSTEM DATE.%T I t°lE FORMAT MON DL? YYYY HH:MM:SS xM S'1'O~_ IDALE T'EXAGO 13004 STOCKDALE HWY BAKERSFIELDaCA 9331'' SHIFT TIMtE 1 DISABLED SHIFT TIME 2 : DISABLED E+HIFT TIME 3 DISABLED SHIFT TIh1E 4 : DISABLED PER I OL? I C. TEST WARiV T iVGS DItiAHLED ANNUAL TEST WARNINGS DISABLED FRINT Tt• VOLU1°iE;~ ENABLED TEI`1P i:Oh1PENSAT'!C?N VALUE {DEi.~ F 7: 60.0 H-PROTOCOL DATA FORMAT HEIGHT RE-DIRECT LOCAL PRINTOUT DISABLED SYSTEM SECURITY CODE 000000 ~OMMUN C CAT I OtVS SETUP PORT SETTINu^S: COhlhl BOARD 1 {RS-232! BARDTRATE ODDO . STOF BIT 1 STOP DATA LENGTH: 7 DATA AUTO TRANSMIT SETTINGS: AUTO LEAk ALARM LIhIIT DISABLED AUTO HIGH WATER LIh1IT DISABLED i AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT DISABLED AUTO THEFT LIMIT DISABLED AUTO DELIVERY START DISABLED AUTO DELIVERY END DISABLED AUTO EXTERNAL INPUT ON DISABLED AUTO EXTERNAL INPUT OFF DISABLED AUTO SENSOR FUEL ALARM DISABLED AUTO SENSOR WATER ALARM DISABLED AUTO SENSOR UUT ALARM DISABLED RS=23 SECURITY GODS 040000 RS-232 END OF MESSAGE DISABLED IN-TANK SETUP t~-ti~Sy r~`- T 1:87 UNLEADED PRODUCT CODE 1 THERMAL COEFF :.000700 TANK DIAMETER 96.00 TANK PROFILE 1 PT FULL VOL 12000 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 h1AX OR LABEL VOL: 12000 OVERFILL LIMIT 95% . 11400 HIGH PRODUCT 90% 10800 DEI. I VERY L I M I T 15%t lsoa LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 0%~ 0 LEAK MiN ANNUAL 0~: 0 PERIODIC TEST TYPE STA IVDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GRASS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TESL' NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 1 MIN [. f -:t•y PLUS PRODUL T C~?DE 2 THERI.1AL CO);FF :.000700 TA1VK D I At°IETER 96.00 'rA1VK PROFILE 1 PT FULL VOL 1000 T 3:91 PREMIUM PRODUCT CODE 3 THERMAL COEFF :.D007QO TANK DIAMETER 129.00 TANK PROFILE 1 PT FULL VOL 10000 F'Li~A'I' S I';:E : 4 .0 I N . 8496 WATER 6•J;-1RNING 2.0 H[GH WATER LIh1IT: 3.0 r1AX OR LABEL VOL: 1000 OVERFILL LII.IFT 95% 11400 HIGH PRODUCT 909 10800 DELIVERY LIhIIT 15 % 1800 LO4J PRODUC I' : 500 LEAK ALARM LIh1IT: 99 SItDDEN LOSS LIMIT: 99 TANK TILT 0.00 I°IAIVIFOLUED TANKS Ttt: NONE FLOAT SIZE: 4.0 IN. 8496 WATER WARNINu^ 2.0 HIGH WATER LIMIT: 3.0 MA'X OR LABEL VOL: 10000 OVERFILL LIMIT 95% 9500 HIGH PRODUCT 90% 9000 DELIVERY LIMIT 15% 1500 LOW FRODUC'T 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 MANIFOLDED TANKS Tti: NONE LEAK I`1I N PER I OU I C.: 0Qo ' 0 LEAK M I N F'ER I OD I C: Ori. LEAK MIN AIVIVUAL 0% 0 ' 0 LEAK MIN ANNUAL 0% 0 PER I t~D I C. TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED FERIODIu^ TEST FAIL ALARM DISABLED GROSS TEST FAEL ALARM DISABLED ANI'J TEST A1r'ERAu^I NG : OFF PEk TEST AI~ERAGING: OFF TANK TEST IVOTIFY: OFF TNK TST SIFHON BREAK:OFF DELIVERY DELA1` I MIN PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERi0D1C TEST FAIL ALARM DISABLED ' GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK 'PEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 1 MIN 1' 4:DIESEL PRODUCT CODE THERMAL COEFF :,000450 TANK PROFELE 129.PT FULL VOL 10000 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING HIGH WATER LIMIT: 3.0 LABE M E I L L ~ 10 0 O RF L h j I T 95 NIGH PRODUCT ~ 9500 901, DELIVERY LIMIT 9000 15% • 1500 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 MANIFOLDED TANKS Tit : NONE LEAK MIN FERIODIC: OY • 0 LEAK MIN ANNUAL 0% • 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF FER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY I MIN ti2e'Sy -~----~~ 4 c LEAK TEST METHOD - - _ _ T'E:.%T O!V DHTE ALL TANK tAN 1. 1996 DISABLED STr'+RT TIF1E :0 Zp GAL: HR 'fEST khTE ~, HOURS LluRflT I O N • LL:AK 'LEST kEPOkT NORMAL _iuUIfi-SENSOR_SETUP- - - L 1 :87 ST'F ThI-STATE {SINGLE FLOAT) CATEGORY : STP SUMP L 2:89 STP '!'RI-STATE {SINGLE FLOAT) CATEGORY : STP SUMP L 3:91 STP 'f}?I-STATE (SINGLE FLOAT) CATEGORY STP SUMP L 4:DIESEL STP TRI-STATE (SINGLE FLOAT) CATEGORY STF SUMP L 5:87 'ANNULAR TRT-STATE (SINGLE FLOAT) l":AT'EuOR~' ANNULAR SPACE L G:89ANNULAR TRI-STATE (SINGLE FLOAT) c:•ATEu"ORY ANNULAR SPACE L r:91-llIESEL ANNULAR TRI-STATE (SINGLE FLOAT) CATEuORY ANNULAR SFACE OUTPUT RELAY SETUP R i:UNLEADED TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L 1:FUEL ALARM L S:FUEL ALARM R 2:89 PLUS TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L 2:FUEL ALARM L 6:FUEL ALARM R 3 : PREM I Uhi TYFE: STANDARD NORi"tALLY CLOSED LIQUID SENSOR ALMS L 3:FUEL ALARM L 7:FUEL ALARM R 4:DIESEL TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L 4:FUEL ALARM L 7:FUEL ALARM ALARM HISTORY REPORT SYSTEM ALARM PAPER OUT MAR 1. 2006 6:49 AM PRINTER ERROR MAR 1. 2D06 6:54 AM BATTERY IS OFF JAN 1. 1996 8:00 AM ALARM HISTORY REPORT ---- IN-TANK ALARM - T 1:87 UNLEADED OVERFILL ALARM MAR 3. 2006 12:02 AM JAN 3, 2006 11:01 PM 'pEC 6. 2005 12:43 PM LOW PRODUCT ALARM NUV 1. 2005 3:47 PM OCT 24. 2005 6:30 PM SEP 1~ 2005 3:48 PM H[GH PRODUCT ALARM MAR 2, 2006 11:59 PM FE8 13, 2006 7:35 PM FEB 10. 2006 10:23 PM INVALID FUEL LEVEL NOV 1. 2005 3:45 PM OCT 24, 2005 6:28 PM SEP 1. 2005 3:42 PM PR08E OUT DEC 1. 2004 12:17 PM DEC 1. 2004 10:56 AM NOV 27, 2002 8:54 AM DELIVERY NEEDED MAR 6, 2006 7:25 PM JAN 11. 2006 6:21 AM NOV 2. 2005 12:18 FM MAX PRODUCT ALARM NOV 13. 2005 11:22 AM SEP 10, 2005 11:53 PM LOW TEMP WARNING NOV 27. 2002 10:11 AM L2~ ALARhI HISTORY REPORT ---- 1N-TANK ALARM - T '2:89 PLUS SETUP DATA WARNING OAT 21~ 2002 9:45 AM F11GH FRODUGT ALARM JUN L3, 2005 3:00 AM JUN 19. 2005 2:21 AM DEC 9, 2002 5:26 AM INVALID FUEL LEVEL JUN 15. 2005 12:51 PM JAN 24. 2005 3:30 PM PROBE OUT JAfd 24. '005 3:03 PM D)~C 1.. '2004 12:12 PM NOV 27. 2002 10:25 Ahl DELIVERY NEEDED DEG 2~. 2005 3:48 PM AUG 19, 2005 10:26 PM JUN 29. '2005 B:O1 AM LOW TEhiP WARNING D$C 1. '2004 12:17 PM IJOV 2^. '4002 11 :32 AM ALARM°i HI TORY REPORT ---- I N-TANK ALARP4 ----•~ T' 3 : 91 PREMIUM SETUP DATA WARNING Oi;T 21. 2002 9:45 AM L04J PRODUCT ALARM JUN 17. 2005 2:30 FM HIGH PRODUCT ALARM JAN B. 2003 4:44 AM IP~VALID FUEL LEVEL JUN 17. 2005 2:16 PM PROBE OUT DEC 1. 2004 12:06 PM NOV '27, 2002 11:45 AM DELIVERY NEEDED DEC '28, x005 5:22 PM DEC 27. 2005 2:38 FM NOV 23, ?005 4:38 PM LOW TEMF WARNING NOV 27. 2002 12:23 PM ALARM HISTORY REFORT ---- IN--TANK ALARM ----- T Q:DIESEL SETUP DATA WARNING OCT 21`. 2002 9:53 AM DELIVERY NEEDED h1AR 15, 2006 12:06 PM FEB 27. 2006 ?:34 PM FEB 3. 2006 9:11 AM ALARM HISTORY REPORT -- SENSOR ALARM ----- L 1:87 STP STP SUMP FUEL. ALARM MAR 15. 2006 2:22 PM SENSOR OUT ALARM MAR 15. 2006 2:06 FM SENSOR dUT ALARM MAR 15. 2006 11:19 AM ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 2:89 STP STP SUMP SENSOR OUT ALARM h1AR 15. 2006 11:19 AM FUEL ALARM MAR 15. 2006 11:07 AM FUEL ALARM MAR 15. 2D05 11:05 AM ALARM HISTORY REPORT -- SENSOR ALARM ----- • L 3:91 STP STP SUMP SENSOR dUT ALARM MAR 15. 2006 ll:l9 AM FUEL ALARM hIAR 15. 2006 11:08 AM FUEL ALARM MAR 15. 2005 11:06 AM { ' .ARM HISTORY REPORT ----- SENSOR ALARM ----- L 4:DIESEL STP STP SUMP SENSOR OUT ALARM MAR 15. 2006 11:19 AM FUEL ALARM MAR 15, 2006 11:09 AM FUEL ALARM MAR 15. 2005 11:08 Aht ALARM HISTORY REPORT -- SENSOR ALARM ----- L 5:87 ANNULAR ANNULAR SPACE SENSOR OUT ALARM MAR 15. 2006 11:19 AM FUEL ALARM MAR 15. 20D6 11:11 AM FUEL ALARM MAR 15. 2005 11:02 AM ALARM HISTORY REPORT -----SENSOR ALARM -- L 6:89ANNULAR ANNULAR SPACE SENSOR OUT ALARM MAR 15. 2006 11:19 AM FUEL ALARM MAR 15, 2006 11:12 AM FUEL ALARM MAR 15. 2005 11:04 AM ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 7:91-DIESEL ANNULAR ANNULAR SPACE SENSOR OUT ALARM ' MAR 15. 2006 11:19 AM FUEL ALARM ~ MAR 15. 2006 11:13 AM MARL15LA2005 11:07 AM ~ vL~sy .^---- MONITOR CERT. FAILURE REPORT SITE NAME• G' ~~ ~~ DATE• 5i~ck-7~F~. g/~-k~s~-~~~ , ~A 933Jy THE FOLLOWING COMPONENTS WERE REPLACED/R.EPAIRED TO COMPLETE TESTING. REPAIItS• ~ R~~p~-Pr ~~ tn~ ~ ~t 57~'p ~ ~P 5~ sue, LAFtOR: /U~'y`'~ ~.TS INTALLED• t} it ~~~ l~ 1 0~o S S'~~ S~s~T,2 NADZE: TITLE: SIG]yATURE: THI; ABOVE NAMED PERSON TAKES FULL RESPONSIB:tLITY OF NOTIFYING THI; APPROPRIATE PARTY TO HAVE CORRECTNE Af,TION TAKEN TO REPAIIt THk; ABOVE LISTED PROBLEMS AND NOTIFYING RICI; ENVIRONMANTAL FOR ANA' NEEDED RETESTING. THIS ALSO RELEASES RIC~i ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURIl~tG FROM~NON-COMPLIANCE. A C~JPY OF THIS DOCUMENT HAS BEEN LEFT ON-SITE .FOR XOUR COPdVIENENCE. 5~,',•(~C:t?; .I;.,~iu:,,•y 2002 Page of Secondary Containl~xent Testing Report Form 7'1,is lCrm is intenc{edfar use by cor~tractorsper• formrr~pIIJ'todf~ terttng of USTsecondary ecu~tatrr~alltsystams. Usa the .,~u,•op,•iate pages of this form to report results jot all components tested The completed farm, written test procedures, and p,-~„toc,ts from tests ('if applicable}, shoztId be provided to the faeiliiy owi+erlaperator for srrb-nrttal to the local regulatary agency.' 1. FACII.TTY jNFORMATION }~a~ilityNan~e: G ~vi~tr,-J DateofT -IS'+~(o 1~'aciliry Address: i 3rrb ~T'ac-1C.Dr4~.~. ~-1-v• /4K~i~`~ tfzLl7 ~' ~~• 1=a~ility~ Contace: Phone: Date Local Agency Was Notifled of Testing Name df Local Agency ectar ~f present during tes 2. TESTING CONT~.tACTG1Ii INFOI~MATIOPI ~:umpany Name: R,2CH ENVZR4NMEN{I'AL '1'eclutician Conducting Test: {~/4'rK~•i•J ~c~`~ C:rcdz[ttials: «CSLB Licensed Contractor Q SWRCB Licensed Tank Tester 1-,icense Type. C6 i 1D40 F.ieensaNtxmber, 809850 Maattfactnrer Training Manufacturer ~anot~,}etitfe) Date Trai . Bx ir~es TNCON INCQN S-STS 3. SUMMARY OF TEST RESYILTS Compo~Rent Pass FaIJ Nat ,I,~~d • . epaira 1Vtude ~ Companeat Pala Fai! Not T RepRiirs ~~• u~tsr-s~ FILL ;cam ~ [a' ^ ^ D 0 .^ D 0 . urn t/ ~ tt,4-P - pct (~' 0 ^ ^ D ^ Q 0 . ~nt.~P-~`i Fact ru. b~ t~' ^ ^ 0 ^ ^ ^ D ~. 'vl ~s~ r~i r.~ lcL $~ d ^ ^ D 0 D ^ ^ ~- D D 0 ^ D D 0 0 ^ ^ 0 ^ ^ ^ D ^ ^ ^ 0 ^ 0 D Q ^ ^ o ^ D ^ ^ o 0 if i rydrost~tic testing vvas porfgrmed, describe what was done with the water after completion of tests: RECYCL„~ AN DD F2EUSE'F~. CERTIFiC.tiTION OF TECHNICIAN RE,ap©NSIBLE FOR CONDUCTING THIS TESTING 7'v rh a best of my knoi~vledge, the fact aced !n tlil~s dacrrnasnt are acCetrate acrd lrr,~tcl! eAmpllance with legal rtgr~lrsments 1'et:iulicialr's Signature: Date; ~ ~~S _p ~ SWRCB, 3anuary 20Q2 o cprr .z .inv~u~n T . rnrrrs.~rr Rnx~c ~~s Page of --- Facili : is Not Equi ed With; S ill/4verfzll Containmem Boxes ^ SpilUaverfiU Contfdnment Boxes axe Present, but were Nat Tested. ^ ___ Test Method Developed By: ^ Spin Bucket Manu:fractwrer ^ Indushy Standard ^ Professional Engineer ^ Other (Spec) Test Method Used: ^ Pressure ^ Vacuum D Hydrostatic [a'bther {,~ ec~) U 1 Sv-C~L ~ I H~Q Test Equipment US~d: Equipment Resolution: ~ Spi11 Box # fll(, e~} S . fll Bo]: # v ~ Splll Box # F/u. >~l Spiii Box ' Bucket Diameter: ~ a " ! o~? k job" ~ `r Bucket'Depth: ~ y ~ (~} `~ ~ ~ , r ~~ ~ r Wait time between applying pressure/vacuwn/water and startin .test: 'a y-~l i -.} yJ p !,y r l0 mint U Y+'' /~./ ~ Test Sti<rt Time: ~ =yam ~q-v~n QI = ySA-vr~ ~: ~5,~}'+^-+ `J ~ y5r4'1'''+ it Initial Reading (R~j: I O I ~ r ~ D '~y ~ ~ ~ ~ $ '~a ,~ Test End Tiume: J D : yS A-vvt 1 ~ : `~(~-q-rn ~o; ~/5'~Q-+~ In%`lS~+-~ Final Reading(RF): ~D ~~a ~~ ~ '/ r` /y ~, ~ ~ ~ '' Test Duration: ~' } f GiJ'~ ?'~ t ~ 1 rr Change; in Reading (RFRI}: b ' ` a ' ` n ' ` D ~' Pass/Fail Threshold or Criteria; ~ „ ~ „ O , ~ ~ it 7Cest R~snlt: [9~'ess ^ Fail as ^ Fail B'~ass ^ Fail lass ^ Fail ~ommeIIts - inc:iride information on re~virs made prime io ter_ rtkg, grrd reeommerrc'adfollmwup for~failed tests) ~ ~ L~4~~L7 5~ l (1L. .~y ~-Kti'fS jv~r~~7~~ T1t 5'T/r C~ S W RCB, 3anuary 2002 9_ SFII..IJdZrT.RF1t3., GOI11T~4Il~11+1~1VT BdXES x: S Page of __ Facility is Not Equipped With SpilU4verfill ConrainmeatBox#s S i1UUveri"tIi Contewnment Bm[es are Present, but were Not hosted Q 'rest Method Developed By: Q Spilt Bucket NlsauBiRWraa O Industry Standard [7 ProEPSSianai Engineer Q Other (SPec{fYI Vest Method Used: ^ Pressure Q Vacuum D Hydrostatic ~R'6ther ecify v I S t?ti4-L ~, ~azst~} Test Ecjui nt Used: Equipnueut RCSOlt>tiion: ~ ~ Spill Box # ~F~u- ~ 1 Spill Hoar #U4gp ~k SpiII Box # ~'{tt, Spill Box # Buclaer:I3iarneter. j ~ ~' !~ ,' i D `` Bucket~:Depth: ~~ '~ ! Y '~ 1y ~ Wail time between applying pressntt/vacutunlwater and sta~tin .test ~ O ~ ~ ~ - ~~ m! ~ f D ~ ! 1„/ ' 'l'est Start Time: % yS ~4-w• q; y5~ % ys,~ -~--i Initial ReadmB (Ri); to '/a '` ~ ~• .~ r`y ~. Test Eitd Time: ~ D .` yS d-YrN 1 c7 ! y5.~4w, 10.` x/5.4-••.-, Final Reading (RF): (~ ~ /a ~ ` • ~~ ~ r ~ ~ U " Test D~iration: l ~'FD v~L ~ ~Zr~ _ Chauge in Reading (Rf-Itr): ~ -" ~ ' ` O ' ' Pass/Fail Threshold or Criteria: D ~ ~ ~ << ~ ~~ ')rest Yt~;sult: B'l~'ssy ^ Fail e ^ Fail ea q Fail D Pass D Fail t.OxnaneTil's (ilu:lude ttyLr~atian on re~a~'rs made prtar to tee mrd recont~rtended folla~-KpJor faded tests1 J -a SB989 TESTING F.A,I~..URE REPORT SITI: NA E: ~ ~ ~ u ~''`~ DATA: ~' l ~-"~ ADDRESS: ~ ~~~ ~~"-KA-~ try c cIAN: K~'P rr~v. ~~SF~ , CA 7'~3/~/ crr_ivs•rr~_ TIII: FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REI?'AIItS: ~~ PA~:TS INTALLED • ~~''y''~ NAPiIE: TITLE: SIGNATURE: Tffi, ABOVE NAMED PERSON TAKES'FULL RESPONSI>IILTTY OF NOTIFYING THFC APPROPRIATE PARTY TO HAVE CORRECTNE ACTION TAKEN TO REPAIR THIC ABOVE LISTED PROBLEMS AND NOTIFYING RICii ENVIItONMANTAL FOR ANTI NEEDED RETESTING. TffiS ALSO RELEASES RICK ENVX120NMENTAL OF AN7t FINES OR PENALTIES OCCURING FROM NON-Ci~MPLIANCE. A G~PY OF THIS DOCUMENT kIAS BEEN LEFT ON-SITI: FOR YOUR CO~~VIENENCE. lZasy ~c~~~.~.j,~~ ~ PERMIT STATEMENT ~trtz>rtn~ ,va: BAK~RSFIELD FiR~ DEPT. Prevention Sesvi+res srtr~l 9001Yuxtun Avenue, Suite 210 ARTI T Bakersfield, CA 93301 Trl • (fifil l X76 497Q S ~'ax~ (661! fi57-?171 LOCATION OP PROJECT • ~ PROPlgiilf 01NNER . i --.... sl'At1'i cvG [)A i t Tfi Y NAME ~S~ ._ L~ C /'r `~ 1ROJECI' iv~niE ~ AD P#~KJNE PROJECI'r11y7U1~S$• ~~ ~~ ~ l` ~ ~ J > ~ _ \ ~ ~ (~~1Y C~ ~ n_ J'~ ~ CONTRACTOR NAI~A CA IJCEWBE NO. 1'YPEOF UCF.i~1SE E)(PIRA7ION tb1TE PFW1tE ~ (og°7 ___ CONTRr~C"fOR COMPAN E I ~ fA1CN0. ~ I r--- i,VJU1IESS , I C1SY Z1P w 8 Moddttations - (Minimum Char e) x$282 50 ^ Ala[ms N ~ ~~ i g - e . ~ Over 20 000 S Ft 013125 = Perrnlt fee S FL x ~ ^ u , q. rinklers -New & Modifications - (Minimum Char e} S . q $210 00 ~ I g p . gig r^ Over 5 000 Sq Ft FL x 042 = Perntlt flee S ~ ~ ~ I . , . q. ~ o Mrnor Spnnkter Modrfical,ons (< 10 heads} $ 83A0 ~lnspectrbn Onlyj ' ~ ' ^ Commercial Hoods -New 8 Modifications $398 26 ~ , . --- ~ ^ Additional Hoods $36 00 , r I . ~ ^ ^ Spray Booths -New & Modifiptions $458 00 ~ i . ~ ^ Aboveground Storage Tanks (lnstaNation/lrlsp: 1"Time} $165.00 82 ^ Additional Tanks S 26.00 ~ 82 ^ Aboveground Storage Tanks (Removal/lnspaction} $109.ao , a2 CI Underground Sto a Tanks (lnstalfa6onJlnspedion} $678.Op (pertartk) ~ 82 ^ Underground Siora a Tanks (Modification) $878.Op (perslte) 82 ^ Underground Storage Tanks (Mirror Modification} $155.OQ t3~ ^ Underground Storage Tanks (fiemovaq $675.fJ0 (pertenk) 8A ^ Oitwell (Installation} $ 72.00 ~ ,. 8a Mandated Leak Detection (Testis Fuet lvlond. Csrt. 81.00 (persite) e2 ^ Tents r 0 - 9A ^ ~ Afterhoursinspection fee $12200 ~ 8A l7 Pyrotechnic - (Per event, Plus Insp. Fee (~ $90 per hour} $ 60.00 + (5 ht's. min. stand-.by ke /inspection) _ $5.10.00 84 ^ RE-INSPECTION(S) /FOLLOW-(1P INSPECTION(S) $83.00 {per hour) &t ^ Portable LPG (Propane NO. OF CAGES? $ 66.OQ 8a ^ Explosive Storage $249.00 84 Q Copying St File Research (File Research Fee $33,00 per hr) 25¢ ter page 8a ^ Miscellaneous ; SA FD 2021(~j ev. O9W5) ,~ .;~ ~, iii+lL7Et2GROUND STORAGE TANKS ~~ ;~ ~~~~.iC~iTION `+ i 4 PERFORM ELD i LINE TESTING ~ f SB589 SECONDARY CONTAINMENT TESTING lTAHK'1"IGHTNESS TEST AND TO PERFOR9A FUEL MONITORING CERTIFICATION 1 ~, ~o P~ ,~ B,AKERSgIELD FiR~ DF~PT. w~~~ Prevaeafi~ou 8~1ces w_ ~fM 90014-~ixtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661} 326-3979 Fax: (661) 852-2171 Page 1 of 1 PPl:ivil't NU. U ENHANCED LEAK DETECTION ^ se-sBe SECONDARY CONTAINMENTTESTWG ~I "fvNK T1RHl"NESS TEST Pal Tn aFRFnRM FUEL MONITORING CERTIFICATION l :; ,.. ~_ FACILITY ,,., _ ~ ~ i NAME 3 PHONE NUMBER OF CONTACT PERSON I~'- i.~,ut,~i=ss 04VI~ERS NAME iiAt=.RAI'ORS TJAME PERMIT TO OPERATE NO. tvUMBER OF TANKS TO BE TESTED I PIPi T V i ~ 00O - ~ o C~ - °~ -~ -- i 1 I TANKTE;=ING COMPANY HAMS OF TEST G COMPANY ~~ ~ NAME i PHONE NUMBER OF CONTACT PERSON ` ii~YAiLING ADDRESS q ''7 -'- ~. 1 (~ NAME & PHONE UMBER OF TESTER OR SPECIAL INSPECTOR - U CERTIFICATIO DAl"E 8 TId6£ TEST TO BE CONOUCTfiO ~/~`~ CJ ICC #~: TEST MET1100 SIGNATURE OF APPLICANT - RATE APPROVED BY p,~~ FD 2095 (Rev. OftU05)