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Home My WebLink AboutUNDERGROUND STORAGE TANK #1~~ ~ ,_ S ~: r+. rte, ~___~ -_ -~ _..___._ _ +:a _ ~ C z 04~~ ~'~~ v~^. ~~ ~z" z -.-, ~ Oyu _ ~ axe' zy~, >. ~¢ x a: ~ r c M, d. g'i r. i :_ ~ _ 4 ~ ~~ MONITORING SYSTEM CERTIFICATION For Use $v.rili Jurisdictions It%ithin the State ofCaiifornia ~~ %Juthoriry C,•'te& Chapter 6 7, Health and Sq!ety Code; Chapter 16, Division 3, TitiP23, California Code o.JRegulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepare for each monitorine system contro~anel by the technician who Performs the work. A copy of this form must be provided to the tank systeirt owner/operator. The ownerioperator tnt,st submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility'\ame: V ~ /-1~i., r rY1A~T Bldg. No.: Site Address: to So ( ~ _ i1.~?i~~J ~ City: -.-G~~~f~sF~Ec--s~ Zip: 93307 facility Contact Person: ~Z.f~VSH{~nJ'r_' Contact Phone uo,: (_,,_,} R4ake/Model. of Mcnitorirg System: ~ L-S ~ 3~0 Date of Testing/Servicing: ~o /~~/~ R. Inventory of equipment Tested/Certified Check the a preprate boxes to indicate specin'c eeuipment insoe.red;serviced: INSPECTOR ON-SIT]; Y~JlNO NAME: ,~j76t/t U.i117EfLW6t ~ Tank m: Un9L~Z~I f Tank ID.: /!z~/11 y i ~SQC-.]_ 1 ~ ~ln=rank Gauging Probe. Model: mHG-, I ~Ir:-Tarts: Gauging Probe. iv9odel: m~}LZ i ~ Annular Space or Vault Sensor. Model: ~~(~ ~~ Am:u!ar Space or Vault Sensor. M11ode1: ~CS__~QC~T~ I y~Pipine Sump!Trends Sensor(s). tvlo~ei: ~p g I,l~ Piping Sump /Trench Sensor(s). lvlodzi ,~~~~ ~^ Fil! Sump Sensor(s). ~1odeL 1 ' ^ Fill Sump Sensor(s). Model: I Mechanical Line Leak Dereetor. Model: ~~~ Jg~~ ~iechanicat i.ine Leak Detector. Model: ~G~ J GAe~ ^ Elecu-atic Line Leak Detector. Model; I ^ Electronic Line Leak Detector. Model: ~ ^ Talk Overfill iHigh-Level Sensor. h1odel: I O Tank Overfill /High-Level Sensor. Model. j ^ Other (specify :;~~ment q•pe and mode! in Section B on Page 2j. 1 ^~ecify equipment type and model in Section E on Page 2): Tank ID: ~r~tjE~-- ~„j~t~. ~ 1 i Tank ID: Fd.1r.-Tack Gauging Probe. Model: ~ [] In-Tans: Gauging Probe. Model: 7 ~,4nnular Space or Vault Sensor. Model: ~1~0'[~p~~ ~ `^ Annular Space or Vault Sensor. Model: I .Piping Sump/Trench Sensor(s). ~%todzl: ~(S i~ ~ O Piping Sump /Trench Sensor(s). Model: ^ Fiil Sump Sensor(s). ~4odel: ~ [] Fill Sump Sensor{s). Model: ~ ~-1-fechanical Line Leak Detector. Model: ,QaCn J~~j ^ Alzchanizal line Leak Detector. Model: ^ Electronic Line Leak Detector, tvIodel: I ^ Electronic Line Leak DzizCtor. Ivtodzl: ! _ n Tank Overfill; /High-Level Sensor. Model: 1 ^ Tank Overfill /High-Level Sensor. !vlodeL• ~ ^ Other (specify equipment type and model in Section F un Page 2,1. I !] Otter (specify equipment type and modzl in Section E on Page 2). I Dispenser ID: l ~ I Dispenser Contains;cnt Sensor(s). ModeL• ~ Dispenser 1D: ~,~'~ I I^ Dispenser Containment Sensor(s). Model: _ ,~Shzar Valve(s). 'Shear Valve{s). ^ Dis enserContainment Floats and Chain(s). ^Dis eraser Containment Floats and Chain(s'. Dispenser Ill: S - to Dispenser ID: 1 ~ ^ Dispenser Containment Sensor(s). iviodei: 11] Dispenser Containment Sensor(s). Mode;: I~Sh~aar Valve(s)• Q Shear Valve(s). ~ Di,pcrserContai»ment Ploat(s) and Chain(s). ! ^Dis eraser Containment Float(s) and Chain(s). ti Dispenser ID: ~ Dispenser ID: ~ U Dispenser Contair.:nen[ Sensor(s). Merle;: , ^ Dispenser Containment Sensor(s). Model: ~ ~ ^ Shea; Valve(s). O Shear Valve(s). I. `^Disiienser C'ontainn:era Float(s) and Chain(s). , ^ Dispenser Containment Float(s) and Chain(s) '!f the facility contains morn tanks or dispensers, copy ti~is form. include icfonnation for every tank and dispenser at the facility. C. Ct',I"CIt1C~t10n - i certify that the equipment ideutifled in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information {e. g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the rep -t; (ctreckall brat ap~ty): ~-System set-up ~,~larm history report Technician'Vame (print): ~ ~.1 .~/ ~. ~~ ~~ /~/9~i ~ Signature: ~ • ~------ Certification No.: ~ ~ ~'y~ License. No.: h~~-(~"~U ' V ~ Testing Company Na:~~e: RICH ENVIIZON?~~IEN"I'AL Phone No.: ~ _ 661 ~ 392-5687 Site Address; _!O ~ f ~ ~.l.S~dn..) /9U~ ~ / /~.~ / ~, t t - ~ ~l~f ~~ C/g' Date of Testing, Servicing: ~/~D/ 07 Page 1 of3 03!01 Moniti~ring System Certification ~ c~~a c D. Results of Testing/Servicing Softrt~are Version lnstalled: 17-U a- Complete the following checklist: Yes ^ ~ o"` Is the audible alarm oaerational? Yes ^ o !s the visual alarm operational? ~Y'es ^ ~ 0 1'~~ere all sensors visually inspected,`unction,!ly tested, and cenfin-nod o erational? Yes ~^ 'o; Were alt sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere 4with their proper operation? ^ Yes O • o` If a:arras are relayed to a remote monitoring station, is ail communications equipment (e.g. modem) ~~r~'.A operational? Yes J o For prassu,-ized piping sysie,ns, does the turbine automatically shut down if the piping secondary containment ^ l~!;A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? ("Check al! ti~rr a~pl~~~Sump,-Trench Sensors; ^ Dispenser Containment Sensors. Dd you confirn: positive shu-dov.~n due to leaks ar,d sensor failure/disconnection? Yes; O No. O Yes ~ ^ • .o. I For tank systems that ~.,tilize the monitoring system as the primary tank overfill warring device (i.e. na ~`NiA mechanical overfill prevention valve is instal:ed}, is the overfill warning alarm visible and audible at the tank fal point(s) and operating property? [f so, at what percent of tank capacity does the alarm trigger? Yes ~t~,o 1Vas any monitoring equipment replaced'? ]f yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model f•~r zll re lacement arts in Section E, below. ^ es ~KNo Was linuid found inside any secondary containment systems designed as dry systems? (Check all that apply) ^ Product, O Water. !f yes, describe causes ir. Section E below. ' ~l'es ^ o` \~'as monitorin s stem set-!~ reviewed to ensure ro er settings? Attach set u re orts, if ap liable i r~-Yes *,_~._ ^ ~'o' 1s a!i monitoring equipment operational permanufacturet's specifications? ,~ ~~..~~~~~ L ue,uw, uescnoe now :r nu when [nose ttet,c,enc,es were or tivil! be corrected. E. Comments: ~~~vUP-~ A .2~ ..Joy- ~ ~1ST~ U~~ ,1. ~1 ~z~(~~.~c~2~ j ~T~. ,.1 E ~ J ~ -, ~ >~ y E S~S~ cz-~ ~'-~~S i f} c--(~ C! ~ ~ ~ S oylU f~-R~S~ ~~~ . Page 2 of 3 G31 J1 ~c~~a~ F. In-Tank Gauging /SIR Equipment Check this box if tank gauging is used only fer inventory control. ^ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tanl: gauging equipment is used to perforni leak detection monitoring. Comntete the inllowinv checklist: ~ ^ Yes O Yes ^ o' ^ o Has aiE input wiring been inspected for proper entry and termination, including testing for ground faults? Were a!1 tank gauging probes visually inspected for damage and residue buildup? ^ Yes : ~ O o Was accuracy of system product level reacings tested? ^ Yes ^ o' 1Vas acc:~racy of system ~~~~ater level readings tested? ^ Yes ^ ' o l•Vere all probes reinstal'zd properly? ^ Yes ^ ~ o' ~ `'Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe Itow and when these de(iciei~cies were or will be corrected. G. Line Leal< Detectors (LLD) Complete the following checklist: ^ Check this box if LLDs are r,ot installed. I~~}-}es ~ C7. ~`o' for e~~uipment start-up or annual e.~uipment certifeation, was a leak simulated to verify LLD performance? ^ 1\'!,=1 ;Cheek cll ri:at c;~n!~) Simuiat2d Iz_:ic rave: ~ h., ^ 0. i h , ^ 0.2 h. g~P g•P• g.p. it Yes ^ o Were all LLDs coi:~t~rmew oper ticnai a:~d accurate within regulatory requirements? i }'es ^ ~ o }}ras the testing apparatt!s Froaer'y ca!i;rated? }'es ^ ~ o j per mechanical LLDs, does the LLD restrict product flow if it detects a leak? 4 I ^\~;A , Yes l7 0' For electronic LLDs, does tine turbine at;tomaticaliy shut off if the LLD detects a leak? N/A ^ }'es ~ ~7 ~ o For e[ectro;iic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ~ ,'~. N!A or disconnected? it O Yes ~ O ' o' For electronic LLDs, does the turbine au*.omatically shut off if any portion of the monitori;~g system malfunctions I ;2~N!A ~ or fails a test? CJ Yes Cl ' o' ~or eiectronic LLDs, have all accessible ~.viring connections been visually inspected? `d/.A "eS ~ ' ° ~ Were all items on the equipment manufacn:cer's maintenance checklist completed? [n the Section F-T, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 G3101 ~c~~~d~ ~Monltorltig System Cert3~'cation Forru: Addendum for Vacunm(Pressure Interstitial Sensors LG 163-1, F.nc. II I. Results of Vacuum/Pressure 1Vlonitaring Equipment Testing • This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of this form must be included with the- Monitoring System Certification Form, which must be••provided ~o the tank system owner/operator. The owner/operator must .submit a capy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. • hlanufaeturer; Model: System Type: ~ Pressure; ~ Vacuum Sensor ID / / Component(s) Monitored by this Sensor: _ Sensor Functionality Test Result: ^ Pass; ^ FaiJ Compoi;ent(r) Monitored by this Sensor;~ Sensor Functionality Tcst Result: ^ Pass; ~ ^ Fait Component(s).Monitored by this Sensor: S ensor Functionality Test Result: ^ Pass; ^ Fail Components} Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; ^ Fail ' ~~omponent(s)117onltored by this Sensor: Sensor Functionality Test Result: ^ Pass; ^ Fail Component(s) Monitored by thIs.Sensor: Sensor Functionality Test Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; ^ -Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; ^ Fait Component(s) Monitored by this Sensor: Interstitial Communication Test Result. ^ Pass; ^ Fail Interstitial Cotnrnunication Test Result: ^ Pass; ^ Fair interstitial Com_*n~}n~cation Test Result: ^ Pass; ^ Fail ]:ntcFStitial Commnni~ion TestResult: D Pass; ^ Fail Interstitial Communication Test Result: ^ Pass; ^ Fail interstitial Communication Test Result: ^ Pass; .^ Fail Interstitial Communication Test Result: jJ Pass; (~ Fail Interstitial CommunicationTcst Result:l=.1 Pass; lJ Fail Sensor Functionality Test Result: ^ Pass; ^ Fail ~ Interstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor: ~ ' Sensor Functionality Test Result: ^ Pass; ^ Fail interstitial Communication Test Result: ^ Pass; ^ Fail How waslnterstifial communlcatlon verified? ' .^ Leak h~troduced atFar End of Interstitial Space;l ^ Gavge; ^ Visual inspection; .^ Other (Describe in Sec. J, below) Vacuum wac restored to operating levels in all interstitial spaces: ^. Yes ^ No (~jno, describe in Sec. J, below) J. Comments; / ~ , Page of • r t If the sensor successfully detects a simulated. vacutrm/pressure leak introduced in the interstitial space at the furthest point from the scasor, vacuum/presscuc has been demonstrated to be communicating throughout the interstice. ~ 1~~~ Monitoring System Certification UST Monitoring Site Plan Site Address: ~~ S 1 N a-r~ ~ f~~/ t/ ~ ~~ }~~ ~~-~_~~ , ~ ~ -~-~p~~ ------------------ ~ ~ ~:o -------------•--------- --------5•= ------ ----------------- -- - -------------- -------------- ~ -----. Q--'-- -------'---" ,""""""""' ~ ¢"""""""il """""""" 1t{ """"""• """"""" ~"""""""'pa """"" """"•"" """"""""' ' """"""" '_"' "' "' " " " " " " " " " ' ~ " Date map vas drawn: ~/~/~ In~'-uctions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if instal led: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and i12-tank liquid Level probes (if used for leak detection}. In the space provided, note the date this Site Plan was prepared. Page ~ of t' os~oo (~ ~~ - ,'~T'.T~A T, 5643 ~I~QC}IfS C'`.i' ~CSRS~':~~LD,CA.93308 O~'~'IC'~ ~ a"61.5 ~~2-e~$7 & F.A~S (661) 3~2~4~21 LI,r~CH~IS_aT.~2i~.~~~-,~i".IL.IdFL'r`~ Z'DR T~'y~ w/o#: Fac :i.l i ~y Nam° ; ~ m~~~ f11~}`2l ____, ~ac:l.li~y .~.adr_ mss :1p ~L_ 5 • ~ ~i-o~ I~VE' , f3Al~~~c...t~~4 Proc'luc~ Z,i.n~ ~'yp~ (Pr.essixre, Suctiom~ C~zavity) ~~~~RE QP(:fz3UCT LR.F:I{ IIETECTO~t •~~ti~ TEST TRIP PASS S~~zz,a,z~ z~u:•saE~ B~LQW FBI pR ~~ _ Sk',!2z.A.i. # NI~:c"ay7`~'t/~LAL _ ~p ~~ k'AIL L/D `z'XPE.~~~AL~ f ^_. :L/D TY'PE'.. ._ ~, .s.Z~~r ~~-~~ 6~ATAL ~ ly1~GNfi nl y_./4C-- NJ /~ SAIL Z,,/i~ T~`YF~ 7C~S PASS: I ;;ertify th.e uno~;-~ rests were conducter3 on this date accoxding to ,Red .;faa]cet Pumps .fie ~d ~_es` apPa.xaf:us test:S.;~s ,pro.cedure an limitations. Tki~:r Mer_han.~.ca'. Lea)c. .^::=~ect.oX 'isSt. pass / fa.z~. is detsxtnined by using a lcr~r flow th.ra_sb.old r_rip rate cf ; ga,lloxi ,per hour ax' less at. 10 PSZ. 2 ..~c)cx~.owledge ~h~.t ^.?. dar_a n_cJ.laeeed iei true and Qox•x•eot Ca tk~e -beat of rrY~ knowledge . Tech : ~A~'`1 ~~5 c~^-~ szgiis~cuxe : --`.~- ~ ~ ..- Date ; ~ ~ '~ `0 a'. l~~a SWRCB, January 2( Spill~Bucket Testing Report Form This form is intended for use by contractors perforrr$ing annual testing of US7'spill containment structures. The completed form a printouts from.tests (ijapplicable), should be provided to the facility:owner/operator for submittal to the Ioca1 regulatory agency. X. FACILITY INFORMATION Facility Name: ;(_../ -~ Date ot`Testing: ~-ap-a • Facility Address: ~ v ~T~ ,J A ~ ~ " ~, • • Facility Contact: ~ ~ b ~ ~ Phone: Date Local Agency Was Notified of Testing :. Name of Local Agency Inspeettjr (ijpresent during testing; STEVE ~ ~ ~~ 2. TESTING CONTRACTOR INFORMATION Company Name: ~ ~t!/i .J m~ ~- . .Technician Gbnducting Test: ~ v „} ,,J , Credentials: CSLB Contractor.. C ernce e SWRCB Tank Tester Other (Spec) License Number(s)' S~-Su 4 BG -+) 'r 3. SPILL BUCKET TESTING INFORMATION Test Method Used: Vacuum Other Test Equipment Used: "U,~- ~ ~ Equipment Resolution: Identify Spill Bucket (By~Tank Number, Stored Product, etc. 1 ~? ~ 2 ~ 3 4 ~,~~ ~ Bucket Installation Type: ~~-~-~-~ `"1`~"-"-~ Contained in Sum ~t Containe in Sum ect. Direct Bury Contained in Sum Contained in Sum Bucket Diameter: ~a ' ` ~ ~ ~ ~ ~ ~ . Bucket Depth: Wait time between applying vacuum/water and start of tort: ~ ~ ~ ~O /Y? .~/ /~ ~+ ~~ ,,,J J~, ~ _.._~., f Test Start Time (T~: ~j ~i~'1 ,3v ~ 9.•,3v~ ~ Initial RcBding {R~: ~ . - ,+ i ~ ' . g , r . Test End Time (TF): /D ! 3v /-} yv\, O.' u Are, lU.' !~ Final Reading {Rt,): 9"` i ' ~ .~ Test Duration {TF - T~: / L ~ 1 }} L ~ Change in Reading (RF-R~: Pass/Fai] ThieshoId or ~ ++ ,+ + Comments - (include in ormation on re airs made riot to teshn ,and recommended oJlow-u or ailed tests CERTIFICATION OF TECHNICL•~,..ri RESPO:~'SIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate; and Irt full compliance with legal requirements Technician's Signature: ~ ~~~~~ Date: ~ o?G -U 7 ~ State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. ;oFTw~;kE kEVIEIOrJ LEVEL COf°1r°IUNICATIONS SETUP JERSIOf`J 17.02 - - - - - - - - - - - - 3OFT6~AkEri46017-t00-C TREATED - 39.01.12.18.20 PORT SETTINGS: VO SOFTWARE MODULE 3YSTEf°1 FEATURES : NONE FOUND PER I OU 1 C I tV-TAhJK TESTS APJIVUAL' IN-TANK TESTS RS-232 SECUkITY CODE 000000 RS-232 END OF MESSAGE DISABLED SYSTEM SETUP JUN ~0,. 20U7 1'~:02 FN1- - SYSTEM UNITS U . S s-:.: ~YSTEt°1 ~L.ANGUAGE ENGLISH IIV-TANK SETUP 3YSTEf°1 DATE%T I h1E FORhiAT - - - - - - - - - hON DU YYYY HH : i°lhl : S S xM T 1:UIESEL J. G. f°1 I tV I h1Ak};ET PROD' UCT GODS 1 5501 S. UiVIOPj THERMAL COEFF :. OtJ0045 3AKERSFIELD CA 93307 TANK DIAMETER 96.00 661-398-6152 TANK PROFILE 20 PTS FULL VOL 5013 aH I FT T I h1E 1 5 : 00 Af°i 91 .2 I NCH VOL 4928 SHIFT TIME 2 DISABLED 86.4 INCH VOL 4763 3H I FT T! t°lE 3 D I SABLED 81 .6 I PJCH VOL 4552 SHIFT TIME 4 DISABLED 76.8 INCH VOL 4315 ' 7'?.0 INCH VOL 4047 TANK PER I OD I C WARN I tVGS 67 . '~ I NCH VOL 3767 DISABLED 62.a INCH VOL 3464 TANY, ANNUAL WARNINGS 57.6 INCH VOL 3093 DISAiLED 52.8 INCH VOL 2847 LINE PER I GU [ C WARN I NGS 48.0 I IVCH VOL 2523 DISABLED 43.'~ ]NCH VOL 2208 LINE ANNUAL WARNINGS 38.4 INCH VOL 1887 DISABLED 33 , 6 I tVC:H VOL 1581 28.8 INCH VOL 1285 FR 11VT Ti• VOLUt°1ES 24.0 I NCH VOL 994 cNAI3LEU 19.2 INCH VOL 730 14.4 INCH VGL 482 I'Eh1F' COh1PENSAT I OhJ 9.6 1 NCH VOL 272 JALUE cDEG F ): 60.0 4.8 INCH VGL : 103 STICK HEIGHT OFFSET DISABLED DA`!L 1 GHT SAV I iVG T I f°lE FLOAT S I ZE : 4.0 I tV . 8496 ENABLED START DATE WATER WARNIIVc. : 2.0 aPR WEEK 1 SUiV HIGH WATER LIMIT: 3.0 START TIME 2:00 HI°1 MAh OR LABEL VOLT 5010 END DATE OVERFILL L 1 t°1 [ T 9G% DCT WEEK 6 SUN 4509 ENU TIME HIGH PRODUCT 95% 2:00 AM 4759 DELIVERY LIMIT lai . 751 3`lSTEM SECURITY ;ODE OOG000 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIi°IIT: 50 TANK TILT 0.00 J~IAIVIFOLD>;D TANKS Tit : NONE ~ Lori d ~ LEAK M I I•J PERIODIC : 9%~ 501 LEAK MIN ANNUAL 9i 501 PERIODIC TEST TYPE ~TAIVDARD AIVIVUAL TEST FA I L ALARI°1 D I SHBLED PERIODIC TEST FAIL ALARf~1 DISABLED GROSS TEST FAIL ALARM DISABLED ANIV TEST AVERAGING: OFF PER TEST AVERAG I iVG : OFF TAIVK TEST IvOT 1 FY : OFF TIVI•: TST S I PHOtV BREAK :OFF DEL 1 VERY DELHY 3 hi I N T 2 : PREM [Uhl PRODUCT CODE 2 THERMAL COEFF :.000070 TANK Dl Ah1ETER 96.00 TAIVK PR OFILE 20 PTS FULL VOL 7018 91.2 INCH VOL 6899 86.4 I fVCH VOL 6G66 81.6 INCH VOL 6376 76.8 INCH VOL 6043 72.0 I tVCH VOL : 5666 67.2 INCH VOL : 5273 62.4 INCH VOL 4849 57.6 INCH VOL 4422 52.5 iPJCH VOL 3985 48.0 INCH VOL 3532 43.'.x. INCH VOL 3091 38.4 I tVCH VOL 2642 33.6 INCH VOL : 2214 28.8 INCH VOL 1799 24.0 INCH VOL 1392 19.2 INCH VOL 1022 14.4 INCH VOL : 675 9.6 INCH VOL : 381 4.8 INCH VOL 145 FLOAT SIZE: 4.0 1N WATER 6~dARIVI [VG HIi~H WATER LII°11T: N1AX OR LABEL VOL OVERFILL L I I'1I T • HIGH PRODUCT DELIVERY LIMIT LOW PRODUCT LEAK ALARM L l f°1 I T SUDDEIV LOSS L I f°1 I T THN}`: TILT MAN I FOLUEU TAIVI:S Tia : hJONE LEAK MIN PERIODIC: LEAK M! N f;NIVUAL 8496 '? . 0 3.0 7014 90% 6312 95% 6663 1 4 °4 1052 500 99 50 0.00 9i 701 9% 701 PER10D1C TEST TYPE :,TAtvL~ARD HIvhJUAL TEST FA I L ALARr°1 D I ~aAHLED PERIODIC TEST FAIL HLARM DISABLED GROSS TEST FAIL ALARI°1 D I SABLED AIVfV TEST AVERHG I NG : OFF F'ER TEST AVERAGING: OFF TANK TEST iVOT I FY : OFF TNK TST S 1 PHOh~ bR>rAK :OFF DELIVER"f DELAY 3 M I tV T :~ : UIVLEHD£D PRODUCT CODE 3 THERE°lAL C:OEFF :.000070 TAIVK D I At°IETER 96.00 TANK PR OFILE 20 PTS FULL VOL 12139 91.2 INCH VOL 11933 86.4 I fVCH VOL 1 l 518 81.6 -INCH VOL : 11030 76.8 I INCH VOL 10452 72.0 INCh VOL 9803 67 , 2 I INCH VOL 9100 02.4 INCH VOL 8393 57.6 IIVCH VOL 7637 52.8 INCH VOL 6$63 48.0 I fVCH +JOL 6l 1 1 43.2 INCH VOL : 5339 38,4 INCH VOL 4575 33.6 INCH VOL 3825 28.8 INCH VOL 3100 24.0 INCH VUL 2409 19.2 INCH VOL : 1761 14 , 4 I INCH VOL : 1 171 9.6 I fVCH VOL : 655 4.8 INCH VGL 244 FLOAT SIZE: 4.0 Ihi. 8456 I~~ATER WARNIIVG 2.0 HIGH WATER LINIIT: 3.0 thAY, OR LABEL VOL : 12139 OVERFILL LIMIT 90i !0925 HIGH PRODU:;T 95% • 11532 DELIVERY LIh11T 9% • 1'~0=? LOW PRODUCT 1000 LEA}; ALARt~1 LIMIT : 99 SUDDEN LOSS LIN11T: 50 TAIVK T I LT 0.00 h1ANIFOLUED TANKS T# : IVOtVE LEA}; t°I I tV PERIODIC : 9i 1202 LEAK MIN ANNUAL : 9%0 1202 PERIODIC TEST TYPE STAIVDARD AIVNUAL TEST FA I L ALARf°l D I Sr=BLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED AIVIV TEST AVERAGING: OFF PEk TEST AVERAG 1 tVG : OFF TAIVK T£5T IVOT I FY : OFF TNK TST S[PNOIV BREAK:OFF DELIVERY DELAY 3 MIIV LEAK TEST METHOD l CO ~` ~( TEST ANIVUALL`! : ALL TAIVK ,3AtV WEEK t h1O1d START T 1 N1E : 2 : OO ANl DURATRONE :02~OHOURSHR LEAK TEST REPOENHANkEDT LIQU,1_D__.~E~JSQk_SETUP- - - L 1:87 ANNULAR TR1-STA'T'E (SINGLE FLOAT> CATEGOR`! ANNULAR SPACE L 2:92-DIESEL ANNULAR TRl-STATE (SINGLE FLOAT) GATEGOk`! AIVtVULAR SPACE L 3:DIESEL 5TP TRI-STATE (SINGLE FLOAT} CATEGOR`! STP SUI°1P L 4:92 STP TRI-STATE (SINGLE FLOAT CATEGORY 5TP SUMP L 5:87 STP Tkl-STATE SINGLE FLOAT CATEGORY STP SUMP OUTPUT RELAY SETUP -- / f`i - - - - -- _ _ _ AI-ARI"I H I STORY REPORT ALARM H 1 STOR ~ Y (REPO d R~TL k 1,:87 TYPE: ---- 11V-TANY, ALARM _- --- - I fV-TANK --- ALARIh -- - STAfJDARD IVOkt°IALL'! i:LOSED T~ : PREM 1 UM T 3 : UIVLEADEU SETUP DATA WFiRIVIIVG AUG 4 SETUP DATA WAkNJNG L f ~~il1l D SEIV;;Ok ALI°1S , 1999 y:37 At°1 OCT 12. 2005 l0:Ob Arl ALL:FUEL ALARrI LOW.PRODUCT ALARI°l AUG 4. 1999 5:37 Ar°1 R ,~ : 9' J NOV 7 , 2006 7:16 AM O~.T 15. 2006 OvERF 1 LL ALHRr•I T`!PE : 6:25 PM AUG 6. 7006 9 MAY 24, 2007 B : 00 PM STArvDARD :1o PI°1 APR 27. 2007 6:32 PM rIORMALLY CLUE:ED I IVVAL I U FUEL LEVEL JAN 4, 2007 2:02 Pr1 AUi; 7. 2006 9:50 Arl DEC 77, 2005 LOW PRODUCT ALARf°l LIQUID SENSOR ALMS ALL : FUEL 8:12 PI"I DEC 23, 2005 g:07 PM APR 20, 2007 APR 17. 7007 4:55 7:40 PNl Pfl ALARrI PROFS OUT FEB 16, 2007 9:08 AM R 3 'DIESEL TYPE: APR 6 , :' 005 1 1:22 Arl HIGH PRODUCT ALARI°1 STANDAkD APR 27. 2007 6:33 PM I'JOki°IALLY i, _LG;;I;D , ~ rELIVER. NEEDED JAN 4. 2007 2:06 PM JUIV 18, 2G07 8:36 Arl DirC 78, 2006 1:23 Art L J ~I.1.1 D SEIVSOk ALr"a9 JUfJ 12, 2007 5:16 PM Jury 10. '?007 INVALID FUEL LEVEL I- 7: FUEL ALAkrt 3:31 PM OCT 16. 2006 7:42 Pr1 L 3:FUEL ALARM JAIV 1 1 . 2005 S 1:41 Prl LGW TEriP WARNING JAIV 2, 2005 3:42 PM APR 6, 2005 11:32 AM PROSE OUT APR 6, 2005 11 :3o Art DELIVERY NEEDED AF'R 20, 2007 2:5! PI°1 APR 17, 2007 4:5s? PI°I MAR 6, 2007 1:17 Prl ALHkM hISTOk>` REPORT ---- I N-TAIVr; AL;;kI"1 T ]:DIESEL SETUP DATA WARNING AUi; 4, 1999 9:37 AI°1 LOW PRODUCT ALARI°r JUIV 1 5. JUN 7. 2006 700x 0; 00 pf"1 FE13 17, , 2006 5:5'~ 3:43 PM Pr°1 I IVVAL I D FUEL LEVEL FEB '. k+, '?006 3:43 Pr1 DELIVERY NEEDED JUN 16, 2007 7:1:~ Pri 7U N 18.-•'007 1 0:05 Arl 2007 7:50 Pr"I ENU ~ x * x ALARI°1 H I STOR`f REPORT ----- SENSOR ALARI°l --- L 1:d7 ANNULAR ANNULAR NPACE FUEL ALARM JUN 20, 2007 9:51 Art FUEL ALARM JUIV B, 2006 1 :55 Pr9 FUEL ALARI"1 JUIV 17, 2005 10:41 AM f ALARI°I HISTORY REPORT ALARh1 HISTORY REF'GRT - S>/r1S0R ALARM ----- _ ------ SEfVSuR ALARh1 - --- a ; 92 STP L L 2:92-DIESEL ANNULAR STp SUf°1P ANrVULAR SPACE FUEL ALARI°) FUEL ALARhI 20U7 9:50 Af°} JUN 2G. 2007 9:54 Af'1 JUIV 20 • FUEL ALARhI FUEL ALARM 8. 2006 1:5a Pth JUN JUN 20, 2007 9:50 Aht FUEL ALARI°1 FUEL ALARM 40 AM JUN 17. 2005 ]0: JUN 8, 2G06 1:56 Ph1 * ~ x ~. END :~ ~ ~ ~ x END ~ ~ x ALARM H1~~T0RY REPORT ALARM HISTORY REPORT -- SENSOR - ALARM ----- ----- SENSCR ALHRt°1 -- L 5;d7 STP L 3:DI£S£L STF c STP .SUMP STF SUMP FUEL ALARM FUEL ALARr9 2007 9:51 Ahl JUN %0. • 2007 9:53 Ai"I .JUN ?0. FUEL ALARrI FUEL ALARM JUIV 8. 200b 1:54 PI°} JU1V 8. 2006 1 :56 F't°1 FUEL ALARlh FUEL ALARM JUN 17 • 2005 10 : a0 At°1 JUN t7. 2005 10:39 Ahl x x ~ END # x * ~ '~ i~ x * ~ * END ~ ~ X W % C7"~ MONITOR CERT.- FAILURE REPORT SITE NAME• V G'1 ~rl~~ z n-~ q~T DATE: Co ' a ~ ~ 7 ADDRESS: ~05~ I _5 ~ U ~+~ ~ A V ~ TECHNICIAN: ~~ b ~1 _ irlAfv~J CITY• j3Ax~t~s~.~E ~_ SIGNATURE• -~~~ ~i~~„_ THE FOLLOWING COMPONENTS WERE REPLACED/REPAIItED TO COMPLETE TESTING. REPAIRS: 5~.~l~~ f3-'LE rJc~T r..1~^79u~,~-,i-nJ ~~~A~~f~-~~- °J~'~}TlU••1 ~l`~-L U~TATns /~ ~:~~ ~t G ~T J Fl~l~ rr~~ wo2l~ A J `~ ,z-T' ~ ^J ~ i4.5 sSo r~ f} ~ ~~' ~Sb~_1~ tom. LABOR:- NGn/ G PARTS INTALLED: ~~~ i.1( NAME: _ TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOT~YING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTYFyING RICH ENYatONI~ZANTAL FOR ANY NEEDED RETESTIlVG. THIS ALSO RELEASES RICH ENVII20NMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON COMPLLANCE. A COPY OF'THIS DOCU11-TENT HAS BEEN LEFT ON-SITE FOR YOUR CONVIENENCE. `~ ~~~ 132eW MONITORING SYSTI•;m CE.~TITICATION For Use By All Jrvfsdfctlom Wlrhln the Store of Cel/fornla Authority C'ited.• Chapter 6.7, Xealth and Safety Code; Chapter J6, Dlvlslon .~ Tlt a 23, Callforrrla Code ojRegulations This form trust be treed to docutent testing and servicing of moisitoting equipment. ®~g~te ee~catton er t~eoort mggs he re~a Ior ach m tD~,yr +'~ ~~ystem con J Qanel by die technician wtw performs the work A copy of this farm moat be provides ro the tank systevt owner/opcatior. The owner/operator must sutnnit a copy of this fWm to the focal agency regulating UST systems withLr 30 days of test date. A. General Inlbraratlon . Facility Natne: ~~ w) t ~/1 ~'1 Bldg. No.: Site Addtess:1E~ 1 S . Vy/G"V ~t City. ~~lEC.~ ZrF: ~~ Facility Contact Parson: Contact Phone No.: (_____~ IVlalcelModel of M:c-nitoring System: ,~1(., C ~ ~~ (, Date of TestinglSetvicing. ~l~l___(e B. Inventory ~o~f Equlpwent Tested/CertiPted (`hrek the •nnramtisim hoses to tndreate snecinc eaulement insoeeted/servtced: Tank IA: ~~V lr~~ _ - Tank ID: §~ In•Tank Gaugin@ Probe. ^ Model: _ ~ J~ In-Tank dauging Probe. Model: ~ Annular Space or Vault Sensor. Modc1: O Annular Space or Vault Sensor. Model: Piping Sump / Trr:neh Sensotis). _ Model: ~ ~( Piping Sump /Trench Sensor(s). Model: ~i Q Fill Sump Sensat;s). Modci: (] Fill Sump Sensor(s). Model: Mcchanicall-inel.ealtDetector. ~ Mode1:~J1 t~+N~+`•Z~ ~.MechsaicalLlneLeakDetector. Model:~,,~i~~°' Electronic Line I.rolt Detector. Model: ^ Eledronfc Line Leak Detector. Model: O Tank Overfill / F~igh-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Others i et U' meet and model in Section B on P e 2 , ^ Other cl u' mart and model in Section E on Pa e 2 . Tank ID: ) ~,~~ Tank iD: _ ~} In-Tank Gauging, Probe. Model: /~1/ y O In-Tenlc Osuging Probe. Model: fQ, Annular Space or Vault Seasor. ModeL• _ _- ^ Annular Space or Vault Sensor. Model: ~rl Piping Sump /Trench Sensor(s). Model: O Piping Sump/ Trench Senaot{s~ Model: Q Pill Sump Senso.i's). Model: O Fill Sump 3cnsor{s). Model; ® Mechanical Llne }:ealt Detecror. Model: ~~.~J~ O Mechanical Line Lock DCtectnr. Model: ^ Electronic Line I.~lt Detector. Model: ^ Electronic Line Leak Detector. Modc1: Q Tank Ove~ll / Ffigh-Levt:l Sensor. Model: ~ O Tank QYCrtill /High-Lever Sensor. Model: Q Other s eci aryl mart and model in Sectio E on P c 2 . O Other eci u' meet end model in Serxion E on P e 2 . Dispenser iD: ,~_ ' Dispenser iD: ~ ' `f _ Dispenser Containment Scissor(s). _ Modet: ND L ~~. 1>~Dispenser Containment Sensor(s). Model; s 4 ~ ~~U~ Shear Valve(s). $t Shear Vahrt(s). ... Q Dis user Conran rat Ploe s and Chains . C] Dls eraser Corrtainmeist F! sand Chaff s Dispenser ID: ^~"- Dispenser ID: ~[ Dispenser Containment Sensor(s). Model: _ ~~ ^ Dispenser Conminmrnt Sensor(s). Model: j8 Shear Valve(s). D Shear Valve(s). Q Di. set Containment Floats and Chains . ~ O I?i isser Containment Floe s and Chains . Dispenser ID: _ _~.` Diupenser ID: ^ Dispenser Containment Sensor(s). Model:. ^ Dispenser Containment Sensor(s). Model: ^ Shear Valve(s), ^ Shear Valve(s). qD[s set Containment Flo sand Chains . ^ Di eraser Cemtainmeat Floats and Chains . *ir the txciUty contains more tmrks or dispensers, copy this form. Include Intbmtation forevety tank and dispenser at the facility. C. CertifiCatt~~n -1 certify twat the equipment Identified ie this document was iespected/urvk:ed In accordaaee with the manufachtrers' gufdedaea. Attached M this Certifcation 1' Information (e.l;. maaufachtrers' ehocklIsrte) necexaary to verify that thL lnformatlon ix correct and ^ Plot Plaa showing the layo4t of monitoring a uipment. For any egni meet capable of g~ragag each reports, ]have area attached o eopp of the repo t check all that ap !v): ~ System set-up m lhisto 'ieport Technician Name (print): ~ ~ G~ Signature: Certification No.: _~[~ _ Qi(~- /~Z5 _ ~_____ ,License. No.: Testing Company ]dame: 1216I'f _~(1i~0•~Jj.~ ~T.?11 ~, Ph/o~ne No.:~ jq~/ }s~~:~-~~i7 Site Address: ~L~~ ,~ . U't~/O?J i/7~,~ ~~j~~'~~f-'1~(,,!/pate of Testing/Serviciag: ~/ 6 /~ Page 1 of 3 Q3/0I Monitoring 3ystt:ln Certifration .. t 3~c~ ~ D. [Zesults of'].'esteng/~ervici~agl Software Version I;astailed: 1 ~•~~} l~.. n. nln-n •A. Pnll..evlnv n6~nwlr.IJef• Yes ^ No" Is the audible alarm o erational9 l4 Yes O No" Is the visual alarm o erationalT Yes D No" Wane all sensors visuall ins cted function teste and confumed o bona!? 1~ Yes ^ No"~ Were all sensors inutalled at lowest paint of secondary containment and positioned so that other equipment will not interfere with their ro er o erasion? ^ Yes ^ No" if alarms are relayed to a remote monitoring station, is ell communications equipment (e.g. modern) ~ N/A. operational? Yes ^ No" For pressurized piping systems, does the turbine automaticafiy shut down if the piping secondary containment ^ N/a. monitoring system detects a leak, feria to operate, or is elecMrally discoaaected? If yes: which sensors initiate positive shut-down9 (Check all rAat apply) ~Sump/Trrnch Sensors; O Dispenser Containment Sensors. Did confirm itive shut-down due to leaks a d sensor failure/disconnection? .Yes' ^ No. Q Yes ^ No" For tank systems that utilize the monitoring system as the primary tank overfill warning device (i•e. no N/,4, mechanical overfill prevention valve is installed), is tf~e overfill warning alarm visible and audible at the tank ft11 int s and o gratin o erl If so, at what rcent of tank ca acs does tht alarm tri eNl ^ Yes* No Was any monitoring equipment replaced? lfyes, identify specific sensors, probes, or outer equipment replaced and list the manufachuer name and model for all re lacement in Section fi below. ^ Yes* No- Was liquid found inside any secondary containment systems designed as dry systems? (Chec~E all that apply} ^ Product ^ Water. If es, describe causes in Section fi below. Yes ^ No" Was monitorin s rem set- reviewed to enswe settin s? Attach set u rts lfa fieable Yes O No" Is ell nsonitorin a ui meat rational er manufacturer's s 'ficationsT * IQ Section E below, describe how and when these defreiencics were or will be corrected. E. Comments:, Page 2 of 3 03/01 F. In-Tank Gauging / SIR Fgaipment: Check this bax if tank gauging is used only for inventory control. ^ Check this bax if no tank gauging or 3IR equipment is installed. This section mti:at be completed if izt-tank gauging egtupmern is used to perform leak detection monitoring. Coro -fete the iolia•wia checklist: ^ Yes ^ No~~ kla9 sll input wiring been inspected for proper entry and termination, ittciuding testing for ground faults? ^ Yes ^ No' Were all tank gauging probes visually inspected far damage and residue barildatp7 ^ Yes ^ No' Was eccauscy of system product level readings tested? ^ Yes ^ No' Was accuracy of system water level readings tested? O Yes ^ No• Were all probes reinstalled properly? Q Yes ^ No• Wrre all items on the equipment manufacttver's maintenance checklist completed? * Iu the Section F[. belaw. describe how god when these defciencies were nr avlll be corrected. G. Line Leak 1?eteetors (LLD): Complete the follc~wiap a:iheckl[st: D Check dais box if LLDs are not installed. Yes ^ Noy For equipment sleet-up or annual equipment certification, wss a leak simulated to verify LLD performance? ^ N/?.: (Check aU thor apply) Simulated leak rate: ~(3 gp.h.; O 0. i g.p.h ; ^ 0.2 gp.h. Yes ^ No" Were all LLDs confirmed operational and accurate within a'egnlatory requirements? Yes ^ Nti+' Was the testing apparattas properly calibrated? Yes ^ No" For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N/A: ^ Xes ^ No" For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? t~ N1/!, ^ Yes ^ No+' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/A. or disconnected? ^ Yes O No" For electroai.c LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions • 4~ N/~. or thus a test? D Yes O No" For electronic LLDs, have ail accessible wiring connections been visually inspected? N/A. Yes ^ No'° Were all items on the equiptent manufacturer's maintenance checklist completed? rn the Section ti, ueiaw, describe haw and when these deficiencies were ar will be corrected. H. Comatents: Page 3 of 3 asror ~~y ---.~._ Manttortog System Certiffeatlou 1~,~~ UST Monitoring S#te P Site Address: ~" 1 ~ • (,'i~ I (,j„~V ~U.1" :::::::~ :::::::::::::::Jar'-4. ::::::::::::::::::::: :: :::: ..................... d :::.....::::.:~:~:::::::::: y. ~ :::::::::: ~ .~~::: :: .............~.. ..........j.. .V~l~~........... _..~.~. Date map was drawn: ,~/,~/~. gtre~ i~,,oas 1f you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring Sys'~em Certification. Qn your site plan, show the general layout of tanks grid piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechan~.cal or electronic Line leak detectors; and in~tank liquid level probes {if used for leak deletion), to the space provided, note the date this Site Plan was prepared. Fage ~ of .,~, aypp 1_ 3~a~-1 ~? `r' x''.13' .L:Zl1T~' ~.~' :~. ~*~~ r. 5643 BRdOKS CT ~S~R3F';~EI,D, GA.9330$ OFk'TC74{fi61)392-8687 & F'A:[ {661)39Z~U6$1 k1P~Iin'~I4'AL• fa?A-K DS'~'SL"'+'~R `~'$~„ W/0~ Fae:i.lit~r Name a V(7 ~~'V~ ~"f/W~- ~ Faa:i.l~.~y ,~da.x~ss ; ~~• ~'ti~o~ ~'~~SF~c,0,~,9 Proc'.fuet L1rte Type {Preas~isxe, Suat.iom, (3raviCy) ~~-S~V~~ PF(:-DQCT LEAK AETF'CT012 TX~F~ TEST TRIP PASS s~:~izaL z~t~$~tt ~3$I,Oih] 8SI OR LfD 7CY.P~~GtI•A~/IL~ 3 ,a,8 sxz~z~L # RF.-0 T.~K~4~ x~o 1 rAZr, ,~_~~ ~ 0 L/D TYBE S PASS ~~~~ saz~x.~.L # _~~ ~o ~ ,~ LID fi3CP}3_ ~ ES A$8 S~ItT.A2. ~ ~ N ~ I AIL ~ b~ L -- L/A '1'7fPTs~ YSS PASS S8RI1~,~', #.~.~_ laT4 FAIL I ::ertify tl~e above tests were eQnducted on this dace according to Red ~:raakei i+urgps field :.est. appaxatus testing pxocedure au limitations. Th~~: Mer_han.~.ca]. Leak Detector Test pass / f_a.il is deterFnined ley using a lo•a flow threshold trip rate o£ 3 galloxi per hour or leas at 10 pBI. I .;~cknawledge that all data collected ie true asxd aorrecC to the beet of rr}~ knowledge . Tec.h:~'~~ G~ s igzk: ture Date: ~~"~ c•• SOFTWARE REVISION LEVEL VERSION 17.02 SOFTWAREtt 346017-100-C CREATED - 99.01,12.18.20 NO SOFTWARE MODULE SYSTEM FEATURES: FERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS SYSTENI SETUP JUN 8. 2006 -3:02 PM SYSTEM UNITS U.S. :,~, SYSTEM LANGUAGE ENGLISH .. SYSTEM DATF/TIME FORMAT MON DD YYYY HH:MM:SS xM V.G. MINI MARKET 6501 S. UNION BAKERSFIELD CA 93307 661-398-6152 SHIFT TIME 1 5:D0 AM SHIFT TIME 2 :DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED TANK PERIODIC WARNINGS DISABLED TANK ANNUAL WARNINGS DISABLED LINE PERIODIC WARNINGS DISABLED LINE ANNUAL WARNINGS DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F >: 60.0 STICK HEIGHT OFFSET DISABLED DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK 1 SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM SYSTEM SECURITY CODE OOD000 ~ 3~0~ --~_ '~ ~~ ... .. -1.~v...~ .. . . .- .. .... -- a . COMMUNICATI.ON3_SETl1P. - T 2:PREMIUM -_---- --- --- PRODUCT CODE 2 THERMAL COEFF :.000070 TANK DIAMETER 96.00 PORT SETTINGS: TAMC pROFILE 1 PT 7014 FULL VOL NONE FOUND ': RS-232 SECURITY FLOAT SIZE: 4.0 IN. 8496 CODE 000000 ~TER 1..IMIT: 3.0 HT 7 L M A RS-232 END OF MESSAGE 90 : IT p ERFILL LI 6312 DISABLED HIGH PRODUCT 95i - - -- - - - -- - - - 6663 ~ IN-TANK SETUP - --- DELIVERY L I M I T 159. 1052 T 1:DIESEL LOW PRODUCT 500 LEAK ALARM LIMIT: 99 PRODUCT CODE THERMAL COEFF : 0 1 00045 SUDDEN LOSS LIMIT: 50 00 0 ~' . TANK DIAMETER 96.00 . TAM{ TILT TANK PROFILE 1 PT ~ MANIFOLDED TANKS FULL VOL : 5013 T4; NONE FLOAT SIZE: 4.0 IN. 8496 LEAK MIN pERIODiC: l0i 701 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 LEAK MIN ANNUAL : lOx 701 MAX OR LABEL VOL: 5010 OVERFILL LIMIT 909: 4509 PERIODIC TEST TYPE HIGH PRODUCT 959c STANDARD 4759 DELIVERY LIMIT l4i ANNUAL TEST FAIL . 751 ALARM D I SABI.ED LOW PRODUCT 500 PERIODIC TEST FAIL LEAK ALARM LIMIT: 99 ALARM DISABLED SUDDEN LOSS LIMIT: 50 TANK TILT 0.00 GROSS TEST FAIL ALARM DISABLED MANIFOLDED TANKS Tit : NONE ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF LEAK MIN PERIODIC: 9X TAM{ TEST NOTIFY: OFF 501 LEAK MIN ANNUAL : 9i TNK TST SIPHON BREAK:OFF • 501 DELIVERY DELAY 3 MIN 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 TeT SIPHON BRSAx;OFF DELIVERY DELAY 3 MIN -----~- t-~~~ T 3:UNLEADED OUTPUT RELAY SETUP - PRODUCT CODE 3 LEpI{ TEST METHOD - - - - - - - THERMAL COEFF :. 000070 _ - - - - - - TANK DIAMETER 96.00 TEST ANNUALLY: ALL TANK R 1:87 TANK PROFILE FULL VOL 20 PTS 12139 JAN WEEK 1 MON START TIME : 2100 AM TYPE STANDARD D 91.2 INCH VOL 11933 TEST RATE :0.20 GAI/HR NORMALLY CLOSE 86.4 INCH VOL 11518 DURATION 2 HOURS 81.6 INCH VOL 76.8 INCH VOL 11030 10452 LIBUID SENSOR ALMS 72.0 INCH VOL 9803 ALL:FUEL ALAS `-- 67.2 I NCH VOL 9100 LEAK TEST REPO~N g T -_ ._.._. __ _. _------- - - - • 62.4 INCH VOL 8393 H NCED R 2:92 57:6 INCH VOL 7637 TYPE: 52.8 INCH VOL 6883 STANDARD LY CLOSED 48.0 INCH VOL 6111 NORMAL 43.2 INCH VOL : 5339 38.4 INCH VOL 33.6 INCH VOL 4575 3825 LIBUID SENSOR ALMS 26.8 INCH VOL 31 D0 ALL:FUEL ALARM 24.0 INCH VOL 2409 f9.2 INCH VOL 1761 R 3:DIESEL 14.4 INCH VOL 1171 TYPE: 9.6 INCH VOL 4 8 I 655 STANDARD NORMALLY CLOSED . NCH VOL 244 LIQUID SENSOR SETUP- - - FLOAT SIZE: 4.0 IN. 8496 L l:B7 ANNULAR OAT) LIOUiD SENSOR ALMS 2:FUEL ALARM WATER WARNING 2.0 TRI-STATE (SINGLE FL CATEGORY ANNULAR SPAGE L L 3:FUEL ALARM HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 12139 OVERFILL LIMIT 90%c L 2;g2-DIESEL ANNULAR ' 10925 TRI-STATE (SINGLE FLOAT) HIGH PRODUCT 95X CATEGORY :ANNULAR SPACE 11532 DELIVERY LIMIT 91S 1202 L 3:DIESEL STP LOW PRODUCT : LEAK ALARM LIM[T: 1000 99 (STP g PLOAT> E ALARM HISTORY REPORT SUDDEN LOSS LIMIT: 50 : CATEGORY TANK TILT 0.00 ----- SYSTEM ALARM -'--- MANIFOLDED TANKS L 4:92 STP LOAT) ( E PAPER OUT MAY 5. 2006 2:02 PM Tit: NONE STP SUMP : CATEGORy PRINTER ERROR 2006 2:02 PM 5 MAy . BATTERY I8 OFF LEAK MIN PERIODIC: 9s: L 5:87 STP JAN 1. 1996 8:00 AM 1202 TR[-STATE (SINGLE FLOAT) CATEGORY :STP SUMP LEAK MIN ANNUAL : gsc 1202 , PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED "~ ~ x * ~ END * * ~ * ~ PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF• TNK TST SIPHON BREAK:OFF DELIVERY DELAY 3 MIN -- .~ ~ao~ --t, ALARM HISTORY REPORT x* x x x END x x x x x ---- IN-TANK ALARM ----- T I:DIESEL SETUP DATA WARNING AUG 4. 1999 9:37 AM LOW PRODUCT ALARM JUN 7, 2006 5:52 PM FEB 17. 2006 3:43 PM ALARM H18TORY REPORT NOV 15. 2005 2:09 PM -- IN-TANK ALARM ----- - INVALID FUEL LEVEL i FEB 18. 2006 3:43 PM ~ T 3:UNLEADED SETUP DATA WARNING DELIVERY NEEDED OCT 12. 2005 10:06 AM JUN 6. 2006 11:14 AM AUG 4. 1999 9:37 AM MAY 30. 2006 12:53 PM MAR 8. 2006 11:03 AM _ OVERFILL ALARM MAY 10, 2006 1:36 PM APR 11: 2006 6:48 PM APR 7. 2006 10:27 AM LOW PRODUCT A LARM DEC 5. 2005 3:25 PM OCT 12. 2005 10:06 AM OCT 4. 2005 6:08 PM HIGH PRODUCT ALARM APR 7, 2006 10:28 AM xxxxx END x x x x x MAR 28, 2006 1:21 AM -AUG 18, 2005 7:59 AM INVALID FUEL LEVEL JAN 11. 2005 11:41 PM JAN 2. 2005 3:42 PM DEC 20. 2004 5:58 PM PROBE OUT APR 6. 2005 11:36 AM ALARM HISTORY REPORT DELIVERY NEEDED FEB 27. 2006 2:48 PM ---- IN-TANK ALARM ----- DEC 5, 2005 1:18 PM OCT 12, 2005 10:06 AM T 2:PREMIUM -- SETUP DATA WARNING AUG 4. 1999 9:37 AM LOW PRODUCT ALARM AFR 5, 2D06 11:37 AM JAN 29. 2006 5:56 PM AEC 27, 2005 12:37 PM INVALID FUEL LEVEL DEC 27. 2005 9:12 PM xxxxxENDxxxxx DEC 23. 2005 8:07 PM DEC 19, 2005 9:40 AM PRONE OUT APR 6, 2005 11:22 AM DELIVERY NEEDED JUN 5. 2006 1D:13 PM MAY 31, 2006 9:13 AM MAY 27. 2006 5:42 PM ALARM HISTORY REPORT ----- SENSOR ALARM ----- ' L 1:87 ANNULAR ANNULAR SPACE FUEL ALARM JUN 8. 2006 1:55 PM FUEL ALARM JUN 1?. 2005 10:41 AM FUEL ALARM JUN 21, 2004 9:14 AM xxxxx END x x x x x ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 2:92-DIESEL ANNULAR ANNULAR SPACE FUEL ALARM JUN 8. 2006 1:56 PM FUEL ALARM JUN 17, 2005 10:42 AM FUEL ALARM JUN 21, 2004 9:17 AM x x x x x END x x x x x LOW TEMP WARNING APR 6. 2005 11:32 AM 3 ~O ~ ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 3:DiESEL-STP STP SUMP FUEL ALARM JUN 8. 2006 1:56 PM FUEL ALARM JUN 17. 2005 10:39 AM FUEL ALARM JUN 21. 2004 9:02 AM x ~ ~ * * END * x ~ ~ ~ ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 4:92 STP STP SUMP FUEL ALARM JUN. B. 2006 1:54 PM FUEL ALARM JUN 17. 2005 10:40 AM FUEL ALARM JUN 21. 2004 9:03 AM * ~ * * * END ~ ~ x ~ x ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 5:87 STP STP SUMP FUEL ALARM JUN B. 2006 1:54 PM FUEL ALARM JUN 17. 2005 10:40 AM FUEL ALARM JUN 21. 2004 9:04 AM * * ~ x x END ~ * * x _____ ~ -- - 13a2o I1~iOT~IITOR_CER'~. k'.A:~~E ~. ~f'= NAME• U~~i ~ f'f, ~ ~'" V/i~- ~ _ A~ATE• ~~"~~`~~.Q TH7G FOLLOWING COMPONENTS TE~~TING. Ri~l!AI135: 2~v~ ~A~tURi ~1~ti~ ~A~~.TS )tl`iTA.LLED: NA.1!!IE: TITLE: S.I(aI~ATLTRE: TB~E; ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFXT~IG T)AOF APPROPRIATE PARTX TO HAVE CORRECTIVE ACTF~N TA:KI~1V TO REPAIR TI3l1F; ABOVE LISTED PROBLEMS AND NOTIRYING RICH ENV7RONMANTAL FOR AAT'~' NEEDED RETESTING. THIS ALSO RELEASES RIeH ENVIRONMENTAL OF .~l~f ~.' FINES OR PENAI.TtES OCCiTItING FROM~NON-COMPLIANCE. A 1. ~7PY OT 'Z'IIIS DOCiTMEN7' HAS AI•;EN LEFT' ON-SITE FOR YdUR CCY,MIVIE1kiENCr,. i~ao~( Secontdair~ ~ont,~iatti~o~~tt T~stitig ~~aart Form phis form fs i»rendeclfor rcre by contracrors perforrr~a'r{gp~oi{jF tatcrtng of US'x'sacondpty aor7tatrAv~aAtsysteuhs. Ura tha .•tpw•vpria[e pages u1'this form to report results far dl cotnpanenta tested Tfte com,Flet~t, firm, wr#1rn ter~prgcsdw~e~ and p.•;nrouts iron: tests (?}'aPPlleable}, should be provided !Q the f~rc;~itj, rnyl~ea./aper~ator far subtnrttal fa the lneq! regttjatory agency. i. I~.A~L7T,YT'Y .... ,~1V1A.T~ON Facility A]tirtte; VCS s-~1I~r!/ rt/~T Date o~T - ~- U F k'uoilityAddress: ~q-O/ ~, t/ -~a~ __~1 Q ,~ ~~ 9 !i Facility Contact: ~ p~~; . -"' ~ _~ Date Locat Agenc;~ W as Notit'xed a.f Testlt~ : '~""""'""' ~ -~~ Name of Local A t;ney 1t1s~GCtor ~f present a5rring re8t17~-J; ~~ .. -- - z, _TESTTIVG COI'siT~,AeC~'6?,$,~t~I~NI.~.TI.Oi•I Cuntpsn~ Nstna: Ft•TC$ RIdYTRONMEN~AL ~~ ~, Tecluticisn Conducting Test: tLY,g1! r~tif~s~c,J ~ Credentials: ,~ CSLA Liaetzsed Contractor ^ S~tCB I.,icensod TanJc Tester l..icense'Fype. C611D4.0 •~~ Bf -a IaCeasel~iambex: $09850 - Manufacturer ~mriaz~etrt'lsl Date Tcaaa ~ E fires INCON ..-. - - ~ , IiT~ON '~'S-5~'S ' 3. S[T1MIYIARY 4F T~~T fi.F~~JI~TS Cowpomeat _.__ .. Pass .Tnii ~Eax Tes d •B'epaitx Mae Companont p,~ ~~ Aat Repailrs Ivinci vv~ ire ~i~ • dx ~ ^ ^ 0 ^ .A ^ 0 ~.r- ei Fic.y ~c ~$ 0 ^ ^ 0 0 ^ ~~E,~u FiLC- ox ~ !8 ^ 0 ^ ^ ^ ^ 0 _ D ^ 0 Q ^ p Q ^ -- o a ^ 0~ ~ ^ ^ a ^` _. ^ Q ^ t~ o ~ Q a _- n o 0 ^ Q o p a ---- __ r~ ^ ^ ^ ^ ^ A ^ -- ^ Cl ^ D ^ [] [] ^ - -• 0 ^ ^ ^ ~ ^ Q Q ^ . Q O ^ D ~ D [3 Q ^ If hydrostatic besting-MVas pextf~t~ed, descrt'be yvhat was dot3e w3t}a the water after co~tptccioa e~t~ts; _ RECYCLE A~J US CE,RTki; ICATIE4N UP TECHl~I]ICIAN RBSa'iJN>~I~ PO~t CO~TD~JCTD~TG TH~B TES'~',CJ'~iG 7'o the best of,ty lcnunNler~e he facts sfrtted !n t1:ls dgevranetit eraac~trtrare runt 1n,~1ri/i enAtp~ta~ce wlYJt legs! i+egpdr~tn-wtts T'ect>lucian's Siba2ttue:: Date:~~ ~~.,~ ._. sw>zcs, January 7.062 ~ ~o~ -~ Page ~- of _~_ Facility is JRTot Equipped flir>~ ~biU/OVetfil~ Ce~lt&t'nMiCIIf-HDXC;S ^ S lll/Ove7rf li Cotrtt-i~tea# Boxes arc .Present, but mere Not ~estad ^ - Test Method Devrtinped By: ^ Spill Bucket 14~tantufactut~er O iadttstry Standard O Praf~.ainnal Engineer ^ other (Specify) Test iyethod Used: O Ptessui~e ^ Vacuum Ol~ydroeiatic ^ Other (Syecifi~l i Test Egtti Ui~: _ T s~~a >iiot; # ~ ~pf~ Emti ~ 9 r • eAt Rtso~un: S u Btrz # pS L Spill JBox # Bucket Ditunerer: _ 1 " i` 3" ~ i Bucket Depdx: ~ ~ • ~ r ` - Wait time betwee~t applying pressurn/vscuumJ~a~eter a~a • 5 ~5t: _ 3 ~ ~, ~ ~ .~~,~ ~~ 3U ~ ~ v Test Stsrt Titzte: . ~ ~; ~ -- : ~ __ Inttxal Rleadtttg (!Zf l: . Uj ~ Test Bnd Time: _ ~- / -„~ ' / ..-, „~ --- Final Reading (RF): _, '~ / ZJ J __ Test Duration: h, 7J Q ~„r,, J Change in )<teaditW~ (RF.Rt}: -~/ i ~/ ~i Pass/Fail Tbresl~oJ.d or Criteria: _ t/ ~ 'J r~i'EJ ~jv s Test R~esu,{r. ., ~ Pass o FsilE .NG~ ^ Fsii1 Fria D ~Jtl • O pass ~ Fail Cobnxl;e8te - (~ar:ludc,d~arrnation oa reFat~ts made,srior to tarter dnr~reEarmms»dE,_d,~radlm~-r~u~~'lailed tests) 13.0 ~-~~~9 T]ESTI~TG F.~II.U ~.EPORT ~:~~ ~~ a~an~~~ .~t1a~" ~~ STALLED: -~,~y~ ~,~: asap: ,~ :.. - T~iIC AEB~~~NAMED PERSOly AR~~~P'L7LL RESFONSIBII.I`~'X OF 1~i0TI~IING TIiF. APPROPR~TFu PAIFYTY TO HA:yE eO~RRECT~VE ACTIBN TAKEN ~O ItT~PAIR Tail, ABOVE A,ISTk:Y~ PR~llBirEi'I~YS, .AS431-1~t~[3T~FYING R3CH E1rTVIRO~TMA~ITAL FOR APVIt NEEDEA- RETES'lf'~~G. 7CHiS Ai:SO RELEASES RICH E1V~TRO,N~,NTAL OF A2JX I+'INl~S OR PENAL'I'SES OCC7JiiIh?Q FROM 1~i01~1~-COIWIPLIANCE. A (:SPY U~ TI]0[~S DOCUtA~[.~~TT ~A8 SF~:N I.EF7' 4N-SITE 3+'OR XOUR CO1~NF.NCF,. ~tlclc ~,~: If r~l fvl r1.~42T PATE: (~- fl d~1i UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD / LINE TE5TIN0 156989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAK~;RStFIELD FIRE DEPT. ~~Rrr Prevention Services ~I DTI/ f 900 Tntxtun Ave., Ste. 210 Bakersfield, CA 93301 Tcl.: {661) 326-3979 Fa~c: (66I) 852-2171 Pape 1 of 1 . PERMIT NO. /^ ENHANCED LEAK DETECTION - LWE TESTING - ^ SB-G89 SECONDARY CONTAINMENT TESTING 1 1 TAIJI[ 7Yllf7'YCCC TCICT .~~tn OeeCnou e~ lei IYAUfTno.~~n nreT~e~n wTe FACILITY ~ ` t NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS O ~~ ~ Q ~ A f OWNERS NAME OPERATORS NAME PERMIT TO OPERATE N0. NUMBER OF TANKS TO BE TESTED . -. _. ,, . - . . • : .'r .. . TANK TESTING COMPANY NAME OF NG C PAY NAME d PF(ONE NUMBER OF ONTA T PERSON J MAILING ADDR '.- NAME 3 P1~DN NUMBER OF TESTER OR SPECUIL INSPECTOR CERTIFICAT is DATE d. T1ME 7E$._ BE CQ CTED ICC X: TEST METHOD y SIGNAT ~ LICANT ~ ' DATE -i1PPROVED BY DATE .~~ FD 2095 (Rev. 09/05) i ) ------_ --- -- - - /~ao B~RSFIEI,D FIRE DE LING & PERMIT STATEMENT BiL : Prevention Services t<IRS 900 Truxtun Avenue, Suite 210 ARlM T PERMIT NO.: ~ Bakersfield, CA 93301 ;~_ LocAna+aF - PaoaERnr . suaruacDATE. _ _ C~OIIPLETION TE~ ~} ( NME U~' /,l PRQIECTNM~E ~ + ~oonl:SS !_.S cJ0- _ (~ No. PftD.IECT?DDRESS ~ 1 srATE cm aPO~E 3~0 .- .- CGNTW~CTOR NAWE CA LICENSE No. TYPE Of LICEN3E. EJ WRAT1pN DATE ~ PHONE N0. 7 ' ~~ CON'TgACrpR.00AiPANY ~. Fax Na 3q -0 (~~- l • D Alarms -New & Modtficatrons -(Minimum Charge)' $262.50 ~ • 98 p Over 20,OOD Sq. FL Sq. Flt x .013125 = Permit lee . ~ 98 ^ Sprinklers- New 8 Moddlcaflons - (Minimum Charge) $2'!0.00 . 84 98 O Over 5,000 Sq. FL Sq FL x .042 = Permit fee ~ 98 ^ Minor Sprinkler Modifications (< 40 heads) ; 93.00 (inspection Onty] • ~ 98 ^ Commeraal Hoods -New & Modit'rcations $398.26 ~ 98 ^ Additional Hoods a 36.00 ~ 98 ^ Spray t3ooths -New & Modifications $458.00 84 98 ^ d St a Tanks (/nsta®ediaMlnsp.-1"Tirrre) $166.00 82 ^ Additional Tanks S 26 00 82 ^ Aboveground Storage Tanks (Removetlnspedion) $109.00 8? ^ Underground Storage Tanks {InsEaPalionJirr~pectbn) $878.00 (pertank) 82 ^ Underground Storage Tanks (Modification) $878.00 (persite) 82 O Underground Storage Tanks (Metor Modification) $155.00 ~ 8~ ^ Underground Store Tanks Removaq $675.00 (per tank) 84 O Oilvuell (Installation) ~ 84 Mandated Leak Detection (T ) /Fuel Monfi. $ 81.00 {per site) 82 ^ Tents $ 93.00 {perh~rfj 84 D AfterhoursinspectYon fee $!22.00 84 ^ eCJx1iC -(Per evert, Plus Insp. Fee ®590 per hour) s 60.00 + (Sirs. min. stand Syr fee /Inapedlon) _ $510.00 84 D R£~INSPEC770N(SJ /F0110W-UP MSPECTION(SJ ;93.00 (per hour) 84 ^ Portable LPG (Aropane): NO.OF CAGES? ___. $66.00 64 ^ f ~krsh-e Storage $249.00 84 D Copying & Ffie Research (Fite ResearcJT Fee 533.00 per hr) 25~ per page 84 ^ MisceAaneous 84 Fo 2oxr (rtes. oarosl ~ - oRrcrNnr. uvHITE (to rr,.asury) t-reLt.ow (to Ffla) t~?WK (to cuatomar) A UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION i BAKERSFIELD FIRE DEPT. wiR~ Prevention Services ARlM T 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Pie 1 of 1 PERMR NO. l l ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIrHTNFSS TFST TA PFRFARM FI IFI MANITARIN(; CFRTIFIC FO RMATION FACILITY rn~r~~ ~ NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS 50 ~~ I ~ ~ ~~ _ ~ ~~ l OWNERS NAME OPERATORS NAME PERMIT TO OPERATE N0. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED9 ^ YES ^ NO T VOL ME CO TENTS TANK TESTING COMPANY NAME OF TE ING C PAY NAME & PHONE NUMBER OF CONTACT PERSON J MAILING ADDR ~ ~.~ .~ NAME 8 P1iONE NUMBER OF TESTER_OR SPECIAL INSPECTOR CERTIFICATI N #: ~n mo~dv- - ~ ~--___ __._ DATE & TIME TES BE CONDUCTED ~ ICC #: ~ TEST METHOD ~~~ . SIGNATURE OF APPLICAN DATE APPROVED BY DATE ru ~ua5 ~rcev. uaiua~ ~BIL~LING & PERMIT STATEMENT PERMIT NO.: LOCATION OF PRQJE~T - V STARTING DATE COMPLETION ATE ~ . -D to . 00 r-- PROJECT NAME PROJECTADORESS i ~.~ i- i CONTRACTOR NAME ` I~~ I/1 , _~ CONTRACTOR COMPANY NANJ~ , I / _ ~.~~~•~[, ~ ~~ t~'L//t/, CA//1~ [~ I ADDRESS I d ~ ~ ~ ~^l ~ ~ c „ 1 BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 rei . r~~ii one on~n a c~,..-. icc„ orn s~. CA LICENSE NO. ~ TYPE OF LICENSE ~ EXPIRATION DATE `PHONE NO. Z~~DDE 3 ~v PHONE NO.~~~/ ~~ A FAX NO. 3qa ~o (~~ ZIP CODE92 2n ~y • ~ ~ ^ Alarms -New & Modifications - (Minimum Charge)` $262.50 • ~ • 98 Over 20,000 Sq. FL Sq. Ft x .013125 =Permit fee ~ 98 ^ Sprinklers -New & Modfications - (Minimum Charge) $210.00 ~ 98 ^ Over 5,000 Sq. FL Sq. Ft x .042 =Permit fee ~ 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93.00 [Inspection Only) ~ 98 ^ Commercial Hoods -New & Modifications $ 398.26 ~ 98 ^ Additional Hoods $ 36.00 ~ 98 ^ Spray Booths -New & Modifications $458.00 ~ 98 ^ Aboveground Storage Tanks (Installatronllnsp: 1' Time) $165.00 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (Installation./lnspedion) $878.00 (pertank) 82 ^ Underground Storage Tanks (Modification) $878.00 (persite) 82 ^ Underground Storage Tanks (Minor Modfiption) $155.00 82 ^ Underground Storage Tanks (RemovaQ $675.00 (pertank) 84 ^ Oilwell (Installation) ~ 84 Mandated Leak Detection (T sting) /Fuel Monit. $ 81.00 (per site) 82 ^ Tents $ 93.00 (per tent) 84 ^ After hours inspection .fee $122.00 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. min. stand -by fee Mspection) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00- 84 ^ Explosive Storage $249.00 ' 84 ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page ; ~ ^ Miscellaneous : ~ FD 2021 (Rev. 09/05) 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to Flle) 1-PINK (to Customer F/RE ARTM T May 12, 2006 RONALD J. FRAZE FIRE CHIEF Mr. Raushani Narang VG Mini Market Gary Hutton, 6501 S. Union Avenue Senior Deputy Chief Bakersfield, CA 93307 Administration 326-3650 Re: Failure to Perform /Submit Annual Fuel Monitor Certification Deputy Chief Dean Clason ' Operations/Training REMINDER NOTICE 326-3652 Deputy Chief Kirk Blair Dear Mr. Chauhan, Fire Safety/Prevention Services 326-3653 Our records indicate that your fuel monitor certifications is due/past due on 06-16-06. 2101 "H" Street You will be in violation of Section 2638(a) California Code of Regulations, Title Bakersfield, CA 93301 23, Division 3, Chapter 16. OFFICE: (661) 326-3941 FAX: (661) 852-2170 "All monitoring equipment shall be installed, calibrated, operated and maintained in accordance with manufacturers instructions, and certified every 12 months for operability, proper operating condition, RALPH E. HL1EY, DIRECTOR and proper calibration." PREVENTION SERVICES FlRE S,nFErvSERVICES • EMIIRONMENTAL SEmncES Therefore you have 30 days to comply. 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 OFFICE: (661) 326-3979 Should you have any questions, please feel free to contact me at 661- 326-3190. FAX: (661) 852-2171 Sincerely yours, David Weirather Fire Plans Examiner Ralph E. Huey, 326-3706 Director of Preveption Se 'ces h Howard H. Wines, 111 Hazardous Materials Specialist 326-3649 By: Steve Underwood Fire Prevention Clfficer REH/SU/db "Serving tie Community For~l~lore ~IrianA Century" f E R S F I D F/RE A R TM T April 10, 2006 Mr. Raushani Narang V.G. Mini Market 6501 S. Union Avenue Bakersfield, CA 93307 RONALD J. FRAZE REMINDER NOTICE FIRE CHIEF Re: Guidelines for Unsupervised Dispensing Gary Hutton, Senior Deputy Chief Dear Mr. Narang: Administration 326-3650 It has come to our attention that many convenience stores who sell gasoline, like Deputy Chief Dean Clason yourselves, are closing late at night. If you are using card readers and leaving your fuel pumps On, this is defined in the California Fire Code as: "Unsupervised Operations/Training Dispensing." 326-3652 Deputy Chief Kirk Blair Unsupervised dispensing is allowed when the owner or operator provides, and is Fire Safety/Prevention Services accountable for daily Site visits, regular equipment inspection and maintenance, 326-3653 including any unauthorized release or spills, posted instructions for safe operation of dispensing equipment, and posted telephone numbers for the owner or operator. Signs prohibiting smoking, prohibiting dispensing into unapproved 2101 "H" Street containers and requiring vehicle engines to be stopped during fueling shall be Bakersfield, CA 93301 conspicuously posted within site of each dispenser. OFFICE: (661) 326-3941 FAX: (661) 852-2170 In addition, a sign shall be posted in a conspicuous location readin 9~ Incase of spill or release: RALPH E. HUEY, DIRECTOR 1) Use Emergency Pump shut-off PREVENTION SERVICES FlRE SAFETYSERVICES • ENVIRONMENTAL SERVICES 2) Report the accident 900 Truxtun Avenue, Suite 210 3) Fire Department Telephone Bakersfield, CA 93301 4) Facility address OFFICE: (661) 326-3979 FAX: (661) 852-2171 During the hours of operation; stations having unsupervised dispensing shall be David Weirather provided with a fire alarm transmitting device. A telephone not requiring a coin to Fire Plans Examiner operate is acceptable. The fuel leak detection system must have a remote or 326-3706 phone modem to insure off=site monitoring during hours of unsupervised dispensing. During hours of darkness, sufficient lighting must be maintained so Howard H. Wines, III that all signs associated with fueling operation are conspicuous and readable. A Hazardous Materials Specialist gallon container of an absorbent material used for spills must be made available 326-3649 to the public during hours of unsupervised dispensing. Afire extinguisher with a minimum 2A, 26, and 2C rating must be located on dispenser island during hours of unsupervised dispensing: R ~~ To: Mailing List of Valued Customers Reminder Notice Re: Guidance for Unsupervised Dispensing April 10, 2006 Page 2 If you are currently having hours of unsupervised dispensing, you must comply with the above-mentioned requirements. . Starting April 15, 2006, this office will conduct random checks of all fueling stations within the city limits for compliance. If you shut your station down after normal business hours and are not pumping fuel, please disregard this reminder notice. Should you have any questions, please feel free to call meat 661-326-3190. Sincerely, Ralph E. Huey, Director of Prevention Services (' r l-~A.t~(A. By: .Steve Underwood, Fire Prevention Officer REH/db t ,,., ,, . :' ~E~QN~'•~` SYSTEM CERT[FTCATION F'4RM i;` ~;; . DhTE . ~': ~,, ~: FAC1I:!'t`Y ADDRP,95 ~~; `~., ~N; oil AdE. ~~I~1~ ^ ~ G/~ ~ . . , ,., ~-•~:~ > .. ~•.L-i ~.;~.. T~b~e Summa . 7::.., . .~ - <<; ... ~c,:;,: ~ 5i ~ ~; ` `': Su~rsp Z Sump 3 Sort~p 4 ~: ' 1~. , _, fir, • i . f. ~. df Wshr Gf r ~;;` _ !r . k ~. - . . ~: ; '~"~ : l~ (~a~~ ; Bch ~:. k ~ ~~ ~ fit!, ~ V //N ~ r r `~A` ~:. ~mr ,a: ~o ~~o ~ C ~Aat~an /955 ~ . ~;; .: . ) ~~.; . ;17 . ~ ~: ' ~~~ (~,~,~~~p~~"~_ ~n1I1 DYL-R~Ib , . , ~, ... ~. ~~`~ ~~ ~ ~w ~ o~i: ~ . ~v+erlUt Z ~/ Over#~U 3 s L . vv~n a : ~. t,.{.. ~~~~ . gin,,: ~ ~W~ ,~ ;., ~;.. . ~ ~ a ' . ~. !'••S , ~7 _ . y `i'itine 4. ; ~~ , ~CargAcatlaa , .. ~3q~,n} ~ . ,;. -t, ~ . '~ Page 2 of _ itif' . ,~; . . ,, . F ~ . f~ i ~" SECtll~k4A~~ SYSTENt CER'1'IFICA'x'[ON FORM ~. :~~„~ DA $ ~ S . FACD,,IT iD i) . C~ . i(iR~ n - tMar-~ _ '~ ~ ~ ~ FACYI,TTY ADDRESS ~ ~ l~~Q J J 1r4~~~ ` ~~~ ~:.. , .. ~~:' `' ~~ UDC TCS'fiNG x' ~~ ~. ; . . ~~:: ~~; -.. ;~, ..~ ,,. F. ~ r. ~~ •: ,.; -; . ~,• .. 4.: S. ~.Y ,,, :a _; F, r::: ~~ D~$PErQ9~~• ~< :DISPLNBBR 3 DLSP~ER 3 DIS'PENSEK 4 START TDyE ~.~ ~ ~ 1~tGR"I' OP ' WATER /~ f ~'YATER ~~` ~ , . , ~BIGRT ~ ~r t1 ~'::~ . i mar/ , ~.-~+ t~T~c,-~oN '~ ~ ~ 5 ~~A~ .,. ~/ D~~ `~: ~ l~T$P'i~,[~'S`~t ~ . DLSI~NSBR 7 DISPENSER S START TIMB ~ • tN~Ai, ~I(;HT OF • WATER . '1ZME WATFR ~3ffiGRT ~ _ - ~ ~ - -~ 1M~~ii - - ~ . 'WA?SR ~~iGST ~. ~~x ca~urrv~t~ ~ 3 ~ _... r ~ ~-~[ ~~ B E R S F I F/RE ARTM December 1, 2005 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 V.G. Mini Market 6501 S. Union Avenue Bakersfield, CA 93307 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 Those sites that have not been tested and have not pulled a permit prior to December 31, FlRE SAFETY9ERVICE8•ENVIRONMENrALSERVICES 2005, will have their permit to operate revoked. 900 Truxtun Avenue, Suite 210 This office does not wish to take such action, which is why we will continue to send monthly Bakersfield, CA 93301 reminders. OFFICE: (661) 326-3979 FAX: (661) 852-2171 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. David Weirather Fire Plans Examiner Should you have any questions, please feel free to call me at (661) 326-3190. 326-3706 Sincerely, Howard H. Wines, III RALPH E HUEY, Director of Prevention Services Hazardous Materials Specialist __ ~-1 326-3649 Steve Underwood Fire Prevention Officer SU:db UNDERGROUND STORAGE TANKS TO PERFORM ELD /LINE TESTING ~ / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ~C 1 ~ ~O ^ ENHANCED LEAK DETECTION ^ LINE TESTING BAKEI2SFIELD FIRE DEPT. B $ x s a i D Prevention Services ~r~ae AR~'lN T 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ^ TO PERFORM FUEL MONITORING CERTIFICATION SIT_E_INFQRMAT.fON (FACILITY / / ~-(~C~ NAME & PHONE NUMBER OF CONTACT PERSON I DDRESS , ~O~ D '30 WNERS NAME ~ PERATCRS NAME ;PERMIT TO OPERATE NO. UMBER OF TANKS TO BE TESTED ~1 IS PIPING GOING TO BE TESTED? YES ^ Iv0 TANK# VOLUME CONTENTS _ I i I I I I I j ' _ IffE//,,QQF TESTING CO/M~PANY 0 .^o- _ :NAME &/~PHONE NUMB/~ER OF CONTACT PERSON 'I p iC.Y~i i Ni,. o . -/0.n llw a .~1 o A i fd10~ ~.JN.c._ 1 - )I i aVt.~. - IUA~t~DA ~ ~o~o ~ - X. ~ Y'-~ [ 9 1 . o . ~ ~"1 ('fl 3 0~ ?DAME & PHONE NUMBER OF TESTER OR SP IAL IN ECTOR ERTIFICATION #: ~~,~ ,c4~ (~c~ - 39a - ~ o b I a 9 - bSa3Sl3a SATE IME TEST TO BE CONDUCTED CC #: EST METHOD ooh :oaP 5a~ ~G - UT ~ SIGNATURE OF LICANT ~~~~~ Ate` ATE '~_R _O ~ I APPROVED BY ~ /+ ~ iDATE ~ /~ $/~~ FD21U6