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HomeMy WebLinkAboutBUSINESS PLANi~ GASOLINE INC. I . __, ~~~2500 WHIT_E_ LANE _ ___ ____~~ l ,. ;r ;~ - ~ Y ~~~ "a r-... P ,. `~,,: ~~--~~~° ..~~.__. ~~~ ~ ~ ~ ~, Jul... ~° ~ ~ , d ~_. ~'~`, ~~ ,s~. ^" --~; -~~ Prevention Services r<. UNIFIED PROGRAM INSPECTION CHECKLIST' H___ e R S F 1 D 9ooTruxtun Ave., suite 2l0 ~- ~_ - _ _ _ __~ z~-. ~:~.~ _ ~~~ ~~ FIRE ~ Bakersfield, CA 93301 r rl'1~; ~RrM r Tel.: _ (661) 326-3979 SECTION 1: Business Plan and Inventory Prog a ~ Fax: (661) 872-2171 FACILITY NAME //~~ ~' ~ GLG ~ ~ G INSPECTION DATE ~ g 6 INSPEC110N TIME .fi 1 /L d K? 1 -~ O C- , t7 t ADDRESS ( ~ G / 2 ~©~ W ~ C. [.~ PHONE NO. NO OF EMPLOYEES FACILITY CONTACT BUSINESS ID NUMBER ~ ~~ , 15-021- / I%/ Section 'I. Business Plan and Inventory Program ^ ROUTINE ~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=compliance OPERATION V=Violation COMMENTS ^ ~ APPROPRIATE PERMIT ON HAND /d ~crw~ ~ "Fp Q' P('Ot~< p,~ ~~~~ ^ BUSIYIeSS PLAN CONTACT INFORMATION ACCURATE I~ae~~\h ~ `~a -6~'z ~°-~'}° ~ ^ VISIBLE ADDRESS ( 'E~ ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ~ ^ VERIFICATION OF QUANTITIES ENT'D 1 ~1 O V 1 ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL s t / ^ ^ VERIFICATION OF MSDS AVAILABILITY /~ '~' ~~-°~ VERIFICATION OF HAZ MAT TRAINING N ~ Na ,S~-f+6 0 ~ S t. ~-~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING C~ ~ ^ FIRE PROTECTION X, ~ ^ SITE DIAGRAM ADEQUATE 8 ON HAND 1 ANY HAZARDOUS WASTE ON SI.TE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? P wsE CALL us Ar (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # siness Site Responsible Party (Please Print) White -Prevention Services ^ YES ~ NO ~', V_ Yellow - S[ation Copy Pink-Business Copy FD 2155 (Rev. 09/05 {~~~ - ~~ ~ ~::~ INSPECTIONS B D E R S F I L D BUSINESS PLAN & ,iRrM r INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ~R_n~o~D ~~"Amtus ~aow~ LLC. INSPECTION DATE:1~ 06 Section 2: Underground Storage Tanks Program ^ Routine C~ Combined ^ Joint Agency ^ Multi-Agency 3C mplaint ^ Re-Inspection Type of Tank '~ ~ Sro ~ I Number of Tanks Type of Monitoring~7~~j_,. {2r,~ Type of Piping 'D OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility N ~~ ~~ Monitoring record adequate and current b Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes ^ `lo Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No G~~ ~~ ~, Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services Aggregate Capacity Number of Tanks `~ .~_ Bu i ss Site Responsible Party Pink -Business Copy KeFaa3s FD 2156 (Rev. 09105) .. Vj .Cl~ ~~. C '~S! r~ALU-i,h~, '~50U 6~JH I TE LAI'dE Br=aKE~~FIELD i'h 93304 tds~rJ U, '_' U U r i 9: 1 1 F-9t`9 S'`,',~T'Et`9 ~TA T'L~S ><:EI~ ukT T '~' : L!EL I I~ER`t' h~JEEDEL! I hJVEfVTs?R`.' RE F~:.~RT <. T 1 ~UNLEAL'~EU ~~ FG ULLriGE = 6U?1 GALS 9U`,a ULLAC;E= 4t~G8 ' GALS TC Vs~LUI°lE = 5888 HL HEIGHT = 65,38 IPJC'HES WtiTEk tl%~L = l7 i3ALS Wr~TER = 0.00 II'J~'HES T' '? : F'REP'1 I Uf°1 IT-~LUP~IE = 143? GAL: ULLAGE = 66~G i~ALt 9CJ%8 ULLAGE= 5814 GF1LS Tt' 'vs~LUP'lE = 1418 GALE HEIGHT = 30.8? INCHES WATER 'Jt"1L. = 0 GALS lhIATER = U . UO I NCHES TEMF' _ ?9.0 UEG F T Ci:DIESEL tiULUJ°lE _ ~aJSa~ GALS IJLLAi;E = 1484 GALS 9U%b ULLAGE= 480 iiALS TC V~JLUf^9E = 350? iaALS HEIGHT = 8? . 51 I NC'HES WATER Vs~L = u UALt3 UJATER = U . Ui~ I fVCHES TEI°1F' = 87.3 DEG F x * * F.PJD x ~ x ,~ ..;: , + ARNOLD/JAMES GROUP LLC ______________________________ SiteID: 015-021-001954 + Manager OLEN-~d6i-D i~~e ~~N ~~~ ~ BusPhone: (661) 634-9293 Location: 2500 WHITE LN Map 123 CommHaz Moderate City BAKERSFIELD Grid: 13C FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title ALBERT GONZALES / ASST MANAGER ARNOLD ~'sArolyN / PRESIDENT Business Phone: (661) 634-9293x Business Phone: (661) 634-9293x 24-Hour Phone (661) 205-3890x 24-Hour Phone (661) 871-9242x Pager Phone, ( ) - x Pager Phone ( ) - x Hazmat Hazards,: Fire ImmHlth DelHlth 6~-N--(V---------_ ---------- ----------------------------------------- Contact 8~E-i~i-ARNOLD Phone: (661) 634-9293x MailAddr : 53 01 ~~£'f1~N' Ai3E` ~ ~` ~ Pw ~~- ~ f -~'~ ~ State • CA City BAKERSFIELD Zip 9330~~' Owner VALU GAS INC Phone: (661) 634-9293x Address - '~R~i; P-2s'a8 W~~'~ ~''~'~'~ State: CA City BAKERSFIELD~.~acr ~ .,. .z Ir' ~ ~; ~ Zip 9330~-- _ , _ __ , ~ Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and betlev information is true, accurate, and com ete. Date FNT~ ~~ N p 9 boo 6 5 ~~~ -1- 04/04/2006 IUNIFiED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME ADDRESS ____ as o0 ~n.~, FACILITYCONTACT PHONE No. No. of Employees a ~~ c~3~1-YZ~3 _t~"ycN~~ Business ID Number 15-021- Section 1: Business Plan and Inventory Program ^ Routine Combined ^ Joint Agency ^MultI-Agency ^ Complaint ^ Re-inspection C V \V=Voatiolnnce~ OPERATION COMMENTS L7 ^ PIPPROPRIATE PERMIT ON HAND tf ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE - ------ ------------------------- I~' ^ ~/ISIBLE ADDRESS ^ CORRECT OCCUPANCY I ld ^ VERIFICATION OF INVENTORY MATERIALS ~^ VERIFICATION OF QUANTITIES C~ ^ VERIFICATION OF LOCATION J L7 ^ PROPER SEGREGATION OF MATERIAL L"J ^ VERIFICATION OF MSDS AVAILABILITYE LI' ^ VERIFICATION OF FIAT MAT TRAINING ~''~O VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ ,EMERGENCY PROCEDURES ADEQUATE ~^ CONTAINERS PROPERLY LABELED I' ^ HOUSEKEEPING ® FIRE PROTECTION ~~^ SITE DIAGRAM ADEQUATE Sc ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES ^ NO EXPLAIN: QUESTION EGARDING THIS INSPECTION? PLEASE CALL US AT ~C6'I~ 326-3979 -- -- \--Inspector - - - --------Badge No., ----- White -Environmental Services Yellow - Stetgn Copy ----------1~~--- -~~- -'I'-------- '`- - Business Site Responsible Party Pink -Business Copy ,_ ~~ ;- -•, ~. ARNOLD/JAMES GROUP LLC Manager TERRI ARNOLD Location: 2500 WHITE LN City BAKERSFIELD BusPhone: Map 123 Grid: 13C CommCode: BFD STA 07 EPA Numb: SIC Code: DunnBrad: SiteID: 015-021-001954 (661) 634-9293 CommHaz Moderate FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title ALBERT GONZALES / ASST MANAGER TERRI ARNOLD / PRESIDENT Business Phone: (661) 634-9293x Business Phone: (661) 634-9293x 24-Hour Phone (661) 205-3890x 24-Hour Phone (661) 871-9242x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact TERRI ARNOLD Phone: (661) 634-9293x MailAddr: 5301 OFFICE PARK DR 420 State: CA City BAKERSFIELD Zip 93309 Owner VALU GAS INC Phone: (661) 634-9293x , Address 2508 WHITE LN State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST l id ~"~!~ ~ ~ ~ ~ ~~~ s ua in uir of those indiv Based on my q Y btaining the informatio ~ f Y ~ or o responsible rsonall under penalty of law that I have p Y examined and am familiar with the information submitted and b ve the information is true, accurate, and .,ompl ,te. ~~ Signature Date -1- 01/25/2007 ~. P ARNOLD/JAMES GROUP LLC SiteID: 015-021-001954 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: ARNOLD/JAMES GROUP LLC Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper AARON KOOP ICC Nbr: 5246167-UC PROPERTY OWNER INFORMATION Name TERRI ARNOLD Phone: (661) 634-9293x Address: City Type CORPORATION Name TERRI ARNOLD Address: City Type CORPORATION BOE UST Fee# UNKNOWN Financ'1 Resp: STATE FUND Legal Notif Date:02/25/2002 Name:TERRI ARNOLD State UST # State: Zip: TANK OWNER INFORMATION Phone: (661) 634-9293x State: Zip: Phone: (113) 3 - x Ttl:PRESIDENT 1998 Upg Cert#: 00873 -2- 01/25/2007 F ARNOLD/JAMES GROUP LLC SiteID: 015-021-001954 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP REGULAR UNLEADED GASOLINE F DH L 12000.00 GAL Mt~d PREMIUM UNLEADED GASOLINE F IH DH L 8000.00 GAL Mod DIESEL L 5000.00 GAL Lt~w -.3- Ol/25f2b07 -4- 01/25/2007 F ARNOLD/JAMES GROUP LLC ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME REGULAR UNLEADED GASOLINE Location within this Facility Unit TRIPLE COMPARTMENT TANK SiteID: 015-021-001954 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 25000.00 GAL. 12000.00 GAL 12000.00 GAL t1AGHKLVUS ~:V1~1rV1V~1V1J %Wt. RS CAS# 100.00 Gasoline No 800619 t1E~GHtcL A~a~a~l~l~ly 15 TSecret RS BioHaz RadioactivejAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED GASOLINE Location within this Facility Unit TRIPLE COMPARTMENT TANK STATE TYPE PRESSURE Liquid Mixtur~mbient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 25000.00 GAL 8000.00 GAL 8000.00 GAL tltiGtitcLVU7 ~.V1~1rv1v~1v1.7 oWt. RS CAS# 100.00 Gasoline No 800619 riHGtitCL 1-1. 75~J~71~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- Ol/25/2f~07 ~~ s F ARNOLD/JAMES GROUP LLC SiteID: 015-021-001954 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME DIESEL Days On Site 365 Location within this Facility Unit Map: Grid: TRIPLE COMPARTMENT TANK CAS# STATE T TYPE PRESSURE TEMPERATURE ~~~ CONTAINER TYPE Liquid I Mixtur~Ambient ~ Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION - --- Largest Container Daily Maximum Daily Average 25000.00 GAL 5000.00 GAL 5000.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Fuel Oil No. 1 No 70892103 riE~GEitt1J E~a ~~JJ1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Lotiv -6- 01/25/2007 F ARNOLD/JAMES GROUP LLC SiteID: 015-021-001954 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 09/25/2006 ~ BAKERSFIELD FIRE DEPT. Employee Notif./Evacuation 09/25/2006 SIGNS POSTED INSTRUCTING CUSTOMERS OF EMERGENCY PROCEDURES. A TURN-OFF EMERGENCY SHUT-OFF SWITCH. CALL 911 AND ADVISE EMERGENCY PERSONNEL OF SITUATION. Public Notif./Evacuation Emergency Medical Plan 09/07/1999 LOCAL URGENT CARE AND MEDICAL FACILITIES. -7- 01/25/2007 F ARNOLD/JAMES GROUP LLC SiteID: 015-021-001954 ~ Fast Format ~ ~ Mitigation/PreyentjAbatemt Overall Site ~ ~ Release Prevention 09/25/200 ~ EACH FILL PIPE IS FITTED WITH AN OVERFILL CONTAINMENT DEVICE. EACH DISPENSER IS FITTED WITH A COMBINATION THERMAL/SHEAR VALVE SHUT-OFF FUEL IN CASE OF IMPACT OR FIRE. THERE IS AN EMERGENCY SHUT-OFF ON BLDG WHICH SHUTS OFF ALL FUEL PUMPS AND TURNS OFF POWER TO DISPENSERS. EACH GASOLINE AND DIESEL HOSE BREAKAWAY DEVICES WHICH CONTAIN THE FUEL IN THE EVENT OF A DRIVE-OFF. ALL LINES AND TANKS ARE MONITORED 24-HOURS-A-DAY BY AN ELECTRONIC SENSOR AND INVENTORY CONTROL IS MONITORED BY SONITROL 24-HOURS-PER-DAY. Release Containment LOCATION CHECKED SEVERAL TIMES A DAY. 04/04/200 Clean Up 09j07/1999 SMALL SPILLS WILL BE ABSORBED AND DISPOSED. LARGE SPILLS WILL REQUIRE A LOAD OF SAND FOR CONTAINMENT AND ABSORBTION. V1.11C 1. i[.CSVUL CLC .`i~: l.lVdl.1(J11 -8- 01/25/2007 F ARNOLD/JAMES GROUP LLC SiteID: 015-021-001954 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ Special riazaras Utility Shut-Offs 11/13/2006 A) GAS - NONE B) ELECTRICAL - REAR OF BLDG C) WATER - HUGHES LN SOFT OFF WHITE LN D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - CRNR HUGHES LN & WHITE LN ON PROP. 11/13/2006 Building Occupancy Level 04/04/2006 UNMANNED SITE -9- 01/25/2007 1~ 1~ l^ ~ ~. F ARNOLD/JAMES GROUP LLC SiteID: 015-021-001954 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 09/25/2005 ~ BRIEF SUMMARY OF TRAINING PROGRAM: WHEN ON-SITE, PERSON IS INSTRUCTED TO TURN OFF EMERGENCY SHUT-OFF AND DIAL 911 AND GIVE DETAILS OF EMERGENCY. ray e ~ nciu ivi ru~.utc vac Held for Future Use -10- O1/25/~007 1 ~(~"-O MONITORING SYSTEM CERTIFICATION For Use 13y ~I11 Jurisdictions Within the State of California Authority Cite& Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code o,JRegulations This farm must be used to doctunent testing and servicing of monitoring equipment. A separate certification or report must be prepare for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date, A. General Information Facility Namc: y its-1-i- L~~ Bldg. No.: Site Address: a~A t...ata'L-t~_L.'tJ • City: r£C~~ r fl Zip: Facility Contact Person: __ Contact Phone No.: L~ Make/Model of Monitoring System: ,~ ~~ ~~_,_ Date of Testing/Servicing: ,Ll~/~,p B. Inventory of Equipment Tested/Certified .t7~ c~- ,,. ~_` !--1~~c C`herk the annrnnnarr hnxec rn indicate specific eauinment insnected/serviced: 1\I-1tC~1~~7-Z~ On ~ \ \~ • )r'~~ Tank 1D: CZC C~~ ^t- Tank [D: Ct~ a, - .,. '~-Tn-Tarilc Gauging Probe. Model: m ~ ~ }~-ln•Tank Gauging Probe. Model: ~~ ~=Atutulaz Space or Vault Sensor. Model: ~ l 4,Qt~'C- `~Arurulaz Space or Vault Sonsor. Model: ~~51 ~Q•~•3`r'~ 'Piping Sump /"['tench Sensor(s). Model: ~ ®$- 'Piping Sump /Trench Sensor(s). Model' ~PD r' ^ F i ll Sump Sensor(s). Model: ^ Fil] Sump Sensor(s). Model: ,~ ` ' >~NICCha711 L'al i_ine Leak Detector. Model: ~~C1L~T ~4echanical Line Leak Detector, Model: ~i'~.'S~CI~ _ [] Electronic Lina Lank Detector. Model:. ^ Electronic Line Leak Detector. Model ^ Tank Overfill !High-Level Sensor. Model: ^ Tank Overfll /High-Level Sensor. Model: ^ Others ci a ui ment c and mode] in Section B on Pa e 2 . ^ Other (s eci a ui ment and model in Section E on Pa a 2). Tank ID: ~ ~~~~_ Tank ID: • `~3-In-Tank Gauging Probe. Model: ~ A ~ _ ^ In-Tank Gauging Probe. Model: -)~--Annular Space or Vault Sensor. Model: y a(~( ^ Annular Space or Vault Sensor. Model: ~-Piping Stunp! Trench Sensors}. Model: o~t,~~~ ^ Piping Sump I Trench Sensor(s). Model. Cl Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model: ~ ~~= ~-Mechanical Linc Leak Detector. Model: ! ~-vs~s`'4!c--r ^ Mechanical Line Leak Detector. Model: ^ Electronic Lute teak Detector. Model: ^ Electronic Line Leak Detector. Model: O 'tank Overfill /High-Level Sensor. Model: ^ Tank Ove~ll /High-Level Sonsor. Model: ^ OiJrer (specify equipment type and rnodel in Section E on Page 2). ^ Ottrer (specify equiprent type and model in Section E on Page 2). Dispenser 1D: (~~ l Dispenser ID: _~~1}~ _ '"Dispenser Contairunent Sensor(s). Model: c~~" Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). O Dis enser Containment Floats and Chains . ^Dis enscr Containment Floats and Chains . Dispenser ID: ~' a Cp ' Di penser ID: ~ ~~' ~ ~ Dispenser Contairunent Sensor(s). Model: ~~- P~ h ispenser Containment Sensor(s). Model: a® eaz Valve(s). S ~. Shear Valve{s}. ^ Dispenser Containment Float(s) and Chaut(s). ^Dis enser Containment Floats and Chains . Dispenser ID: Dispenser ID: ^ Dispenser Containment Sensor(s). Model: ^ Dispenser Containment Sensor(s). Model: ^ Shur Valve(s). ^ Shear Valve(s). ^Dispenser Cattaimnent Float(s) and Chain(s). ^Dis enscr Containment Floats and Chains . *If the facility contauts more tanks or dispensers, copy this form. Include utformation for every tank and dispenser at the facility. C ~Certif CiitlCln - I certify that the equipment identltIed In this document was Inspected/serviced [n accordance with the manufacturers' guldefiues. Attached to this Certification is information (e.g, manufacturers' checklists) necessary to verify that this information is correct and a Plot Plau showing the layout of mouitoring equipment. For any equi went capable of generating such reports, I have also attached a copy of the report; (check all that apply): ~-System set-up lar story report Technician N,3rrte (print): ~'7'~11~~ tr~~t~~ Signature: Certification No,: A'aQ~ ~~ ~a.~ (aC,((p t,C"(•' License. No.: '1'estu~g Company Namc: RICH ENVIRONMENTAL Phone No.: { X61 ~ 392-8687 Site Address: ~~?'x~ l,~Ef~f~ (~.)~ ~(~ QS,~~ ~} , pate of Testin Servicin Page I of 3 03191 Monitoring System Certification l `~ ga G1 ------__ D. Results of Testing/Servicing Software Version Installed: ~.._~,_....~._ ~..~~_...:......~..._r.~:~.. ~- Yes ^ o Is the audible alarrn o erational? -Yes ^ o Is the visual alarm o erational? 'Yes ^ o Were all sensors visually ins ected, functional] tested, and confin-ned o erational? Yes ^ o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their pro er o erasion? ^ Yes ^ o If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem} ~- NIA operational? yes ^ o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ^ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check al! that apply) ~Sutnp/Trench Sensors; '~-Dispenser Containment Sensors. Did ou confirm ositive shut-down due to leaks and sensor failure/disconnection? ~'es; ^ No. ^ Yes ^ ~ For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no '~N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating roperly? If so, ac what percent of tank capacity does the alarm trigger? ^ es ~-No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. ^ es ~. No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ^ Product ^ Water. If es describe causes in Section E below. '~ Yes ^ o Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u re orts, if a licable ^ Yes ~- o Is all monitoring equipment operational per tnanufacturer's specifications? In Section r. Uelow, descrtne now anq when t4ese ueucteneres were or wtu Ue corrected. L. Comments: ['t'l • l~L~ ~Z ~-Sr.~~~._ ~ C2~.~1 ~~ F~'S~ 2iX.tiu ~_~ i A lCz. t.I ~ CA 2'~ ©F T1;i.S, Page 2 of 3 03101 ~ ~ ~s a ~/ --___~_ r. In-Tank Gauging /SIR Equipment: `~-Check this box if tank gauging is used only for inventory control. ^ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. lam,. ~. .. L.a.. •L. ,. f..ll.... ~:.. ....M....L I:..a. ^ Yes ^ '° Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ^ Yes ^ o Were all tank gauging probes visually inspected for damage and residue buildup? O Yes O o Was accuracy of system product level readings tested? ^ Yes O ° Was accuracy of system water level readings tested? ^ Yes O o Were al] probes reinstalled properly? O Yes ^ o Were al] items on the equipment manufacturer's maintenance checklist completed? !n the Secpon ri, below, uescnbe now ana when tnese aenclencres were or wu~ oe correctea. G. Line Leak Detectors (LLD): ("r~.n nlaru r6n rnllnwina r6 ar41i~t. O Check this box if LLDs are not installed. Yes ^ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ^ N/A (Check al! that apply) Simulated ]eak rate: '~3 g,p,h., ^ 0. I g.p.h , 0 0.2 g.p.h. C1 Yes o Were all LLDs confirmed operational and accurate within regulatory requirements? '=Yes ^ o Was the testing apparatus properly calibrated? Yes 0 o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N/A ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ~~N/A ^ Yes O ° For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ~--N/A or disconnected? ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions `~--N/A or fails a test? ^ Yes 0 o For electronic LLDs, have all accessible wiring connections been visually inspected? ~-- N/A ~d--Yes O o Were all items on the equipment manufacturer's maintenance checklist completed? ,,, ,,,~ mac.:-,~„ n, urr,uw, uesenoe uuw anu wnen tnese aenclencres were or wnl ue corrected. H. Comments: ~~~L~~ t~• tr,1,p. ~'R~~D CZOt.~ wIRCE, ~~I~~C.uM T-S i~ t L%.ti a U CA{-2.r. ~r ?Z-I~S •-- Page 3 of 3 03101 -- --- - -- -- - ~~-tg"Oy LG 163-1, Enc. II Monitoring System Certiflcafion Form: Addendum for Vacuum/Pressure Interstitial Sensors I. Results of Vacaum(Pressttre IVlonitoring 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 to the tank system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Model: System Type: Pressure; [Vacuum Manufacturer: Sensor 1D Component(s) Monitored by this Sensor: Sensor Ftiuictioaality Tcst Result: ^ Pass; ^ Fail Interstitial Communication Test Result: ^ Pass; ^ Fai] Comporent(s) Monitored by this Sencor:~ ' Sensor Plmctionality Test Result: ^ Pass; ~ ^ Fail Interstitial Cpmmyn;patlon Teat Result: ^ Pass; ^ Fail Component(s).Monitored by this Sensor: 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 COmmnniratlDn TestRcsulTr [j Pass; [] Fail _ 'Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ^, Pass; ^ Fail Interstidsl Communication Test Result: [] Pass; ^ Fail Component(s) Monitored by this.Seiuor: ' SensorFunctionslityIest Result. ^ Pass; ^ Fait Interstitial Communication Test Result: ^ Pass; ^ Fait Component(s) Monitored by this Sensor: Sensnr Functionality Test Result: ^ Pass; ^ Fail Interstitial Communication Test ResulC ^ Pass; ^ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; ^ Fail .Interstitial Co *+~~tnir~tion'Test Result: ^ Pass; ^ Fai] Component(s) Monitored by this Sensor: 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 Comtututication Test Result: ^ Pass; ^ Fait $ow was interstitial communication verified? .^ Leak Introduced at Far End of Interstitial Space;' ^ Gauge; ^ Visual ection; .^ Other (Describe lnSec. J, below) Vacuum was restored to operatlnP levels in all interst3tfal spaces: ^ Yes ^ No (~J'rro, describe to Sec. J, below) J. Comments: tlJ ~~ ~ ~~ '7"{-}-~~~. ~_..~~25~~ ~"t'C ~~. Pape of r• If the sensor succcssfuIly detects a simulated. vacuumipressure leak introduced in tha interstitial space et the fiuthest point firom the sensor, vacuum/pressure has been demonstrated to be communica:ing throughout the interstice. ~~o y Monitoring System Certification UST Monitor><n Site :Plan Site Address: ~~P~D t-~ HZ~'~ L1J t~AtiC~ 2~~_e.O,.,..CA -------------------------------------- - ---------- ---- F v S® ~ V ~S~ F• '~ --- - ----------- Aso; ~~~ _~~ ~~_ -® --~~ _._ --------------------------------------------------- - --------------------------------------------------- - --------------t - ~----------------- - ~-------- - --------------------------------------------------- - --------------------------------------------------- - --------------------------------------------------- - --------------------------------------------------- - --------------------------------------------------- - ----- --------------------------------------- - -I~-~'------- -_-_-----_-------------------------------- - ~}~gr~Srsucsa2.--- - -- ------------------ -_ FS_------- - 5~ V~('_ --------------------------------------- - ~.:t4AC~~f2fJ~..- --------------------------------------- - ~ag~,~sofz-- --------------------------------------- - Date map was drawn: ( ~ / l y /Q~(.v Instructions If you already leave a diagram that shows all required information, you may include it, rather than this page, with your Monitoruig System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of tl~e following equipment, if installed: 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 in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page of osioo ~~~a ~ ~:--___ ,~..~.. 56~k3 BR.QO~S ~'~' ~FCERSFX~T,A,C.A.933C38 aFFxc~(ss1}392-BG87 ~ F`,A~C (6fi1)3~2~0627. T1~TFi<S`Tt~it .a ~t4~a~I'y~F,+.T W/0~: Fac:I.~a..~y Nam~:~~L .~-C f Fac:E.~.ity Address:~~'~_l~~'r~~• ~~S`~-~+~, b~~~~_ ; PZ'Qf~(LICC ~.1..~~ `~'~pC ( rb3R6Lix'P..r ~iLtCriQXla a7C'h,V~f-']r~ PRC>DVC7l' LE.i`~ I].r TEC~'OkZ TkP~ T TEST 'TR.~P PASS s~~z~.z, zttraaa~~ SEI.~OW F1~S2 OR L/~ xY~~ ~D~'AG~~T X&s PAS ~~ S&P,z.AT. # 1'~1~{aAN'~CF~_ ~0 t ~ FAZL, L/D TYFk: ~~~~AC~CE-T ~S k'AS 1 S~zti.A.L #.~ ~HAeJ~I.._. z50 ~~ FATL. -_ L/D TY'PE_F~I,~CI~~ 9fSS D,~~ S~E82.AL 3#.;~~C~-f_~1~CL xd0 (o~ FATL L /Ta TYPE ___. ~.._ YES PARS S~Rfi.~.~ #---- --~-- xd0 FAxJ~ I :;ertif.~ tb.e aba1;~. Yest_s.ware conducted on this dace according to ,Red ,:~aakat Pumps L-a.eld tee r_ apparatus testing procedure an limitations, Tki~:~ Merhani.ca.l. Lea}< Detect.ar. Testa pass / fail is determined by using I a lcr~r £law thxesholri trip rate cif 3 galloxi ,per hour or less at 10 PSI. I s~Ckzzowledge tl~a,c a. J. 1. dar_a en~lacCec3 1s true anc9 aorreet to the beet ~ of rr4~ knowledge . Tech : ~~~~ Sigzzs~tuxe: ~ _,._ Aate: ~ •. /~gdy OUTPUT RELAY SETUP R 1:87 TYPE: STANDARD NORMALLY CLOSED L1QUI0 SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM R 2:92 TYP1= : STANDARD NORMALLY CLOSED L[QUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM R 3:DIESEL TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM R 4:REMOTE ALARM TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:BHORT ALARM T 2:PREMIUM PRODUCT CODE 2 THERMAL COEFF :.000700 TANK DIAMETER : 131.75 TANK PROFILE 1 PT FULL VOL 8057 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 8057 OVERFILL LIMIT 90i 7251 HIGH PRODUCT 95i 7654 DELIVERY LIMIT 20i . 1611 LOW PRODUCT 1000 LEAK ALARM LIMIT: 99 SUDDEN LOSS L[MIT: 50 TANK TILT 1.07' MAN[FOLDED TANKS Til: NONE LEAK MIN PERIODIC: l0i 805 LEAK MIN ANNUAL l0i 805 PERIODIC TEST TYpE STANDARD ANNUAL TEST FA[L ALARM DISABLED PER[ODIC 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 15 M1N ..._ .... _ ..... - - na,nrtii n1,71VECY 1CGYVrt! • v"~ - -- -.... 4----~ i LI9UID SENSOR SETUP .-- T 3:D[ESEL - - - - - - - - - - - - ---- IN-TANK ALARM ---- - ---- SENSOR - L 6:DISP 5-6 ALARM ---- PRODUCT CODE : 3 . DISPENSER PAN THERMAL COEFF :.000450 L 1:ANNULAR T 2:PREMIUI~1 FUEL ALARM TANK DIAMETER 131.75 TRI-STATE (SIIdGLE FLOAT> NOV 11 TANK PROFILE 1 PT CATEGORY ANNULAR SPACE OVERFILL ALARM . 2005 10:32 HM FULL VOL : 5036 MAR 23. 2000 11:31 AM FUEL ALARM MAR 12. 2000 7:34 AM MAR 4. 2000 10:07 AM FE$ 3. 2005 10:45 AM FLOAT SIZE: 4.0 IN. 8496 L 2:87 STP TRI-STATE (SINGLE FLOAT) LOW PRODUCT ALARM FUEL ALARM OCT 29. 2004 WATER WARNING : 2,0 CATEGORY STP SUMP OCT 4. 2006 11:46 AM 1;45 PM MIGM WATER LIMIT: 3.0 SEP 29. 2006 8:54 PM ALHRM HISTORY REPORT MAX OR LABEL VOL:~ 5036 L 3:92 STP AUG 31. 2006 1:27 PM ----- SENSOR ALARM ---- OVERFILL LIMIT 90i TRI-STATE (SINGLE FLOAT) CATEGORY STP SUMP INVALID FUEL LEVEL L 5:D1SP 3-4 4532 H1GM PRODUCT 95~ AUG 24, 2004 8:47 PM DISPENSER FAN 4764 ' DEC 22. 2001 12:49 PM FUEL ALARM 0 DELIVERY LIMIT 2 L 4:AIESEL STP OCT 25. 2001 5:16 PM NOV I1. 2005 10:32 AM 7 1 0 TRI-STATE (SINGLE FLOAT) PROBE OUT FUEL ALARM CATEGORY STP SUMP MAR 15, 2005 11:43 AM OCT 29. 2D04 1:42 P1~1 LOW PRODUCT 1000 MAR 15, 2D05 11:25 AM LEAK ALARM LIM1T: 99 DEC 19. 2000 8:29 AM FUEL ALARM SUDDEN LOSS LIMIT: 50 L 5:DISP 3-4 DEC 17, 2003 9:33 AM TANK TILT 0.00 TRI-STATE (SINGLE FLOAT} CATEGORY : D I SPENSER PAN DELIVERY NEEDED ~. - - ~~ --- ~ "-' ` ~ "" '~ MAN I FOLDED TANKS NOV 13. 2006 12:09 PM ALARM HISTORY REPORT Tii: NONE NOV 7. 2006 4:39 AM L 6:DISP 5-6 NOV 1. 2006 4:44-AM ----- SENSOR ALARM L 4:DIESEL STP °--- LEAK M[N PERIODIC: l0i TRi-STATE (SINGLE FLOAT) STP SUMP 503 CATEGORY : DISPENSER PAN FUEL ALARM „ ._.... NOV l1. 2005 10:22 AM LEAK MIN ANNUAL : 10% ALARM HISTORY REPORT 503 ' L 7:AISF 7-8 TRI-STATE (SINGLE FLOAT> ~- [N-TANK ALHRM ----- FUEL ALARM OCT 29. 2004 1:36 PM PERIODIC TEST TYPE CATEGORY : DISPENSER PAN T !:UNLEADED FUEL ALARM STANDARD OCT 31. 2003 9:31 AM OVERFILL ALARM ANNUAL TEST FAIL L e:DISP 1-2 JAN 15. 2005 5:40 PM _ - ~._._ . ..._.._.. ALARM DISABLED TRI-STATE (SINGLE FLOAT} JUL 31. 2003 7:46 AM JUN 18, 2003 1:22 PM ALARM HISTORY REPORT PERIODIC TEST FAIL CATEGORY DISPENSER PAN ---- IN-TANK ALARM ---- ALARM DISABLED LOW PRODUCT ALARM OCT 19. 2006 8:42 AM T 3:AIESEL GROSS TEST AUG 19. 2D06 3:41 PM ALARM DISABLED MAY 26. 2006 1:32 PM OVERFILL ALARM SEP 18, 2003 2:01 PM ANN TEST AVERAGING: OFF HIGH PRODUCT ALARM JUL 24. 2003 6:38. PM PER TEST AVERAGING: OFF OCT 21. 20D0 12:54 AM LOW PRODUCT ALARM TANK TEST NOTIFY: OFF INVALID FUEL LEVEL NOV 14. 2006 7:06 API FEH 20. 2006 12:47 PM NOV 6. 2006 5:07 PM TNK TST SIPHON HREAK:OFF JUL 12, 2005 10:26 AM NOV 2. 2006 7:57 AM SEP 21, 2004 11:58 AM DELIVERY DELAY 15 MIN INVALID FUEL LEVEL -'-"" ~- ~ ~- PROBE OUT SEP 12. 2006 9:16 AM ALARM HISTORY REPORT MAR 15. 2005 10:55 AM JUL 11. 2006 10:04 AM DEC 18. 2000 11:28 AM OCT 4. 2005 7:51 AM _____ SENSOR ALARM ----- PROBE OUT L B:DISP 1-2 DELIVERY NEEDED DEC 22. 2003 11:26 AM DISPENSER PAN FUEL ALARM NOV 7. 2006 11:24 AM DEC 22. 2003 11:25 AM NOV 11. 2005 10:31 AM NOV 2, 2006 7:59 AM NOV IQ, 2000 9:01 AM OCT I8, 2006 2:58 PM DELIVERY NEEDEp LOW TEMP WARNING NOV 14. 2006 7:06 AM DEG l8, 2000 12:59 PM NOV 6. 2006 5:06 PM NOV 2, 2006 7:53 AM LOW TEMP WARNING NOV 14. 2000 9:03 AM OCT 16, 1999 3:01 aM FUEL ALARM OCT 29. 2004 1:40 PM FUEL ALARM ^T ?9, 2004 1:40 PM ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 7:DISP 7-8 DISPENSER PAN FUEL ALARM NOV 11. 2005 10:33 AM FUEL ALARM OCT 29. 2004 1:54 PM =il-.r11111 ..JLI UC- - - - - - T !:UNLEADED PRODUCT CODE 1 TNERMAL COEFF :.000700 TANK DIAMETER 131.75 TANK PROFILE 1 PT FULL VOL 12026 FLOAT S12E: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 12026 OVERFILL LIMIT 90% 10823 HIGH PRODUCT 95% 11424 DELIVERY LIMIT 15% 1803 LOW PRODUCT 1000 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 1,22 MANIFOLDED TANKS TtI: NONE LEAK MIN PERIODIC: IU% 1202 LEAK MIN ANNUAL 14% 1202 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLEA ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON HREAK:OFF DELIVERY DEi Au ~ E. ~..,, T-... ALARM MISTORY REPORT ___-- SENSOR ALARM ---"'- L !:ANNULAR ANNULAR SPACE FUEL ALARM NOV 11. 2005 10:23 AM FUEL ALARM OCT 29. 2004 1:37 PM SENSOR 0 UT ^ALA pM'~F AM ~ ALARM HISTORY REPORT COMMUN1CATlUNS SETuY ----- ~L{V.SUK H1.HKI"1 --"-- ------ ------ L1:ANNUL:AR ANNULAR SPACE FUEL ALARM PORT SETTINGS: NOV 14. 2006 9:23 AM COMM BOARD : I (RS-2327 BAUD RATE 9600 PARITY : EVEN STOP BIT 1 STOP DATA LENGTH: 7 DATA AUTO TRANSMIT SETTINGS: AUTO LEAK ALAR1~1 L I M I T DISABLED AUTO HIGH WATER LIMIT DISABLED AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT TRANSMIT/REPEAT AUTO THEFT L1M1T DISABLED AUTO DELIVERY START TRANSMIT/REPEAT AUTO DELIVERY END TRANSMIT~REPEAT AUTO EXTERNAL INPUT ON DISABLED AUTO EXTERNAL INPUT OFF DISABLED AUTO SENSOR FUEL ALARM TRANSMIT/REPEAT AUTO SENSOR WATER ALARM DISABLED AUTO SENSOR OUT ALARM DISABLED AUTO REPEAT TIME: 60 MIN AUTO DELAY TIME 5 S£C RS-232 SECURITY CODE : 000000 SEtVSOR ALARM L 3:92 STP STP SUMP FUEL ALARM NOV 14. 2006 9:24 AM •` -- SENSOR ALARM -- -- L 4:DIEaEL STP STP SUMP FUEL ALARI'1 9 ; 26 AM NOV 14. 2006 SYSTEM SETUP NOV 14. 2006 -9:03 AM SYSTEM UNITS u.s. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYYY HH:MM:SS xM /~-~~J E,?- ' L ~ rJ.:J~4 i ti ' i ~ D 6.9Ky2 wR!~ ?H~tESHO ~ .~JT ?.G _ U~ , ,~ ~r. 91r-T'~_ TES' ST, ~ik'.T'4+~ 9: 0~j t11 TL$T fiTART4D it/;3/LC~OE E;EG'.k~ '._EliEi;~,-._-- -r..-i.3?2_ I' h?t; GATE E 1i/i''2~~0 _ 1~11,, ~`IV .:.V tl . ~- ; d Lrlf .} - T LEAK THRE•~HOL~~ F, O~i2 . VEST RESULT ' '" ?kSuE. ~ ~. TES' STAR: (c,D ~GIC.t F'-ast.c-. B: c H ~k,ST a^'RRTEJ il/13/260+ oEGIN ?,EUEL 4,?31~ a ~;vry ?~rE . 8:55 RF END DATE li/i3/2~3ai END LEVEL 4, ?318 IP LEAK ?HRESHOLG 9.8p2 it TE.,T ~'tSUL' ('RSSEC VALU-GAS _........... _.. _ -.. 2500 WHITE LANE ~, BAKESFIELD CA 93304 SHIFT TIME i : 12:30 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 T~,ST STAB'?£D >=':22 A E,T ST,~iRTED 1:: i3/150i pErlti' Lc"DEL ~.~3:5 Ii E`~0 rrjrE -: ~'l ~~I' EivC~ DATE Ii/:3/200~ cN0 ~liEf C.'r'.:~Ic3 iP LEAK 7HRE5HOLI: k7,~+02 ii -- SENSOR ALARM ---- L B:DISP 1-2 DISPENSER PAN FUEL ALARM NOV 14. 2006 9:31 AM RS-232 END OF MESSAGE PRINT TC VOLUMES DISABLED ENABLED LEAK TEST METHOD TEMP COMPENSATION ~ ----- SENSOR ALARM --- _ - VALUE (AEG F 5: 6D.0 L 6:DISP 5-6 TEST MONTHLY ALL TANK STICK HEIGHT OFFSET DISPENSER FAN WEEK 2 WED DISABLED FUEL ALARM START TIME : 2:00 AM NOV 14. 2006 9:28 AM TEST RATE :0.2D GAL/HR H-PROTOCOL DATA FORMAT - - •-._.._._. _ ...._,... _.. --,.... ~. DURATION 2 HOURS HEIGHT DAYLIGHT SAVING TIME --'-- SENSOR ALARM ---- ENABLED L 7:DISP 7-8 START DATE DISPENSER PAN LEAK TEST REPORT FORMAT APR WEEK 1 SUN I A L ENHANCED ~ START TIME 2006 9:29 AM I4 . NOV END DATE ALARM HISTORY REPORT OCT WEEK 6 SUIV END TIME -- SENSOR ALARM ----- L 2:67 STP STP SUMP FUEL ALARM NOV il. 2005 10:22 AM -- SENSOR ALARM ----- L-3:92 STP STP SUMP FUEL ALARM NOV 11. 2005 10:22 AM FUEL ALARM OCT 29. 2004 1:35 PM FUEL ALARM ' OCT 29. 2004 1:34 PM FUEL ALARM OCT 31, 2003 9:25 AM 2:00 AM RE-DIRECT LOCAL PRINTO U I SABLI;D SYSTEM SECURITY CODE : OOODOD ----- SENSOR ALARM ---- L 5:DISP 3-4 DISPENSER PAN FUEL ALARM NOV 14. 2006 9:30 AM ----- SENSOR ALARM ---- L 2:97 STP STP SUMP FUEL ALARM NOV I4. 2006 9:24 AM FULL ALARM _ _ , , , f~~oy _____- MONITOR CERT. FAILURE REPORT SITE NAME: ~ A LL•t [ r~RS DATE: R ~ l I ~ ~ ~ ADDRESS: c~ ~PS.Z~ t ~ ~ t-E ~~i„t...1~1 • TECFINICIAN: ,~TF ~~f`1 ~' ~ CITY: `~Fl ~C~2.~F~ SIGNATURE: ~`\ THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS: N t E(~ 'Tt~ 2 ~P c_AC~ t~rl . . ~ , ~ • Fc~ 2 ~€Sr~.` CfZo~ zs t.J +q Q.2a~y~-2~r~ c~ -c~t~:L,` LABOR: t~ ©~ L.__ PARTS INTALLED: p '"` NAME: TITLE: SIGNATURE: . THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING T1iE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIIt THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVHtONMANTAL FOR ANY NEEDED RETESTING. TffiS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON-COMPLLANCE. A COPY OF TffiS DOCUMENT HAS BEEN LEFT ON-SITE FOR YOUR CONVIENENCE. /~~y~ ---~ SWRCB, January 2006 Spi11 Bucket Testing Report Form This form is intended jor use by contractors performing annual testing ojUSTspill containment structures. The completed form and. printouts from.tests ({f applicable), should be provided to the jacility.owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: ~` ~~ Date of Testing: ( `Qj(O Facility Address: ~{ t t tLF~~ Facility Contact: Phone: Date Local Agency Was Notified of Testing ; Name of Local Agency Inspector (f present during testing): Rt~~ (? [ t 2. TESTING CONTRACTOR INFORMATION Company Name: (Z~.cl~-( '` 'Tl~(.- ,Technician Conducting Test: t t Credentials: CSLB Contractor Se tce Tec . SWRCB Tank Tester Other (Spe ~) Zt~ C t~ License Number(s): ~a (a,~ to ur1 ~c.(~c.E 4 3. SPILL BUCKET TESTING INFORMATION TestMethod Used: drostatic - --- Vacuum Other Test Equipment Used: ~ ~ t^p N ~ St~A ~ Equipment Resolution: '~", Q~ Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 ~~- 2 ~~~ Q ( 3 4 ~~, L Bucket Installation Type: irect Bu Contained in Sum irect B Contained in S irect B Direct $ury Contained in Sum Contained in Sum Bucket Diameter: ~ ~ ~~ ~ ~~ ~ 3 ~ ~ Bucket Depth: I a'~ '' ~ l (~ r Wait time between applying vacuum/water and start oftcst: 3~ m~N ~ fr1~ `3`~ M~-~' Test Start Time(T~: ;0/o1~"t ~~yl A G:~ C~, q ;~~~ Initial Reading fit): 1 ~ ,~-'~t ~ (p. ~ (~ . f'3'} 1 ~~ ~ Test End Time (Tr); g:'~'~A ', l5 Q: 3'~ A ~ ~: ~ >~ Final Reading (RF): t-/,'~ 1 y .'~3 t fo.13~3 .133 l 3 Test Duration (TF - Tl): ISrt~ t i~~~ 1 (- j--1t~Q Change in Reading (RF - R~: PasslFail Threshold or .~.. ~~a Criteria: •}-~~ l +- -f'.~a - , ~•~.....~ ..~ viri~ctaiva un re airs maae nor to testin ,and recommended follow-u or ailed tests CBRTIIzICATTON OF TECHNICIAN RESPOIYSIBI.E FOR CONDUCTING THIS TESTING I hereby cerh, fy that all the information contained in this report is true, accurate; and rx jull compliance with legal requirements. t'echnician's Signature:~~~_ Date:~_] I y lmc~ 1 State laws and regulations do not currently require testing to be performed by a qualified cpntractor. However, local requirements maybe more stringent. ~~~~y __~___ SB~989 TESTING FAILURE REPORT SITE NAME: I H--t~ S A~_ C~~`7~ _ DATE: ~ ~~~u1~ AnnRF4s ~ti?~ l..Jl-~1T~ ~ IJ TECHNICIAN'~~ cam.-J~~JLX.~C~ CITY' ~~{L~~J~L~ SIGNATURE: r~(~ J~ SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE THE SB989 TESTING, LIST OF PARTS REPLACED/REPAIRED: REPAIRS ; /~' Q~~~ LABOR : {~j ('~ rJ PARTS INSTALLED : I\J (`~ ~ ~ ~~o UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING I S8989 SECONDARY CONTAINNtENT TESTING (TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAKERSFIELD FIRE DEPT. Prevention Services flRl ARTIII f 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 TeI.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 PERMIT N0. ^ ENHANCED LEAK DETECTION _ C~~~LF TESTING ©SB-998 SECONDARY CONTAINMENT TESTING ~.~~. 11 + a~cc rocT ~~ ~ 'rn oGOCARAA FI IFI AAC1NITnRINQ CERTIRCJ1TiOXI'~~ u ini. ~. w~~u,.......w, ._. _. .. .... ___. __._.. _..... _ _. FACILITY ! NAME Ji PHONE NUMBER OF CONTACT PERSON ADDRESS - OWNERS NAME r-- Q OPERATORS NAME - PERMIT TO OPERATE NO. NUMBER OF TANKS 7p BE TESTED I IP I T i,~N L C~' ~ / ~~ ~ ` , j ., TANK,TESTING COMPANY '::: -.:. NAME OFT TING COMPANY t NAME 3 PHONE NUMBER OF CONTACT PERSON MAILING ADDRESS ~r~, NAME 8 PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR CE IFICATION #: DATE & TI E TEST TO BE CONDUCTED . Cx~~.vYl ICC #: TEST METHOD SIGNATURE OF APPLICANT - ~ DATE APPROVED BY DATE FD 2095 (Rev. 09105) ;s --- --- - - - ~ ~l~C~ BAKERSFIELD FIRE DEPT. BlL.L1NG & PERMlT STATEMENT prevention services. ~~Rii 900 7Yuxtun Avenue, Suite 210 PERMlT NO.: Axles T Bakersfield, GA 93301 __ _ _Tel.: 16611 326-3979 F x• 16fi11 852-217 L_ .~„~~..~ LOCATION OF PROJECT PROPERTY $TARTiNG DATE CObIF'1ET10N r NAA~E PROJECT NAME AOORESS PHONE N0. PROJECT ADDRESS ~ (-~ ' • ~ ~ U w CRY STATE ZIP CODE ~j J •- .' CONTRACTOR NAME CA LICENSE NO. • TYPE OF UCfiNSE. EXPIRATION DATE PHONE 0. 2 '~g~ CONTRACTOR COMPANY NAME FAX NO. ~ ` tJ (~ ADDRESS CnY Z1P CODE ~~- • ~ ~ • J ^ Alarms -New & Modifiptions - (Minimum Charge) $262.50 ~ 98 000 S FL 013125 =Permit fee FL x S ~ ^ q. Over 20, q. . sa ^ r i Mi Ch dif ti i & M N 00 $210 ~ mum ica ons - ( a ge) o n nklers - ew Spr . 98 ^ FL Ov 000 S 5 042 =Permit fee S FL x ~ q. er , q. . 98 ^ rinkler Modiflcatlons (< i0 heads) Minor S 00 [inspection Only) $ 93 ~ p . 98 ^ Commeraal Hoods -New & Modifications $ 398 26 ~ . 98 ^ Addltlonai Hoods 00 E 38 ~ . 98 ^ ~ Spray Booths -New & Modifications $458 00 ~ . 98 ^ Aboveground Storage Tanks (Installa~on/insp.-1 ° Tlrne) $165.00 82 ~ Additional Tanks 3 28.00 82 ^ Aboveground Storage Tanks (RamovaUlrtspedion) $109:00 82 ^ Underground Storage Tanks (InstalladorrJinspedion) $878.00 (per tank) 82 ^ Underground Storage Tanks (Nlodification) $878.00 (persite) 82 ^ Underground Storage Tanks (Minor Mod'~f+Cation) $155.00 82 ^ Underground Storage Tanks (Removal} $675.00 (pertank) 84 ^ Oi)well (Installation} $'J2,Qp ~ 84 Mandated Leak Detecxlon (Test; i Fuel Montt. Cert. $ 81.00 (perslte) 82 D Tents $93.00 (per tent) 84 ^_ After hours inspection fee $122.00 84 ^ PyratechniC - (Per event, Ptus Insp. Fee ~ $90 per hour) $ 60.00 + (5 hrs. mn stand --by tee ilnapectbn) _$510.00 84 C1 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 333.00 per hr) 25¢ per page B4 ^ Miscellaneous " r 84 FO 2021 (Rev. 09/05) i -ORIGINAL WHITE (to Treuury) 1-YELLOW {to Flle) t-PINK (to Cuatomeh :a.LD ~; ~1~y` '~~~~ CITY OF BAKERS~'IEI.D FIRE DEPAR'T'MENT d ~ ~ b~ OFFICE OF ENVIRONMEN'1'A1. SERVICES ;° , yp` UNIFIED PROGRAM INSPECTION CHECKLIST ~:.w ~ ;Rti,,!'~ 1715 Chester Ave., 3r`' Moor, Bakersfield, CA 93301 FACILITY NAME yG~~l}~~ ~A5 INSPECTION DATE ~ ~ 03 Section 2: Underground Storage Tanks Program ^ Routine ~ombined ^ Joint Agency ^Multi-Agency ~ ^ Complaint ^ Re-inspection Tyre of Tank VJ~-CS Number of "Tanks Type of Monitoring _.(` (kV~ Type of Piping ~_~ OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data un file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/laheling Is tank used to dispense MVF? Ifyes, Does tank have overfill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO / . Inspector: - Office of Environmental Services (661) 326-3979 white - r nv. Svcs. TJGG~.. ~ -._~--. Business Site Responsible Party fink -Business Copy