HomeMy WebLinkAbout2010 FMC RESULTS MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of California
Authority Cited. Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be
prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided
to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems
within 30 days of this date.
A. General Information IIIIIIIIIIIIIIIIIIII 61
Facility Name: #1001 Wholesale Fuels, Inc. IE Bldg.No.:
Site Address: 2200 East Brundage Lane City: Bakersfield Zip: 93307
Facility Contact Person: Omero Garcia Contact Phone No.: 661-393-7000
Make/Model of Monitoring System: Veeder-Root TLS-350 Date of Testing/Servicing: 9/30/2010
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to intricate specific equipment impeded/serviced:
Tank ID: T-1 L-S Clear 10000 gallons Tank ID: T-2 L-S Dyed 10000 gallons
[X] In-Tank Gauging Probe. Model:847390-107 [x] In-Tank Gauging Probe. Model:847390-107
❑ Annular Space or Vault Probe. Model: ❑ Annular Space or Vault Sensor. Model:
❑ Piping Sump/Trench Sensor(s). Model: ❑ Piping Sump/Trench Sensor(s). Model:
❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s). Model:
❑ Mechanical Line Leak Detector. Model: ❑ Mechanical Line Leak Detector. Model:
[X] Electronic Line Leak Detector. Model:Campo-Miller [x] Electronic Line Leak Detector. Model: Campo-Miller
[XI Tank Overfill/High Level Sensor. Model:847390-107 U Tank Overfill/High Leval Sensor. Model: 847390-107
❑ Other(specify equip.type and model in Sec. E on Pg.2) ❑ Other(specify equip.type and model in Sec. E on Pg. 2)
Tank ID: T-3 Clear Diesel 20000 gallons Tank ID: T-4 Unleaded 20000 gallons
[x] In-Tank Gauging Probe. Model:947390-107 [x] In-Tank Gauging Probe. Model:847390-107
❑ Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model:
❑ Piping Sump/Trench Sensor(s). Model: ❑ Piping Sump/Trench Sensor(s). Model:
❑ Fill Sump Sensors(s). Model: ❑ Fill Sump Sensor(s). Model:
❑ Mechanical Line Leak Decector. Model: ❑ Mechanical Line Leak Detector. Model:
[x] Electronic Line Leak Detector. Model:Campo-Miller [x] Electronic Line Leak Detector. Model: Campo-Miller
[x] Tank Overfill/High Level Sensor. Model:847390-107 Tank Overfill/High Level Sensor.Model:847390-107
❑ Other(specify equip.type and model in Sec. E on Pg. 2) ❑ Other(specify equip.typs and model in Sec. E on Pg.2)
Dispenser ID: T-1 Clear Dispenser ID: T-2 L-S Dyed
[x] Dispenser Containment Sensor(s). Model: 794380-208 [x] Dispenser Containment Sensor(s). Model: 794380-208
[X] Shear Valve(s). Shear Valve(s).
❑ Dispenser Containment Float(s)and Chain(s). ❑ Dispenser Containment Float(s)and Chain(s)
Dispenser ID: T-3 Clear Diesel Dispenser ID: T-4 Unleaded
[x] Dispenser Containment Sensor(s). Model: 794380-208 [x] Dispenser Containment Sensor(s). Model: 794380-208
[x] Shear Valve(s). Shear Valve(s).
❑ Dispenser Containment Float(s)and Chains(s). ❑ Dispenser Containment Float(s)and Chain(s).
Dispenser ID: T-5 Dyed Dispenser ID: T-6 Dyed
[x] Dispenser Containment Sensor(s). Model: 794380-208 [x] Dispenser Containment Sensor(s). Model: 794380-208
[x] Shear Valve(s). L] Shear Valve(s).
❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s).
If the facility contains more tanks or dispensers,copy this form. Include information for every tank and dispenser at the facility.
C. Certification -I certify that the equipment identified in this document was inspected/services in accordance with the
manufacturers'guidlines.Attached to this Certification is information(e.g.manufacturers' checklist)necessary to varify that
this information is correct and a plot plan showing the layout of monitoring equipment.For equipment capable of generating
such reports,I have attached a copy of the report; (check all that apply) x❑System Set-up Alarm history report
Technician Name(print): Kristopher Karns Signature: y� a�r�--`
Certification No: B34106 License No:804904
Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930
Site Address: 2200 East Brundage Lane,Bakersfield,CA 93307 Date of Testing/Servicing: 9130/2010
IIIIIII III III IIII 62
IE
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of California
Authority Cited: Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be
prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided
to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems
within 30 days of this date.
A. General Information
Facility Name: #1001 Wholesale Fuels, Inc. Bldg.No.:
Site Address: 2200 East Brundage Lane City: Bakersfield Zip: 93307
Facility Contact Person: Omero Garcia Contact Phone No.: 661-393-7000
Make/Model of Monitoring System: Veeder-Root TLS-350 Date of Testing/Servicing: 9/30/2010
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to in irate specific equipfomt inrpectedleerviced:
Tank ID: T-5 L-S Dyed 20000 gallons Tank iD: T-6 L-S Dyed 20000 gallons
[X] In-Tank Gauging Probe. Model:847390-107 [x] in-Tank Gauging Probe. Model:847390-167
❑ Annular Space or Vault Probe. Model: ❑ Annular Space or Vault Sensor. Model:
❑ Piping Sump/Trench Sensor(s). Model: ❑ Piping Sump/Trench Sensor(s). Model:
❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s). Model:
❑ Mechanical Line Leak Detector. Model: ❑ Mechanical Line Leak Detector. Model:
[X] Electronic Line Leak Detector. Model:Campo-Miller 1�1 Electronic Line Leak Detector. Model: Campo-Miller
U Tank Overfill/High Level Sensor. Model:847390-107 [x] Tank Overfill/High Leval Sensor. Model: 847390-107
❑ Other(specify equip.type and model in Sec. E on Pg.2) ❑ Other(specify equip.type and model in Sec. E on Pg.2)
Tank iD: T-7 L-S Dyed 20000 gallons Tank iD: T-8 Clear Diesel 12000 gallons
[x] in-Tank Gauging Probe. Model:847390-107 [x] in-Tank Gauging Probe. Model: 847390-107
❑ Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model:
❑ Piping Sump/Trench Sensor(s). Model: ❑ Piping Sump/Trench Sensor(s). Model:
❑ Fill Sump Sensors(s). Model: ❑ Fill Sump Sensor(s). Model:
❑ Mechanical Line Leak Decector. Model: ❑ Mechanical Line Leak Detector. Model:
❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model:
Fx] Tank Overfill/High Level Sensor. Model:847390-107 [x] Tank Overfill/High Level Sensor.Model:847390-107
❑ Other(specify equip.type and model in Sec. E on Pg.2) ❑ Other(specify equip.typs and model in Sec. E on Pg.2)
Dispenser ID: T-1 Clear Dispenser ID: T-2 L-S Clear
[7 Dispenser Containment Sensor(s). Model: 794380-208 [x] Dispenser Containment Sensor(s). Model: 794380-208
[x] Shear Valve(s). LX] Shear Valve(s).
❑ Dispenser Containment Float(s)and Chain(s). ❑ Dispenser Containment Float(s)and Chain(s)
Dispenser ID: Dispenser ID:
❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model:
❑ Shear Valve(s). ❑ Shear Valve(s).
❑ Dispenser Containment Float(s)and Chains(s). ❑ Dispenser Containment Float(s)and Chain(s).
Dispenser iD: Dispenser ID:
❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model:
❑ Shear Valve(s). ❑ Shear Valve(s).
❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s).
*if the facility contains more tanks or dispensers,copy this form. include information for every tank and dispenser at the facility.
C. Certification -1 certify that the equipment identified in this document was inspected/services in accordance with the
manufacturers'guidlines.Attached to this Certification is information(e.g.manufacturers'checklist)necessary to varify that
this information is correct and a plot plan showing the layout of monitoring equipment.For equipment capable of generating
such reports,i have attached a copy of the report; (check all that apply) x❑System Set-up [x]Alarm history report
Technician Name(print): Kristopher Karns Signature:
Certification No: B34106 License No:804904
Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930
Site Address: 2200 East Brundage Lane,Bakersfield,CA 93307 Date of Testing/Servicing: 913012010
D. Results of Testing/Servicing
Software Version Installed: 123.02
Complete the following checklist:
[x] Yes ❑ No* is the audible alarm operational?
x Yes No* Is t e Visual a arm operationa?
x Yes No* Were all sensors visually inspected, functionally tested,and confirmed operational?
x Yes ❑ No* Were all sensors installed at the lowest point of secondary containment and positioned so that other
equipment will not interfere with their proper operation?
Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment(e.g.modem)
Hx N/A operational?
x Yes ❑ No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary
❑N/A containment monitoring system detects a leak,fails to operate, or is electrically disconnected? If yes:
which sensors initate positive shut-down? U Sump/Trench Sensors❑Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? [X] Yes; [x] No;
L] Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e. no
[]N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visual and audible at
the tank fill point(s)and operating properly?if so,at what percent of tank capasity does the alarm
trigger? L9p %
❑ Yes* U 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 replacement parts in Section E,below.
❑ Yes* ❑ No Was liquid found inside any secondary containment systems designed as dry systems?
0 Product; ❑ Water. If yes,describe causes in Section E,below.
RFYes::l W as monitoring system set-up reviewed to ensure proper settings?Attach set-up reports, if applicable.
No* Is all monitoring equipment operational per manufacturer's specifications?
* In Section E below,discribe how and when these deficiencies were or will be corrected.
E. Comments:
F. In-Tank Guaging/SIR Equipment: [.X] Check this box if tank guaging is used only for inventory control.
❑ Check this box if tank guaging or SIR equipment is installed.
This section must be completed if in-tank guaging equipment is used to perform leak detection monitoring.
Complete the following checklist:
E Yes ❑ No* Has all input wiring been inspected for proper enter and termination,including testing for ground faults?
x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
Jx�Yes No* Was accuracy of system product level readings tested?
x Yes No* Was accuracy of system water level readings tested?
x Yes No* Were all probes reinstalled properly?
E Yes ❑ No*I Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H,below,describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): ❑Check this box if LLD's are not installed.
Com lete the following checklist:
Lx] Yes ❑ No* For equip. start-up or annual equipment certification,was a leak simulated to varify LLD performance?
(Check all that apply) Simulated leak rate: E3 g.p.h.: ❑0.1 g.p.h.; 00.2 g.p.h.;
Yes x No* Were all LLD's confirmed operational and accurate within regulatory requirments?
x Yes No* Was the testing apparatus properly calibrated?
❑ Yes No* For machanical LLD's,does the LLD restrict product flow if it detects a leak?
4Yes N/A
o* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak?
❑ N/A
❑ Yes x No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is
❑ N/A disabled or disconnected?
❑ Yes x No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system
❑ N/A malfunction or fails a test?
❑ Yes x No* For electronic LLD's,have all accessible wiring connections been visually inspected?
❑ N/A
Ej Yes I x No I Were all items on the equipment manufacturer's maintenance checklist completed?
* In the section H,below,describe how and when these deficiencies were or will be corrected.
H. Comments: All six Campo Miller Electronic Leak Detectors failed,and need to be repaired or replaced and retested.
The Regular 87 and#5 Carb Diesel, Phil Tite direct burial Spill Buckets need to be replaced and retested.
1* 5:L-$ OYED
OLUME
C;AL: S,, - - - - -
LS
TC
HE IGHT -=VOLUME 3226
25-90
VOL 0 CALJO� 8'.1STEI'l 1jpjlTs
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2200 E BRUNDAC-E LN DEG SYSTEM u-oqc;LlAcE
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93304 "$-`STE11 VIATE,T]ME FOPMAT
T G:L-S oyED MON DD YM
8EI. o- -0010 0 Da w I )0j !L u
3001 GALS
11`162.4;AL�,1 FUEL
90*- ULLf-i-'E� I 5uir,5 2�200 E SPUNDAGE LN
Tt- voL,-njE 2a EAKESF I ELD CA
4EICHT 0A Ls
SY'ST0, 11 !:iTATI-*�; PE)"URT I N>IE'.". 93304
1111'FP U- GAIS.
AU FU11h-T1 G+2 h)OFIJL'JAL kvwLt- 00 1 Ni�Hr�S pi,.I
I 1"IVENTORY PEPOR'T TFJ•iP F SHIFT 1*11,IE 12:CJG AM
sH I Fr 'r I ME 3 I :on #N1
SH I FT T1 ME 4 2:00 i44
T 7:j--2 PYED
T I C'IXAR VOLUME C41 L S TAmic r, : •rs'r NEEDED A,pN
VOLUME = 1;70'a L,ALO ULLAC413 '= 131x8 GAI P, D I SABLIED
IJLLi4Gr-*. 12'q 1 90% 0 C,-A TANK ANN T.3T NEEDED WF'N
907. U[,LmC:E- 29) VOLUME 1 ri959 GALS D 1 SABLED
TC VOLUME - 2 HE I(;H,r �,os.qq
. . I Nc.Hc,::
HE I CHT - ?7.26 1 1JATER VOL = 0 GAL$ LINE RE.-ENI-1141-r mETHOD
WATER VOL = cl CIALS MATER C1.110 1 NCHI-�.7, PASS LINE TEST
WATER = 0.clo I w1c.- TEMP 8 .6 DEC,
TF-Hp . '20 bI c F LINE PEP TST NEEDED WRN
DIS4.11-131[1
T 8 D I MEL L 114E ANN TST NEEDED 14RN
T :L-S DYFJ VC-LumE. = 103115 t:;A L c DISABLED
VOLUME = 77ID1.1 4ALS ULLA(�E 16-85
OLUIGE 2P l rN L S' 90�'- tJLL•1#--,E= 48F, GALS PRINT TO V0LL9'1ER-
901. #JLI-HkC E= 1271 Ca;LS TC VOIJAIE al - ENABLE}
TC- VOLUME - ?bill C,h L.;, HE I 1--;HT 9F, C'ALS
HE I k3f-IT = '18,57 1 NCHES Wf-1TFP VOL, .99 1 NCHI:'S 110-ir, commww4,riom
WATFY: V01. - D C;AJ.12 IAY;TLR 0 VALUE (DEG F 60.0
WATER TEt-11- 00 1 tv'HE:3
- 0.C10 J,li�'HFS D
-W 5 GEC: F STIC)' HEIGKr OFFSET
T
a
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END H-PRopcoi- DATA rOPMAT
HEICHT
VOLU-IE
ULJ_Ar�F ' I DAYL.I(;HT SAV 1 11.1', T I PIE
z1)„17 -ILS ENABLED
90�,
T(" Votj 1�)E START DATE
HE 11', �,i MAR WEEK SUN
.,HT 7t; sq(ART T I ME
U,4Tr-.P vol, 0 2:00 AM
WATER
TEMP 0 'JL' END DATE
89-�i DF0 F NOV WEEK I SLIN
mo 'rimE
T 2:00 AM
I H:17C, 0-4 P, PP�411PEL:T 1.(Y,'AL r*RINTOLIT
^I
913%
TC' VOLUI.IE I r,L)- EURO PROTOC701-
HE I C-HT I Fib.41
WATER VOL = 0 CZALs
TEMP
WATF-P 00 1 i,fr'f4E:;:
sys'rEm t3ECURITY
cio(inoa
P I SA BLED
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PRODlic.1, Cc&c 2
THEr,MiFL ----.QEFF 000450
T 11 h CIRAP Im p9mown w on
Poor SM1(52: PCs Nlc;T c-OpE- I TANK PROFILE I PT
THER;1AL EN-Q 4 5 0 FLILL VOL 1,0000
9600 TANK PlAlETF-R it CC'
EAU TANK PROFRE' I PT
PAR IT FULL DICIOD 121.0e;T .SIZE: 2.'0 1
TOP B I T I c IT C v P
WA LE'N.--,TH: DATA wATP-p I-JARIVJflia 4.0
RWY2 SIXWRVr'V PLOAT '-*i I:7F-: cl.0 1N. HIGH WATER f-111IT" 5.0,
WARIvi NG ;1.0 NA'X 0,R LABEL VOL: 10000
HI i wrvrr-'r., LA ri 11: OVERP-1 LL L I rl 1 F :
I"V f Wf."3.: 900P
A J, 14 • H 951%
wvRN L"TIT
PEE jERY LIHIT t tt
I i-.,H t-JATER I..I H I T HI AN •DU11- 954 )on
D 1 SAM ED 95.00 'T 0
--)vERr-ILL IIRLI��,�ERY I-'�, LOW PRODIX�
D r SA 8L ED 100 LEAY ALARM 11111T.' 75
A1jT,2` I ;kl WON LOSS WIT: 99
DISARAD LN PR,)L111s 31' .0 TILT 0.00
HI ITO THEFT -LEA)". LI HIT; 713 PPOBE IFR,'Vf r4 00,
DISAFLEL UDDEN L.OS2 L111IT: 99
ALITO DELI IEP.'Y STARIV TAN O QQ I JAQ
D 1:-ABLEP smosu VMS 0 0100
WO rELIVES' E'Ptl Tii:JIONE
DI-SABLED L I ME
EXTtRbWiL INPLIT C.'111
Tn: OONE
TO HONE
EXTEPPIAL If-4PLIT L I,NE HANIFOLDED
fi 12ABLED r0:, NONE LE*11 f !;t p8R 1.01)1i;
F,�FARAD,
LEAK VHM AMVAL.
F-N'60P WATT ;;r,.`PH LE�;K 4111+1 PEM OM C: yj
D 12'.A P I-F-T" 4100
LEAK QUA, ANKRI; I DIX
FrF'FfOWC: FE21' T'/PE
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TU 1* FAIL PERIQ10C. TE�517 rrill-
DIS'ABLED
TLST FAML GKIS TETr I1-
AL kF'I
DISAELED A1,AR'M 011";WIBLED
PNIIJ OFF
TC.ST A
FIL.
xam,, Plrk TEST OPP
C-FF TANY. TEST NOTIF�': OFF
PER :TEI�T NQ� 01'7 Vjl� T=-T !31 PW-'P;f BKAK:0F1=
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T;ivii: I+ti4mi;:rI:R 1:10.00 TAM, 1.11AwIETER 1210.lCI Tatl'J): O1t4fMFTCR 120.orl
TANK PROIz 1 LE 1 PT TANK F'l'y?F I LE I PT TANK PPOF I LLI_ 1 PT
FIJI :14) 20
L 205&1 FULL VOL 0500 AOL 2050
1-1-CHAT c:1 ZE: .1.b I N. 1"LJiaT t E: Q.CI IN. FJ..OAT ti I z C: -J.U IN.
WATER I fliF:l-t I N'; -1.0 VATER WriRN 1 PIC; a.0 WITCP M-1PN I NIs -1.0
HIGH IMTER UNIT; 5.0 HIGH WATER LJMIT: c.CI H101 IJATEP LIMIT: 5.1)
PIA:, OR I.r;1tl;L. '00L: 01 63 I'IR-, OR LAREL VOL.: :_'!lS r3 mt-o' Ok, t.is Et. '.Csl_: _'G!5ny;
OVEI•:FILL LIMJ'1' f1s: l3vGN.FfLI_ LIMIT a(w OVERFILL LIMIT 901.
1 3506 1 8506
HIC;H PPODLIP-T q51. HII::H PRODuk"T 95 . Hl(1H NRODWT 95%
I �53F, 19535 t 153_
I+ELIVEPI! I.IIIIT "�5 DELIVERY LIMIT I•t 11CLIVCPY LIMIT r
205 G5
1-010 Ph'l}ri.ti:'I' 0
1 L% PrUOwl, 0
LEA1' ALARM L • i l: 75 LEA; fLAP1' LIMIT: 75 I.E01: ALARM LIMIT: 75
:3L.IDPEN LOSS: LIMIT: 9 flUDDEN LOSS _I M I T: 99 SUDDEN I.CrE:. LIMIT: 9q
'AN TILT 0.50 TANK 7.1 LT 7.7l TAM TILT 00
0.00 PPOt E',WFS1-r 5.Oct PPOSE or 'ET 0.60
S I PHC'N f1;N I FOL,L+EL+ Tf;w,,°' S I PHON MAN I FOLDED TANKS `t 1 P1 ION MAN I F0LI+FI, THrJm
To: NONE To: NONE
I.1 N1: iMAN 1 FC71.I�L--I+ 'rMf..S Tn: NONE r LINE MAN 1 FOLDED Ti-INKS
Tv: Ph)NE LINE MAN)F✓LDE15 1'r;N12 Ta: NONE Ta: NONE
L.EW-.' tM 114 1`131.10f,l It'll. LEmI.: IM I N PER I OW I 0: l rt. LEHI{ MIN F`ER I OID I t': 101.
L't35r. 3'056 056
f.EriJ: IMIPt ,al'ItJI1ft1.. ti>°. L&O', M114 WINUPAL 104:
205e. IMIN i~NNLIAL lO': 20
r.r,
P 'P1001+' 'rc I' T'LI'F. PEE''1UL+1C•• TEST TYPE l,F:h'1+7111!a TEST TYPE
9NNIV RD ;;TF;NGAYD STAIVI.+riPrI
mNNL1mL 'l MT FH I L mvINUAL TL%T FH 1 L APIplI ii�L Tl :T F�"11 L.
ALARM I+ ALFPII DISABLED ALAM11 011:,'APLEI,
F'(::P14)Dic 'rF:r1T FAIL F`£f I OP I C TEST Fat 1 L Pt-.PP)L+!C TE3T Frill.
riL�if?fM 1+i;�;;Sl ~C+ A -I h"1 AI-tiRf
a�Ir3LEh
TES I 1:61L. ',RC?SS TI:y'I' FH 1 L .'(>� Tr-,:,T F.A I L
„tr,(�tI r+I:;rtEfLF:I+ Fiu0l,l LiISABLED HLr�PP1 Lrl�1LLEq
:-)NI-J TEST OFF ANN TEST MVEPA' t IkK;: (OFF ANf+J TL":il`r r:11,'11ka1+::1 fVr�: OFF
PER MA' rittrPHC I N,;: OFF PER TEST AVEP;Aa31 PIG: OPF PLN 'I'F.. 'r i4VEPA+s I Nf;: OFF
"rAwg 're,�'r Iv t'1'1F'`1: DFF k'rthlt TENT 1'10TIP-;: OF'F'
TI-t14J; 'fE: 'r IV�iT l F'',': OFF
TNI: 1':;f I P H+;N f IF;1:rrC:OFF TN): TST SIPHON PREt~I::OFF 1'IVJ: T:�r I PHOPI
PEL I VERV UT'L i 1 1-111-1 + r nF1.l� rmi riia.mY F I°11 N
F�LIf9F TFIk1::�hR)LD IO.00% PI31..iirTH SHOO I hIIN F11.119P THR :340L,D 10.Oir»
PtJIMF' TtII�L5HG1-t+ Il�.�r�•�
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SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and
printouts from tests(f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
L FACILITY INFORMATION
Facility Name: #1001 Wholesale Fuels I Date of Testing: 9/30/2010
Facility Address: 2200 East Brundage Lane,Bakersfield,CA 93307
Facility Contact: Omero Garcia I Phone: 661-393-7000
Date Local Agency Was Notified of Testing: 9/2/2010
Name of Local Agency Inspector (if present during testing): Ester
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials: X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester ❑Other(Spec)
License Number(s): CSLB#804904 ICC#5264406-UT SWRCB#09-1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic ❑Vacuum ❑Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket(By Tank 1) T-1 2) T-2 3) T-3 4) T-4
Number, Stored Product, etc.)
Bucket Installation Type: X Direct Bury X Direct Bury X Direct Bury X Direct Bury
Contained in Sump Contained in Sump Contained in Sump Contained in Sum
Bucket Diameter: 12.00" 12.00" 12.00" 12.00"
Bucket Depth: 14.25" 13.75" 13.75" 14.00"
Wait time between applying
5 minutes 5 minutes 5 minutes 5 minutes
vacuum/water and start of test:
Test Start Time(Tj): 9:00am 9:00am 9:00am 9:00am
Initial Reading(R4): 11.25" 11.50" 11.50" 12.00"
Test End Time(TF): 10:00am 10:00am 10:00am 10:00am
Final Reading(RF): 11.25" 11.50" 11.50" 8.00"
Test Duration (TF—Ti): 1 hour 1 hour 1 hour 1 hour
Change in Reading(RF-Rj): 0.00" 0.00" 0.00" 4.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" 0.0625"
Criteria:
Test Result: X Pass 'Fail X:Pass ❑Fail X Pass_' ❑Fail A ❑Pass X'Fail '
Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests)
The T4 ReQUlar 87 and the T5 Carb Diesel Phil Tite, direct burial Spill Buckets
Failed, and need to be replaced and retested.
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician's Signature: �a�."'`'` Date: 9/30/2010
State laws and regulations do not currently require testing to be performed by a qualified contractor. However,local requirements
may be more stringent.
SWRCB,January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and
printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: #1001 Wholesale Fuels Date of Testing: 9/30/2010
Facility Address: 2200 East Brundage Lane, Bakersfield,CA 93307
Facility Contact: Omero Garcia I Phone: 661-393-7000
Date Local Agency Was Notified of Testing: 9/2/2010
Name of Local Agency Inspector('(present during testing): Ester
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials: X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester ❑Other(Spec)
License Number(s); CSLB#804904 ICC#5264406-UT SWRCB#09-1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic ❑Vacuum ❑Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket(By Tank 1) T-5 2) T-6 3) 4)
Number, Stored Product, etc.)
Bucket Installation Type: X Direct Bury X Direct Bury Direct Bury Direct Bury
Contained in Sump Contained in Sump Contained in Sump Contained in Sum
Bucket Diameter: 12.00" 12.00"
Bucket Depth: 14.00" 14.25"
Wait time between applying 5 minutes 5 minutes
vacuum/water and start of test:
Test Start Time(Ti): 9:00am 9:00am
Initial Reading(Ri): 12.25" 12.50"
Test End Time(TF): 10:00am 10:00am
Final Reading(RF); 9.25" 12.50"
Test Duration (TF—Ti): 1 hour 1 hour
Change in Reading (RF-R,): 3.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625"
Criteria:
;Test Result ' d ❑Pass X F*a►1 ;X Pass ❑Fail n s *p ss �Fim", ss �Fail
.to�W .e,. �«:L.,,y �... �r,ab.::z`..,n°.+u• �'�`° ...na�r::a,.,.�*s.._.�
Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests)
The T4 Regular 87 and the T5 Carb Diesel Phil Tite, direct burial Spill Buckets
Failed, and need to be replaced and retested.
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true,accurate, and in full compliance with legal requirements.
Technician's Signature: — - t--� Date: 9/30/2010
State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements
may be more stringent.
6
a°#OD4c
T11+w
-CMh]AM[fWRMOD11f1OLVCP Invoice No.: 24102
Site: #1001 Wholesale Fuels
2200 East Brundage Lane
Bakersfield, CA 93380-2277
Repairs Requested:
Repairs completed:
Required Repairs, Still Pending: All six Campo Miller Electronic
Line Leak Detectors failed and need to be repaired, replaced,
and retested. The T4 Regular 87, and the T5 Carb Diesel Phil
Tite direct burial Spill Buckets failed and need to be replaced
and retested.
Technician Name: Kristopher Karns
Signature: rLA A A,
Date: 9/30/2010