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HomeMy WebLinkAboutFMC 2010 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California IE 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 test date. A. General Information Facility Name: Arco Am-Pm Bldg.No.: Site Address: 2301 "F" Street City: Bakersfield Zip: 93301 Facility Contact Person: Kamal Contact Phone No.: (661) 303-7961 Make/Model of Monitoring System: Veeder Root TLS-350 Date of Testing/Servicing: 12/1/2010 B. Inventory of Equipment Tested/Certified Check the ap2ropriate boxes to indicate specific a ui ment inspected/serviced: Tank ID: 87 Unleaded Slave Tank ID: 91 Unleaded Premium ®In--Tank Gauging Probe. Model: 847390-109 ®In-Tank Gauging Probe. Model: 847390-109 ®Annular Space or Vault Sensor. Model: 794390-409 ®Annular Space or Vault Sensor. Model: 794390-409 ®Piping Sump/Trench Sensor(s). Model: 794380-208 ®Piping Sump/Trench Sensor(s). Model: 794380-208 ❑Fill Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: ®Mechanical Line Leak Detector. Model: RJFX1 V ®Mechanical Line Leak Detector. Model: RJFX1 V ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ®Tank Overfill/High-Level Sensor. Model: OPW Flapper ®Tank Overfill/High-Level Sensor. Model: OPW Flapper ❑Other(specify equipment type and model in Section E on Page 2). ❑Other(specify equipment type and model in Section E on Page 2). Tank ID: 87 Unleaded Master Tank ID: ®In-Tank Gauging Probe. Model: 847390-109 ❑In-Tank Gauging Probe. Model: ®Annular Space or Vault Sensor. Model: 794390-409 ❑Annular Space or Vault Sensor. Model: ®Piping Sump/Trench Sensor(s). . Model: 794380-208 ❑Piping Sump/Tre nch Sensor(s). Model: ❑Fill Sump Sensor(s). Model: ❑Fill Sump Sensor(s). Model: ®Mechanical Line Leak Detector. Model: RJFX1 V ' ❑Mechanical Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ❑Electronic Line Leak Detector. Model: ® Tank Overfill/High-Level Sensor. Model: OPW Flapper ❑Tank Overfill/High-Level Sensor. Model: ❑Other(specify equipment type and model in Section E on Page 2). ❑Other(specify equipment type and model in Section E on Page 2). Dispenser ID: 1/2 Dispenser ID: 7/8 ®Dispenser Containment Sensor(s). Model: 794380-208 ®Dispenser Containment Sensor(s). Model: 794380-208 ®Shear Valve(s). ®Shear Valve(s). ❑Dispenser Containment Float(s)and Chain(s). ❑Dispenser Containment Float(s)and Chain(s). Dispbnser ID: 3/4 Dispenser ID: 9/10& 11/12 ®Dispenser Containment Sensor(s). Model: 794380-208 ®Dispenser Containment Sensor(s). Model: 794380-208 ED Shear Valve(s). ®Shcar Valve(s). ❑Dispenser Containment Float(s)and Chain(s). ❑Dispenser Containment Floats)and Ch"ain(s). Dispbiiser ID: 5/6 Dispenser ID: 13/14& 15/16 ®Dispenser Containment Sensor(s). Model: 794380-208 ®Dispenser Containment Sensor(s). Model: 794380-208 ®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 -I certify that the equipment identified 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 report;(check all that apply)_: ®System set-up ®Alarm history report. Technician Name (print): Jerry Rangel Signature: Certification No.: ICC: 5309489=UT,VR: B35460 License.No.: 532878 A-haz Testing Company Name: Redwine Testing Services, Inc. Phone No.: (661) 834-6993 Site Address: P.O. Box 1567, Bakersfield,CA.93302 Date of Testing/Servicing: 1211/2010 Page 1 of 3 "-036—1/4 www.unidoes.org I IIII I III I I IIII 12 Rev.01/26/06 IE Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: 15.01 Complete the following checklist: ® Yes ❑ No* Is the audible alarm operational? • Yes ❑ No* Is the visual alarm operational? • Yes ❑ No* Were all sensors visually inspected,functionally tested,and confirmed operational? ® Yes ❑ No* Were all sensors installed at 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) ® N/A operational? ® Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ❑ N/A monitoring system detects a leak,fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) ®Sump/Trench Sensors; ®Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ®Yes; ❑No. ❑ 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 visible and audible at the tank fill point(s)and operating properly? If so,at what percent of tank capacity does the alarm trigger? % ❑ Yes* ® 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? (Check all that apply) ❑ Product; ❑ Water. If yes, describe causes in Section E,below. r::O::Ye ❑ No* Was 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,describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 UN-036—2/4 www.unidocs.org Rev.01/26/06 Monitoring System Certification F. In-Tank Gauging/SIR Equipment: ® Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: ® Yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? • Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? • Yes ❑ No* Was accuracy of system product level readings tested? ® Yes ❑ No* Was accuracy of system water level readings tested? ® Yes ❑ No* Were all probes reinstalled properly? ® 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 LLDs are not installed. Complete the following checklist: ® Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: ® 3 g.p.h.; ❑0.1 g.p.h; ❑0.2 g.p.h. ❑ Yes ® No* Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ® No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? ® N/A ❑ 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 ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions ® N/A or fails a test? ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? ® N/A ® Yes ❑ No* 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: 91 premium LLD failed testing. unable to connect to the 87 LLD's. Page 3 of 3 UN-036—1/4 www.unidoes.org Rev.01/26/06 ALARM H I STORY REPORT ALARM HISTORY REPORT ---- IN-TANK ALARM ----- IN-TANY ALARM T 2:87 MAIN TANK T 1 :91 SETUP DATA WARNING AUG 3, 2010 3: 13 Pfl ALARH HI STt-%RY R'Ef.:'ORT S.E T U P E*)TH b)HRIIJING LIG 0, 2010 3:09 Pfl "'i"'STEI'l AUC; 3, 2010 1 :21 P11 AUG 3, 2010 3:0'2 PM S H AUG 3, 20 10 1 : 10 PM PAPER OUT r"'I U G 3�- 2010 cA:224 AM HIGH WATER ALARM NOV "1 , 2010 3:06 Pt"I AUG 3. 2010 2:226 Pm PR I LATER ERROR LO(-J PRODUCT ALARM NOV 21 , '2010 3:06 P11 NOV 24. 2010 2:56 PM LO(..J PRODUCT ALARM BATTERY IS OFF NOV 22, --,Olo x3:43 All NOV 17, 2010 49 P11 JAN 1 1996 AM OCT 2.- 201 IJ 9:24 All OCT 22, 2010 3:20 PH SEP 28,3, 2010 3:00 Pfl I NVAL I D F UEL L0 EL AUG 3, 2010 3:31 Ptl I NVAL I D FUEL LEVEL AUG 3, 2010 2:50 Pm NOV 17. '_'010 "1:4 6 PH OCT 9-2, 2010 3: 19 PI-I PROBE OUT SEP '2h, 2010 2,:5e PH AUG 3.. 2010 3:28 P11 PROBE OUT AUG 3. 2010 1 .14 P111 A LIG 3, 2010 9:24 All AUG 3, 2010 51 P11 AUG 3, '2'010 3:'27 Pl"I END AUG 3. 2010 3:08 PH DELIVER`! NEEDED NOV '24.. 2010 12:G6 Pt I DEL I VER NEEDED NOV 21 , 2)0 10 7: 16 Ptl Y NOV 19. 21 010 2:23 P111 NOV 24.- `1010 8:33 PH NOV 17, 'G1 U 2: 16 Pt"I NOV 13, 2010 10:59 AM X END X X X END x X � ,-,LARM HISfORY REDRT ----- NSA ALARM ----- L 1 :91.27 ANNULAR ALAR11 H12•`i; REPORT ANNULAR SPACE SETUP DATA WARNING ----- SENSOR ALARP'l ----- A 3, 21010 5:24 AM L 4:87 MAIN ANNULAR ANNULAR SP�E SETUP DATA WARNING AUG 3, 2010 9:224 � ALARM H1 Y REPORT I N-TANY HLARH ----- E[AD T 3-1:-1:37 TA[-6� 2 SETUP D'" WiR 1'4 1 tlG E IAD AUG 3, 2010 2:35 P11 Au Cl' 3, 2010 22:06, PIl AUG 3, 2010 11 :49 r;ll"l HIGH [,,JATER PlLi-ARI'l AUG a, 2010 2 P11 LOW PRODUCT 110V /o. 2010 2:34 PH ALAP11 HISTO REPORT NO'v' 24, 2010 5:33 PM NOV 21 , 2010 3.04 P11 ----- �NSOR ­L`Rll ----- IN AL I D FUEL LEVEL L 2:91 TURBINE HLr`lRl"l HISTC"R", REPORT A UG 3, 2010 2:35 Pf"I STP SUMP SETUP DATA W;RNING ----- --3ENS,:)P -'LARH ----- PROBE OUT AUG 3, 2010 9:24 AM L 5:87 TURBINE STP SUMP A U C, 3' 2010 ,�_ :56 Pl"I SETUP DATA WARNING AUG 3 -1010 :3: 15 PH AUG 3, 2010 9:2-4 AM ALA �_j 2_1 0 t 0 3:09 Pill DE LIVE R'i' NEEDED NOV 30. 2010 1 :51 Pl"l NOV 27, 2010 9:38 PM NOV 24, 2010 4:44 P11 Err X E 1AE) ­LARM HICYT li REPORT ----- SENSOR �ARM ----- E 3:87 TURBINE ALARM HISITORV REPORT STP SUMP SETUP DATA WARNING ----- -"'ENSOR ALARM ----- Au 3, 2010 9:24 At"I L 6: OTHER SENSORS END * �. * * -. EN * ALARM H!STORY REPORT ALARM REPORT ----- SENS �ARM ----- ----- S E WS 0 R r"i L A R M ----- L10:3-4 UDC L13:9-10 UDC (�LiL�R['l H ISTCR", REPORT DISPENSER PA14 DISPENSER PAN SETUP DATA WARNING SETUP DATA WARNING SEN'r!,,C":,R HLARH ----- AUG 3. 2010 9:24 HM HUG 3, 2010 9:24 HP1 OTHER SENSORS X X El--iD 71. X ENE Eros ALARM HI2-',TOR'Z REPORT ALARM HISTOR'i" REPORT ALARII H! OP? REPORT ----- SENSOR ALARM ----- ----- SENSOR HLHRM ----- E14: ! !-!2 UDC ;-,EN2-',OR HLr'IRM L I I :Fj-b- UDC L 8: DISPENSER PAN DISPENSEi OTHER SENSORS SETUP DATA WARNING SETUP DATA �J`RI'411`4(3 rl AUG 3, 2010 9:24 All AUG 3, 2010 9:224 All El-Z -k END * E fID * --z ALA RII HI; ? REPORT ----- SENS� HLARIII HISTOR',/ REPORT ALARII HISTORY REPORT L 9: 1-2 UDC: DISPENSER PAN ----- SENSOR ''LAPM ----- SENS',R HLHT-I'l SETUP DATA dr'IRNING -8 UD(- L15: 1'-14 UDC L12:7 - 'ER PAN AUG 3, 2010 9:24 Hill DISPENSER PAN DISPENS SETUP IAT Wi:�RNI TUP DATA WARNItJO AUG 3, 2010 9:24 All AUG S. 112010 9:24 All END END ALAPH HISTORY PEPORT ----- SEt,1SCR 4LARI'l ----- L16: 15-16 UDC DISPENSER PAN SETUP DATA 1,J"'RNING AUG 3, 2010 9:224 AM EVE) + ALHRH HIST-DR`I' REPORT SENSOR HLAR11 L 1 :91-87 ANNULAR ANNULAR SPACE SETUP DATA WARNING AUG 3, 2010. 9:24 A41 END S/S`I'Efl SETUP - ARC", - - - - -7:42- - - - - :- PtlPm DEC, In 2010 AM 2301 F STREET BAKER S:7FIELD. C A9:3301 80146445705001 S'Y'STEll UNITS DEC 1 - 2010 7:42" AP-1 U.S. SYSTEll UiI,4GUAGE ENGLISH SYSTEM Dt�-;TE.,TP,IE FORMAT 23"i'�_lEm STATUS REPORT MON DD YYll.'Y HH:I,,Irl:SS x[,l — — — — -- — — — — — — — ALL FUNC_'TIO IS N_iRMAL ARCO AMP11 SETUP 2301 F STREET — — — — — — — — I f`A,'Et4'fOP'Y` REPORT BAKERSFIELD, CA93301 8014644570500I PORT T 1 :191 SHIFT TIME I DISABLED VOL UflE = 12247 GALS SHIFT TIME 21 DISABLED COMI'l BOARD 22 ULLAGE = 9 122 GALS SHIFT TIME :3 DISABLED BAUD RATE 9600 90% ULLAc,E= 8085 C4ALS SHIFT TIME 4 D ISABLED PAP I TY NONE TC %)C*,LL4-,iE = 1243 GALS STOP BIT I STOP HEIGHT = 21 -80 INCHES TANK PERIODIC, WARN[[.ICS DATA LENGTH: 8 DATA WATER 'vViL = 0 G A LS DISABLED WATER = 0.CIO 11,41_:HES TANK ANNUAL IJARNINGS TEMP = 63.7 DEG F DISABLED REC".EIVER SETUP: LINE PERIODIC t,JHR[lINGS DISABLED NONE T 1:87 tlAli,i TANK LINE ANNUAL L-Jh'RNiNGS VOLUME = 55122 GALS DISABLED ULLAGE = 14191 GALS 90% ULI_AC3E= 1'22'20 GALS PRINT TC VOLUMES TC V,,lUt­lE = 5512 GALS ENABLED HEIGHT = 38.04 INCHES WATER VOL = 0 GALS TEMP COMPENSAT TON WATER = 0.00 INCHES VALUE (DEG F ) : 60.0 TEP•P = E,9.9 DEG F STICK HEIGHT OFFSET DISABLED T 3:87 THHY H—PFI,'�TOCOL DATA FORMAT AUTC1 DIAL TlIlE SETUP: VOLUME = 2016 GALS HEIGHT ULLAGE = 8353 GALS DA%''LIGHT SAVING TIME NONE 90% ULLAGE= 7316 GALS ENABLED TC VOLUME = 2016 GALS START DATE HEIGHT = 30.09 INCHES MAR WEEK 3 SUN WATER VOL = 0 GALS START TIME WATER = 0.00 INCHES 2:05 AM TEMP = 59.4 DEG F ENE) DATE NOV WEEK I SLIN END TIME MA111FOLDED TANKS 2:00 AM I NVENTORY TOTALS T 2'8' tlAIN TANI" RE—DIRECT LOCAL PRINTOUT T 3'87 TANI 2 DISABLED ES-232 SECURITY VOLUME = 752CI GALS CODE : 000000 Ti: VOLUME = 7528 _'.HLS SYSTEM SECURITY CODE : OOOOOCI x lk < PID -*z 'I, ENO OF t9ESSI;1GE DISABLED AUTO DIAL ALARM SETUP - - - - - - - - - - - - T 87 TANK 2 PRODUCT CODE 1 N-TAP-Jl' SETUP THEPHHL COEFF : .000700 - - - - - -- -- - - - - - T 2:87 MAIN TANK TANK DIAMETER 117.00 PRODUCT CODE 2 TANK PROFILE 4 PTS T 1 :91 THERMAL f"OEFF : .0013700 FULL VOL 10369 PRODUCT CODE I TANK DIAMETER 117.00 87.8 INCH VOL 8460 THERMAL f-7c+EFF : .000700 TANK PROFILE 4 P T S 50.5 1 NCIIH VCL 5199 TANK DIAMETER 117.00 FULL VOL 19703 29.3 1 Nl'.,H VOL 1933 TANK PROFILE 4 PTS 87.8 INCH VOL 15948 FULL 0--)L 10369 58.5 INCH VOL 9879 8''7.8 INCH VOL 8472 29.3 INCH VOL 3801 FLOAT SIZE: 4.0 IN. 6496 58.5 INCH VOL 5199 2 2,0 WATER WARN I N(-�9.3 INCH VOL 1933 FLOAT SIZE: 4.0 IN. 8436 HIGH iJATER LIMIT'. FLOAT SIZE: 4.0 111. 8496 IJHTER Wr"IRN I NG 2.0 ll OR LABEL VOL: 10369 HIGH WATER LIMIT: 3.0 OVERFILL LIMIT 130% WATER WARN 1116 1.0 9332 ' HIGH WATER LIMIT: 3.0 lllk�" OR LABEL VOL: 1970!3' HIC,H PRODUCT 95% OVERFILL LIMIT 90;4 9850 MA, OR LABEL VOL; 10369 17739 DEL I VERI. L I("I I T 10% J ERFILL LIMIT HIGH PRODUCT 95% 90%� 1036 93:32 18718 HIGH PRODUCT 95`%: DELIVERY LIMIT 10% LOW PRODUCT Soo 9850 1970 LEAK ALARM LIMIT: 99 DELIVERY LIMIT 101.1 SUDDEN LOSS LIMIT: 99 1036 LOW PRODUJ- 800 TANK TILT 2.35 LEAK ALARM LIMIT: 99 LOW PRODUCT Boo SUDDEN LOSS LIMIT: 99 flANIFOLDED ThtlKS LEAK Al-(�PH LIMIT: 99 TANK TILT 1 .75 T#: 02 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 t1ANIFOLDED TA1'4K---, T#: 03 LEAK MIN PERIODIC: 5?-. MANIFOLDED TANKS i7l 2592 TO' NONE LEAK M11-4 PERIODIC: 25% LEAK MIN ANNUAL 2 5�S • 4925 59q LEAK H I N PERIODIC: "25% '-'59'2 LEAK MIN ANNUAL 25 49''25 PERIODIC TEST T'f"PE LEAK Mll'-1 ANNUAL STANDARD '259'2 PERIODIC TEST TYPE ANNUAL TEST FAIL STANDARD ALARM DISABLED PERIODIC, TEST T"1'?E STANDARD S ANNUAL TEST FAIL PERIODIC TEST FAIL ALARM DIP,14BLED ALARM DISABLED ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL GROSS TEST FAIL ALARM DISABLED ALARM DISABLED PERIODIC TEST FAIL * P hLrlR(l DISABLED GROSS TEST FAIL ANN TEST AVERAGING: OFF ALARM D I Sr"'iBLED PER TEST A�.,'ERAG I 11G: OFF GROSIB TF-ST FAIL ALARM DISABLED ANN TEST HVERAGING: OFF TANK TEST NOTIFY: OFF PER TEST AVERAGING: OFF r;*INIU TEST AVERAGINk-4: OFF TNK TST SIPHON BREAh:0-FF PER TEST AVERAGING: OFF THNN TEST 14OTIF" OFF TNK TST SIPHON BREAK:OFF DEL I'v'ERl' DELA'i" : 5 M I t"i TANK TE,�31* N'.TI FY: OFF Tf,11" TST SIPHON BREAK:OFF DEL I VERY DELA"x' : 5 M I I'l DELIVERY DELA'-z' : 5 11 IN LIQUID SENSOR SETUP - - - - - - - - - - - - OUTPUT REL---%)-' SE'rup• -- - -- - - - - - - - - - L 1 1-,'tA,7 ANNULAR TR I -STATE (S I NGLE FLOAT) R 1 :91 SHUTDOWN CATEGORY .: ANNULAR SPACE T"..'PE: STANDARD NORMALLY CLOSED L TURBIllE TPi-STATE (SINGLE FLOAT' I ALHE.-f-IS CATEGOR"' : STP SU11P T I :HIGH WATER ALARM T 1 :LOW PRODUCT ALARM L 3.87 TURBINE LIQUID SENSOR ALMS TRI-;'-',TMTE (SINGLE FLOAT) ALL:FUEL ALARM CATEGORY : STP SUMP ALL:SENSOR OUT ALARM ALL:SHORT ALARM L 4:87 MAIN ANNULAR R 2:87 MAIN SHUTDOi,,JN TRI-STATE ,SINGLE FLOAT) TYPE: CATEGORY : ANNULAR SPA,:--'E STANDARD LEAK TEST METHOD NORMLiLLY C-71-CISED - - - - - - - -- - - - - TEST ON DATE : ALL TANK SAN I � 1996 L 5:87 TURBINE N-TANK TRI-STATE (SINGLE FLOAT) T 2:HIGH WATER ALARl,l ST'RT TIME DISABLED TEST RATE 0.220 G'AL. 'HR CATEGOR`/ : STF, SUMP T 2:LOtJ PRODUCT ALARM DURATION 21 HOUR: LIQUID SENSOR HLI%lrC L 9: t­2 UDC ALL:FUEL ALARM TR I-;ST�.)TE (SlfJGLE FLOAT) ALL:SENSUR OUT ALARM LEAK TEST REPC)PT FORMAT G TEC,'O'PY : DISPENSER PAN ALL:SHORT ALARM NORMAL R :3:8�7 TANK 2 SHUTDOWN TYPE: LI0:3-4 UDC STANDARD TRI-STATE (SINGLE FLOAT) NORMALLY CLOSED CATEGORY : DISPENSER Pr-'IN I 14-TANK ALARMS T 3:Hlk-"H WATER ALARM L 1 :5-6 UDC T 3:LOW PRODUCT ALARM TRI-STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAI4 LIOUID SENSOR ALMS ALL:FUEL ALARM ALL:oENSOR OUT ALARM ALL:SHORT ALARM L I'--':7-8 UDC TRI-STATE (SIN(iLE FLOAT) CATEGORY : DISPENSER PAN L13:9-10 UDC TRI-STATE (.SINGLE FLOAT) CATEGORY DISPENSER PAN 1-14: 11-12 UDC TRI-STATE (SINGLE FLOAT) CATEGORY DISPENSER PAN SOFTWARE REVISION LEVEL VER��I�jt.4 1.5.1il" SOFTWAREa 346ciII71-100-B CREATED - 97. 10._'3.08.5b L15:13-14 UDC TRI-STATE (SINGLE FLOAT) NO SOFTWARE MODULE CATEGOPI/ DISPENSER PAN SYSTEM FEATURES: PERIODic,. IN-TAN)" TESTS' ANNUAL IN-TANK TESTS 1-16: 15-16 LIDO TRI-STATE FLOAT) CATEGOP'i DISPENSER PAN 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: Arco Am-Pm I Date of Testing: 12/01/10 Facility Address: 2301 "F°'Street,Bakersfield,CA. 93301 Facility Contact: Kamal I Phone: 661.303.7961 Date Local Agency Was Notified of Testing: 11/24/10 Name of Local Agency Inspector(if present during testing): Ernie Medina 2. TESTING CONTRACTOR INFORMATION Company Name: Redwine Testing Services Inc. Technician Conducting Test: Jerry Rangel Credentials': CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other(Specify) License Number(s): ICC:5309489-UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic Vacuum Other Test Equipment Used: Measuring tape Equipment Resolution: '/a inch Identify Spill Bucket(By Tank 87 slave fill 87 master fill A 87 master fill B 91 rill Number, Stored Product, etc.) Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury X Contained in Sump X Contained in Sump X Contained in Sump X Contained in Sum Bucket Diameter: 12" 12" 12" 12" Bucket Depth. 14" 14" 14" 14" Wait time between applying vacuum/water and start of test: 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time(TO: 1:00 pm 1:00 pm 1:00 pm 1:00 pm Initial Reading(RI): 9" 9" 9" 9" Test End Time(TF): 2:00 pm 2:00 pm 2:00 pm 2:00 pm Final Reading(RF): 9" 9" 9" 9" Test Duration(TF—Tj): 1 hour 1 hour 1 hour 1 hour Change in Reading(RF-RO: one None None None Pass/Fail Threshold or No drop No drop No drop . No drop Criteria: TestR ult SIN W&N XP F l�NOV*s `Fail XtP F X Pa s Fa►14 Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) 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: Date:-12/01/10 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However,local requirements may be more stringent.