HomeMy WebLinkAboutMONITORING SYSTEM CERTIFICATION 10-5-10 17 MONITORING SYSTEM CERTIFICATION Pam
IE 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: Chevron Bldg.No.:
Site Address: 2525 White Lane City: Bakersfield Zip: 93304
Facility Contact Person: Gaby Jabbour Contact Phone No.: 805-444-4229
Make/Model of Monitoring System: Veeder-Root TLS 350 Date of Testing/Servicing: 10/5/2010
B. Inventory of Equipment Tested/Certified
Check the appropriate boxy to indicate specific equipment inspected/serviced:
Tank ID:_12000 gal. Regular Tank ID: 12000 gal.Super
[x] In-Tank Gauging Probe. Model:847390-107 [x] In-Tank Gauging Probe. Model:847390-107
[x] Annular Space or Vault Probe. Model:Ronan [x] Annular Space or Vault Sensor. Model: Ronan
[x] Piping Sump/Trench Sensor(s). Model:794380-208 [x] Piping Sump/Trench Sensor(s). Model: 794380-208
❑ 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:PLLD U Electronic Line Leak Detector. Model: PLLD
U Tank Overfill/High Level Sensor. Model:oPW-61-So U Tank Overfill/High Leval Sensor. Model: OPW-6I-SO
❑ 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: 12000 gal. Diesel Tank ID:
[x] In-Tank Gauging Probe. Model:847390-107 ❑ In-Tank Gauging Probe. Model:
[x] Annular Space or Vault Sensor. Model:Ronan ❑ Annular Space or Vault Sensor. Model:
[x] Piping Sump/Trench Sensor(s). Model:794380-208 ❑ Piping Sump/Trench Sensor(s). Model:
❑ Fill Sump Sensors(s). Model: [I Fill Sump Sensor(s). Model:
❑ Mechanical Line Leak Decector. Model: ❑ Mechanical Line Leak Detector. Model:
[x] Electronic Line Leak Detector. Model:PLLD ❑ Electronic Line Leak Detector. Model:
[x] Tank Overfill/High Level Sensor. Model:OPW-6I-SO ❑ Tank Overfill/High Level Sensor.Model:
❑ 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: 1 &2 Dispenser iD: 3&4
❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model:
[X] Shear Valve(s). [X] Shear Valve(s).
[x] Dispenser Containment Float(s)and Chain(s). [x] Dispenser Containment Float(s)and Chain(s)
Dispenser ID: 6&6 Dispenser iD: 7&8
❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model:
[xj Shear Valve(s). U Shear Valve(s).
[x] Dispenser Containment Float(s)and Chains(s). [X] 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 -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 U Alarm history report
Technician Name(print): Kristopher Karns Signature:. 15A
Certification No: 834106 License No:804904
Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930
Site Address: 2525 White Lane,Bakersfield,CA 93304 I IIII I VIII III IIII 18 _Date of Testing/Servicing: 10/6/2010
IE
D. Results of Testing/Servicing
Software Version Installed: 329.01
Complete the following checklist:
[x] Yes ❑ No* Is the audible alarm operational?
x Yes No* Is the Vi—sual alarm operational?
x Yes No* Were all sensors visually inspected,functionally tested,and confirmed operational?
x I 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?
Ix I 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? Sump/Trench Sensors❑Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? U Yes; ❑ No;
Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no
U 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? %
❑ 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?
❑ Product; [x] Water. If yes,describe causes in Section E,below.
Tx No* Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports, if applicable.
x Yes 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:
Removed 1/4 gallon of water from the Regular STP sump.
I repaired the Regular float and chain in dispenser 45-6,and retested it and it was confirmed operational.
All tanks are equiped with OPW-6I-SO flapper valves'.
F. In-Tank Guaging/SIR Equipment: N 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:
❑ Yes ❑ No* Has all input wiring been inspected for proper enter and term ination,including testing for ground faults?
x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
x Yes No* Was accuracy of system product level readings tested?
x Yes No* Was accuracy of system water level readings tested?
[_[xl Yes No* Were all probes reinstalled properly?
xL] 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.
G. Line Leak Detectors (LLD): ❑Check this box if LLD's are not installed.
Complete the following checklist:
[x] 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.: 00.1 g.p.h.; 00.2 g.p.h.;
x Yes No* Were all LLD's confirmed operational and accurate within regulatory requirments?
x Yes No Was the testing apparatus properly calibrated?
❑ Yes No* For machanica LLD's,does the LLD restrict product flow if it detects a leak?
Hx N/A
[x] Yes No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak?
❑ N/A
❑ Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is
❑ N/A disabled or disconnected?
[x] Yes 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 No* For electronic LLD's,have all accessible wiring connections been visually inspected?
❑ N/A
• 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.
H. Comments:
SYSTEM SETI.II:'
WHITE LHNE C:HE%+,0N OCT 5. 2010 8:49 AM
2525 WHITE LANE
BAKERSFIELD '.A 93304
6bt-832-9781 j
SYSTEM UN17B
OCT 5 2010 8:49 AM 1
WHITE LriNE �:HE'-F'{iPl . U.S.
2525 WHITE L;-+NE SYSTEM LANGUAGE
BAKERSFIELD CA 93304 ENGLISH
661-632-9761 SYSTEM STP`'D_v.; REPORT SYSTEM DATE TIME F
hiON DD YY`,'Y HH:1111:SS Sy :4T
;:hl
- -
O,;T 5. 2010 73:48 A"' T t :DELIVER'! NEEDED
WHITE LANE CHEVRON
2525 WHITE LANE
INVENTORY REPORT BAKERSFIELD CA 93304
SYSTEM G;TATUS REPORT 661-632-9781
T 1 :p$41VEF IlEEDEU T ] ;DIESEL SHIFT TIME 1 DISABLED
SHIFT TIME 2 DISABLED
VOLUME 1159 GALS SHIFT TIME 3 DISABLED
INVENTORY REPORT ULLAGE - 10863 GALS SHIFT TIME 4 DISABLED
90% ULLAGE- 9660 GALS
Ti: VOLU11E = 1142 GALS TANK PER TST NEEDED WRN
T 1 :DIESEL HEIGHT = 16.88 INCHES DISABLED
1159 GALE; WATER VOL a 0 GALS TANK ANN TST NEEDED WRN
VOLUME 1�tATER 0.00 INCHES
ULLAC,E ° 1OB6- GALS a DISABLED
c ULLAGE6 9660 GALS TEMP 91 .3 DEG F
T�_ VOLUME - 1142 GALS LINE RE-ENABLE METHOD
HE1C;HT - !o.a8 INCHES T 2:6UPREhIE PASS LINE TEST
WATER v='L 0 GALS
WATER 0.133 INr_.HE9 VOLUME _ 3141 GALS LINE PER TST NEEDED WRN
TEMP 91 .:3 F'E1- F ULLAGE BNtJ i GALS DISABLED
90% ULLAGE- 7678 GALS L114E ANN TST NEEDED WRN
TC VOLUME = 3080 GALS DISABLED
:SU1'RES1E HEIGHT - 34.10 INCHES
3141 Gi4LS' WATER VOL - 13 GALS PRINT TG VOLUMES
VOLUm WATER o 0.81 INCHES
ULLAGE a 8681 �'ALS TRIP a 87.3 DEG F ENABLED
90sc u"A'� E- 7678 GALS TEMP COMPENSATION
TC VOLUME = 3060 GALS VALUE (DEG F 1 : 60.0
HEIGHT n 34.10 1NCHES T 3:REGULAR
WATER VOL - 13 GALS = STICK HEIGHT OFFSET
WATER - 0.81 INCHES VOLUME 5486 GALS DISABLED
TEMP ° d7.3 DEG F ULLAGE
94 ULLAGE- 5331 GALS ULLAGE: 901
T(,' VOLUME - 5376 GALS H-PROTOCOL DATA FORMAT
T 3:PEGULAP. HEIGHT = 51 .69 INCHES HEIGHT
�U3:PE 54138 GALS WATER VOL = 0 GALS PRECISION TEST DURATION
ULLAGE ° 6534 GALS WATER 0.00 INCHES HOURS: 12
TEMP = 818.3 DEG F DAYLIGHT SAVING TIME
90% ULLh •I.- 5331 GALS ENABLED
TC VOLUI•tE 5378 GALS START DATE
HE 1 GHT 51 .69 INCHES r; � x * END � � � � � MAR WEEK 2 :�IN
WA'f ER VOL - D GALS
WATER = 0.00 1VICHE': START TIME
TEI°1P ° B6.3 PEG F 2:00 Am
END DATE
NOV WEEK I SUN
ENP END TIME
2:00 AM
RE-DIRECT lj.)C:L PRINTOUT
DISABLED
EURO PROTOCOL PREFIX
S
YSTEM SECURITY COMr1UNICATIOWS SETUP - - IN-TANK SETUP
ODE : 000000 - - - - -
AINTENANCE HISTORY T ( :DIESEL
PORT SETTINGS: PRODUCT CODE t
15ABLED
THERMAL COEFF : .000450
COMM BOARD : I (RS-232) TANK DIAMETER 111 .00
'ANY, CHART SECURITY BAUD RATE 4600 TANK PROFILE 4 PTS
)ISABLED PARITY EVE14 FULL VOL 12022
STOP BIT : I STOP 83.3 INCH VOL 9677
DATA LENc-TH: 7 6RTf; 55.5 INCH VOL ; 6011
USTOM ALARMS RS-232 �:El::IJR I TY 27.8 INCH VOL 2357
D 1 BAWLED CODE : 1�I�iv,bLFP
COMM BOARD :EDIM r FLOAT SIZE: 4.0 IN.
ER�)1 C E P)071 CE RS-232 SECUR I TY
S
S 1 SABLEC� r'^DE : D 1 SMBLE6 WATER WARNING 2.0
HIGH WATER LIMIT: 3.0
C" BOAR[) w t FS-485)
ISO 3lbo GOUN7RY BAUD RATE x'400 MAX OR LABEL VOL. 12022
PARITY EVEN +'1'Jt,t. LIMIT 90,
CODE: STOP SIT I STOP 10819
DATA LENGTH: 7 DATA T 95%
MASS!DENSITY RS-232 SECURITY 11421,
DISABLED CODE : DISABLED t11T 124
COMM BOARD 6 (IZ3-232) 1442
BAUD RATE : 1200 LOW PRODUCT 500
PARITY : ODD LEAK. ALARM LIMIT: 32
STOP BIT : I STOP SUDDEN LOSS LIMIT: 2S
DATA LENGTH: 7 DATA TANK TILT 3.70
RS-232 SECURITY PROBE OFFSET 0.00
CODE : DISABLED
SIPHON HAN I FOLO1 L, TANVS
AUTO TRANSM17 SETTINGS: Tit: NONE
L 119E MAN i FOLDED TANKS
HUTO LEAK ALARM LIMIT Td: NONE
DISABLED
AUTO HIGH WATER LIMIT
DISABLED LEAK MIN PERIODIC': 0X
ALTO OVERFILL LIMIT 0
DISABLED
AUTO LOW PRODUCT LEAK MIN ANNUAL : 0•�
DISABLED 0
AUTO THEFT LIMIT
DISABLED
AUTO DELIVERY START PERIODIC TEST TYPE
DISABLED STANDARD
AUTO DELIVERY END
DISABLED ANNUAL TEST FAIL
AUTO EXTERNAL INPUT ON ALARM DISABLED
DISABLED
AUTO EXTERNAL INPUT OFF PERIODIC TEST FAIL
DISABLED ALARM DISABLED
AUTO SENSOR FUEL ALARM
DISABLED �° GROSS TEST FAIL
AUTO SENSOR WATER ALARM ALARM DISABLED
DISABLED
AUTO SENSOR OUT ALARM ANN TEST AVERAGIM3: OFF
DISABLED PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY 1 MIN
PUMP THRESHOLD 10.O0k
RS-232 END OF MESSAGE
DISABLED
T ` :SUPREh1E L I NE 1.444 I F��LDkE
PRODUCT CODE 2 TO'. WC iN£
THERMAL COEFF : .000700 T 3:REGULAR
TANK DIAMETER 111 .00 PRODUCT CODE 3 LEAK MIN PER IOE'i' I°
TANK PROFILE 4 PTS THERMAL COEFF : .000700 �
FULL VOL 12022 TANK DIAMETER 111 .00
83.3 114CH VOL 9677 TANK PROFILE 4 PTS LEAK MfN ANtluAL '
55.5 INCH VOL 6011 FULL VOL 12022 0
27.8 INCH VOL 2357 83.3 INCH VOL 9677
55.5 INCH VOL 6011
27.8 INCH VOL : 2357 pgR1pD[C TEST TYPE
FLOAT SIZE: 4.0 I1q. STANDARD
WATER WARNING 2.0 FLOAT SIZE: 4.0 IN. ANNUAL TEST FAIL
HIGH WAT17-R LIMIT: 3.0 ALARM DISABLED
WATER WARNING : 2.0
1-6 %A,, LH1itL VOL: 120'22 HIGH WATER LIMIT: 3.0 PERIODIC TES( FAIL
i�rLl 1'ILL L 11M IT 90i: ALARM DISABLED
10819 MAX OR LABEL VOL! 12022
ri[GH PRODUCT 95% OVERFILL LIMIT 90h GROSS TEST FAIL
11421 10819 ALARM DISABLED
DELIVERY LIMIT 12% HIGH PRODUCT 95%
1442 11421 ANN TEST AVERAGING: OFF
DELIVERY LIMIT 12% PER TEST AVERAGING: OFF
LOW PRODUCT 500 14.12 OFF
LEAK ALARM LIMIT' 32 TANK. TEST NOTIFY:
SUDDEN LOSS LIMIT: 25 LOW PRODUCT : 500
TANK TILT 2.00 LEAK ALARM LIMIT: TNK TST fiIFHON BREAK:OFF
PROBE OFFSET 0.00 SUDDEN LOi,'S LIMIT'
TANK TILT DELIVERY DELA'1 3 MIN
PROBE OFT' PUMP THRESHOLL, 1O.00�s
SIPHON MAIM I FOLDED TANK'S
TO: NONE
LINE MANIFOLDED TANKS -
TO: NONE
LEAK MIN PERI DIi,•: 0%
0
LEAK HIN HNNUHL 0%
0
LEAK TEST mETHOD _
PERIODIC TEST TYPE ALL TANK
STANDARD TEST ON DATE
JAN 29, 2009
ANNUAL TEST F�I L START TIME : I'I•-,;ULED
Al,tiRl 7 DISABLED TEST RATE - � :"LIAR
DURATION RvURS
PERIODIC TEST FAIL
ALARI'l DISABLED TST EARLY t. 1 :U I SABLEU
CROSS TEST FFO L LEAK TEST REPORT FORMAT
ALARM D1St'BLED NORMAL
AN14 TEST AVEPA C�1 1Ck : OFF
PER TEST AVERA: I NG: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY 3 MIN
PUMP THRESHOLD 10.00:
LINE LEAK LOCKOUT SETUP f PLLD-LINE DISABLE-SETUP
P.F'1tiUFE LINE L,Iit�1, ak'1'IIP - - _ _ _ - - - - - - - -
- - - - - - - LOCKOUT SCHEDULE G I :DIESEL
DRILY
START TIME: DISABLED IN-TANK ALARMS
t :Li 1 E:E1 STOP TIME D 1 SASLED i T 1 :HIGH WATER ALARM
TVP:2.0/3.01 I I i i bEPGL ASS T, 1 :LOW PRODUCT ALARM
2.01N DIA LEN: 180 FEET LIQUID SEI4SOR ALMS
3.0114 DIA LEN: 0 FEET L 1 :FUEL ALARM
L 2:FUEL ALARM
SHUTDOWN RATE: 3.0 GPH L I :SENSOR OUT ALAR11
LOW PRESSURE SHUTOFF:NO L 2:SENSOR OUT ALARM
LOW PRESSURE : 0 PSI L I :SHORT ALARM
L 2:SHORT ALARM
T I :DIESEL L 2:HIGH LIQUID ALARM
DISPENSE MODE: Q 2:SUPREME
STANDARD LIQUID SENSOR SETUP 1pp SENSOR: HIGH PRESO.OPSI - - - - - - - - - - - _ IN-TANK ALARMS
PRESSURE OFFSET: T 2:HIGH WATER ALARM
L I :DIESEL AI4N T 2:LOW PRODUCT ALARM
NORMALLY CLOSED
CATEGORY : A14NULAR SPACE LIQUID SENSOR ALMS
L 3:FUEL ALARM
L 4:FUEL ALARM
L 2:DIESEL STP L 3:SENSOR OUT ALARM
TRI-STATE (SINGLE FLOAT) L 4:SENSOR OUT ALARM
CATEGORY : STP SUMP L 3:SHORT ALARM
L 4:SHORT ALARM
L 3:SUPREME ANN ; ISD SITE ALARMS
0 2:SUPREME NORMALLY CLOSED ISD GROSS PRES FAIL
CATEGORY : ANNULAR SPACE ISD DEGRD PRIES FAIL
TYP:2.Of3.01N FIBERGLASS ISD VAPOR LEAK FAIL
2.0114 DIA LEN: 180 FEET ISD VP PRIES FAIL
3.01N DIA LEN: 0 FEET L 4:SUPREME STP ISD HOSE ALARMS
TRI-STATE (SINGLE FLOAT( ALL:GROSS COLLECT PHIL
SHUTDOWN RATE: 3'.0 GPH CATEGORY : STP SUMP ALL:DEGRD COLLECT FLAIL
LOW PRESSURE SHUTOFF:1'10 ALL:FLOW COLLECT FAIL
LOW PRESSURE 0 PSI 0 3:REGULAR ANN
T 2:SUPREME L NORMALLY CLOSED
DISPENSE MODE: NORMALLY CLOSED IN-TANK ALARMS
STANDARD CATEGORY ANNULAR SPACE T 3:HIGH WATER ALARM
SENSOR: HIGH PRESSURE T 3:LOW PRODUCT ALARM
PRESSURE OFFSET: O-OPS' LIQUID SENSOR ALMS
L 6-STATEAk 5TP L S:FUEL ALARM
TRI-STATE {SINGE£ FLOATS I
CATEGORY OTHER SENSORS L 6:FUEL ALARM L 5:SENSOR OUT ALARM
C L 6:SENSOR OUT ALARM
L 5:SHORT ALARM
L 6:SHORT ALARM
L 6:H1GH LIQUID ALARM
ISD SITE ALARMS
ISD GROSS PRES. FAIL
ISD DEr.RD PRG. FtA I I
to 3:REGULAR ISD VF&oi? LEA(' rii I L
I SD VP PRIES FA I L
2, FIBERGLASS
.OIN DIA LEN: 180 ISD HOSE ALARMS
ALL_:GROSS FAIL.
3.01 N DIA LEN: G FEET ALL:DEGRD +:'r Ll I,+ I Fr;I I.
ALL:FLOW +:ULI.t;'1 I:+IL
LOW PRES SURE E
SURESHUTC'rFCNO
LOW PRIES 01-.1
'1' 's:k
D I SI ErtSE MODE:
Sl riNLIARE0
SENSOR: HI;H FRI' e:URE
PRESSURE QFFSET: 0-UPS 1
SMARTSENSOR SETUP EVR:ISD SETUP PMC SETUP
- - - - - - - - - - - PMC VERSION. 01 .02 _
s 1:PRESS SENSOR EVR TYPE: BALAN+:F. VAPOR PROCESSOR TYPE
CATEGORY VAPOR PRESSURE VEEDER-ROOT POLISHER
BALANCE NOZZLE TYPE
s 2:CANISTER VST
CATEGORY VAPOR VALVE
VAPOR PROCESSOR TYPE
s 4:FM 1-2 VEEDER-ROOT POLISHER
CATEGORY AIR FLOW METER
s 5:FM 3-4 ANALYSIS TIMES
CATEGORY AIR FLOW METER TIME: 10:00 All
DELAY MINUTES: 2
s 5-6:Fhl SOFTWARE REVISION LEVEL
ti
VERSION 32
CATEGORY AIR FLOW METER 100-B
ACC 34632 EPT HIGH URVR: SOFTWAR£q 3a63..9-
s 7:FM 7-8 DISABLED CREATED - 09.01 .29.15.44
CATEGORY AIR FLOW METER !SD HOSE TABLE S-MODULE0 330160•-004-4
e 8:ATMP PRESSURE 10 FP FL HI_ AH RR SYSTEM FEATURES:
CATEGORY ATM P SENSOR ------------------------ PERIODIC IN-TANK TESTS
Ol 00 01 02 01 UU ANNUAL 1N-TANK TESTS
02 01 02 02 01 UU !SD
03 02 03 02 0" UU
04 03 04 02 02 UU
05 04 05 02 03 UU
06 05 06 02 03 UU
07 06 07 02 04 UU
08 07 08 02 04 UU
ISD AIRFLOW METER MAP
!D SERIAL NUM LABEL
------------ _______ ALARM HISTORY REPORT
1 36974 FM 1-2 _____ SENSOR ALARM -----
3 36687 FM 3-4 L I :DIESEL ANN
3 36611 FM 5-6 ANNULAR. SPREE
a 36598 FM 7-3
ISD FUEL GRADE HOSE MAP
t 2 3 4
FP MHH MHH MHH MHH AA
00 401 501 901 U U 1
01 402 502 902 U U 1
03 403 503 903 0 U 2
03 404 504 904 0 U 2 EWD "
x
04 405 505 905 U U 3
05 406 506 906 U U 3
06 407 507 907 0 U 4
07 408 508 908 0 U 4
LABEL TABLE
------------------------
1 : UNASSIGNED
2: BLEND3
3: REGULAR ALARM HISTORY REPORT
4: MID GRADE
5: PREMIUM -- SENSOR ALARM
6: GOLD
7: BRONZE L 2:DlESEL STP B: SILVER STP SUMP
9: BLEND2
10: BLENDS
'r. END ri t
ALARM HISTORY REM{:PT ALARM HISTORY REPORT
ALARM HISTORY REPORT
----- SENSOR ALARM ----- ----- SENSOR ALARM -----
----- SENSOR PLARM --- L 6:REGULAR STP Q 3:REGULAR
L 3:SUPREME ANN OTHER SENORS
ANNULAR SPACE
x K R END x x x d o
u �: xxk END rixxhx
;< t ,t R END - r
PRESSURE LINE LEHI:
ALARM HISTORY REPORT G 3:REGULAR
ALARM HISTORY REPORT PLLD SHUTDOWN A!J;kM
---- SENSOR ALARM ----- OCT 5. 2010 4:12 AM
----- SENSOR. ALARM ----- G I :DIESEL
L 4:SUPREME STP PLLD SHUTDOWN ALARM
STP SUMP SEP 10. 2010 12:35 Phl
CROSS LINE FAIL
SEP 10. 2010 12:35 PM
PLLD SHUTDOWN ALARM ----- SENSOR. ALARM -----
AUC 27. 2010 4:20 PM L 6:REGULAR STY'
OTHER SENSORS
x > R A END x x ► x X FUEL ALARM
CROSS LINE FAIL OCT 5. 2010 9:12 AM
AUG 27, 2010 i:^n FM
PRESSURE LINE LEAK ALARM
ALARM HISTORY REPORT O 2:SUPREME
PLLD SHUTDOWN ALARM
----- SENSOR i4LARI-1 ----- x x k x END x �k X A OCT 5, 2010 3:12 AM
L 5:REGULAR ANN
ANNULAR SPACE
-- SENSOR ALARM -----
L 4:SUPREME STP
t a A ALARM H I STOR`: K-0 oRT STP SUMP
FUEL ALARM
----- SENSOR ALARM ----- OCT 5. 2010 9:12 AM
Q 2:SUPREME
PRESSURE LINE LEAK ALARM
x * * x x END A t id I :DIESEL
PLLD SHUTDOWN F+[-ARM
OCT 5. 2010 9:13 AM
----- SE14SOR ALARM --- ----- SENSOR ALARM ----- WHITE LANE CHEVRON
L 2:DIESEL STP L S:REGULHR ANN 2525 WHITE LANE
STP SUMP ANNULAR SPACE 9AIiERSFIELD �A 93304
FUEL ALARM FUEL ALARM 661-632-9781
OCT 5. 2010 9:13 AM OCT 5. 2010 9: 15 AM
OCT 5, 2010 9: 17 AM
SYSTEM STATUS REPORT
T 11DELIVERY NEF.UEU
L 3:FUEL ALARM
PRESSURE L I NE LEF+I: i4LARM PRESSURE LINE LEN): ALARM 0 2:PLLD SHUTDOWN ALARM
0 1 :DIESEL 0 2:SUPREME
PLLD SHUTDOWN ALARM PLLD SHUTGOW14 ALARM
OwT 5, 2010 9:14 All OCT 5, 2010 9:15 HM
----- SENSOR HLaARM ----- ----- SENSOR HLHRM ----- PRESSURE LINE LEAK :ALARM
L I :DIESEL ANN L 3:SUPREME ANN Q 3:REGULAR
ANNULAR SPA('E ANNULAR SPACE PLLD SHUTDOWN ALARM
FUEL ALARM FUEL ALARM OCT 5. 2010 9:20 AM
OCT 5, 2010 9: Ia AM OCT 5. 2010 9:tS AM
----- SENSOR ALARM -----
PRES'SURE 1-1NE LEAP ALARM WHITE LANE CHEVRON L ANNULAR ANN
0 2:SUPREME 2525 WHITE LANE ANNULAR SPACE
FUEL ALARm
PLLD SHUTDOWN ALNFM BAKERSFIELD CA 93304 OCT 5, 2010 9:20 AM
0C'1' 5. 2010 9: 14 Am 661-832-9781
OCT 5, 2010 9:17 All
SYSTEM STATUS REPORT
T t :DEL1VERY NEEDED
—�— SENSOR ALARM ----- L 3:FUEL ALARM PRESSURE LINE LEAs; ALARM
L 3:SUPREME ANN P ! :DIESEL
P
AN14ULAR SPACE 0 2:PLLD SHUTDOWN ALARM LLD SHUTDOWN ALARM
FUEL ALARM OCT 5. 2010 9:20 0 AM
OCT 5, 2010 9: I4 All
----- SENSOR HLAWl -----
PRE~:SURE LINE LEHI: ALARM L 1 :D 1
0 3:RECULAR ANNULAR R SPACE
PLLD SHUTDOWN kLARPI FUEL ALARM 20 10 9:20 AM
OCT 5, 2010 9:15 NI`I OCT 5. 20
----- SENSOR ALARM ----- ----- SENSOR ikLARM -----
L 6:REGULAR STP L I *IESEL ANN
OTHER SENSORS HNNULAR SPACE
SENSOR OUT ALARM FUEL ALARM
OC:T 5. 2010 9:20 NM OCT .5. 2010 3:21 tAM
PP.E5:5URE LINE LEAK ALAR1I
0 3:REGULAR
CROSS LINE FA I I.
OCT 5, 2010 10:uu i4-1
----- SENSOR ALARM ----- P'RES'SURE LINE LEAK ALARM
L 2:DIESEL STP 0 2:SUPREI'IE
STP SUMP PLLD SHUTDOWN Ab4RM
SENSOR OUT ALARM OCT 5, 2010 '3:!21 iHi1
OCT 5, 2010 9:20 Ali PRESSURE L.l NE LEAK ALARM
0 3:REC:ULAR
PLLD SHUTDOWN ALARM
OCT 5. 2010 10:00 Ali
----- SENSOR ALARIi -----
PRESSURE LINE LEAK. ALraRM L 4:SUPREME STP
0 2:SUPREME STP SUMP
PLLD SHUTDOWN ALARM P.EN=UR OUT ALARM
OCT 5, 2010 9:20 0411 GOT 5, 2010 9:21 AM PRESSURE LINE L.EMK ALARM
@ 2:StIPPENE
L 1 NE F,01-
i_
01'T 5. 2010 1 0:fh :M
----- SENSOR ALARM ----- WHITE LANE CHEVRON
L -1:.:I.IPREME STP 2525 WHITE LANE
STP SUMP BAKERSFIELG CA 93304
SENSOR OUT ALARM 661-832-9761 PRESSURE LINE LEAI: ALARM
O =�:SUPRFNE
OCT S. 2010 9:20 HM OCT 5. 2010 9:31 AM PLLD SHUTDOWN ALARM
OCT 5, 2010 10:03 AM
SYSTEM STATUS REPORT
—
T ] :DELIVERY NEEDED
L 1 :FUEL ALARM
---- SENSOR ALARM
L 3:SUPREME ANN L 4:2iENSC•R OUT t;LARNI
PRESSURE L I I'lE LEAK' r;LAk
ANNULAR SPACE 1°t
FUEL ALARM L 5:FUEL ALARO 0 1 :D[LIN
E FAIL
OCT 5, 2010 9:20 fll9 GROSS LIN
4a 1 :PLLD SHUTDOWN ml_�4Pfi OC'T 5, 2010 10:06 All
Q 2:PLLD SHUTDOWN
0 31 PLLD SHUTi OWI! .
PRESSURE LINE LEAK ALARM `FESSURE LINE LFil' HLARPI
0 I :G1ESEL. :DIESEL
PLLD SHUTDOWN ALARM SHUTDOWN ALARM
OCT 5. 2010 9:21 AM 010 10:06 AM
SWRCB,Januay 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: Chevron 71704te of Testing: 10/5/2010
Facility Address: 2525 White Lane, Bakersfield,CA 93304
Facility Contact: Gaby Jabbour I Phone: 805444-4229
Date Local Agency Was Notified of Testing: 9/13/2010
Name of Local Agency Inspector(f present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services,Inc.
Technician Conducting Test: Kristopher Karns
Credentials: (] 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 I Regular 2 Super 3 Diesel 4
Number, Stored Product, etc.
X Direct Bury X Direct Bury x Direct Bury ❑Direct Bury
Bucket Installation Type: ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum
Bucket Diameter: 12.00" 12.00" 12.00"
Bucket Depth: 13.50" 13.50" 14.00"
Wait time between applying 5 minutes 5 minutes 5 minutes
vacuum/water and start of test:
Test Start Time(Ti): 9:00am 9:00am 9:00am
Initial Reading(Rj): 11.00" 11.25" 11.75"
Test End Time(TF): 10:00am 10:00am 10:00am
Final Reading(RF): 11.00" 11.25" 11.75"
Test Duration(TF—Tj): 1 hour 1 hour 1 hour
Change in Reading(RF-Rj): 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625"
Criteria:
Test Result: X Pass ❑Fail X Pass ❑Fail X Pass ❑Fail ❑ Pass ❑Fail
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:„ ek,�A.� Date:_10/5/2010
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
�p� IDac
us
y�
•�P".WA+�•M - Invoice No.: 24120
Site: Chevron
2525 White Lane
Bakersfield, CA 93304
Repairs Requested:
Repairs completed: Removed '/4 gallon of water from the
Regular STP Sump. I repaired the Regular float and chain in
dispenser # 5-6 , then retested it and it was confirmed
operational.
Required Repairs, Still Pending: Further repairs are not
necessary .
Technician Name: Kristopher Karns
Signature: � j ,�.
Date: 10/5/2010