The URL can be used to link to this page

Home My WebLink AboutFMC 2010 t MONITORING SYSTEM CERTIFICATION 11111111H11111 23 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 this date. A. General Information Facility Name: SamCo Food Store#2 Bldg.No.: Site Address: 3300 White Lane City: Bakersfield Zip: 93309 Facility Contact Person: Sam Jouda/Sam Jr. Contact.Phone No.: (661)333-0000/472-9090 Make/Model of Monitoring System: Veeder Root TLS-350 Date of Testing/Servicing: 12/23/2010 B. Inventory of Equipment'Tested/Certified Check the appropriate oxes to Indicate specific equipment Inspeciedlsen9ced: Tank ID: 12000 gal. Regular Tank ID: 12000 gal.Super [X] In-Tank Gauging Probe. Model:847390-107 U In-Tank Gauging Probe. Model: 847390-107 Fx] Annular Space or Vault Probe. Model:794390-420 Fx1 Annular Space or Vault Sensor. Model: 794390-420 U Piping Sump/Trench Sensor(s). Model:794380-208 U Piping Sump/Trench Sensor(s). Model: 794380-208 [] Fill Sump Sensor(s) Model:794380-208 E Fill Sump Sensor(s). Model: 794380-208 5:1 Mechanical Line Leak Detector. Model:FX1y [X] Mechanical Line Leak Detector. Model: FX1V ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: 1x] 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: Tank ID: ❑ In-Tank Gauging Probe. Model: ❑ In-Tank Gauging Probe. Model: ❑ 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 Detector. Model: ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill/High Level Sensor. Model: ❑ 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 See.E on Pg.2) Dispenser ID: 1 &2 Dispenser ID:_3&4 . Mx Dispenser Containment Sensor(s). Model: 794380-208 U Dispenser Containment Sensor(s).Model: 794380-208 Ex-1 Shear Valve(s). U Shear Valve(s). ❑ Dispenser Containment Float(s)and Chain(s). ❑ Dispenser Containment Float(s)and Chain(s) Dispenser ID: 5&6 Dispenser ID: 7&8 U Dispenser Containment Sensor(s).Model: 794380-208 U Dispenser Containment Sensor(s).Model: 794380-208 U Shear Valve(s). U Shear Valve(s). ❑ Dispenser Containment Float(s)and Chains(s). ❑ Dispenser Containment Float(s)and Chain(s). Dispenser ID: 9-10 Dispenser ID: 11-12 U Dispenser Containment Sensor(s).Model: 794380-208 U Dispenser Containment Sensor(s),Model: 794-380-208 [x] Shear Valve(s). LX] 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 i Set-up Alarm ' ory eport Technician Name(print): Bryan A Self Signature: Certification No: B37501 License No: 804904 Testing Company Name: Confidence UST Services,Inc. Phone N : 800-339-9930 Site Address: 3300 White Lane,Bakersfield,CA 93309 _Date of Testing/Servicing: 1212312010 IIIIIIIIVIIIIIIIIII 24 IE D. Results of Testing/Servicing Software Version Installed: 329.00 Complete the following checklist: [x] Yes ❑ No* Is the audible alarm operational? x] 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 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? ❑Sump/Trench Sensors Lx]Dispenser Containment Sensors Did you confirm positive shut-down due to leaks and sensor failure/disconnected? Lx] Yes; ❑ No; U 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? 90 ❑ 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* I-1 No Was liquid found inside any secondary containment systems designed as dry systems? ❑ Product; ❑ Water. if yes,describe causes in Section E,below. Tx ye, No* Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports, if applicable. Lxj 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: F. In-Tank Guaging/SIR Equipment: E 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: U 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? x 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 LLD's are not installed. Complete the following checklist: Fx] 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: [x]3 g.p.h.: ❑0.1 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? L] Yes No* For mac amcal LLD's, does t e LLD restrict product flow if it detects a leak? N/A ❑ Yes No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? Lx] N/A ❑ Yes No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is [x] N/A disabled or disconnected? ❑ Yes No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system U N/A malfunction or fails a test? ❑ Yes No* For electronic LLD's,have all accessible wiring connections been visually inspected? U N/A Lxj Yes .!'E 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: RE-DIRECT LOCAL PRINTOUT DISABLED SYSTEM SETUP _ _ _ _ _ _ _ _ _ _ _ _ EUR'0 PROTOCOL PREFIX DEG 23, 2010 10:00 All S BIG c:UUN'rpv CHEVRON 3300.WHITE LN. S'lSTE1°f UNITS SYSTEM SECURITY BAKERSFIELD.CA 93309 U.S,, CODE : 000000 661 7827 0487 SYSTEM LANGUAGE DEC: 23. 2010, 10:00 AM ENGLISH MAINTENANCE HISTORY SYSTEM STEM DATE.-,T 1 ME FORMAT D I•SABLED MON DD YY,'Y HH:MM:SS r-M SYSTEM STATUS REPORT 8113 COUNTRY CHEVRON TANK CHART SECURITY 3300 WHITE IN, DISABLED BAKEkSFIELD.GA 93309 ALL FLINi_:T 1 ONS NORIHAL 661-827 0497 INVENTORY REPORT CUSTOM ALARMS SHIFT TIME I DISABLED 'DISABLED SHIFT TIME 2 DISABLED SHTF'T TIME 3 DISABLED T I ;SUPREM SHIFT TIME 4 DISABLED SERVJCE NOTICE VULUOE - 922.1 GALS DISABLED ULLAaGE Q 2769 GALS TANK PER TST 'NEEDED WRN .905c ,ULLAGE- 1569 GALS DISABLED TC VOLUME - 9200 GALS TA14K ANN TST NEEDED WRN ISO 3166 COUNTRY HEIGHT - 68.99, 1NCHES DISABLED CODE: 'WATER VOL = 0 GALS , 61ATER = 0.00 INCHES i LINE RE-ENABLE METHOD lmtr p = 64,7 DEG F PASS L 114E TEST MASS:DENS I TY DISABLED T •2:UNLEADED LINE PER TST I,I EDEri WRN VOLUME' 8521 GALS DISABLED ULLAGE - 3479 GALS LINt LED E ANN TST rVEEDED WRPI 90% ULLAGE= 2279 GALS DISABLED TO VOLUME - 8505 GALS PRINT TC .VOLUME: H I�HT - 64. 15 INCHES ENABLED WATER VOL - 24 GALS WATER = 1 .06 'INCHES TEMP COMPENSATION TAMP - 6216 DEG F- VALUE f DEG F. ) : 60.0 STICK HEIGHT OFFSET n ri R r x EIVD x x x x X D I SABLED ULLAGE: 90`i H-PROTOCOL DATA FORMAT HE'I GHT DAYLIGHT SAVING TIME ENABLED - START ,rjATE, MAR WEEK 2 SUN START TIME 2:00 AM END -DATE NOV WEEK 1 SUI4 END 'TIIIE 2:b0 AM T 2:UNLEADED 011MUNIGATIGNS SETUP IN-TANK SETUP PRODUCT CODE 2 - - - - - - - - - - - - - -- - - - - - - - - - THERMAL COEFF : .000700 TANK DIAMETER 96.00 T I :SUPREM TANK PROFILE I PT PORT SETTINGS: PRODUCT CODE I FULL VOL : 12000 THERMAL COEFF :.000700 COMM BOARD 1 (ED IIll > TALK DIAMETER 96.00 RS-232 SECURITY TANK PROFILE I PT FLOAT SIZE: 4.0 IN. CODE DISABLED FULL VOL : 12000 WATER WARNING 2.0 COfNl.l. BOARD 2 (RS-232 S HIGH WATER LIMIT: 3.0 .BAUD RATE 9600 FLOAT SIZE: 4.0 11-1. PARITY EVEN MAX-OR LABEL VOL: 12000 STOP BIT .I STOP WATER WARNIIVG, 2.0 OVERFILL LIMIT 90% .DATA LEI4GTH: 7 DATA HIGH WATER LIMIT: 3.0 1OBUO RS-232 SECURITY MAX OR LABEL VOL: 12000 11400 HIGH PRODUCT CODE : DISABLED OVERFILL LIMIT 90: DELIVERY LIMIT 10f 10800 1200 AUTO TRANSMIT S iTfI*3S: HIGH PRODUCT 95% 11400 LOW PRODUCT 1200 AUTO LEA), ALARM LIMIT DELIVEPV LIMIT 10s; LEAK ALAR11 LIMIT: 99 D1'SABLED 1200 SUDDEN LOSS LIMIT: 99 AUTO. H IGH WATER L 1111 T TANK' T I LT 0.00 DISABLED' LOW PRODUCT 1200 PROBE OFFSET 0.00 AUTO OVERFILL LIMIT .LEAK ALARM LIMIT:. 99 DISABLED SUDDEN LOSS LIMIT: 99 AUTO",LOW PRODUCT TANK TILT 0.00 SIPHON! MANIFO.LDED TANKS DISABLED PROBE OFFSET 0.00 TO. NONE AUTO-THEFT LIMIT LINE.MANIFOLDED TANKS AUTO,DEL SIPHON MANIFOLDED TANKS Td: NONE* DELI VERY START D1SABEED TO:' NONE 'AUTO*.-`bELIVERY END LINE 'MANIFOLDED TANKS LEAK MIN PERIODIC: 10 'DISABLED TO: NONE 1200 AUTO''EXTERNAL INPUT ON DISABLED LEHY. MIN ANNUAL : 10% AUTO'EXTEP.NAL I NPUT OFF LEAK MIN PERIODIC;: 10% 1200 DISABLED 1200 AUT.O..,SENSOR FUEL ALARM 01SABLEC: LEAK I'll N.ANNUAL 10% PERIODIC TEST TYPE AUTO"'SENSOR WATER ALARM 1200 'STANDARD AUTO'SENSOR OUT ALARM ANNUAL. TEST FALL DISABLED PERIODIC TEST TYPE ALARM DISABLED STANDARD ANNUAL TEST FAIL PEk1GDI0 TEIBT ALARM. D•ISABLED GROSS TEST FAIL PERIODIC TEST FAIL ALARM DISABLED ALARM DISABLED ANN. TEST AVERAGING: OFF GROSS TEST FAIL. RS-23e END OF MESSAGE; PER TEST AVERAGI'NC: OFF DISABLED ALARM DISABLED ANN TEST AVERAGING: OFF TANK TEST NOTIFY: OFF PER TEST AVERAGING: OFF + TNK TST SIPHON BREAK:OFF l TANK. TEST NOTIFY: OFF DELIVERY DELAY I MIN PUMP THRESHOLD : 10.00 TNK TST SIPHON.BREAK:OFF DELIVERY'DELAY 1 11101 PUMP THRESHOLD 10.00%: `1 LEAK TEST METHOD TEST MONTHLY ALL TANK. WEEK .1 • MON START TIME : 2:00 AM TEST RATE :0.20 GAL/HR DURATION 2 HOURS TST EARLY STOP-:ENABLED LEAP TEST REPORT FORMAT NORMAL SMARTSENSOR SETUP OUTPUT RELAY SETUP L I OU i D. SENSOR SETUP - - - - - - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ s I :FM 1-2 R I :POSTITIVE SHUT OFF L I,:D.JSP 1-2 CATEGORY AIR FLOW METER TYPE: •TRI=STATE. (SINGLE FLOAT) .STANDARD 'CATEGORY : DISPENSEP'PAN s 3.:FM 5-6 NORMALLY CLOSED CATEGORY AIR FLOW METER TANK 0: 1 s 4:FM 7-8 L. 2•:DISP 5-6 CATEGORY AIR FLOW METER TRI-STATE' (SINGLE FLOAT) LIQUID SENSOR ALMS CATEGORY :' D 1 SPENSER' PAN s 5":FM 9-!0 L ] :FUEL ALARM CATEGORY AIR FLOW METER L 2:FUEL ALARM L 3:FUEL ALARM s 6:FM 11-12 L 4:FUEL ALARM L 3:D[SP 3-4 CATEGORY AIR FLOW METER L 5:FUEL ALARM TRJ-STATE (SINGLE FLOAT) L 7--FUEL ALARM CATEGORY :' DISPENSER PAN s 7.:FM 3-4 L 9:•FUEL 'ALARM r,ATEGORY AIR FLO(J METER L 13:1=UEL ALARM L t :9EN8OR OUT- ALARM 8:PS 1-2 L 2:SENSOR OUT ALARM 'L 4:DISP 7-8 CATEGORY VAPOR PRESSURE L 3:13 ENSOR OUT ALARM TRI-STATE (SINGLE FLOAT) L 4:SENSOR OUT ALARM CATEGORY : DISPENSER PAN L 5:SENSOR OUT ALARM L 7:SEMR OUT ALARM L 9:,SENSOR:OUT 'ALARM L 5:D)SP 9-10 L13:SE1,190R OUT ALARM TR,1-STATE '(aI WLE FLOAT) L I SHORT AL:AR14 'r,ATEGORY DISPENSER PAN L 2:9HORT ALARM L 3:SHORT ALARM L 41-SHORT ALARM -- L 5:SHORT ALARM T.ALARM L 7 iI71 Sp. 1 1-1^ L 7:SHOR L 9:'SHORT ALARM TRI•-STATE (SINGLE FLOAT) L13:SHORT ALARM CATEGORY : riTsPENSER PAN ISD SITE ;ALARMS ISD �GROSS :PRIES FAIL L.9;::87 STP ISD ..DEGRD PRES FAIL TRI`_STATE (SINGLE FLOAT) ISD'VAPOR LEAK FAIL -CATEGORY : STP SUMP ISD VP PRES FAIL ISD VP STATUS FAJL Ld 0,:13"I AfJN ISD HOSE ALARMS -TR:I`�STATE 4SINGLE FLOAT) ALL:GROSS COLLECT FAIL CATEGORY : ANNULAR SPACE ALL:DEG9D COLLECT FAIL ALL:FLOW COLLECT FAIL L11 :87.FILL R\ 2::OVERFILL ALARM TRI=STATE (SINGLE FLOAT) TrSTANDARD CATEGORY : PIPING SUMP NOSTRMAI:L1 OPEN L 1;2,:91.. ANN TANY d: NOME .T,R',V4bT,+TE (,$1,4 LE FLOAT) CATEGORI' ANNULAR SPACE IN-TANK ALARMS ALL:OVERF1LL ALARM ALL:H 1 GH PRODUCT ALARM L1-3:9,1' STP ALL:MAX PRODUCT ALARM TRI-STATE (SINGLX FLOAT) .CATEGORY : 'S'I'P SUMP 'L14':.91 FILL TKF'-STATE (SI.WGLE FLOAT) CATEGORY : PIPING SUMP EVR;•1SD SETUP ALARM HISTORY REPORT PMC SETUP ----- SENSOR ALARM ----- PMG VERSION: 01 .02 L '2:DISP. 5-6 :EVR ;TYPE: VACUUM ASS I ST D 1 SPEIVSER PAN VACUUM ASSIST TYPE VAPOR PROCESSOR TYPE FUEL ALARM HEAL`! VAC NONE OCT 13, 2009 10:39 AM NOZ?LE A/L RANGE PROCESSOR CONTROL LEVEL: SENSOR OUT ALARM MAX, 1 .15 111 N: 0.95 NONE OCT 13. 2009 10:08 All VAPOR PROCESSOR TYPE FUEL ALARM NONE OCT 13 2009 9:59 AM ANALYS 1 S TIDIES T 1ME:` .10:00 All DELAY 1.11 NUTES I SOFTWARE REVISION LEVEL ACCEPT •HI,GH ORVR: VERSION 329.00 DISABLED SOFTWAREO 346329-100-A CREATED - 08.10.09.17.08 ISD' HOSE TABLE x x +� � � END x ik K x R ID FP FL HL AA "RR. S-MODUL:EP, 330160-004-a ------------------------ SYSTEM FEATURES:. 01 33 01 02 01 UU PERIODIC ,IN'-TANK TESTS Q2 34 02 02 01 OU ANNUAL IN-TANK TESTS 03 .35 03 02 07 UU ISD 04 00 04 02 07 UU '05 01 05 02 03 UU 06. 02 .06 02 03 UU 07' 03 07 02 04 UU -08 04 -08 02 04 UU 09 05 D9 02 OF U0 ALARM HISTORY REPORT 10 06 10 02 0., UU 1,1. 07' 11 02 06 UU 1.2_ 08 12 02 06 UU L__3:G1SP 3-4 ALARM ----- ALARM HISTORY, REPORT DISPENSER PAIN ISD AIRFLOW METER MAP FUEL ALARM LD SERIAL NUM LABEL ----- SENSOR ALARM ----- OCT 113, 2009 10:38 art L I : SP :l-2 SENSOR OUT ALARM ,I-240?7------FCi-1-1---- 'DI'SPENSER NSER PAN 3. 25068' FM 5-6 FUEL ALARM OCT 1,3, .2009 10:08 All 4' 2.4030 FM 7-8 OCT 13. 2009 10:38. AM FUEL ALARM 5: 24373 FM '9-.1.0 6 25167 F11 11-1'2 SENSOR OUT ALARM OCT 13. '2009 9.:58 All 7 2505A FM 3=4 OCT 13. 2009 10:08 AM FUEL ALARM l.SD FUEL GRADE HOSE MAP OCT 13. 2009 9:58 HM ^ 3' 4 FPS MHO MHH MHH MHH AA -------------------- 010 209 304 9.04;'U .0 7 01 205 305 905 U U 3 02. 206 306 906 'U U 3 x x x x x END * x x x x 03, 207 307 907 U U 4 04 208 .308 908 U U 4 05` 209.309 909'U U 5 06' 2103109*10UU 5 0. 211 311 9.11. UU 6 x END xxxx 08.21231291.2UU 6 33 201 301. 901 U U 1 34 202 302 902 U U 1 38- 2m 303 903 U U 7 LABEL TABLE ---------------- I UNASSIGNED 2;. BL;END3 3: REGULAR 4:% MfD' GRADE 5•: rOEH I UM' 6: GOLD 7: BRONZE 8: SILVER 9: BLEND2 10: BLEND4 r ALARM HISTORY REPORT ALARM HISTORY REPORT ' ALARM HISTORI REPORT ----- SENSOR ALARM ----- ----- SENSOR ALARM ' SENSOR ALARM ----- L 4:GISP 7-8 L 7:DISP 11-12 1-10:87 ANN _ DISPENSER PAN DISPENSER PAN ANNULAR SPACE FUEL ALARM FUEL ALARM FUEL ALARM OCT 13. 2009 10:39 All OCT 13. 2009 10:39 AM OCT 13. 2009 10:36 AP1 SENS'OR OUT ALARM SENSOR OUT ALARM SENSOR OUT ALARM OCT 13. 2009 10:08 AM OCT 1.3. 2009 10:08 AM OCT 13. 2009 10:36 All FUEL 6LARM FUEL ALARM SENSOR OUT ALARM OCT 13.2009 9:59 AM OCT 13. 2009 10:00 AM OCT 13. 2009 10:08 AM END END ENO ALARM HISTORY REPORT ALARM HISTORY REPORT ALARM HISTORY REPORT .----- SE14SOR ALAP11 ----- ----- SENSOR ALARM ----- --- SENSOR ALARM i ,5:DISP: 9=-10 L 9:87 STP L1 ! 87 f:I,LL DISPENSER PAN STP SUMP P1PI'NG SUMP FUEL ALARM FUEL ALARM FUEL ALARM OCT 13, 2009 10:39 AM OCT 13, 2009 10:35 AM ,TAN 21 . 2010 5:42 PM SENSOR OUT ALARM SE14SOR OUT ALARM FUEL ALARM OCT 13. 2009 10:08 AM OCT 13, 2009 10:08 AM OCT 13, 2009 10:38 AM FUEL ALARM FUEL ALARM SENSOR OUT ALARM OCT 13, 2009 10:00 AM OCT 13, 2009 9:55 AM OCT 13, 2009 10:08 All END hxxri rri rtEND E14D + � # " , 3 t ALARM HISTORY REPORT ALARM HISTORY REPORT ----- SENSOR ALARM ----- ----- SENSOR ALARM ----- L14:91BERSOR ALARM ----- DISP£ISP' 3PAN ANNULAR ANN SUMP ALARM ANNULAR SPAr,E PIPING �UriP FUEL ALARM. FUEL.ALARM DEC '23. '2010 10:11 AM OCT"13, 2009 10:37 AM DEC 22. 2010. 12:12 PM SENSOR OUT ALARM FUEL ALARM OCT 13, 1009 10:08 AM DEC 18. 2010 5:26 PM FUEL ALARM FUEL ALARM OCT 13. 2009 9:5k. AM FEB 9, 2010 11 :45 All ---- SEM: OR ALARM ----- L 2XISP .5-6 DISPENSER PAN .FUEL 'ALARM DEC 23. 2010 10:12 mll x 0 END x x n x w x x x x END x x x x X ---- SENSOR ALARM ----- L ,4:D;ISP 7-8 DISPENSER PAN FUEL ALARM DEC. 23. 2010 10:12 AM ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 9:87 STP SENSOR AL'AR11 ----- STP SUMP L1,3:91 STP FUEL ALARM STP "P DEC 23, '2010 10:09 AM FUEL ALARM OCT 11, 2009' 10:37 AM l3E4SOR: .OUT ALARM -- SENSOR ALARM OCT' i1, '2009- 10:06 All L 5:G I SP 9-10 DISPENSER PAN FUEL ALARM FUEL-ALARM WT 13. '2009 9:54 AM DEC 23. 2010 10:13 AM ----- SENSOR ALARM ----- 1_13:91 STP STP SUMP FUEL ALARM DEC 23. 2010 1.0:09 AM ----- SENSOR ALARM -- _- :; ri x x x END t L 7:D I SP 11-12 DISPENSER PAN FUEL 'ALAPM DEC 23, 2010 10: 11 AM ----- SENSOR ALARM ----- L I :DISF 1-2 DISPENSER PAN FUEL ALARM DEC 2J. 2010 10: 10 AM ----- SENSOR ALARM ----- L 14:.91 F1•LL - P I.P.I NG SUMP FUEL.ALARM DEC 23. 2010 10:14 AM T I ;SUPREM. - IN-TANK ALARM ----- INVENTORY INCREASE T I :SUPREM ----- FENr;OP Al-ARM ----- OVERFILL ALARM INCREASE START LI1 :67 FILL DEC 23. 2010 10:16 AM DEC 23, 2010 10: 18 AM PIPING SUI°1P FIJ ALARM VOLUME . 9327 GALS DEC: 23, 2010 10: 15 All HEIGHT - 69.66 INCHES WATER = 0.87 INCHES TEMP - 59.3 DEG F INCREASE END IN-TANK ALARM DEC; 23. 2010 10:21 AM ---•- ----- T I :SUPREM VOLUME - 10645 GALS PROBE OUT HEIGHT - 79.66 INCHES - - SENSOR ALARM --- DEC 23. 2010 10:19 HM WATER = 0.93 1,NCHES L12:91 ANhI TEMP = 59.4 DEC F ANNULAR SPATE FUEL ALARM DEC '23. 2010 10:15 AM GROSS INCREASE- 1318 TC NET INCREASE- 1318 ---- I N-TAANK ALARM -- -- T I :SUPREM INVALID FUEL LEVEL SENSOR ALARM DEC 23. 2010 10: 19 Art ----- ----- L•10: T 2.:UNLEADED -------SENSOR ALAP11 ----- 1 NVENtO.RY I NUEASE L 1 :D I SP 1-2 _ DISPENSER PAN INCREASE START SENSOR OUT ALARM -- SENSOR ALARM ----- DEC 23, 2010 .10:20 AM DEC' 23. 2010 10:24 AM - L12;.91 ANN ANNULAR SPACE VOLUME m 8521 GALS SENSOR OUT ALARM HEIGHT a 64.15 1NC;HES DEC 23. 2010 10:24 AM WATER S 1 .08 INCHES; TEHP Q 59.3 DEC:' F INCREASE END DEC: 23. 2010 10:23 AM -- SENSOR ALARM ----- VOLUME 11290 GALS 1_10:87 ANN HEIGHT - 85.52 1NC:HES ANNULAR. SPACE MATER a 1 :04 1NCHES SENSOR OUT ALARM ----- :SENSOR ALARM ----- TEMP' . 59.3 DES,' F DEC 23, 2010 10:24 AM 7:DI'SP 11-12 DISPENSER -PAN GROSS INCREASE- 2769 SENSOR OUT ALARM TC NET INCREASE- 2770 DEC: 23, 2010 10:24 AM ---- SENSOR ALARM ---- L 3:DISP 3-4 DISPENSER PAN SENSOR OUT ALARM ----- SENSOR ALARM ----- DEC 23, 2010 10:24 All L 2:DISP 5-6 DISPENSER PAN -- -- E ----- SENSOR OUT ALARM SENSOR ALARM L i 3 NP DEC 23, 2010 10:24 Alt STP' SUMP SENSUR OUT ALARM DEC 2j. '2010 10:24 AM ----- SENSOR ALARM ----- L 4:DISP 7-8 DISPENSER PAN SENSOR OUT ALARM 131C, COUNTRY CHEVRON DEC" 23. 2010 10:24 AM 3300 WHITE LN. . BAKER SF 1•ELD.CA 93309 -- SEI45Ok ALARM ----- 651-.827 0487 t :9•:87 S'I'P DEC' 23. 2010. 10.:25 All STP SUMP SENSOR'OUT AL41.1 DEC '23�. 2010 10:24 AM SYSTEM STATUS REPORT ----- •SENSOR ALARM ----- . ALL FUNCT1014S NORM AL 1.II :87 FILL PIPING SUMP SENSOR OUT ALARM DEC 23, 2010 10:24 All ----- SENSOF ALARM ----_ L S.:DISP 9 710 DISPENSER PAN SENSOR' OUT ALARM DEC 23, 2D10 10:2a AM ---- SENSOR ALARM ----- -1.4:.91 FILL P:IPINC,, SUMP SEIZOR OUT ALARM DEC 73, 2,010 I0:24 All SWRCB, .ianuaiy 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)owneiloperator foi-submiiial to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: SamCo Food Store#2 1 Date of Testing: 12/23/2010 Facility Address: 3300 White Lane, Bakersfield,CA 93309 Facility Contact: Sam Jouda/Sam Jr. Phone: 661-333-0000/661-472-9090 Date Local Agency Was Notified of Testing: 12/10/2010 Name of Local Agency Inspector(cf present during testing): Ernie Medina 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. Technician Conducting Test: Bryan A Self Credentials: X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester ❑Other(Specif) License Number(s): CSLB#804904 ICC#8022804-UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic ❑Vacuum 0 Other Test Equipment Used: Lake Test Equipment Resolution: 0.0625" 4?L� _ A'�.i+l'T_ tT �1Z"RCI-`ihL.'..,--mot•-_-J."S: Identify Spill Bucket(By Tank 1 Regular(Fill) 2 Super(Fill) 4 Number, Stored Product, etc.) Bucket Installation Type: 0 Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury x Contained in Sump x Contained in Sump 0 Contained in Surrip ❑Contained in Sum Bucket Diameter: 12.00" 12.00" Bucket Depth: 14.00" 14.00" Wait time between applying 5 min. 5 min. vacuum/water and start of test: Test Start Time(Ti): 10:00 AM 10:00 AM Initial Reading(R): 9.25" 10.00" Test End Time(TF): 11:00 AM 11:00 AM Final Reading(RF): 9.25" 10.00" Test Duration (TF—Ti): 1 hour 1 hour Change in Reading(Rr-Ri): 0.00" 0.00" Pass/Fail Threshold or 0.0625" 0.0625" Criteria: Test Result ` `> I_� ._ X�Pass O��Fath' ;!� ` X:Kass ��I+,aill � , 1°ass�` ❑Fail' ;p.bass ❑Fai4 . 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: 12/23/2010 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. I 1. TLS 350 2.Clean Air Seperator 3.Extier Over Fill Alarm �. 4.208 Sump Sensor 5.FX1V LLD 6.420 Tank Annular Sensor 7.Tank A.T.G. F= Fill Spill Bucket V=Vapor Spill Bucket 4. 4. 4. 4. Wible 4. 4. 00 00 4. 4. 5. 5. 6. 6. 7. 7. Regular Super STP STP 2. { I