HomeMy WebLinkAboutFMC 2010 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. I IIIIIIIIIIII IIIII� 73
A. General Information
Facility Name: #773 Fastrip#31 IE Bldg.No.:
Site Address: 3501 Mt. Vernon Avenue City: Bakersfield zip: 93306
Facility Contact Person: Omero Garcia Contact Phone No.: 661-393-7000
Make[Model of Monitoring System: Veeder-Root TLS 350 Date of Testing/Servicing: 8/11/2010
B. Inventory of Equipment Tested/Certified
Check the appropriate how to indicate specific equipment fmpected/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:794390-420
[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:
[x] Mechanical Line Leak Detector. Model:FX1V [X] Mechanical Line Leak Detector. Model: FX1V
❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model:
[X] 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: 12000 gal.Diesel Tank ID:
[x] In-Tank Gauging Probe. Model:847390-107 ❑ In-Tank Gauging Probe. Model:
[x] Annular Space or Vault Sensor. Mode1:794390-420 ❑ 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: ❑ Fill Sump Sensor(s). Model:
[x] Mechanical Line Leak Decector. Model:FX1DV ❑ Mechanical Line Leak Detector. Model:
❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model:
U Tank Overfill/High Level Sensor. Model:847390-107 ❑ 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
[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: 6&6 Dispenser ID: 7&8
[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: Transition Sump Dispenser ID:
[x] Dispenser Containment Sensor(s). Model: 794380-208 ❑ Dispenser Containment Sensor(s). Model:
[X] 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❑S in Set-up U m h' Cory report
Technician Name(print): Bryan A Self Signature:
Certification No: 837501 License No:604904
Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930
Site Address: 3501 Mt.Vernon Avenue,Bakersfield,CA 93306 I D
IIIIIIIIIIIIIII III ate of Testing/Servicing: 8/11/2010
74
1 E
D. Results of Testing/Servicing
Software Version Installed: 327.04
Complete the following checklist:
[x] Yes ❑ No* Is the audible alarm operational?
x Yes I No* s t e Visua a arm operational?
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 irritate positive shut-down? U Sump/Trench Sensors[x]Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? [x] Yes; ❑ No;
Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no
r 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* ❑ No Was any monitoring equipment replaced? es,i enh specific sensors,probes,or other equipment
replaced and list the manufacturer name and model for all replacement parts in Section E,below.
gYes* ❑ No Was liquid found inside any secondary containment systems designed as dry systems?
❑Product; [x] Water.If yes,describe causes in Section E,below.
No* Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable.
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: I changed the Regular STP sump sensor due to sludge buld up.I also removed approximately two gallons
of water From the transtion sump and put the water in a 55 gallon waste drum.
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:
U Yes ❑ No*lHas all input wiring been inspected for proper enter and termination,including testing for ground faults?
_1xJ Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
[xj 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?
U 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.
Com fete 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: [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?
fxYes No* Was the testing apparatus properly calibrated?
s No* For mac amca LLD's, oes the LLD restrict pro uct ow if it detects a lea ?
N/A
s No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak?
Lx] N/A
❑ Yes F 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?
L] N/A
x 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: The Super PLLD failed and was replaced,retested,and passed
SYSTEM SETUP
S .3
- - - - - - - - - - - -
AUG I I
- 2010 12:48 PM
sysuh mi ITS
U.S.
3501 MT.VERNON SYSTEM LANMVICE GOMMUNICATION:' SETUP
BAKER!':;FIELD t:A-9330u' ENGL I SH
60 -872-1389 S','STEII DATE TINE FOP[-"T
MON DD '-.",YY HH:L14:S:- -cM
Auc. I I . '-0I Cl 12:46 N-I PORT SETT I NGS:
FASTRIP
3501 MT.WLRN014 r-,'0hRI-- I iEDIM
RHKEESF I ELCI CA 92,306 RS-2:3
qos-v -108-4 OD
- - - - - - - - - - - - . E
ALL FUNC71011,'� I-JOkIllil- SHIFT TIME I DISHBLED k::of-wl 80r-Ipf)
SHIFT TIHE 2 D I SABLED BAUD PHTE 9600
1 NVEi,j,roky REF'ORT SHIFT TINE 3 DISABLED PARITY NONE
SHIFT TIME 4 DISABLED STOP 0 1 T I STOP
LATH LEI-161*11: 8 DHTA
T I :LIWL TANK PER 'rear NUDED WRN RS-2:32
V01-Ul1E . 776e GALS D I SABLED CODE : DISmBLF ,
ULL;A,3E 4424.7 GALS TANK ANN TST NEEDED WRI'l
ir-;
Wro ULI- C;E=. 3087 i�;ALS DISABLED f;01-11-1 sooRD 3
TC VOLUME - 7554 CALS BA(J[j RmTE 9600-
HE riwr = 68. 17 1 N-'HES LINE RE-ENABLE HFTHOD pop 111* NONE
6pATER VOL = )o GALS PPS S LINE TEST STOP 61T t S T 0,P
W�,TER . 0.89 1 tF-HE-*- DATA LENGTH: 8 DATA
TEMP . 49.4 DEG F LINE PER TRT NEEDED WRI11 F.9-232 SEg-UPIT`1
DISABLED CODE : Li§;;r:%LF-D
L I 14E ANN TST NEEDED 61RN
T 21:b I ESEL ISHOLE'D
VOLUME . 6143 C.ALS Au'vo TkiAiVspilT 2',ETTINGS:
ULL(AGE . 5y 1 y GmLS PR I NT TC VOLUMES
90', ULLAC-E- 4^I �4
ENAUL-EC) 01'0 LEMI: ALr011 Lipirr
Tl*' VOLUME = 663-1 GALS DISABLED
HEIGHT = 56.:i1 1 w-Ht!!3 TEMP o'C411VENSATION FtUrO HIGH 14ATER LIMIT
WATER VOL 15 GALS VALUE (DEC, p ) : 60.0 ri I SABLEF,
WATER 0.94 1 1,.'C'Hr—c-* STI",)! HE D>(T OFFSET AUTO OVERFILL LIMIT
TEMP 100.2 IAEG F DISABLED D I SABLED
ULLAGE: 90% AUTO LOW PRODUCT
D I 5ABI.Erj
T 3:PiC H-PPOTOCOL DATA FC)Pllt.;T AUTO THEFT LIMIT
VOLUME 54:34 Ci;-;Ls HE I G HT D IS-Ant-Fr.,
ULLAGE 66218 (3AL-S DAYLD314T SjAVINi3 TINE AUTO DELIVER" STOiRT
90-; 5.1'21 CALS ENABLED I SABLED
Til VOLUME - 527J GiALS STi-iff DATE AUTO DEL.IvERIII END
HEIC,HT = 51 . 18 1 PA-HE'S MiAP WEEP 2 SUN 0l SIABLED
WATEP VOL - 0 Gi4t-S sp4wr T I mE AUTO EXTERNAL I HIPUT 014
WATER - 0.00 1 NC"i-iE2 2,-00 AM D I SABLED
- I CK-1. DEG 1: END F,f4TF- AUTO E?%"rcRf`041- INPUT OFF
NOV WEEK I SUN DI
END T I ME AUTO SENSOR FUEL. ALARM
END 2:00 All D 1 Si i9LED
AUTO SENSOR WATER LAF51
RE-DIREi"T L.OQAL n wroiji, t�D I SABLED
D I SAKE, ALITO SENSOR OUT mbAPH
DISABLED
EURO PROTOCOL PREFIX
CODE : 13001A,C)
f-IRINTENiANC'-E HISTORY RS-23i END OF HCE Zi4,iGE
DISABLED D I SAKED
T(-)NI, "HART SEC:IJRIT',
11 1-ii'mBLED
1:11STON ALARM
ENABLED
mFiSS, DE 1,12 IT%
T ':LtEhEt.
I P�-'t'A14{; 8F fUF' PPFr.,u l' (:ODE ' T 3:PNL
- - - - - - - - - - - THERMAL COEFF : .000450 PRODUCT f OfiE u
TANK DIHMETEP. 111 .00 '1'FlEPt1H1_ COEFF : .000700
T I :UNI_ TANK PROF I LE I PT T:;NK D I kI'IETEP. 1 1 1 .00
PK,DUC'T )DE I FULL VOL 1 062 TANK PROFILE I PT
THEPHAL C0EFF : .C101a700 FULL VOL
TAN); DIAML"TEP f1I .ub
TNP4: PROF I LE I PT FLOAT SIZE: 4.0 IN.
FULL VCil. 1 2062 FLOmT SIZE; 4.0 1 N.
- WATEP WHRh!1 NG ='.U
HIGH WATER LIMIT: 3 0 HIGH WATER 7'.0
FLOAT . I'Z"Ji 4.0 IN. 3.0
MAX OP. L:aHF.1. VOL: 12062
WATER LiAP141 hl 0 OVERFILL LIMIT 90; rV•1`t OR I.HBFL VOL: 1?Oo2
HIGH W,.TEF LIMIT: 3.0 10855 OVERFILL LIMIT 90:;
HIGH PPODUI1 t' 951« 10855
Mlx:; OR L:;BEI-. VOL: 1 21362' 1 1 459 HIGH PRODUCT 95'.
OVEPI=I1.1. 1-IMI1' 90—
DELIVERY LIMIT 15.0 11x55
10855 1B09 DELIVERY LIMIT 154
H I UH PI•:(40:7 95"c 1809
11459 LOW F'POf,IK'T 50U
DEL I VEPY LIMIT 151, LEA' :iL Pjl LIMIT: 99 LOW PFK3G11:7
1 809 SUDDEN LOSS LIMIT: 99 LFf 4: riLARr1 LIMIT: 99
TAm: 'TILT 0.00, SUDDEN LOSS LIMIT: 99
LC$J PRODIIC'T 500 PROBE OFFSET 0.CIO TANX TILT 0.00
LEAN r;LAkll L 1 M I T: 99 PROBE OFFSET 0.00
SUDDEN LOSS L!1'1IT: 99
TANE TILT 0.00 SIPHON MAN I FOl_1.lED THNIE
PROBE OFFSET 0.00 TV: NONE SIPHON MAN I FOLDED TnNFKS
LINE 1,1AN I FOLDED TH NI;s LINE: MA v t FOLDED TANKS TO: 14014E I : NONE
S 1 PHON 11AN I FOLI CI., TANKS
Tu: Nf,}I4L
LINE TmNI'S LEAK MIN PERIODIC::: I
TO: NONE 120 LEAI: N I N PERIODIC:
LEAK Ill IN ANNUAL : 1 I`U
L.EHK M I N F ER I OD 1 C,: 1 120 LCkK I'1 t N ANNU�;L 1:.
120 1 2.0
LEAI! [III I.1 HNr1UaE.. 1 PER 1 OU I C. TEST TYPE
120 STANDO.F., PERtCIDI!' TEST 'f'iPE
AI4IVUAL TE�T FAIL STr~IVL'�Al:'D
PEP I UD I TEST 'rYF'E ALARM IA S1 S1 -;I.EC, ANNUAL PEST FA 1 L
STr shlTl�:RD ALARM Cl I"i; ILED
PERIODIC TEST FAIL
ANNIP-11- TEST FA I L ALARM DISABLED PER I OIL 1 C: TEST FA 1 I_
rLr�Rl I G t S ASLED HL:aRI 1
i;RO9S TEST FAIL D 15ABI.Erj
F•ER 1 C!I-I C TEST Fa,l L .;LHRM DISABLED GROSS T[.ST FAIL
:;LAkM P I SAY.LED ALfiRht D F �
ANN TEyT AVERA'31 NG: OFF I Sr>IBL
MST Fri 11.. PER TEST HVERA(*-I NG: OFF ANN TE'E;r lR EP;:i,::1 NG: OFF
ALAF:Ih Is 1 SHBLEI, PER '1'Es.r HVERZ 1 Nu: uFF
TH NK TEST NOT I FY: OFF r;h114 TE�'T HVEf H4'.l Nk : OFF TANK TEST NOT 1 FY: OFF
PEI' TE:3T ,-;VM+,I NG: OFF TtII'. TST SIPHON BREAM:OFF
TN}; Tat'S I PHOtl BkEH}::OFF
T,00, TEST N'YI'IFY: OFF DELIVERY DELAY I MIN
PUMP THRESHOLD 10.00% VEL t VERY DELAY 1 rl l r1
TNK TS'T S I F'HGN BPEi;K:C>FF PUMP THRESHOLD 10.ClCI'.
DF_t.l VEPY r,EI Al" 1 1-11 N
PUMP THRESHOLD 10.00
LEAK 1'f--::,!T METHOD OUTPUT REL.6Y SE •UR
- - - - - - - - - - - -
TEST ON DiAT E ALL THNK
FEB 6. 2007 R I :U IqL
START T I ME : 5 1 1:48LED TYPE:
TE.':-'T Ri4TE :0.20 HR PI.11-IP GONTPOL OUTPUT
DUPAT 1 Or4 -2 HOIJR': TANK 0: 1
PUMP SEMPOR ,,CTUp
T2T EARLY STOP:NSABLED
DA." TEST REPORT FORMAT LIOUID SENSOR 141-H.S
I-
S I :UNL L. 4:FL)FL ALARll
TANK 0: I L 9:FUEL ALARM
DISPENSE mou: [.IO:FUEL ALARM
STA14DAPD LII :FIJEL ALART"t
Lt':FIJEL ALARM
S 2:PlqL L13:FUEL ALARM
TAN.I..' It: 3 L 4:SEV6*OR OUT ALARM
DISPENSiE 1*)[,E: L 9:SErt7SOR OUT ALARM
STANDAPD L I(J SENSOR OUT AL;.iPM
L I I SEf,&()R our ALARM
L 12:SENSOR OUT f4l-AFN
L 13:SEWS OR OUT ALIARM
L 4:SHOPT ALARM
L 9:SHORT ALARM
1-10:SHORT ALARM
Lll :SHORT ALARM
L I UNL ANN 1-12:SHOFT ALARM
WR[W-1-Y lA-O.$Eb L 13:SHORT ALARM
ANIvJL,-p Srpjjc,F
ISE, SITE A1-ARH0
PSD GROSS PEES FAIL
'El I ESEL ANN 1 Sri r,
ISD VAPOR LEAK FAIL,
L � EGRD PRES FAIL
TP I-STATE t S I Ni'31.F. FLOHT> ISD VP PRES FA I L
1 S VP STr}TLIS FA I L
I SD I IOSE ALARMS
ALL:GRDS- ' COLLECT FAIL
3:PNj- jil-ji-t
TR I— - ALL:DE�;RD COLLEC:T FA I L
STATE FLOAT) ALL:FLOW C'OLLEC'T FAIL
P 2:PNL
TYPE:
PUMP -.-ONTPOL OUTPUT
L gl:UljL :;Tl, Th[W V: 3
TRI-STATE <21N'-;LE FLOAT)
r!--'-TEG0R,1' : STP SUMP
LIA-WID ALMS
L 6:FUEL ALHFH
L 5:111ESEL STP L 9:FUEL ALARM
TRI-STATE (SINOLE FLOAT) I-10:FuEL ALMPI-I
('ATECORY : STP SUIP L I I 'HiLl. ALARII
Ll 2:17lip-L fil-mRti
L I fl:FIJEL "LARIrl
L 6:PNL STP L 6:SE14SOP OUT -iDARll
TPI-S`ri;TE (SlIIC;[,F FLOHT7 L 9:SEt4SOR OUT ALARK
C.'ATEGOR" - 2TP SUMP LICI:SENSOR OUT Al-API'l
L I I :SENSOR Our F;L.APm
L 9:D I SP 1-:2 L 12:S E. R OUT HLARI/I
L 13:$DISOR OUr ALARM
TR I-STATE (SINI-A-E FLO;-�T) L 6:S14ORT f-iLARM
Cf-;TEGOR'. pAjq L 9:sH4.)R'1' iLAPI'l
LIO:SHORT f-kL/AFJl
L I I :SHORT HDAP11
LIG:DISP L 13:E;HORT ALAPH
TRI','TATE �Slfll--,LE FD)A'r� IST, SITF f41.ADVE;
CATE"3ORY DISPENSER PAN ISD (;ROS ; PRE� F AIL
isD DE,-.RD G-RE.S FAIL
JSr.j VHrlf)R LEA), FrAll
-
I SD vp PRES FA I L
L I I '.fj I.%, c,-6 1 SD VP STATUS F",I L
TPI-STATE FI-OtiT)
bl-SPEW;EP PiAil ISD HC'E HLj-013
ALL_'.(rROS'Si (AXLEC-1• Fill-
ALL'.DEC,PD COLLECT FAIL
ALL,FLOW COLLECT FA 1 L
fpf-STATE't INGLE FLW; T)
DISPENSER 14iml
1-1<:TRAHS SwIlp
'rpj--:--,TATE (SINGLE FI-OmTJ
("ATEC',C)PY F I P I hIG SL4-)p
TYPE:
EVFl I SP SETUP
ITW�LLI.l
TAM: 0:
EVR TYPE: VACL111-1 k [Eff LLVEL
VACUUM AS'SIST T`YPE
LIOUID ril-MS HEALY VAC VERSION
L 5.'FU1 - fALAPM CREf�TED -
L I O:FUr.L h)-,iRN NOZZLE L PANGE
I-IT:FUEL i4bHRfl 5 111 N: 0.95 S-1-10I)OLF9 330160-004—
I.J;3:FUEL vEATUPES.
L OUT HLARH OiPOR f'P0i:!M',SGR TYPE PERIODIC IN •TAN).' TESTS
L I OUT ALARri NO VAPOR PR0,:'ES!-*R ml,4NWiL IPJ-TmNY. TE:61':;
IA2:SEl,S0R OUT Al-f4.M 191,
1.13:2',EmSOP OUT HLARm IS TI NES PmC
R 4!OVERFILL ALkPfl TINF: 10:00 hl-1
PTE: DELHY MINUTES: I
STWWRI,
iAC*:'EPT HIGH ORVR:
TRK 0: WQNE romBLED
HvS E THffl-.E
1111-TI-OW. r,LHPNS 11) FP FL. HL A;A RP
i-II-APH -------------------- - -- ;4LhFt-1 HISTORY REPORT
HLL:H!C.*fl F•k,*A:,Ll,-'!,r ALARM U1 01 01 02 01 UU
PPC-DUL'T HLHRPI 02 02 02 02 01 UU ---- IN-Tim,W ALARM
0:3 03 03 02 02 uu
04 04 04 02 02 UU T I !WL
05 05 05 02 03 ULI
06 06 06 02 03 UU OVERFILL 0-41•1vRN
07 07 07 02 04 UIJ
08 08 08 02 04 UU JUL 21 . 2010 11 :40 PH
JUL S. 2010 9:5S Mi
JUN in 200) 1 :32 m'
ISD A I PFLOW METER MmP
ID SERIAL N1,V LARE-L L•',)W PPODUC'T FALtAM
JUL 24. 201n 1 :49 Ph
JUL 18. 2010 9:49 PH
- - - - - - - - - - - - 2 8674 F.11 3-4 P161P 15. 2010 1 :31? v
3 @tl?8 F.M S••G S l-UD.'-DEN LO20SS AL,01
I S 1 4 8684 Fol 7-8 A � 7. 07 9:49 All
HTEC�(>F£j, PPE!�E:LJRE JUL 19, 2007 9:54 PJ1
2:10m 1-2 1 S FUEL (;PADE HOSE FIAT, F-F.,,bLiui 7T ;LHRII
TIP. FL,)!-1 METC14, 1 2 3 4 3. 2005 3,3 AM
FP I-Mli HHH HHH IIHM AA
MAY 26. 2009 9:52 Pd'l
F.!-1 3-4 AUG 7. X008 10:04 AM
FLOW leMP 0! 110 1 901 0 U 1
02 202 302 902 U 0 1 1 LAVAL I b FUEL LEVEL
4:17A 5% 03 201 302 903 5 U 2 M 2C 200 2:03 PM
I P FLi*)tl METER 04 904 204 2U4 5 U 2 ��1
3 20 10 1 :45 ptl
1'.)5 905 205 305 u U jul. I a. -�cj I 1� 10:2 Pm
OF M 7- 06 206 306 906 U u 3
CHTEGORY ii 111 Fl-fW METEk 07 207 307 907 5 U &I pf<oFiE ClUT
OG 206 'G@ 908 5 U 4 AUG 11, 201 ) 124-15 Pf"I
Atji� 'a, 2C409 9:34 AN
UMBEL TAOLE AUG 3. 2009 9:19 ptl
- --------------------
) : UNA�I 6NEC,
2: BLENDS DELIVERY NEEDED
3 EGUI-iiR ALK, 6, 2Cjj0 7:z4:-' ftl
: P AUG 10, 2010 6:45 F",
4: PI I Ll GRADE AUG 5, 2010 1 :35 PM
6: PREP)I um
G: :;OLD
7: BPOPCE
IkW TQP lQRQ Q B! SID ER
9: 6LISQ2 ALIG ?I 2on? 103
: ` ml
lo: BLEND4 JUL Y 2N7 10:01 PQ,l
PI-IC SETUP
PROCZS.�*Rl c0i,1TROL LEVEL:
NONE
mb,4.11
114-TANK, A".11
T �:Pft
E-rLIP Eli AI_mRI1 HISTOP111 PEPORT
-iT;-i Wi4JA I Nh';
;4LiAPI-1 H[,�TORV PrPORT NAY 10, 21307 12.53 PM
__ - SEw;oP tiLARm -----
lt)-T�ANE OVERF I LL AL;ARH I. 2:DIESEI- POIN
AUG 3. 2009 9:1-15 r1kil tiNNULAP SPA-.:E
T 2:1,1 ESEL JUL 19. 22007 9:56 Al I `Ei
:� OUT ;-iL;L;Pt;l
OVEPFILL ALi-iRI•I SUDDEN LO'T*. ;LARN JUL 25. 20W 8:23 Am
AUG 3, 200'-i 9::'7 AM AUG I I - 20 10 1=':22 PM SENSOR 011T ALARM
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SENSOR r4LHRM
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END
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7—:3
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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.
1. FACILITY INFORMATION
Facility Name: #773 Fastrip#31 Date of Testing: 8/11/2010
Facility Address: 3501 Mt.Vernon Avenue,Bakersfield,CA 93306
Facility Contact: Omero Garcia I Phone: 661-393-7000
Date Local Agency Was Notified of Testing: 7/23/2010
Name of Local Agency Inspector(if present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bryan A Self
Credentials: 0 CSLB Contractor Nx ICC Service Tech. Z SWRCB Tank Tester ❑Other(Specify)
License Number(s): CSLB#804904 ICC#8022804-UT
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 Regular 2 Super 3 Diesel 4
Number, Stored Product, etc.)
Bucket Installation Type: ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury
Nx Contained in Sump Nx Contained in Sump Nx Contained in Sump ❑Contained in Sum
Bucket Diameter: 12.00" 12.00" 12.00"
Bucket Depth: 14.00" 14.50" 14.50"
Wait time between applying 5 min. 5 min. 5 min.
vacuum/water and start of test:
Test Start Time(Ti): 1:00 pm 1:00 pm 1:00 pm
Initial Reading(R[): 11.75" 11.50" 11.50"
Test End Time(TF): 2:00 pm 2:00 pm 2:00 pm
Final Reading(RF): 11.75" 11.50" 11.50"
Test Duration (TF—Tj): 1 hour 1 hour 1 hour
Change in Reading(RF-Ri): 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625"
Criteria:
Test Result: '. ® Pass ❑Fail ®, Pass ❑Fail ® 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: Date: 8/11/2010
State laws and regulations do not c tly require testing to be performed by a qualified contractor. However,local requirements
may be more stringent.