The URL can be used to link to this page

Home My WebLink AboutFMC 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 subtnit:a oopy;of this form to th.0 local.agency, regulating UST systems;within30 days of tw,date. A. General Information Facility Name: HUNGRY'S MARKET' Bldg No: Site Address: 3711 MT VERNON AVENUE City: BAKERSFIELD Zip:. 793306 Facility Contact Person: Contact Phone No.:, (. Make/Model of Monitoring System: INCON Date of.Testing/Sery cing::7 1612016 B. Inventory of Equipment TesteWCertifed IIIIIIIIIIIIIIIIIIII Check-the-a2gro riate boxes to indicates cifie 2guipment ins ted/serviced: 03 Tank ID: UNLEADED 87 "Tank ID: PREMIUM 91 IE_ ®In-Tank Gauging Probe. Model: INCON ®In-Tank Gauging Probe, Model:INCON ❑Annular Space or Vault Sensor. Model: ❑Annular`Space.or Vault Sensor. Model: ®Piping Sump./Trench Sensor(s). Model:,LS-3 ®:Piping Sump]Trench Sensor(s): Model: LS-3 ❑Fill Sump Sensor(s). Model:: ❑Fill'Sump Sensor(s). Model: ®Mechanical Line Leek Detector:., M odel RED JACKET ED Mechanical Line Leak Detector. Mode.L RED JACKET ❑Electronic Line Leah Detector. Model: ❑Electronic lane Leak Detector: Model ❑Tank Overfill/High-Level.Sensor. Model: [],Tank Overfill/High-LevetSensor. Model: ❑Other(specify cquipment.type and model-in Section E on,Page.2). [3 Other(specify.equipment type and model in Section Son Page 2). Tank ID: DIESEL Tank it: ®In-Tank Gauging Probe., Model: INCON ❑in-Tank Gauging Probe. Model: ❑Annular Space or Vault Sensor. Model: ❑Annular Space;or Vault Sensor. Model:, ®Piping Sump/Trench Sensor(s). Model: LS-3 []Piping Sump/Trench Sensor(s). Model! ❑Fill Sump Sensor(s).. Model: Q Fill Sump Sensor(s). Model- Mechanical Line Leak Detector. Model: RED JACKET ❑:Mechanical Line Leak Detector. Model ❑Electronic Line Leak Detector. Model: ❑Electronic Line.Lwk.Detector., 'Model: ❑Tank Overfill/High-Level Sensor: Model: ❑-Tank Overfill/High-Level Sensor: .Model-, ❑Other(specify equipment type and model in Section Eon Page 2). ❑Other(specify equipment type and model in Section E on Page 2). Dispenser ID: 112 Dispenser 1W 314 ®Dispenser:Containment Sensor(s). Model: LS-3 ®Dispenser Containment Sensor(s). Model: LS-3 ®Shear Valve(s). ®Shear Valve(s). ❑Dispenser Containment Float(s)and Chain(s).. ❑:Dispenser Containment Float(s).and Chain(s),. Dispenser ID: Dispenser EV ;❑Dispenser Containment Sensor(s). Model: ❑.Dispenser Co Sensor(s). Model: (]Shear Valve(s)_ ❑,Shear Valve(s). ❑,Dispenser Containment Float(s)and Chain(s). ❑.Dispenser Containment Float(s),and,Chain(s). Dispenser 1D. ID:. � ` Model:❑jpe ser Ctammern Sensor(s). ModeF �Dr ContainmenSensor(s).{❑ ) . Shear Valve(s).. Disperser Containment Float(s):and.Chain(s).. ;❑Dispenser;Containment Floats)and Chain(s), +Ifthe 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/servrced,in accordance with the manufacturers' guidelines. Attached to this Certification.is,information (e g: manufacturers' checklists)' necesiary 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 aU that apply): System set-up arm histo report, Technician.Name(print): . RYAN MASON: Signawre: Certification No.: 1584383701 802937141T License.No:: 1 809850 Testing Company Name: RICH ENVIRONMENTAL `one N ,4661) 326-8402 Testing Company Address: 3306 BRITTAN RO..BAKERSFIELD,CA.93308 Date of Testing/Servicing;7/6/2010 Page 1 of 6 UN-036—114 www.unrdocaorg 11111111111111111111 04 Rev.OV17/08 IE z)I t k-) Monitoring System Certification. D. Results of Testing/Servicing Software Version Installed Complete the following checklist: ® Yes ❑ No* Is the audible alarm operational? M Yes ❑ No* Is the visual alarm operational? ® Yes ❑ No' Were all sensors:visually inspected,functionally tested,and confirmed,operational? ® Yes 1 ❑ 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) ID N/A operational? ® Yes O 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? ff yes: which sensors initiate positive shut-down? (Check all that apply) M Sumpffrench Sensors; ®:Dispenser Containment Sensors. Did you confirm positive shut-down duelo leaks-gad sensor,failure/disconnection? S Yes; O"No.. ❑ Yes ❑ No* For teak systems that utilize the monitoring system as. the primary tank overfill warning_device (Le„ 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* S No Was,an y monito ' ring 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). El Product; ❑Water. If yes;describe causes:in SectiomE,below. ® Yes ❑ No* Was monitoring system set-up reviewed to ensure:proper,settings?Attach,set up,reports,if applicable Yes ❑ No Is all monitorin ui ment'o ..rational. r manufacturer's specifications? I� * g P pe Pe is L *In Section E,below,describe how and when these deficiencies were or.will;be.corrected. E .Comments: FAIL SAFE DID NOT WORK LINE:TESTWILL NEED TO BE PERFORMED, Page 2 of 5 UN-M—2/4 www.unkloeemerg Rev.01/11/08 Olt tv Monitoring System Certification F. In-Tank Ganging/SIR Equipment: ® Check,this box if tank gauging is.used.only for inventory control. p Check this:box ifno.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:inspec 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 systemwater level.readings tested? • Yes ❑ No* Were all probes reinstalled properly? • Yes ❑ No* Were all items on the equipment manufactur 's.maintenance;checklist completed? *In Section H,below;describe how and when these deficiencies were or will be corrected, G. Line Leak Detectors(LLD):. ❑ Cheek:this:bax if LLDs are not installed. Complete the;followin 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) Simufated leak rate: 03 g:p.li:; ❑0.1 g pi; ❑0:2 g.p h. • Yes ❑ No* Were all LLDs confirmed operational;and accurate within regulatory requirements? • Yes ❑ No* Was the testing apparatus properly.cabbrated? • Yes ❑ No* For mechanical LL,Ds,does the LLD.restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off.ifthe.LLD detects a leak? ® N/A ❑ Yes [I No* For electronic,LLDs;;does the turbine automatically shut,off°if any portion of the,monitoring systemis disabled. ® N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs,.does;:the.hiibine,automatically shutoff if any portion of the monitoring system.malfimetions '® N/A. orfails a test? ❑ Yes ; ❑ No* For electronic LLDS,have all:ac cesuble wiring connections been visually inspected? ® N/A Yes p JNo* Were all items on the equipment-manufacturer's:maintenance-checklist completed? '!In'Sepdon H,.below,describe how and when.these,deficiencies were or,w ill'be corrected. 'H: Comments:: Page 3 of :5 -UN-03b-3i4 wwwmaj.400-Org Rev.6VI7/08 Monitoring System Certification UST Monitoring Site Plan Site Address:. 11 /1)7 J Lafs- /J AV E i 1 1 `'1 � -i� r . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .d. _ . . . . . . . . . . . . . . . . .. . . X : . : . . . . . . . . . 11. 4 Date map was'drawn: r-P?/, 6q. _ Ensfructfons If you already have a diagram that shows all required information, you may include it,rather.than this page, with your Monitoring System Certification. On your site plan, show the general:layout of tanks and piping. .Clearly identify.locations of the following equipment, if installed: monitoring system control.panels; sensor§ rrionitoring tank annular spaces, sumps,.dispenser pans, spill containers,or other.secondary containment areas;mechanical or,.eleetronio'line'leak"detectors;;and in-tank liquid level probes I fused for leak detection): In the space provided,.note the date this Site Platrwas prepared: c _ Page 4 of .4. VNi 36-4/4 w.ww.unidoes.org Rev.01 117/08 a L t Monitoring System Certification Form:Addendum for Vacnum/Pressure,Interstitial Sensors I. Results of Vacuum/Pressure Monitoring Equipment.Testing This page should be used to document testing and.servicing of vacuum and pressure interstitial sensors. A copy of this form.must be included with the Monitoring System Certification Form, which must be provided to the tank system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification.Form to the. local agency regulating UST systems within 3U days-of test date. Manufacturer: NIA Model: System Type: ❑Pressure;.❑Vacuum Sensor ID Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑'Pass;: El Interstitial Communication.Test Result:❑Pass; .❑ Fail. Component(s)Monitored by this Sensor: Sensor Functionality Test Result:.❑Pass;- ❑ Fail. Interstitial..Communication Test,Result:❑Pass; ❑ Fail Component(s)Monitored by'this Sensor: Sensor,Functionality,Test Result- ❑Pass; El Fail Interstitial Communication Test.Result;❑Pass; .❑ Fail Component(s)Monitored by this'Sensor: Sensor Functionality Test,Result: ❑:Pass; ❑; Fail Interstitial Commmiicat ion'Test:Result.❑Pass; ❑ Fail_ Component(s)Monitored:by this Sensor: Sensor Functionality Test Result ❑Pass- ❑ Fail Interstitial'Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored by this-Sensor: Sensor Functionality Test,Result ❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored by this Sensor; Sensor Functionality Test.Result:.n: ass- ❑ Fail Interstitial Communication Test.Result:.❑Pass;. ❑ Faii Component(s)Monitored.by thisaensor,:, Sensor Functionality Test Result-:.❑.Pass ❑ Fail Interstitial Communication Test Result::.❑Pass;: ❑ Fail Component(0)Monitored bytW Sensov Sensor Functionality Test Result:.El Pass;. ❑ Fail Interstitial.Commumcati(m,TestResult:❑Pass; [] Fail Component(s)Monitored by:this Sensor_: Sensor Functionality Test`Result:.❑Pass; I❑ Fail Interstitial Communication Test Result: ❑Pass; ❑, Fail 1 ;HOW was interstitial communication verified? k ❑ .Leak Introduced.at.Par End oflmerstitial Space.;: ❑ Gauge; ❑ Visual.Inspection;. ❑ Other,epescribe in Sec:J, below) .Was vacuum/pressure restored to operating:levels in all interstitial spaces? El Yes ❑'No.(Ifno, describe in Sec.J-below) N J .J Comments: WA Page 4 of 5 i If the sensor successfilly detects.a simulated`vacuum/pressure leak introduced in.the interstitial space at:the.fwthest point from•the sensor,vacuum/pressure has been demonstrated to be,conmumicat►ng throughout the interstice: UN-036A-14 www.unidomoM Rev.01%26!06 fl nnn c LINES JA C H TEXACn #MME; PREMI1fh! TYPE. TA 371' M7. VERNON j�li4: gTANDpRD 15 NUMBER O LINES 6 BAKERSFIELD CA. 93366 PROBE PROBE 2 661.571.75#39 PRODUCT PRODUCT 2 pORT'SCHEDULES MANIFOLD HONE 05 0712918 21,17 PROD: OFFSET' 0 5,00 IhIVENTORY WATER OFFSET. -1. 100 PRODUCT DETAIL. SYSTEM 'SETUP REPORT DEi. YHl2ESHOlD No SCHEDULE HONE H°IOH HIGH'LIM 93.000 NODUCT SUMMARY SYSTEM INFO N'IGN NIrH:: O/G NONE !SCHEDULJ NONE HIGH LIMIT 93.000 ?RObUCT USAGE DETAIL �TWARE HIGH LIMIT V6 14 NE 'SCHEDULE NONE DART T1Pi41 i7 LOW LIMIT 12.0 PRODUCT' USAGE SUMMARY UERSION1. 1,if LOW LIMIT 0/0 `NONE SCHEDULE NONE RELEASED 10/05/1998 LOW LOW LIMIT f2.6 TANK :DETAIL LOW LOW 0/0 NONE,. SCHEDULE NONE SYSTEM ID SEE ABOOE WATER LIMIT 3.000 TANK SUMMARY WATER. 0/11 .NONE SCHEDULE NODE MEASUREMENT UNITS TANK 3 RECONCILIATION VOLUME Gk—IONS NAME DIESEL SCHEDULE NONE LEVEL INCHES TANK TYPE STANDARD: 15. DELIVERY TEMPERATURE FAHRENHEIT PROBE PROBE 3 PRODUCT DETAIL PRODUCT PRODUCT 3 SCHEDULE NONE r'LOCK/CALENDAR MANIFOLD NONE PRODUCT `$llMMA.RY TIME STYLE 24 HOUR PROD OFFSET. 1.500 SCHEDULE HONE DATE.STYLE tMM/DD/YY WATER OFFSET •1.000 DELIVERY HTSTORY DAYLIGHT SAV ENABLED DEL THRESHOLD, 20.0 SCHEDULE_ NONE SET TIME 21118 -HIGH HIGH' LIM1 93 0 ALARM'S SET DATE 05/07/2610 HIGH HIGH b/o 4ONE ACTIVE ALARMS HIGH LIMIT . SCHEDULE; • ... . NONE SENTINEL .MODE HIGH LIMI.T ,O�G NONE CLEARED;ALARMS MODE OFF .LO�i LIMIT, i2.0 SCHEDULE NONE START TIME 0:89 LOW LIPIIT OlG NONE ALARM HISTORY END TIME 0:06 LOW LOW .LIMIT 12.0: SGNEDULE NOME LOW LOW O/G NONE SENSOR.:STATUS REPORT PRINT ENABLES WATER: LI'MIT 3.' 8 SCHEDULE . NONE DELIVERIES EFIAB,LLD WATER 0/0 NONE REGU1_ATbRY ALARMS ENABLED $,CHEDLILE NONE 1:1 TEAK TFSTS ENABLED PROBES COMM ;PORTS LINE TESTS ENABLED PROBE 1 L IM I TS TYPE STD 101 COMM :PORT' I LEAK LIMIT 2..00: GRADIENT :9 00169 MODE NATIVE LEAK LIMIT 0/0 NONE FLOATS 2 FLOATS BAUD 1266 BAUD' T14EFT 'LIMIT 25.00 FLOAT TYPE 6AlSbLINE DATA BIT'S 8 BITS THEFT LiMIT.O�G . .NINE PROBE 2 STOP BITS I STOP BIT TYPE STD 101 PARITY Na PARITY MISCELLANEOUS GRADIENT 89559.7' SECURITY SYSTEM FAIL O/G. NONE FLOATS 2 FLOATS COMM PORT 2 DELIVERY DELAY 25 'FLOAT' TYPE GASOLINE MODE; NATTUE HISTORY LENGTH 50 PROBE '3 BAUD 1200 BAUD PRINT INTERVAL 1 TYPE STD 101 DATA:BITS $ BITS GRADIENT 8:94 09 $TbP BITS 1. STOP 3IT TANK FLOATS . 2 FLOATS 'PARITY NO PARITY FLOAT.TYPE OIL SEp,1RITY !408ER OF TANKS 3' ACCESS 1 . PRODUCTS PHONE 1 TANK. ? REDIAL 1. DISABLED NAME UNLFAD: PRODUCT 1, ACCESS:�2 TAW TYPE STANDARD 15 NAME PROD 1 PHONE, 2 PROBE PROBE i TYPE, UNLEADED PLS_ REDIA.L 2 DISAt�_ED PRODUCT RRODUCT 1' PRODUtT 2 ACCESS'3 MANIFOLD NONE NAME PROD; 2 PROD OFFSET A.000 '7VPE_ UNLEADED SUP REDIAL.Z DISABLED WA,TER .OFFSET -1.:599 PRODUCT 3, PROD 3 ACCESS 4 DEL.THRESHOLD 206 NAME PHONE4 HTGH HIGH LIM 93.689 TYPE UNLEADED REG RFDIAL. 4 DISABLED HIGH HIGH 0/G NONE DIAL DELIV HIGH LIMIT 93.000 DIAL ALARM HIGH LIMIT 0/G NONE DIAL LEAK LOW LIMIT 12.0 LOW LIMIT 0/G NONE LOW LOW LIMIT 12.0 LOW LOW 0/G NONE WATER LIMIT 3.000 WATER 0/6 NONE T81aV 7 -,AX/MODEM t DATA MODE SENSORS MODE NATIVE ;fI 3?,KERSrl 11 MT. 93306. BAUD 1200 BAUD NUMBER OF SENSORS 5 DATA BITS 8 9TTS '21 STOP BITS 1 STOP BIT 2,1..* PARITY NO PARITY' 14AIIE UNL-s,ump SECURITY STD O/G ALL GROUPS ACCE I SENSOR 2 STD TAW: SETUP :REPORT PHONE I NAME SUP-somp NO. j., :5728.0 GAL REDIAL I DT-W- FLED STD: O/G ALL GROUPS TANK ACCESS 2 SENSOR STD, NAMEE UNLEAD PHONE 2 NAME DIESEL-tUHP TKW STANDARD 1�5 .REDIAL 2 DISABLED STD ;OfG ALL GRIDUPS T�ANK TYK .12!0 DIAMETER.. ACCESS 3 SENSOR 4 STD 337.98 PHONE 3 HARE DI,$P 1-2 PON LE,kGT'14 ESHOLD 200.00 REDIAL 3 DISABLED. STD 0/G ALL GROUPS DEI THR jMjt.T ACCESS 4 SENSOR 5 STD k�ROTiUGT PROD I PHONE 4 NAME D I SP-7-3-4, PAN PROD, NAME QNLEADM P11-s REDIAL 4 DISABLED STD b/a AL! , GROUPS PROD TYPE @.00 r DIAL DELIV OFFSET OFFS DIAL ALARM AUXILIARY INPUTS, . . . I T NONE MAL LEAK MANIFOLD. PROEM 1 FAX MODE -INPUT I PROEM TYPE -TD 101 ACCESS PROBE TYPE'ACTIVE CLOSED FLOATS PHONE NAME AUXILIARY I FLOATS GASOLINE : ACCESS 2 AUX INPUT OrG: NONE FLOAT TYPE p -PHONE-2. INPUT 2 GRADI-w 93.00 ACCr_SS' 3 ACTIVE CLOSED HIGH LIMIT. 0/i3l NONE kt N, 'j,t,MIT . PHONE 3 �NAW_ MUXILIARY"2 LOW -LIMIT ACCESS 4 AlUX INPUT V.6 NONE' NONE PHONE 4 93.G!9 FAX DELIVERY TS-ROM' HIGH HI�_ NONE FAX ALARM HIGH 03H 04 FAX LEAK GRAM PERIOD LOW LOW sOmE FAX REPORT -LOW LOW' OG CHANNEL I wATFR tIMIT wO00 WATER LIMIT O/G LEAK TESTS OUTPUT GROUPS Comp 01 68/548 A- -P, Y---- TEMP :1 62.80 I� CONFIDENCE 99.61 FF . . . . mpl GRAVITY 320.0A MIN TEST TIME 4 ALPHA 5 LEAK TEST OUTPUT GROUPS 4b•. RIDS 11.4"'LOG 1 30. TANK 1 0.20 " Y---:- . .q.;. . W TANK 2 0.20 Q_Fr_ RTD Lot 2. 45-81 TAW 3 0.20 CHA N I NEL 3 m, Lm,'.3 60.41 TEST SCHEDULES OUTPUT GROUPS RTb LOC 4 77.,1' RTD LOC 5. TANK I A�P Y --SCHEDULE 28TH DAY STRAPPING DATA TIME' CHANNEL .4. CN lt4 INcHES, _LIJ TAW 2 OUTPUT GROUPS: 0.0e "SCHEDULE 28TH DAY A-P.. Y-- 129.3c TIME 22:30 FF 21 I&L TANK' 3, CHANNEL,5 SCHEDULE 78TH DAY 0.UTPUT 'GROUPS, 15.ON 1422.11 20.8e@ TIME 22*30 2053.0 25.NO -6 ALARM ON TEST FAIL NO 2672 CHANNEL,6 333e.- ANNUNCIATORS OUTPLIT, GROUPS • ;4w A-P 45.ON MODULATED ANNUNCIATOR 12-FF 50.006, 5431, TTMEOUT CHANNEL 7 55-�*_o 6126.4 OUTPUT GROUPS, 67% -.0-UTPVT.,GROUPS ;A-P A-P Y_ 65M0 7431- Q-FF -------- .-70-NO S023- SOLID ANNUNCIATOR CHAHMFL ,8 '75-ON ir361. TIMEOUT 0 OUTPUT'GROIRS Q032. OUTPUT GR04JPS A-P go-om 9415 85.OW A-P ge.:m Q-FF- RELAYS RELAY I TI MEOLrTl 15 !OUTPUT GROUPS A-P ----------- RELAY 2 TIMEOUT 15 OUTPUT GROUPS ,07FF TANK NO. 2 w2ti.a titiL TANK NAME PREMIUM TANK N0: 3. 9728.9 'GAL TANK TYPE STANDARD 1.5 C 'H TEXACO DIAMETER 92.80 TANK NAME DIESEL 3711 .46, VERNON LENGTH 337..98 TANK, TYPE STANDARD 15 BAKERS`�IELD_CA..::933A6 DEt ..T,HRE5HCtL0 200.80 DIAMETER 92.00 PRODUCT PRODUCT'2 'LENGTH, , . 337.98 PROD NAME PROD 2 DEL THRESHOLD 200:00 05i07/2910 21:23 PROD TYPE UNLEADED SUP PRODUCT PRODUCT `S .OFFSET P G.t 50- PREDD'NAME POD _, ALARM HISTORY OFFSET W -1.00 PROD TYPE UNLEADED REG MANIFOLD NONE OFFSET P 1.55 PROBE PROBE 2 OFFSET `W PROBE TYPE STD 181 MANIFOLD NONE FLOAT.. 2 FLOATS PROBE PR�1BE, 3 FLOAT TYPE GASOLINE PRDBE, TYPE STD 101 GRADIENT 8.95597 FLOATS: 2 R-OATS HIGH LIMIT 93.88, FLOAT TYPE OIL 05107r2@i9 20:29 HIGH LIMIT O/G NONE GRADIENT 8.94409- POWER, UP LOW LIMIT 172.00 HIGH LIMIT . 93.00 LOW LIMIT 010 NONE HIGH LIMIT O/G NONE Q5107�291s� 2+0:28 HIGH HIGH 93.00 LOW LIMIT 12.07 POWER pray# HIGH HIGu DIG NONE LOW !._IMIT 0!0 NONE LOW LOW !'.'..08 HIGH HIGN 93. 00 95.f07r2N18 20:09 LOW LOW O1G NONE HIGH HIGH DIG Nh� E STANDARD SENSOR MATER LIMIT 3.80 LOW LOW 12.80 DISP z-2,PAN WATER LIMIT 0/0. NNE LOW :� OW O/G NONE: SENSOR N0. 4 TEMP COMP API 681548 WATER LIMIT 3..80 API GRAVITY 51.30 WATER LIMIT.06 t. OHE. 05/07/2010 ALPHA .. 328.00 TEMP.*COmo 'API: 68/548 STANDARD SENSOR'' NO. RTDS 5 API GRAVITY 63.,50: bISP-3--4PAN RTD LOC 1 11.49 ALPHA x20:00 BEFtSQR NO. 5 RTD LOC 2 30.93 NO. RTDS -5 RTD LOC 3 45.8.1 RTD LOC: 1 11._45 95/07!1819 19:59 RTD LOC 4 68.47 RTD LOC 2` 30.93 STANDARD' SENSOR RTD LOC 5 77.19 RTDl LOC. 3 RTD' LOC 4 60.,4 UNL-SUMP STRAPPING DATA RTD LOC 5 77.:19 SENSOR f�tO. 1 INCHES GALLONS 05i97f291&. 19:59 0.890 0.000 i17APP�ZNG DATA STANDARD SENSOR 5.000 • 189.-,cm INCHES GALLONS "-sump TAND D 19.E 531.21:1 9. 8:000 SENSOR NO. 2 15.000• 968.709 5.000: 189.395 20.,090 1482.163 10.009 531.211 05/87/2918 19:51 25.099 ?053:074 1"5.090 968.709 STANDARD SENSOR 30.000 2672.692 .20:900, 1482.163 IIESEL-SUMP' 35.099 3338,361" 25i A916 2053.974 :SENSOR NO. 3 48.008 4016.533 30.ON 2672.692 45.090 4721.879 35..093 &30.U.1 04/29/2010 6:97 58.980 . 5431.'445 49.NO 401'6:533 POWER UP 55.099 6126.905 45.000 4721,879 60.000 6796..220 59".008 5431.945 04129,2019 6 .u37 65.080 7431.573 55.00 X6126.40:5 l POWER 1?06dF1= 79.090 8823.747 60.:0009 6796.228 75.009 8561,..640 65.890 7431.573 04/0&2918 21.:25 89.000 9932.387 70.CA 0 :8023.747 POWER';UP 85.088 9415.248 75.080 8561,648 96.000 900.21.1 80.008 9032.387 85.900' 9415.24$ POWER!�DOWN 17:.34 9A..;090 96 .211. POWER 'DOWN 03 .142818 16:23 POWER UP 93,,14/2010 16:23 POWER :DOWN 031142019 1:5:13 POWER UP 03.14120 0 15•X13 POWER DOWN 93✓87i2@110 15:55 POWER UP 03t97v29.10. 15:55 POWER. DOWN 02i-15/2010 1$:096 POWER UP 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%perator for submittal to the local regulatory agency. 1. FACH ITY INFORMATION Facility Name: HUNGRY'S MARKET Date of Testing: 7/6/10 Facility Address: 3711 MT VERNON AVENUE,BAKERSFIELD,CA Facility Contact: Phone; Date Local Agency Was Notified of Testing: Name of Local Agency Inspector(rfpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL. Technician Conducting Test: STEVEN OBE RT Credentials': ❑CSLB Contractor X ICC Service Tech. C SWRCB Tank Tester D Other(Specify) License Number(s): 5261246-UT 3. SPILL.BUCKET TESTING°INFORMATION Test Method Used: X Hydrostatic ❑Vacuum 0`Other Test Equipment Used:VISUAL F,guipment;Resolution:0 Identify.Spill Bucket(By Tank 1 2r 3 4 Number,Stored Product; etc.) REG 87-FILL PREM 91-FILL DIESELYILL. Bucket Installation Type: X Direct-Bury X Direct Bury. X DireaBury ©Direct Bury ❑Contained in Sum ❑Contained in Sump O:Contaiued in Sum 0 Contained in Sum Bucket Diameter: 12" . 12" 12" Bucket Depth: 14" 14 14" Wait time between applying 30 MIN 30 MIN 30 MIN vacuum/water and start of test: s Test StartTime(TI): /' %� •-- I iJ . 'Initial'Reading(Ri): Test End Time.(TF): (Final Reading(F�) i� "Test Duration;(TF,—Ti}: -HOUR 1-HOUR 1-HOUR q.Change in Reading(RF-Ril: t °'• Pass/Fail Threshold or +/-0.00 +/-0.001 +/-0.00 Criteria: i Comments—(include it formation on repairs made prior to testing and recommended follow-up for,failed-tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING,TM TESTING l.hereby certify thiW all the lief n conidMed in this repart'is?nuy accurate,avid in full:compliance with legal requirements. 't'echnician's Signature: Date:' 7/6/10 ,1 State-laws andregulations no curre y r .uire testing:to be perf6rmed by a qualified"contractor.However;:.local requirements may be more stringent. 1 SWRCB,,January 2006 Spill Bucket Testing Report Form This form is intended for use by.contractors-performing annual testing,of USTspiff containment structures. The completed form and printouts from-tests(f a)9plicable), should be provided'to the facility ownerloperator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: HUNGRY'S MARKET Date of Testing' 7%6/10 Facility Address: 3.711 MT VERNON AVENUE,BAKERSFIELD,CA Facility Contact: 1.Phone;' Date.Local Agency Was Notified.of Testing Name of Local.Agency Inspector(fpresent°during testing)' 2. TESTING CONTRACTOR-INFORMATION Company Name: RIC14 ENVIRONMENTAL Technician Conducting Test: STEVEN OBERT Credentials': ❑CSLB Contractor X.ICC Service Tech. 0 SWRCB Tank Tester ❑Other(S ecify). License'NumbWs): 5261146XT 3. SPH.L BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic E:Vacuum El Other Test Equipment Used:VISUAL Equipment Resolution:0 Identify Spill`Bucket(By Tank 1 2 3 4 ;Number,Stored Froduct, etc.) REG.87-FILL PREM 91 7FILL DIESEL FILL Bucket Installation.Type: X Direct Bury X Direct Bury X Direct Bury ❑Direct Bury. Contained in Sump 11 Contained'in Sump 0-Contained in Sump 0.Contained.in Sum Bucket Diameter: 12" 12" 12" Bucket.Depth: 14" 14" 14" Wait time between applying 30 MIN 30 MIN 30 MIN vacuum/water and start of test: Test Start Time(Tj): 1:0.0PMI 1:00PM 1:OOPM. Initial Reading M): 1,211 12" 12" Test End Time(TF): 2 OOPM 2:OOPM 2 O.OPM, Final Reading(RF): 12" 12" 12" Test Duration(TF_TO: 1-HOUR. 1-HOUR 1-HOUR Change in Reading(RF-R�: O 0 0, Pass/Fad Threshold or +/-.0.00 /-0:00 +%-0:00 Criteria: Comments—(include information on rep giis made.prior to testing;.and recommended follow-up fo r.failed:tests) y CERTIFICATION OF TECHNIC RESPONSIBLE FOR CONDUCTING THIS TESTING 1 hereby certify that all the info madon contain .in this report is true,:accurate,and in full compllance-with legal requiremenlL Technician's-Signature: Date: 7/640' 'State laws and regulations do not wls4ntiy r. testing to be performed by.a qualified contractor.However,Iocal'requirements may be more stringent. RICK EAWIROAMENTAL 3305 BRITTAN ST. BAKERSFIELD,CA. 93308 OFFICE(661)326=840 FAX;(661)326-8934 PRODUCT LINE.LEAK DETECTOR TEST WORK SHEET W/O#• FACILITY NAME: 'HUNGRY'S MARKET FACILITY ADDRESS': 3711 MT VERNON AVENUE,BAKERFIELD,CA. PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL UNL87 UD TYPE: RED JACKET . PASS YES 9; SERIAL:#. MECHANICAL PREM91 L/D TYPE: RED JACKET PASS .YES 9 SERIAL# MECHANICAL DIESEL L/D TYPE; RED JACKET PASS YES' g SERIAL#E MECHANICAL L/D TYPE-: 'PASS YES SERIAL-# FAX I CERTIFY THE ABOVE TESTS WERE CONDUCTED ON THIS DATE ACCORDING TO RED JACKET PUMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMITATIONS,. THE MECHANICAL LEAK DETECTOR TEST PASS.I FAIL IS DETERMINED BY USING A LOW FLOW THRESHOLD'TRIP RATE OF.3 GALLONS ,PER'HOUR OR LESS AT 10 P.S I I ACKNOWLEDGE THAT ALL DATA COLLECTED IS TRUE AND.CORRECT TO THE BEST OF MY KNOWLEDGE:.. TECHNI.CIAN: .RTAN MASO T SIGNATURE: DATE: -7/6110 i I a �b .lam MONITOR CERT, FAILURE REPORT. SITE NAME HUNGRY'SMARKET DATE : 7/61.10 ADDRESS: 3711 MT VERNON AVENUE. TECHNIC RYAN MASON CITY : BAKERSFIELD SIGNATURE: THE FOLLOWING.COMPONENTS WERE REPLACEWRE D VO COMPLETE TESTING. REPAIRS : FAIL SAFE.SHUT-DOWN DOES NOT WORK-LINE TESTING NEEDS TO BE PERFORMED / c) Z37— P&2rk<<' LABOR: NONE PARTS INSTALLED : 'NONE' NAME : T3TLE SIGNATURE THE ABOVE NAMED:PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING TBE APPROPRIATE PARTY TO HAVE FULL.. CORRECTIVE ACTION TAKEN TOREPAIIt THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH,ENVIRONMANTAL FOR ANY NEEDED RETESTING.THIS ALSO RELEASES RICH'ENVIRONMENTAL OF ANY FINES OR PENALTIES.OCCURING FROM NON=COMPLIANCE. A COPY OF THIS DOCLUVIENTHAS BEEN LEFT-ON-SIMFOKYOUR CONVIENENCE.