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Home My WebLink About2011 RESULTS MONITORING SYSTEM CERTIFICATION 47 For Use By All Jurisdictions Within the State of California I 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: California Chevron Bldg.No.: Site Address: 4100 California Avenue City: Bakersfield Zip: 93309 Facility Contact Person: Sam Jouda Contact Phone No.: 661-333-0000 Make/Model of Monitoring System: Veeder-Root TLS 350 Date of Testing/Servicing: 2/14/2011 B. Inventory of Equipment Tested/Certified Check the appropriate ores to indicate specific equipment Inspected/serviced: Tank ID: 10000 gal.Regular North Tank ID: 10000 gal. Regular South [x] In-Tank Gauging Probe. Model:847390-107 Lx] In-Tank Gauging Probe. Model: 847390-107 [x] Annular Space or Vault Probe. Model:794390-409 [X] Annular Space or Vault Sensor. Model: 794390409 [x] Piping Sump/Trench Sensor(s). Model:794380-420 [x] Piping Sump/Trench Sensor(s). Model: Ronan [x] Fill Sump Sensor(s) Model:Ronan [x] Fill Sump Sensor(s). Model: Ronan [] Mechanical Line Leak Detector. Model:FX1V [x] Mechanical Line Leak Detector. Model: FXiV ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: [x] Tank Overfill/High Level Sensor. Model:OPW 61-SO [X] 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: 10000 gal.Regular(Siphon) Tank ID: 10000 gal.Super [x] In-Tank Gauging Probe. Model:847390-107 [x] In-Tank Gauging Probe. Model: 847390-107 Lx] Annular Space or Vault Sensor. Model:794390-409 [x] Annular Space or Vault Sensor. Model: 794380-409 [x] Piping Sump/Trench Sensor(s). Model:Ronan Lx] Piping Sump/Trench Sensor(s). Model: Ronan [x] Fill Sump Sensors(s). Model:Ronan Lx] Fill Sump Sensor(s). Model: Ronan ❑ Mechanical Line Leak Decector. Model: [x] Mechanical Line Leak Detector. Model: FX1V ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: [x] Tank Overfill/High Level Sensor. Model:OPW 61-SO [x] Tank Overfill/High Level Sensor. Model: OPW 61-SO ❑ 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: [x1 Shear Valve(s). U Shear Valve(s). [x] Dispenser Containment Floats)and Chain(s). [x] Dispenser Containment Float(s)and Chain(s) Dispenser ID: 5&6 Dispenser ID: 7&8 ❑ Dispenser Containment Sensor(s).Model: ❑ Dispenser Containment Sensor(s).Model: L] Shear Valve(s). [X] Shear Valve(s). L] Dispenser Containment Float(s)and Chains(s). [, Dispenser Containment Float(s)and Chain(s). Dispenser ID: 9&10 Dispenser ID: 11 &12 ❑ Dispenser Containment Sensor(s).Model: ❑ Dispenser Containment Sensor(s).Model: [X] Shear Valve(s). [X] Shear Valve(s). Ex-] Dispenser Containment Float(s)and Chain(s) [z] Dispenser Containment Floats)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) Ex System Set-up U Alarm history report Technician Name(print): Kristopher Karns Signature: Certification No: B34106 License No: 804904 Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930 Site Address: 4100 California Avenue,Bakersfield,CA 93309 Date of Testing/Servicing: 2114/2011 1111111111111 48 IE 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. A. General Information Facility Name: California Chevron Bldg.No.: Site Address: 4100 California Avenue City: Bakersfield Zip: 93309 Facility Contact Person: Sam Jouda Contact Phone No.: 661-333-0000 Make/Model of Monitoring System: Veeder-Root TLS 350 Date of Testing/Servicing: 2/14/2011 B. Inventoryy of Equipment Tested/Certified Check the appropriate boxes to Indicate specific equipment inspected/serviced: Tank ID: 10000 gal.Regular Diesel Tank ID: Ex-I In-Tank Gauging Probe. Model:847390-107 ❑ In-Tank Gauging Probe. Model: [x] Annular Space or Vault Probe. Model:794390-409 ❑ Annular Space or Vault Sensor. Model: [x] Piping Sump/Trench Sensor(s). Model:Ronan ❑ Piping Sump/Trench Sensor(s). Model: ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s). Model: [1 Mechanical Line Leak Detector. Model:FX1 DV ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: [x] Tank Overfill/High Level Sensor. Model:OPW 61-SO ❑ Tank Overfill/High Leval Sensor. Model: ❑ 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 Decector. 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 Sec.E on Pg.2) 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) 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 Chains(s). ❑ 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) Q System Set-up L Alarm history report -i A, Technician Name(print): Kristopher Karns Signature: t ,. `h CkA . Certification No: 834106 License No: 804904 Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930 Site Address: 4100 California Avenue,Bakersfield,CA 93309 Date of Testing/Servicing: 2/1412011 1 1 D.Results of Testing/Servicing Software Version Installed: 327.04 Complete the following checklist: [X] Yes ❑ No* Is the audible alarm operational? x Yes No* Is the Visual alarm operational? x Yes No* Were all sensors visually inspected,functionally tested,and confirmed operational? -il 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? ET 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? El Sump/Trench Sensors❑Dispenser Containment Sensors Did you confirm positive shut-down due to leaks and sensor failure/disconnected? [X] Yes; [:1 No; E] 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* U No Was liquid found inside any secondary containment systems designed as dry systems? ❑Product; ❑ Water.If yes,describe causes in Section E,below. x 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: Both the Regular North and Regular South have stuck relays and need to be replaced and re-tested to verify positive shutdown. 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: [ Yes F] No* Has all input wiring been inspected for proper enter and termination,including testing for ground faults? Kx:Y:es No* Were all tank guaging probes visually inspected for damage and residue buildup? No* Was accuracy of system product level readings tested? No* Was accuracy of system water level readings tested? No* Were all probes reinstalled properly? ❑ 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: [X]3 g.p.h.: ❑0.1 g.p.h.; ❑0.2 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? es o For mac ca LLD's,does the LLD restrict product flow if it detects a ? N/A ❑ Yes No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? [x] 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 LLIYs,does the turbine automatically shut off if any portion of the monitoring system [x] N/A malfunction or fails a test? ❑ Yes No* For electronic LLD's,have all accessible wiring connections been visually inspected? Fx] N/A x 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: CALIFORNIA CHEVON SYSTEM SETUP '4100 CALIFORNIA AVE - - - - - - _ - - - _ _ COMMUNICATIONS SETUP EkRSFLD 'CA 93309 FEE 14, 2011 8:20 AM - - - - - - - - - - - - 66I-336-0263 FEB 14, 2011 8:20 w.l PORT SETTINGS: SYSTEM UNITS COMM BOARD 1 (RS-232) U.S. BAUD RATE 9600 SYSTEM STATUS REPORT SYSTEM LANGUAGE PARITY ODD _ _ ENGLISH D STOP BIT I STOP ISD GROSS PRIES WARN - SYSTEM DATE/TIME FORMAT W DATA LENGTH: 7 DATA MON DD YY H1i:MM:SS xM RS-232 SECURITY h 1:DECRD COLLECT WARN CALIFORNIA CHEVON CODE : DISABLED 4100 CALIFORNIA AVE COMM. BOARD 2 (,RS-232} INVENTORY REPORT BKR8FLD. CA 93309 BAUD 'RATE 9600 661-336-0263 PARITY ODD SHIFT TIME .1 5:00 AM STOP BIT 1 STOP T I :UNLEADED NORTH SHIFT TIME 2 DISABLED DATA LENGTH:. 7 DATA VOLUME - 2279 GALS SHIFT TIMH 3 :DISABLED RS-232 SECURITY ULLAGE 7405 GALS SHIFT TIME 4 : 'DISABLED CODE : DISABLED 9011 ULLAGE- 6436 GALS TO VOLUME - 2265 GALS, TANK PER TST NEEDED WRN COMM BOARD : 3 (EDIM 1 HEIGHT - 25.54 'INCHES DISABLED RS-232 SECURITY WATER VOL - 0 GALS TANK. ANN TST NEEDED WRN i CODE : DISABLED WATER - 0.00 I14CHES DISABLED I TEMP - 68.6 DEG' F AUTO TRANSMIT SETTINGS: ! LINE RE-ENABLE METHOD I T 2:SUPREME PASS .LINE TEST AUTO LEAK ALARM LIMIT VOLUME - 2273. GALS LINE PER TST NEEDED WRN DISABLED ULLAGE - 7411 GALS DISABLED AUTO 'HIGH WATER LIMIT 903 ULLAGE- 6442 GALS DISABLED LINE ANN TST NEEDED WRN TO VOLUME - 2267 GALS DISABLED AUTO OVERFILL LIMIT HEIGHT - 25.49 'INCHES" DISABLED WATER VOL 0 GALS AUTO LOW PRODUCT WATER - 0.00 INCHES PRINT TG VOLUMES DISABLED TEMP - 62.9 DEG F ENABLED AUTO THEFT LIMIT TEMP COMPENSATION DISABLED VALUE (DEG F ): 60.0 AUTO DELIVERY START T3:UNLEADED SIPHON STICK HEI:GHT .OFFSET DISABLED VOLUME - 3127 GALS DISABLED AUTO DELIVERY END ULLAGE - 6557 GALS DISABLED 9OU ULLAGE-. 5588 GALS ULLAGE: .90%t AUTO EXTERNAL INPUT ON TO VOLUME = 3121 GALS H-PROTOCOL DATA FORMAT DISABLED HEIGHT - 32.06 INCHES HEIGHT AUTO EXTERNAL INPUT OFF WATER VOL 0 GALS DAYLIGHT SAVING TIME DISABLED WATER a 0.00 INCHES ENABLED AUTO SENSOR FUEL ALARM TEMP . 62.9 DEG F ;DISABLED START DATE AUTO SENSOR WATER ALARM APR. WEEK I SUM DISABLED T ND 4:UNLEADED SOUTH START TIME AUTO SENSOR OUT ALARM VOLUME 2978 GALS ND D AM DISABLED ULLAGE - 6706 GALS E DATE 90•d ULLAGE- 5737 GALS END WEEK 6 SUN E TIME TO VOLUME - 2963 GALS 2:00 AM HEIGHT - .30.94 INCHES WATER VOL - 0 GALS RE-DIRECT LOCAL PRINTOUT WATER = 0.00 .INCHES DISABLED TEMP - 66.9 DEG F EURG PROTOCOL PREFIX -232 END OF MESSAGE: T 5:DIESEL S 'DISABLED VOLUME - 1596 GALS ULLAGE. - 8088 GALS 90.4 ULLAGE- 7119 GALS SYSTEM SECURITY TO,, VOLUME - 1.586 GALS CODE : 000000 HEIGHT a 1.9.83 INCHES WATER VOL - 0 GALS MA I NTE14ANCE H I STORY WATER 0.00 INCHES DISABLED TEMP - 68.4 DEG F I T.HNK CHART SECURITY MAN I FOLDED,fT S .- -,,_ DISABLED rwttgTO12`7 0 T 1:UNLEADED NORTH T 3:UNLEADED SIPHON CUSTOM ALARMS T 4:UNLEADED SOUTH DISABLED VOLUME - 8384 GALS TO VOLUME 8348 GALS MASSiDENSITY, k X x K .* END x A x x w DISABLED T 2:SUPREME T 3:UNLEADED SIPHON IN--TkNK SETUP PRODUCT CODE 2 PRODUCT CODE 3 - - - - -- - - - - - - - THERMAL COEFF : .0007DO THERMAL COEFF : .000700 - TANK DIAMETER 89.75 TANK DIAMETER 89.75 T J :UNLEADED NORTH TANK PROFILE 4 PTS TANK PROFILE 4 PTS PRODUCT CODE 1 FULL VOL 9684 FULL VOL 9684 THERMAL COEFF : .000700 67.3 INCH VOL 7891 67.3 INCH VOL 71391 TANK DIAMETER 89'.75 44.9 INCH VOL 4918 44.9. .INCH VOL 4118. TANK PROFILE 4 PTS 22.4 INCH VOL 1900 22.4 INCH VOL 1900 FULL VOL : 9684 67.3 INCH VOL 7891 44.9 INCH VOL : 4918 FLOAT SIZE: 4.0 114. FLOAT SIZE: 4.0 IN. 22.A INCH VOL 1900 WATER WARNING 2.0 WATER WARN 11VG 2.0 HIGH WATER LIMIT: 3.0 HIGH WATER LIMIT: 3.0 FLOAT SIZE: 4.0 I.N. MAX OR LABEL VOL: 9684 MAX OR LABEL VOL: 9684 WATER WARNING 2.D OVERFILL LIMIT 92% OVERFILL LIMIT 92% HIGH WATER LIMIT: 3.0 8909 8909 HIGH PRODUCT 98% HIGH PRODUCT 98% MAX OR LABEL VOL: 9684 9490 9490 OVERFILL LIMIT 92% DELIVERY LIMIT 5% DELIVERY LIMIT 5X 8909 500 500' HIGH PRODUCT 9BY 9490 LOW PRODUCT 500 LOW, .PRODUC,'T 500 DEC)VFR L1111T 54 LEAK ALARM .LIMIT: 99 LEAK ALARM LIMIT: 99. 500 SUDDEN LOSS. LIHIT: 95 SUDDEN LOSS LIMIT: 99 TANK TILT_ 3.40 TANK Td LT 4.70 LOW PRODUCT 500 PROBE OFFSET. 0.00 PROBE OFFSET 0.00 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 1 .75 SIPHON MANIFOLDED TANKS SIPHON MANI'FOLDED TANKS PROBE OFFSET O.DO Tit: NONE TO: 01,04 LINE MANIFOLDED TANKS LINE MANIFOLDED TANKS TO: NONE TO: 01 :.04 SIPHON MANJFOLDED TANKS TA: 03..04 LINE� MAN I-FOLDED TANKS LEAK MIN PERIODIC: 1% LEAK: MIN PERIODIC: 1% T4: 03.04 100 160 LEAK MIN ANNUAL 1`. LEAK MIN ANNUAL ': l% LEAK M I N' PER I OD 1 C' 1% 100 100 100 LEAK MIN ANNUAL 1 t PERIODIC TEST TYPE PER IOD.IC 'TEST TYPE 100 STANDARD STANDARD ANNUAL TEST FAIL ANNUAL TEST FAIL PERIODIC TEST TYPE ALARM DISABLED ALARM DISABLED ,STANDARD PERIODIC TEST FA'IL -PERIODIC TEST FAIL ANNUAL TEST FAIL ALARM DISABIEn ALARM DISABLED ALARM D I SARLED. GROSS TEST FAIL GROSS. TEST, FAIL PERIODIC_.: TEST FAIL ALARM DISABLED ALARM DISABLED ALARM DISABLED ANN TEST AVERAGING: OFF ANN TEST AVERAGING: OFF GROSS TEST FAIL PER TEST AVERAGING: OFF PER TEST AVERAGING: OFF ALARM DISABLED TANK TEST NOTIFY: OFF TANK TEST NOTIFY: OFF ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TNK TST SIPHON BREAK:OFF TNK TST SIPHON BREAK:OFF TANK. TEST NOTIFY: OFF DELIVERY DELAY 1 MIN DELIVERY DELAY 1 MIN PUMP THRESHOLD 10.00%o PUMP THRESHOLD 10.00% TNK TST'SIPHON BREAK:OFF DELIVERY DELAY 1 MIN PUMP THRESHOLD : 10.00: LEAK TEST METHOD T 4:UNLEADED SOUTH - - - - - - - - - - - - PRODUCT CODE 4 T 5:DIESEL TEST ON .DATE : ALL TANK THERMAL COEFF : .000700 PRODUCT CODE 5 FEB 6. 2007 TANK, DIAMETER 89.75 THERMAL COEFF : .000700 START TIME : DISABLED TANK PROFILE : 4 PTS TANK DIAMETER 89.75 TEST RATE :0.20 GAL/HR FULL VOL 9684 TANK PROFILE 4 PTS DURATION : 2 HOURS 67.3 INCH VOL 7891 FULL VOL 9684 44.9 INCH VOL : 4918 67.3 INCH VOL 7891 TST EARLY STOP:DISABLED 22.4 INCH VOL 1900 44.9 INCH VOL 4918 22.4 INCH VOL 1900. LEAK TEST REPORT FORMAT NORMAL FLOAT SIZE: 4.0 IN. wATER,WARNING 2.0 FLOAT SIZE: 4.0 IN. HIGH WATER LIMIT: 3.0 WATER WARNING 2.0 MAX OR LABEL VOL: 9684 HIGH WATER LIMIT: 3.0 OVERFILL LIMIT 92% MAX OR LABEL VOL: 9684 HIGH PRODUCT 896%OVERFILL LIMIT 8909 9490 HIGH PRODUCT 98% DELIVERY LIMIT 5v- 9490 500 DELIVERY LIMIT 5%, LIQUID SENSOR SETUP 500 - - - - - - - - - - - - LOW PRODUCT 500 LEAK ALARM LIMIT: 99 LOW PRODUCT 500 L I :UNLEADED NORTH SUDDEN LOSS LIMIT: 99 LEAK ALARM LIMIT: 99 NORMALLY CLOSED TANK TILT 4.70 SUDDEN LOSS LIMIT: 99 CATEGORY : OTHER SENSORS PROBE OFFSET 0.00 TANK TILT' 4.70 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS L 2:SUPREME Td: 01 .03 SIPHOM MANIFOLDED TANKS NORMALLY CLOSED LINE MANIFOLDED TANKS TIC hIONE CATEGORY : OTHER SENSORS TO: 01,03 LINE MANIFOLDED TANKS TO: NONE LEAK MIN PERIODIC: 14 L 3:UNLEADED SIPHON IGO LEAK MIN PERIODIC: 1% NORMALLY CLOSED iuO CATEGORY : OTHER SENSORS LEAK MIN ANNUAL : 1% 100 LEAK MIN ANNUAL ly . 1G0 L 4:UNLEADED SOUTH PERIODIC TEST TYPE NORMALLY CLOSED STANDARD PERIODIC TEST TYPE CATEGORY : OTHER SENSORS ANNUAL TEST FAIL STANDARD ALARM DISABLED ANNUAL TEST FAIL ALARM DISABLED L 5:DIESEL PERIODIC TEST FAIL NORMALLY CLOSED ALARM DISABLED PERIODIC TEST FAIL CATEGORY : OTHER SENSORS GROSS TEST FAIL ALARM "DISABLEP ALARM D15ABLED GROSS TEST FAIL ALARM L ANN TEST AVERAGING: OFF DISABLED TR6-STATER(SINGLE FLOAT> PER 'TEST AVERAGING: OFF ANN TEST AVERAGING: OFF CATEGORY : OTHER SENSORS TANK TEST NOTIFY: OFF PER TEST AVERAGING: OFF TNK TST SIPHON BREAK:OFF TANK TEST IVOTIFI': OFF L 7:GHOST DELIVERY DELAY 1 MIN TNK. TST SIPHON BREAK:OFF TRI-STATE PUMP THRESHOLD 10.00% DELIVERY DELAY 1 MIN 'PUMP THRESHOLD 10.00•. L 8:GHOST �°- - - - TR I--STATE (SINGLE FLOAT) CATEGORY OTHER :TENSORS PUMP SENSOR SETUP OUTPUT RELAY SETUP - - - - - - - - - - - - EVR/1 SD SETUP R I :POSITIVE-SHUT OFF SMARTSENSOR SETUP TYPE: - - - - - - -- - - - - - STANDARD s 1 :PS -$ EVR TYPE: VACUUM ASSIST NORMALLY CLOSED CATEGORY VAPOR PRESSURE VACUUM ASSIST TYPE TANK 0: NONE HEALY VAC s 2:FM 1-2 NOZZLE A/L RANGE CATEGORY AIR FLOW METER MAX: 1 .15 MIN: 0.95 IN-TANK ALARMS s ALL:LF-AK' ALARM 3:FM 3-4 VAPOR PROCESSOR TYPE ALL:HIGH WATER ALARM CATEGORI AIR FLOW METER NO VAPOR. PROCESSOR LIQUID SENSOR ALMS s 4:FM 5-6 ALL:FUEL ALARM CATEGORY AIR FLOW METER ANALYSIS TIMES ALL:SENSOR OUT ALARM s 5:FM ?-8 TIME: 10:00 AM ALL:SHORT ALARM CATEGORY AIR FLOW METER DELAY MINUTES: 1 ISD SITE ALARMS ISD GROSS PRES FAIL s 6:FM 9-10 ACCEPT HIGH ORVR: ISD DEGRD PRES FAIL CATEGORY AIR FLOW METER DISABLED ISD VAPOR LEAK FAIL ISD ,VP PRES FAIL ° 7:FM 11-12 ISD HOSE TABLE ISD VP STATUS FAIL CATEGORY AIR FLOW METER 1D FP FL HL AA RR ISD HOSE ALARMS ------------------------ ALL:GROSS COLLECT FAIL 0 33 01 02 0l UU ALL:DEGRD COLLECT FAIL 02 2 34 02 02 01 UU 03 35 03 02 02 UU ALL:FLOW COLLECT FAIL 04 02 04 02 02 UU R 2:UNLEADED NORTH 05 08 05 02 03 UU TYPE: O6' 01 06 02 03 UU STANDARD U? 00 07 02. 04 UU NORMALLY CLOSED 08 04 08 02 04 UU 09 05 09 02 05 UU TANK is: 1 10 06 10 02 05 UU 11 07 11 02 06 UU. 12 03 12 02 06 UU LIQUID SENSOR ALMS ALL.:FUEL ALARM ISD AIRFLOW METER MAP ALL:SENSOR OUT ALARM ID SERIAL NUM LABEL ALL:SHORT ALARM ----------- ISD SITE ALARMS 1 18422 ---FM 1-2— — ISD GROSS PRES FAIL 2 18424' FM 3-4 ISD DEGRD PRES FAIL 3 18415. FM 5-6 a 12370 FM 9-9 I'SD VAPOR LEAK,'FAIL ISD VP PRES FAIL 5_ !9032 FM —1 1 ISD VP STATUS FAIL b ,l,8433 FM 1 11-12 ISD HOSE ALARMS ISD FUEL GRADE HOSE MAP ALL:GROSS COLLECT FALL 1 2 3 a ALL:DEGRD COLLECT FAIL FP MHH MHH MHH MHH AA ALL:FLOW COLLECT FAIL ------------------------ 3:UNLEADED SOUTH 00 207 307 907 5 U 4 TYPE: Al 206 306 906 5 U 3 STANDARD 02 204 304 904 5 U 2 NORMALLY CLOSED 03 212 302 912 U U 6 Oa 208 308 908 U U a TAN d: 4 05 209 309 909. 0 U 5 K' 06 21.0 310 910 U U 5 07 211 311, 911. U U 6 LIQUID SENSOR ALMS 08 205 305 905 U U 3 ALL:FUEL ALARM 33 20.1 301 901 5 U I ALL:SENSOR OUT ALARM 202 302 902 5 U 1, ALL.SHORT ALARM 35 203 303 903 5 U 2 ISD SITE ALARMS LABEL TABLE ISD GROSS PRES FAIL ------------------------ D DEGRD PRES FAIL is UNASSIGNED ISD VAPOR LEAK FAIL 2: BLENDS ISD VP PRES FAIL 3: REGULAR ISD VP STATUS FAIL 4: MID GRADE ISD HOSE ALARMS 5: GOLD:PREMIUM ALL:GROSS COLLECT FAIL 7: GOLD: ALL:DEG,RD COLLECT .FAIL 7: BRONZE ALL:FLOW COLLECT FAIL 8: SILVER 5: 9LEND2 10: BLEND4 PMC SETUP ALARM HISTORY REPORT ALARM HISTORY REPORT PROC:ESSOR CONTROL LEVEL: ----- SENSOR ALARM ---- ----- SENSOR ALARM ----- NONE L 2:SUPREME L 5:DI6SEL OTHER SENSORS OTHER SENSORS ----- SENSOR ALARM L4:UNLEADED SOUTH xkf * EIVO END uxxxx OTHER SENSORS FUEL ALARM FEB 14, 2011 8:35 AM ALARM HISTORY REPORT ALARM HISTORY REPORT SOFTWARE REVISION LEVEL VERSION 327.04 ----- SENSOR ALARM ----- ----- SENSOR ALARM SOFTWAREO 346327-100-E L 3:UNLEADED SIPHON L 6:CASPER CREATED - 07.02.06.10.28 OTHER SENSORS OTHER SENSORS' S-MODULEO 330160-004-a SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS ISD PMC A � .* x ENIi x * x. iF x Yf END ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 1 : E NORTH OTHER R SENSORS ALARM HISTORY REPORT ALARM HISTOR`. REPORT FUEL ALARM SENSOR ALARM ----- --- SENSOR ALARM ----- DEC 20. 2010 4:3G A19 ----" L 4:UNLEADED SOVT" L 7:GHOST OTHER SENSORS OTHER SENSORS FUEL ALARM FEB 14. 2011 8:35 AM x is ti x END r. ac ii i{ 3i END iit K x 1i ,� x �t x x END x x A w x CALIFORNIA CHEVON R ALARM HISTORY REPORT 4.100 CALIFORNIA AVE CALIFORNIA CHEVON BKRSFLD CA 93309 41.00'CALIFORNIA AVE -- SENSOR ALARM ----- 661-336-0263 BKRSFLD CA 93309 L 8':GHOST 66.1-336-0263 OTHER SENSORS FEB 14. 2011 9;52 AM FEB la. 2011 9:53 AM - SYSTEM STATUS REPORT. - - SYSTEM STATUS REPORT I-0 .OROSS PRES WARN - `- - - - - - - - LSD GROSS -PRES WARN {; I :.DEGRD COLLECT WARN j h 1,:•DEGRD ,COLLECT WARP! Axx .Ax END xK ; .x i CALIFORNIA CHEVON 4100 CALIFORN'I'A AVE _- SENSOR ALARM ----- BXRSF'LD CA 93309 L 4:UNLEADED SOUTH 661-336=0263 OTHER'SENSORS FUEL ALARM FEB 14. 2011 9:53 AM FEB 14. 2011 .9:03 KM SYSTEM STATUS REPORT ISD .CPOSS,PRES-WARN- CALIFORNIA CHEVON . 4100 CALIFORNIA AVE h 1 :UEGRD fiOLLECT WARN 'BKRSFLD CA .93309 661=336-0263 CALIFORNIA CHEVON FEB 14. 2011 9:54 Ali 4-00 CALIFORNIA AVE BKRSFLD CA 93309 661.-336-0263 SYSTEM STATUS 'REPORT FEB 14, 2011 9:52 AM - - ` - - - - ISD GROSS PRES WARN h I :.DEGRD COLLECT WARN SYSTEM. STATUS REPORT CALIFORNIA,CHEVON' ISD GROSS PRES WARN- BKRSFLDLCA 93309A 667-336-0263 h i:DEGRD COLLECT WARN FEB 14. 201.1 9:53• AM SYSTEM STATUS REPORT GR05S.,PR£S WARN ----- SENSOR ALARM L 5:DIESEL h 1 :DEGRD COLLECT WARN OTHER SENSORS FUEL ALARM CALIFORNIA CHEVON FEB 14. 2011 1.0:19 AM_ 4100,'CALIFORNIA AVE BKRSFLD CA 93309 66.1=336-0263 FEB 14, 2011 9:52 AM SYSTEM STATUS REPORT ----- SENSOR. ALARM ----- - - - - - - - - - - - L 4:UNLEADED SOUTH ISD GROSS PRES WARN OTHER SENSORS FUEL ALARM h I DEGF.D COLLECT WARP! FEB 14. 201t 10:20 Aft -- SENSOR ALARM ----- CALIFORNIA CHEVON L 3:UNLEADED SIPHON SENSOR ALARM ----- 4100 CALIFORNIA AVE OTHER SENSORS L 4:UNLEADED SOUTH BKRSFLD CA 93309 FUEL, ALARM OTHER SENSORS 661-.336-0263 FEB 14. 2011 10:24 AM FUEL ALARM FEB 14. 2011 10:41 AM FEB 14, 2011 10:50 Art SYSTEM STMTUS REPORT L 2:FUEL ALARM - - - - - 1SD GROSS PRES WARN -- SENSOR ALARM ---- L 2:SUPREME -- .SENSOR fiLr►Rm --- h 1 :DEGRD COLLECT WARN OTHER L 5;DIESEL SENSORS OTHER SENSORS FUEL ALARM; FUEL ALARM FEB 1'4. 2011 10:33 All FEB 14. 2011 10:41 AM ----- SENSOR ALARM - --- SENSOR ALARM ----- L 3:UNLEADED SIPHON L-1-UNLEADED NORTH -"" SENSOR -ALARM'-----. OTHER SENSORS OTHER SENSORS L 1 :UNLEADED NORTH FUEL ALARM FUEL ALARM OTHER SENSORS FEB 14. 2011 10:52 AM FEB 14. 2011 10:36 AM FUEL ALARM FEB 14, 2011 10:44 Apt ----- SENSOR ALARM _---- -- SE14SOR ALARM ----- L 4:UNLEADED,;SOUTH. L-1:UNLEADED NORTH -"" SENSOR ALARM ---L 2:SUPREME OTHER' S£NSORS OTHER SENSORS FUEL ALARM FUEL ALARM OTHER SENSORS, FEB 14, 2011 10:56 AM FEB 14. 2011 10:39 AM FUEL ALARM FEB 14. 201t 10:49 AM ----- SENSOR ALARM ----- -- PREMIEF. ALARM ----- -- SENSOR ALARM --- OTHER SENSORS L HER SENSORS L 2:SUPREME FUEL ALARM OTHER SENSORS FUEL ALARM OTHER SENSORS FEB 14. 2111 11 :03 AM .FUEL ALARM FEB 14. ,2011 10:40 Arl FEB 14. 20,11 1.0:4? AM ----- SENSOR ALARM ----- ----- SENSOR ALARM ----- L 6:CASPER L 3:UNLEADED SIPHON OTHER SENSORS OTHER SENSORS SENSOR OUT ALARM FUEL ALARM FEB 14. 2011 11 :03 04M FEB 14. 2011 10:40 AM -- -- SE14SOR ALARM ----- L 7:13HOST _ OTHER SENSORS ----- SENSOR ALARM ----- SENSOR OUT ALARM L 4:UNLEADED SOUTH FEB 14, 2011 II :O3 AM OTHER SENSORS FUEL ALARM FEB 14, 2011 11 :03 (41 ----- SENSOR ALARM ----- L I :UNLEADEL NORTH OTHER SENSORS ----- SENSOR ALARM ----- FUEL ALARM L 2:9UPREME FEB 14, 2011 11 :03 All OTHER SENSORS FUEL- ALARM FEB L4. 2011 1 1 :0:: AM ----- SENSOR ALARM ----- L 8:GHOST OTHER SENSORS CALIFORNIA CHEVON SENSOR OUT ALARM 4100 CALIFORNIA AVE FEB 14. 2011, 11 :03 AM BKRSFLD CA 93309 661-336-0263 FEB 14, 201A 11 :47 AM SYSTEM STATUS REPORT ISD GROSS PRES WARN- -- SENSOR ALARM ----- L 3:UNLEADED SIPHON h I :DEGRD COLLECT WARN OTHER.SENSORS FUEL ALARM FEB 14, 201l i1 :02 AM 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/operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: California Chevron I Date of Testing: 2/14/2011 Facility Address: 4100 California Avenue,Bakersfield,CA 93309 Facility Contact: Sam Jouda I Phone: 661-333-0000 Date Local Agency Was Notified of Testing: 1/28/2011 Name of Local Agency Inspector(if present during testing): Ester 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services,Inc. Technician Conducting Test: Kristopher Karns Credentials: X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester ❑Other(Spec) License Number(s): 804904 5264406-UT 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 1 Regular(North) 2 Regular(South) 3 Regular(Siphon) 4 Super Number, Stored Product, etc. Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑Direct Bury ❑Direct Bury X Contained in Sump X Contained in Sump X Contained in Sump X Contained in Sum Bucket Diameter: 12.00" 12.00" 12.00" 12.00" Bucket Depth: 13.75" 14.25" 14.00" 13.75" Wait time between applying 5 min. 5 min. 5 min. 5 min. vacuum/water and start of test: Test Start Time(Ti): 9:00 AM 9:00 AM 9:00 AM 9:00 AM Initial Reading(Rq): 6.25" 6.75" 7.25" 6.50" Test End Time(TO: 10:00 AM 10:00 AM 10:00 AM 10:00 AM Final Reading(RF): 6.25" 6.75" 7.25" 6.50" Test Duration(TF—Tj): 1 hour 1 hour I hour 1 hour Change in Reading(RF-Ri): 0.0" 0.0" 0.0" 0.0" Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" 0.0625" Criteria: Test Result. X Pass,: ❑Fail. X Pass ❑Fail X Pass i ❑Fail X 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: lA� ]�,,,�.� Date: 2/14/2011 State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent. 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/operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: California Chevron Date of Testing: 2/14/2011 Facility Address: 4100 California Avenue,Bakersfield,CA 93309 Facility Contact: Sam Jouda Phone: 661-333-0000 Date Local Agency Was Notified of Testing: 1/28/2011 Name of Local Agency Inspector(af present during testing): Ester 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services,Inc. Technician Conducting Test: Kristopher Karns Credentials: X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester ❑Other(Spec) License Number(s): 804904 5264406-UT 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 1 Diesel 2 3 4 Number, Stored Product, etc.) Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑Direct Bury ❑Direct Bury X Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum Bucket Diameter: 12.00" Bucket Depth: 15.75" Wait time between applying 5 min. vacuum/water and start of test: Test Start Time(Ti): 9:00 AM Initial Reading(Rj): 6.25" Test End Time(TF): 10:00 AM Final Reading(RF): 3.25" Test Duration (TF—Tj): 1 hour Change in Reading(RF-Rj): 3.00" Pass/Fail Threshold or 0.0625 Criteria: Test Result: D Pass X Fail 0 Pass ❑Fail ❑Pass 0 Fail ❑Pass ❑Fail Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) Leaking from Diesel CNL drian valve, We need to order a new drain valve and have it replaced and re-tested. 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: 2/14/2011 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. California Chevron 4100 California Avenue Bakersfield, CA 93309 1 2/14/2011 0 10 g 12 11 3,5,8,10 4,5,015 O 0 20 20 3,5,8,13 415,018 O7 6 5 8 7 3,5,12 4,5,017 6 20 20 0 0 3 5 8 11 4,5,016 6 4 3 2 1 0 .0 20 20 0 3,5,9,14 4,5,019 O California Chevron Refrence Material 1=Veeder Root TLS 350 2= ESO Switch 3=ATG 4= OPW-61-SO Flapper Valve 5= Ronan 6=Veeder Root 409 Annular Sensor 7=409 Ronan Sensor 8= FX1V 9=FX1DV. 10= Regular North STP Sump 11= Regular South STP Sump 12= Regular Siphon STP Sump 13= Super STP Sump 14= Diesel STP Sump 15= Regular North Fill Sump 16= Regular South Fill Sump 17= Regular Siphon Fill Sump 18= Super Fill Sump 19= Diesel Fill Sump 20= Bravo Box OWO Rosedale Hwy V B Elaketsftfd,Cafifomia MOB PhGnc 661 W 2777 Fax:661 588 2766 I c To, Clty Fire Dept Front Kelly Tacked Faun 852-2171 Dalro 3-8-11 Phone: Re: Arno AM/PM 7851 Rosedale Hwy CC: 0 UrgoMIJ For Review 0 Pismo Comnwnt 0 Please Reply 0 Pismo RGOWI* *Comnwnt4u Attached are test results for SB989 testing for the above location. Please call K you have any questlons. Thanks, Kelly (661)588-2777 ZI/I d GOD 4< W60 90-CO-LIOZ: CD CO CO C) Franklin Fueling Systems Franklin Fueling Systems V $� V alchael english CedftakW 0 58605&3702 5.1', Ai'L bssr inc. F u•Fv*j.--:- CeNfication Ty zry System Opet-atlon-INCOft L"4 Sump Tosr 0 Training Date:Much 8,2011 CO Expiration Dace-Mwh 8.2013 Code c8Wr12bfnF r-r To receive this certification as a laminated wallet card email this PDF file to CERTCARID@FRANKLINFUELlt4G.COM Your email must inclWe the mailing address you want the card sent la. Please allow up to 2 weeks to receive your laminated card. UH0Encrnou"u TTOnAQCTANKd BAKERSFIELD FIRE DEPARTMENT Prevention Services 1600 Truxtun Ave., Suite 401 SECONDARY SYSTEM 1R1 R Bakersfield, CA 93301 CERTIFICATION FORM *Aj r if r Phone: 661-326-3979 . Fax: 661-852-2171 Page 1 of 4 FACILITY ADDRESS FACILITY ID DATE 72$S( I�Qsbr�(� �{� .� - C� • e333� ' 3�2. _3 g ac ( 7 UST ANNULAR SPACE TANK 1 TANK 2 TANK 3 TANK 4 START TIME n ,r INITIAL PRESSURE END TIME j/ Am FINAL PRESSURE /3 �.� �'- �3 "Wc +� 1 CERTIFICATION (Signature) p�-ss SECONDARY PIPING LINE 1 LINE 2 LINE 3 LINE 4 i l START'TIME f>!M n 7 INITIAL PRESSURE P�� 5^I051- f'S� END TIME FINAL PRESSURE CERTIFICATION (Signature) FD 2098(Rev OW07) WE d 90) « 1160 80-£0-110Z Cry Amz FACILITY AbbRESS F CILITY ADDRESS FACILITY ADDRESS SUMPS SUMP 1 SUMP 2 SUMP 3 SUMP 4 START TIME "!'3 Q, INITTFAL OF WATER IGHT - 3'-S'! 13 3 -9 4 t 2.1 TIME c�_gyp ,Zp A�V% WATER HEIGHT .31 S f l !I --� •�`{ ��"" 2.`f ?��' � � TIME 4 3 0 '+`�` Cj;3 a �h 1� tC> WATER HEIGHT ( '7 TIME .... .. — - 9 3 3 WATER HEIGHT �, $ 1 ( � °r { 'r( ) 2-°1 '7 CERTIFICATION (Signature) !M i OVERFILL BUCKETS OVERFILL 1 OVERFILL 2 OVERFILL 3 1 OVERFILL 4 START TIME q tii INITIAL HEIGHT ..... OF WATER -G $N 67 1 t 2.. TIME ry ' l5 ... ly A� y WATER HEIGHT 3 ° -`f° �.� �, t 1-1`89 3 1 5-7 / 9 � TIME rwATER HEIGHT M I 3,0 2. ( ( 2-4 +9 5 �(-g >{ G o '3;---? t a- Q 1 CERTIFICATION (Signature) I ?ugc 2 of d FD 2098(Hev 06+07) Zl/tr d 80) « Z1:60 80-CO-11OZ FACILITY ADDR658 R GLITY ADDRIrSS FACILITY ADDRESS ( ^ 2- TyRs'lY� - Mpg SUMP f SUMP 2 SUMP 3 SUMp 4 START TIME 12 :;t !,;k _`1 / P INITIAL HEIGHT OF WATER TIME p"7 ---- WATER HEIGHT L{ _�,g 5 ? 3- '7 a ry S= G S S 3 TIME WATER HEIGHT Lf-S 6 O :3�7 7 TIME WATER HEIGHT 3� 7 e CERTIFICATION(Signature) OVERFILL BUCKETS OVERFILL 1 OVERFILL 2 OVERFILL 3 OVERFILL 4 STARTTIME INITIAL HEIGHT r OF WATER '' TIME 2 >4S WATER HEIGHT !-9 90 r (a 'f ? 2 1 7 0 ca TIMS 3"f 3 ;$ �� tr = WATER HEIGHT 4-.M (3 CERTIFICATION (Signature) /).441 `0 5 y Page 2 of 4 FD 2096tR.,08107) Zl/S d 80? « ZI:60 80-£0-HE v � FACILITY ADDRESS FACILITY ID DATE UDC TESTING DISPENSER 1 DISPENSER 2 DISPENSER 3 0ISPENSER 4 I START TIME .3S — �,►t '�'"� 11:1411 INITIAL_HEIGHT - � OFWATER 3 '�Z�a ��d�4 11, 377� 3-` zfI TIME WATER HEIGHT 3.1 112 TIME /.�:Sa �-='4 10 ,' 570 (WATER HEIGHT 31 04 1-5rd17 -tY- 377'? 1 3-'Y5` � ICERTIFICATION (Signature) 4-1S i l `�� I *11; I a- 9•- (o 13 /,9 DISPENSER 5 DISPENSER 6 DISPENSER 7 DISPENSER 8 START TIME cy INITIAL HEIGHT " - OF WATER -`�4!SS �.2 �{ S S 3$o 2, g 1 3�+ An TIME cr7:3ra ''WATER HEIGHT 3„Q 45�;- .2 2, I I TIME WATER HEIGHT i �.` '-IS� �_2re2 �f S':3 2 21-V12q CERTIFICATION (Signature) ' Page? of 4 FD 2098(R(-.v 06MI) ZI/9 d 90) « Z1:60 90-EO-11M !7A, RFlsJ*.PF-,---.l vy -P RS.Sre (N(,.—TFctTc,-- Sf,,K `f N(; 12:36 Pr; F'):14 pm Pm TF,!:T START{( I 1 FFT 5TARMN Ck K.-I TEST Ec.1D iv?L 9 r .7 IP EHO 7XmF 7 pp1 IN 64) LFOP!, `NU DATE 2f-I -1 J�,rt T.4 5.69710 IN � TN pr po p 0- 7PC:7 PFI.; l.E'AK jr T TF—�T RERIL.T TrIly f)m TH 71!j(: 1 W orm (.;7()Fl "1:IG PM rwr,� rjmF FN!' 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IN i - 17P TN r..F�!f:. n.`+;4ll� ;r, cNo TTME 1:45 PA Nh i>ATF t�T�/?.A,q1 F.ND TIME �O,:tiA F: 1{Jt�1!7{J11 END LEVEL 55.044 IN "Nh 7tiT.~„ `i.T END L.VWi 4.1% IFt t••AK �'NRF.�F;fJ' a.�1.92 TN . AY. TF;ar;}a„_r, �t,lft2 IIJ TEST RESIJLT PASS"- F►1A 1 i?Ucl. 1>,572r 71•: Tr;? FRILE.I) TE I RFgUir CNrkF_PIS[:i Tr.'CT STfRTFr, 19%39 PM ?P rES' :�T f?r {. i:S6 P T"cT cTARTFn (1:: m"/IV T A f r! �?S'RkTF.D BEGITTM 'C UEI. 77 6 �1 p;ti!r SEC Iv LF'VcL 4.5866 IN " 4�1 RM EJJD DATE t :ril11F CFk;-41 ':� F.ND DATE G+z.�O7:7.I?i1 �vn r.r4+F.!. 7744 IN lFpy( THRMHOL D R.J1O . TH f_'NA (!F Tc )'/02,/20 1 tier) .fir n F 7f 1H t'ti' n r J(y 1 LFflK THI�SHPH.1D lJ.89'? IN T ,, REoUL? P>i,';.:3EU LEAK HII�kIFl ;;a ".T,rT F I L2UPI? i FIL✓ IP M,—j ,ThPTED 12139 PM IL?4Jf'R TEST STARTED 83/02/201.1 r,• r Ti,i?'f:n ;:4th nM 9F,rrN LFI 1.. 3.5445 IN T F ST fiTr1!'ITFn :firr r'>n1 TS-cT eTARTF{}' 03/02./)11 END TIME. 12:55 PM TF;F'T STAR7Eb 03,'O2/A .17 iAl2 Ts • F1. 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EW 4AT`I F14) nAT7 1I'+r 28 Aq �1SFi0I D rJn 1 F I fEry Azag7 11 r g cl4q? 1N , Z1/01 d 900 ac 171:60 90-M-IIOZ A o1 AIRCL) m-p!l 7PS1 64r)A; HWY c, 78SI ROSEDAL5 HUY I BSSP INC.-TraTER- 301 -'-H< Pl, f)V TV`T tjFPoRT 717 TE)'T STARTED FNr, Trpl.F- T�j 11:57 Am P,A I Am TFST 4%TARTFD R7,11WW I 1 10. iN "'Nf% I FUFi. ?.Pl-n rN END TIME 12s 12, Ph 13 ;W nA.Tp- i4j1qj.1'-oj rrGr ' PFRI.t, 7 QAS rp END La uEL 4,771,8 IN 1 FPK THRCE3HCA.0 kla2 7N t TEST RFSIJL7 PASSEI) T T cr 0 TP,I;T `TAPT;7n 714F. 11,4 F HT 10F -14p .92W—', ENO L, 11:157 At, 'y' TEST STAPTED ;..FA Tr7Q.7 c.TAI TM. f17/q7/?P1 I F,4r, DATA " rwo TIME I?t 12 PH t't-, 1-rAy THRCF.HOty) fi,qpin IN END DATE RI/814)o t I LEAK THRESHOLD 0.002 IN TF;T ;:TARTY T77 RFqJL.T DR!i-t" It TFFT ,TACPTFn /1)p I I 2r. r-4 rNh TTMr R!A! Am WCO KM-�'m P-d" L,FUF!. 6„2622 7951 ROSEDALE HWY -,." 7ui;lr-011P) N A.''1A^ rtj T4 7cT Pc'q!11 T INc.-TESTC-R- 44 a !jA AM ! 7R91 r.4"y ..CAK TEST RF':`rJRT TEST qTAQTFO 1 tz41 AM TEST STARTED I I I(Mp -T 7�-Vl)r�P rIF(-,TN J,7L)FL," TN END TIME. It:% AM rip 1 FND �%ATI-- /P0/1?0t I ESD LFVEL 4.3779 IN T-- ir-Aj( VWF�,HOI..D 9.1.907 IN TFf%y•TAT RESULT PASSED lirn-1: 7—r FWi I F 1 ll:', TEST STARTED 11-'41 AM I nsw --Jqf("'(11 TEST PFF',!j� eFrilN LEVEL. 5.4494 1 h END DATE ov, 63/2011 Ct4D l..EV.FA. 1,4509 IN TFST STARTED Lf-W THRESHOLD 0,002 IN T�-qT ;T,�PT�N 07 If TF..,%T PF5,p,T -),9A80 pCOIN LFUEL 1. . . �k TtAf) rTtIc" ! ,-.'.'? END WITF p evl7r4 Tt4 I-F.AK THRESHOLD N. yF� rl/ll d 41:60 90-E0-1102 UIC ARro rim-pm IR'r.0 78'31 ROSEDALE HWY 7pl;l R M-F. mly -`,owr�rTri N �"% ; ! OAVERISFICO ;Rcf." -rim SSSR INC.-TE.STER- 78ril ROSEDAIJ: HWY i-ROP-984-626A BGSR IW_-TKSTER- 03103e.2@1 1 9.22 AM l-'�00-984,A266 1 FLI/03/201 1 8:IS W. ,LIMP F7AX TFST RE7PORT $?F-11A. 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ZA AM 01/03/201t TFRT ;.F,Ar, TrST PFT0R`,' 1)rM.1P.1 T$J I 87FILI, rwp, TTkir 4f7l AtA t tn 16T7 147 T7.r'rSl I I 775IT qTAQTrD Or7I AM N J F-11r, . JFRT STARTED -!? r.e-.. j IN L!UFL. '.I Yr,qT RFQJ 7 FND TTMF. q,38 AM rlg) DAT17. END LEVEL 31 wM 1,FAK THRESHOLD MA? IN TEST RESULT PASSED Tr.<',T qTAPT'F.r) q.M AM RFRTN i.rtjq.. TN TMC 9?12 7 AM TEST START 937 AM END DATE 0110.3.e2ol t O yl 7i4r% LEAK T+4KSHOlxl 0.002 IN BFGIN LEUFL 3,9 55 IN I 1:1p TTM� q132 o" FND DATE 01/83/2011 END LFVF1. '.'n45T YN LEAK THRESHOLD e.082 IN L 77 T Zl/Zl d 80) K4 S1:60 SO-CO-UZ