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HomeMy WebLinkAbout2010 FMC MONITORING SYSTEM CERTIFICATION Jc For Use By A11 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 sgparate 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 test date. A. General Information IIIIIIIIIIIIIIIIIIII 23 Facility Name: STOCKDALE FOODMART IE Bldg.No.: Site Address: 5321 STOCKDALE HWY City: BAKERSFIELD Zip: Facility Contact Person: FONG CHAO Contact Phone No.: ( ) Make/Model of Monitoring System: TLS-350 Date of Testing/Servicing: 911612010 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicates ecific Sgulpment ins ted/serviced: Tank ID: UNL87 Tank ID: PREM91 ®In-Tank Gauging Probe. Model: MAG ®Jn-Tank Gauging Probe. Model: MAG 120 Annular Space or Vault Sensor. Model: 4201463 ®Annular Space or Vault Sensor. Model: 4201463 ®Piping Sump/Trench Sensor(s). Model: 2081304 0 Piping Sump/Trench Sensor(s). Model: 2081304 ®Fill Sump Sensor(s). Model:,206/304 ®Fill Sump Sensor(s). Model: 2081304 ❑Mechanical Line Leak Detector. Model: ❑Mechanical Line Leak Detector. Model: ®Electronic Line Leak Detector. Model: VEEDER=ROOT ®Electronic Line Leak Detector. Model: VEEDER-ROOT ®Tank Overfill/High-Level Sensor. Model: GOA Tank Overfill/High-Level Sensor. Model: GOA ❑Other(specify equipment type and model.in Section E on Page 2). ❑Other(specify equipment type and model in Section E on Page 2). Tank ID: DIESEL Tank ID: VENT BOX ®In-Tank Gauging Probe. Model: MAG ❑In-Tank Gauging Probe. Model: ®Annular Space or Vault Sensor. Model:4021463 ❑Annular Space or Vault Sensor. Model: ®Piping Sump/Trench Sensor(s). Model:.2081304 ID Piping Sump/Trench Sensor(s). Model: 2061304 ®Fill Sump Sensor(s). Model: 208/304 ❑Fill Sump Sensor(s). Model:. ❑Mechanical Line Leak Detector. Model: ❑Mechanical Line Leak Detector. Model: ® Electronic Line Leak Detector. Model: VEEDER-ROOT ❑Electronic Line Leak Detector. Model: ®Tank Overfill/High-Level Sensor. Model: GOA ❑Tank Overfill/High-Level Sensor. Model: ❑Other(specify equipment type and model in Section E on Page 2). (]Other(specify equipment type and model in Section E on Page 2). Dispenser ID: 112 Dispenser ID: 314 ID Dispenser Cowaimnent Sensor(s). Model: 208/3D4 ®Dispenser Containment Sensor(s). Model: 2081304 ®Shear Valve(s). ®Shear Valve(s). ❑Dispenser Containment Float(s)and Chain(s).. []Dispenser Containment Floats)and Chain(s). Dispenser ID: 516 Dispenser ID: 718 ®Dispenser Containment Sensor(s). Model: 2081304 ®Dispenser Containment Sensor(s). Model: 2081304 ®Shear Valve(s). E Shear Valve(s). ❑Dispenser Containment Float(s)and Cbain(s). ❑Disperser Containment Float(s)and Chain(s). Dispenser ID: .9110 Dispenser.ED: ®Dispenser Containment Sensor(s).. Model: 2081304 ❑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/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information(e g. manufacturers' checklists) necessary to rift' that this information is correct and a Plot Plan showing the layout of monitoring a uipment- For any equipment capable of rating such reports,I have also attached a copy of the report;(check alt that apply): �System set-up ZN Alarm h' port Technician Name(print): RICH PHILLIPS Signature: Certification No.: A2908411035169-UT License. o:: C611 D40 809850 Testing Company Name: RICH ENVIRONMENTAL Phone No.:(661) 392-8687 Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date of Testing/Servicing: 911612010 Page 1 of 5 UN-036—114 www.unidomorg I IIIIIII VIII III IIII 24 Rev.01/17/08 IE Monitoring System Certification U � D. Remits of Testing/Servicing Software Version Installed: 326.01 Complete the following checklist: • Yes p No* Is the audible alarm operational? • Yes p 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 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) ® N/A operational? • Yes ❑ 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? If yes: which sensors initiate positive shut-down? (Check all that apply) ®Sump/Trench Sensors; ®Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ®Yes; ❑No. • Yes ❑ Nos 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 visible and audible:at the tank fill point(s):and operating properly? If so;at what percent.oftank capacity does the alarm.trigger? 90% • Yes* ❑ No Was any monitoring equipment replaced? If.yes,.identify specific sensors,probes,or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E.below. • Yes* ® No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑Product; ❑Water. If yes,describe causes in Section E,below. • Yes ❑ No* Was monitoring system set-up reviewed to ensure:proper settings?Attach set up reports,if applicable ® Yes ❑ No* I Is all monitoring equipment operational per manufacturer's specifications? * In Section E below,describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 5 Il!Mi-036—2/4 www.u6idocs.org Rev.01/17108 Monitoring System Certification F. In-Tank Gauging/SIR Equipment: ❑ Check this box if tank gauging is used only for inventory control. [I Check this.box if no tank gauging or SIR equipment is installed. This section must be comp]eted if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: ® Yes ❑ No* Has all input wiring been inspected 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 system water level readings tested? R Yes ❑ No* Were all probes reinstalled properly? ® Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? *In Section A below,describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. Com lete the follo ing checklist. 9 Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated.to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: ®3 g.p:h.; ❑0.1 g.p.h; [10.2 g.p.h. ® Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ® N/A ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ® Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? ® Yes ❑ No* For electronic LLDs,.does the turbine automatically shut off,if any portion of the monitoring system malfunctions ❑ N/A or fails a test? ® Yes ❑ No* For electronic LLDs,have all accessible wiring connections been.visually inspected? ❑ N/A ® Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? *In Section H,below,describe how and'when these deficiencies were or will be corrected. H. Comments: Page 3 of 5 LTN-036—3/4 www.unidomorg Rev.01/17/08 t .4 YW . . - ��ILCj ���/.. r - • - r • r �i'.. r r r . r,- - • J • .. r • ► . - . . -,r a r . — . ► . . . ,. . r . . . . Y. .!'. - — - - - - - - --- n • ...R1 • • . - . w . a r ► . r . • . . r • • r . • • —..• r r . . . r _ � -. r r — r . . r •'. r..r �"• r'r r'• . _ . r. • • . . . . . r • r . • - - • - • - • • . . . . . . . . •. r . . - • • .•'� w: • • ., . .,. - r • r r . . • r . • - - - - - - - - - - - - - - - - T .r... T� _ O ! . - i . �r r . -w . . . . Y • r • r r. • o r . - . r • . . r . . . . . . . . . . . . .• r �.'• . s . • . . • - . r .- . - r . . . � r J- r t r _ r r.r _. -. '' 'w . � . r . •+ T . r Y . r r 's - . . • r r r r w'• • • . •.r r. r .. . . T .� . - - r r - - r - - - - - r r — -. Y r . - - • •.i - •� ..' r M' �' • Y �► . . . . . . . . . - r r • - - - - - - - - • - • - - - - r - • 4.� - •.+ • . • • r r ■b,1f� • . . . . . . . . . . . • • . . 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The owner/operator must submit a copy of the Monitoring System Certification.Form to the local agency regulating UST systems within 30 days of test date. Manufacturer:VEEDER-ROOT Model:463 System Type: ❑Pressure;®Vacuum Sensor ID S:1 Component(s)Monitored by this Sensor: 87 ANNULAR Sensor Functionality Test Result: ®Pass; ❑ Fail. Interstitial Communication Test Result: Pass; ❑ Fail S:2 Components)Monitored by this Sensor: 87 PRODUCT Sensor Functionality Test Result: ®Pass; ❑ Fail Interstitial Communication Test Result: ®Pass; ❑ Fail Component(s)Monitored by this Sensor: 87 VAPOR S:4 Sensor Functionality Test Result:ED Pass; ❑ Fail Interstitial Communication Test Result: ®Pass; ❑ Fail Component(s)Monitored.by this Sensor: 87 VENT S:3 Sensor Functionality Test Result-®Pass; ❑ Fail Interstitial Communication Test Result: ®Pass; ❑ Fail Component(s)Monitored by this Sensor: 91 VENT S:5 Sensor Functionality Test Result:®Pass; ❑ Fail Interstitial Communication Test Result:Z Pass; ❑ Fail S:6 Component(s)Monitored by this Sensor: 91 PRODUCT Sensor Functionality Test Result;®Pass; ❑ Fail Interstitial Communication Test Result:ED Pass; ❑ Fail Component(s)Monitored by this Sensor: DIESEL-91 ANNULAR S:7 Sensor Functionality Test Result:®Pass; ❑ Fail Interstitial Communication Test Result:ED Pass; ❑ Fail S:8 Component(s)Monitored by this Sensor: DIESEL PRODUCT Sensor Functionality Test Result;.,®Pass;. ❑ Fail Interstitial Communication.Test Result:,0 Pass; E] Fail, Component(s)Monitore&by this Sensor: DIESEL VENT S:9 Sensor Functionality Test.Result:®Pass; ❑ Fail Interstitial Communication Test-Result:®Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test.Result: ❑Pass; ❑ Fair Interstitial Communication Test Result:❑Pass; ❑ Fail How was interstitial communication verified? ❑ Leak Introduced at Far End of Interstitial Space; ❑ Gauge; ® Visual Inspection; ❑ Other(Describe in Sec.J, below) Was vacuum/pressure restored to operating.levels in all interstitial spaces? ®Yes [I No(If no, describe in Sec.J, below) J. Comments: SA 87 FLOAT NOT WORKING NEEDS TO BE REPLACED. Page 4 of 5 ' If the sensor successfully detects a situated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor,vactium/pressure has been demonstrated to be communicating throughout the interstice. UN-036A-1/l www.unidomoit Rev.01/26106 RICH ENVIRONMENTAL 5643 BROOKS CT. BAKERSFIELD, CA. 93308 OFFICE(661)392-8687 FAX(661)392-0621 PRODUCT LINE LEAK DETECTOR TEST WORKSHEET W/8#: FACILITY NAME: STO.CKDALE FOODMART FACILITY ADDRESS: 5321 STOCKDALE HWY,BAKERSFIELD PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL 87 LID TYPE: VEEDER-ROOT YES 0 PASS SERIAL#ELECTRONIC 91 L/D TYPE:VEEDER-ROOT YES 0 PASS SERIAL# ELECTRONIC DIESEL LID TYPE:VEEDER-ROOT YES 0 PASS SERIAL#ELECTRONIC LID TYPE:. YES PASS SERIAL# NO FAIL 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/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. TECHNICIAN RICH P SIGNATURE: DATE: 9/16110 SWRCB,January 200 . 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(tf applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: STOCKDALE FOODMART I Date of Testing: 9/16/10 Facility Address: 5321 STOCKDALE HWX,BAKERSFIELD Facility Contact: FONG CHA:O phone: Date Local Agency Was Notified of Testing: 7/22/10 Name of Local Agency Inspector(f present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RICH PHILLIPS Credentials: ❑CSLB Contractor XICC Service Tech. ❑SWRCB Tank Tester ❑Other(S ectfy) License Number(s): 1.035169-UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic O.Vacuum ❑Other Test Equipment Used:VISUAL Equipment Resolution:0 IMMMINS09MMM --- Identify Spilt Bucket(By Tank 187 2 91 3 DIESEL, 4 Number,Stored Product; etc. Bucket Installation Type: C Direct Bury ❑Direct Bury ❑Direct Bury C Direct Bury X Contained in Sump X Contained in Sump X Contained in Sump ❑Contained in Sum Bucket Diameter: 12" 12" 12" Bucket Depth: 14" 14" 14 Wait time between applying 30 MIN 30.MW 30 MIN vacuum/water and start of test: Test Start Time(TI): 1200 0845 0845 Initial Reading(R1): 14' 14" 14" Test End Time(TF): 1300 0945 0945 Final Reading(RF): 14" 14" 14" Test Duration(TF—Tj): 1-HOUR I-HOUR. 1-HOUR Change in Reading(RF-R;): 0 0 0 Pass/Fail Threshold or +/-0.00 +/-0.00 +/-0.00 Criteri a: till.j:r ;f Ps Mh 7n , Iff '7'{:�'rr. 1• � ��,:r.:4i !",� ',3.4 }, r .,-�jii'�'� Comments—(include information on.repairs made prior to testing, and recommended follow-up for failed-tests) CLEANED DRAIN ON 87 —,RETEST —ALL PASSED CERTIFICATION OF TEC N RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that aU the information co ed in this report is true,accurate,and.in full compliance with legal requirements. Technician's Signature: Date: 9/16/10 State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent. wJ 3'V1 "•. w WOCKDALE FOOD MART _ _ - =•v _ _ _ - _ _ 7 ©W1 f;tJl p"tuiv t vn t /u, - --- 5321 STOCKDALE HWY SEP 16, 2010 8:46 AM - - - - - - - - - - HAKERSFIELD CA 93309 PORT SETTINGS SEP 16, 2010 8:45 AM SYSTEM UNITS U.S. CGMM. $.OAR17 i t ED I M ) SYSTEM LANGUAGE RS-232 SECURITY ENGLISH CODE : DISABLED SYSTEM STATUS REPORT SYSTEM DATE/TIME FORMAT 2 2 PION bl) YYYY HH:MM:SS xM COMM BOARD 2 tR:s-°3~ L 4:FUEL ALARM BAUD.RATE : 12ou STOCKDALE_ FOOD MART PARITY : ODD L24:FUEL ALARM 5321 STOCKDALE HWY ' STOP BIT : 1 STOP BAKERSFI.ELD CA 93309 DATA LEN DATA SECURITY INVENTORY REPORT CODE : DISABLED SHIFT TIME i : DISABLED T 1 :87 SHIFT TIME 2 : D I SABLED COMM BOARD 2400 P10D'' SHIFT TIME 3 : DISABLED BAUD RATE VOLUME - 10792 GALS SHIFT TIME 4 : DISABLED PARITY : ODD ULLAGE - 4230 GALS STOP BIT 1 STOP 90% ULLAGE- 2727 GALS TANK PER TST NEEDED WRN DATA LENGTH: 7 DA'fA TC VOLUME - L0596 GALS DISABLED RS 7232 SECURITY HEIGHT - 76.90 INCHES TANK ANN TST NEEDED WRN CODES DIISf'ABLEDONE WATER VOL - 0 GALS D I SfrffLED WATER - 0.00 INCHES ANSWER ON 1 RING TEMP . 65.8 DEC F LINE RE-ENABLE METHOD MODEM SETUP STRING PASS LINE TEST DIAL TONE INTERVAL: T 2:91 LINE PER TST NEEDED WRN VOLUME . 1392 GALS DISABLED ULLAGE = 4650 GALS LINE ANN TST NEEDED WRN AUTO TRANSMIT SETTING. jO%b ULLAGE- 3845 GALS DISABLED TC VOLUME - 3332 GALS AUTO LEAK. ALARM LIMIT HEIGHT = 49.87 INCHES PRINT TC VOLUMES DISABLED WATER VOL - 0 GALS ENABLED AUTO HIGH WATER LIMIT WATER - 0.00 INCHES DISABLED TEMP = 84.9 DEG F TEMP. C:OMPENSATION AUTO OVERFILL LIMIT VALUE (DEG F ) : 60.0 DISABLED STICK HEIGHT OFFSET AUTO LOW PRODUCT T 3:DIESEL DILED DISABLED SAB VOLUME = 3792 GALS AUTO THEFT LIMIT ULLAGE = 3278 GALS H-PROTOCOL DATA FORMAT DISABLED 90% ULLAGE- 2571 GALS HEIGHT AUTO DELIVERY START TO VOLUME - 3744 GALS PRECISION TEST DURATION. DISABLED. HEIGHT 60.12 INCHES HOURS: 1.2 AUTO DELIVERY END WATER VOL - 0 GALS DAYLIGHT-SAVING TIME DISABLED WATER - 0.00 INCHES ENABLED AUTO EXTERNAL INPUT TEMP a 87.9 DEG F START DATE DISABLED APR WEEK I SUN AUTO, INPUT * END x * x START TIME DISABLED 2:00 AM AUTO SENSOR FUEL. Ab END DATE DISABLED OCT WEEK 6 SUN AUTO SENSOR WATER A .END TIME DISABLED 2:00 AM AUTO SENSOR OUT ALA DISABLED REDIRECT LOCAL PRINTOUT DISABLED EURO PROTOCOL PREFIX S \ SYSTEM SECURITY - CODE : 0000ao TANK CHART SECURITY DISABLED CUSTOM ALARMS DISABLED MASS.�DENS i TY DISABLED , T 2:91 2i7 T 3:DIESEL SIN—TANK SETUP _ PRODUCT CODE PRODUCT CODE 3 THERMAL COEFF : .000700 THERMAL COEFF : .00 5G TA►�K DIAMETER 113.75 TANK DIAMETER 11 ?5 T 1 :87 TANK PROFILE. 1, PT TANK PROFILE PT PRODUCT CODE 1 FULL VOL 8042 FULL VOL 7070 THERMAL COEFF : .000700 TANK DIAMETER 113,75 TANK PROFILE 1 PT FLOAT SIZE: 3.0 IN. FLOAT SIZE: 3.0 I.N. FULL VOL 15022 2 p WATER WARNING 2 0 WATER WARNING NIGH WATER LIMIT: 3:.0 FLOAT SIZE: 3.0 IN. HIGH WATER LIMIT: 3.0 MA,< OR LABEL VOL: 8042 MAX OR LABEL VOL: 7070 WATER WARNING 2.0 OVERFILL LIMIT 90f OVERFILL LIMIT 90% HIGH WATER LIMIT: 3.0 7237 6363 HIGH PRODUCT 95% HIGH PRODUCT 95% MA:--,' OR LABEL VOL: 15022 7639 6716 OVERFILL LIMIT 72 DELIVERY LIMIT 10% DELIVERY LIMIT I0'1. 10815 604 707 HIGH PRODUCT 76 11416 LOW PRODUCT : 500 LOW PRODUCT : 500 DELIVERY LIMIT 10"0 LEAK ALARM LIMIT: 99 LEAK ALARM LIMIT: 99 1502 SUDDEN LOSS LIMIT 50 SUDDEN: LOSS LIMIT: 50 TANK. TILT 0.00 TANK TILT O.OU LOW PRODLICT 500 PROBE OFFSET 0,.00 PROBE OFFSET 0.00 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT' 0.00 SIPHON MANIFOLDED TANKS SIPHON MANIFOLDED TANKS PROBE OFFSET 0.00. Tp; NONE T#Y: NONE LI_NE 'MANIFOLDED TANKS LINE MANIFOLDED TANKS SIPHON MANIFOLDED TANKS T NONE T#:, .NONE TO: NONE LINE MANIFOLDED "TANKS LEAK MIN PERIODIC: 10: LEAK MIN PERIODIC: 1O% Tat: NONE $04 70, LEAP MIN ANNUAL : 104 LEAK MIN ANNUAL I0! LEAK MIN PERIODIC: 10% 804 70' 1502 LEAK MIN ANNUAL 100/6 PERIODIC TEST r"PE PERIODIC TEST TYPE 1502 STANDARD STANDARI ANNUAL TEST FAIL ANNUAL TEST FAIL PERIODIC TEST TYPE ALARM DISABLED ALARM DISA15LEI STANDARD ANNUAL TEST FAIL PERIODIC TALARM�DISABLED PERIODIC TEST FAIL DISABLEI ALARM DISABLED GROSS TEST FAIL GROSS TEST FAIL PERIODIC TEST FAIL ALARM DISABLED ALARM DISABLEI ALARM-DISABLED ANN TEST AVERAGING: OF] GROSS TEST FAIL ANN TEST AVERAG ING: OFF ING: OFF PER TEST AVERAGING: OFI FtLARhI nISABLED PER TEST AVERAGING: TANK TEST NOTIFY: OFF TANK 'TEST NOTIFY: OF] ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TNK TST SIPHON BREAK:OFF TNK TST SIPHON BREAK:OFI TANK TEST NOTIFY: OFF DELIVERY DELAY 15 MIN DELIVERY DELAY : 15 .Mll PUMP THRESHOLD : 10.00% PUMP THRESHOLD : 10'.[]0' TNK TST SIPHON BREAK:OF'F DELIVERY DELAY 15 MIN PUMP THRESHOLD 10.00% LEAK TEST METHOD TEST ANNUALLY: ALL TANK DEC WEEK 1 SUN START TIME :15 AM TEST RATE 0. 0 GAL/HR DURATION 2 HOURS TST EARLY STOP:DISA&LED PkEySURE LINE LEAK SETUP LINE. LEAK LOG?BOUT SETUP_ TrI—STATE—(SINGLE FO A _ -- — — — _ — — — _ _ _ _ _ _ CATEGORY : ANNULAR A LOCKOUT SCHEDULE DAILY Q 1 :87 START TIME: D I SAB,LED STOP TIME : DISABLED Ll3:DIESEL FILL TYP:2.0i3.QIN FIBERGLASS TRI—STATE (SINGLE FLOA 2.0IN DIA LEN: 120 FEET CATEGORY : PIPING SUMP 3.0IN DIA LEN: 0 FEET _ L14:DIESEL FILL FINN SHUTDOWN RATE: 3.0 GPH TRI—STATE (SINGLE FLOA LOW PRESSURE SHUTOFF:NO CATEGORY : ANNULAR SPJ LOW PRESSURE G PSI T 1 :87 DISPENSE MODE: L15:DISP 1-2 STANDARD TRI—STATE (SINGLE FLOA SENSOR: NON—VENTED LIQUID SENSOR SETUP _ CATEGORY : DISPENSER P, PRESSURE OFFSET: O.OPSI — — — — — — — — — — L ;1 :87 STP TRI—STATE (SINGLE FLOAT.) 1.16*1SP 1-2 ANN CATEGORY STP SUMP' TRI—STATE (SINGLE FLOA CATEGORY ANNULAR. SPA L 2:.87 STP ANN TRI—STATE (SINGLE FLOAT) CATEGORY : .ANNULAR SPACE L17:,D:ISP 3-4 TRI—STATE (SINGLE FLOA CATEGORY : DISPENSER P. Q 2:91 L 3:91 STP TRI-STATE (SINGLE FLOAT) TYP:2.0i3.0IN FIBERGLASS CATEGORY : STP SUMP L18:DISP 3-4 ANN 2.0IN DIA LEN: 120 FEEET TRI—STATE (SINGLE FLOA CATEGORY ANNULAR SPA, 3.01N DIA LEN: O FEET L 4:91. STP ANN TRI—STATE (SINGLE FLOAT) SHUTDOWN RATE: 3.0 GPH CATEGORY ANNULAR SPACE LOW PRESSURE SHUTOFF:NO LI 9:DISP 5-6 LOW PRESSURE 0 PSI TRI—STATE (SINGL.E FLOA' CATEGORY DISPENSER P T 2:91 L 5.:DIESEL STP DISPENSE MODE: TRI—STATE (SINGLE FLOAT). STANDARD CATEGORY : STP SUMP SENSOR: NON—VENTED L20::DISP 5-6 ANN PRESSURE OFFSET: O.GPSI TRI—STATE (SINGLE FLOA G':>`6 D £.�aE1- STF j4)N . CATEGORY ANNULAR SPA Tk7 STATE (SINGLE. FLOAT CATEGORY ANNULAR SPACE L21 :DISP 7-8 TRI=STATE (SINGLE FLOA L 7:VEIgT CATEGORY : DISPENSER P TR-I—STATE (SINGLE FLOAT.). CATEGORY OTHER SENSORS L22.:D.ISP 7-0 ANN TRI.—STATE {SINGLE FLOA' Q 3:DIESEL L sa:VENT ANN. CATEGORY : ANNULAR SPA+ TRI—STATE (S:INGLE FLOAT.) TYP:2.0t3.0IN FIBERGLASS CATEGORY ANNULAR SPACE 2.OJN DIA LEN: 60 FEET L2:3:D1SP 9-10 3.01N DIA LEN: 0 FEET TRI.—STATE (SINGLE FLOA' L 9:87 FILL CATEGORY : DISPENSER P, SHUTDOWN RATE: 3.0 GPH TRI—STATE (SINGLE FLOAT) LOW PRESSURE SHUTOFF:NO CATEGORY : PIPING SUMP LOW PRESSURE 0 PSI L24:AISP 9-10 ANN T 3:DIESEL L1U:€+7 FILL ANN TR3.—STATE (SINGLE FLOk DISPENSE MODE.: TRI—STATE (SINGLE FLOAT) CATEGORY ANNULAR SPAT STANDARD CATEGORY : ANNULAR SPACE SENSOR: NON—VENTED PRESSURE OFFSET: O:UPSI L11 :91 FILL , TRI'-STATE (SINGLE FLOAT} CATEGORY : PI_PING SUMP SOFTWARE REVISION LE PLLD LINE DISABLE SETUP - - - - - - VERSION 326.01 • • - - - - - - - - - - - s 1 :87 TANK ANN CkEATEDE� 06bulE .i Q 1 :87 CATEGORY VAC SENSOR PUMP #: S-MODULE# 33016 -004 LIQUID SENOR ALMS Q 1 `87 SYSTEM FEATURES: L 1 :FUEL ALARM VOLUME: 200. 7 GALLONS PERIODIC IN-TANK T L15:FUEI. ALARM RELIEF VALVE: : NO ANNUAL IN-TANK TES L17:FUEL ALARM s 2:87 PROD pSD L19:FUEL ALARM CATEGORY VAC SENIOR L21 :FUEL ALARM PUMP #: L23:FUEL ALARM Q 1 :87 L ! :SENSOR OUT ALARM VOLUME.: .128.8 GALLONS L15:SENSOR OUT ALARM RELIEF VALVE: : NO L17:SENSOR OUT ALARM L19:SENSOR OUT ALARM L CATEGORY OUT ALARM s TEGO VENT L23:SENSOR OUT ALARM RY VAC SENSOR PUMP #: 181) SITE ALARMS Q 1 :67 ISD GROSS PRES FAIL VOLUME: 64.4 GALLONS ALARM HISTORY REPORT ISD DEGRD PRES FAIL RELIEF VALVE: NO ISD VAPOR LEAK FAIL s 4:87-VAPOR, `-"- IN-TANK ALARM - ISD VP PRES FAIL CATEGORY VAC SENSOR 18r) VP STATUS FAIL PUMP #: T 1 ;87 ISD HOSE ALARMS Q 1 '87 OVERFILL ALARM. ALL:GROSS COLLECT FAIL VOLUME: 9.9.0 GALLONS SEP 15. 2010 8:36 P ALL:DEGRD COLLECT FAIL FEI:IEF.VALVE: NO SEP 13. 2010 1.1:31 A ALL:FLOW COLLECT FAIL s 5:91 VENT SEP 8. 2010 2:44 P Q 2:91 CATEGORY VAC SENSOR SUDDEN LOSS ALARM PUMP 0: DEC 23. 2008 10:20 A LIQUID SENSOR ALMS 0 2:91 L :FUEL ALARM VOLUME.: . 64.4 GALLON.e HIGH PRODUCT ALARM L15:FUEL ALARM RELIEF VALVE: : NO SEP 15, 2010 8:37 P 1-17:FUEL ALARM s 6:91 PROD SEP 1.3. 2010 11 :32 A L19:FUEL ALARM CATEGORY VAC SE14SOR AUG 16. 2010 9:52 A L',I :FUEL ALARM PUMP #: L'23:FUEL ALARM Q 2;91 L 3:SENSOR OUT ALARM VOLUME: 110.4 GALLONS L15:SENSOR OUT ALARM L17:SENSOR OUT ALARM RELIEF VALVE: NO 1.19:SENSOR OUT ALARM s 7:DIESEL-91 TANK ANN L21 :SENSOR OUT ALARM CATEGORY VAC SENSOR L23:SENSOR OUT ALARM Pump ;t: ISD SITE ALARMS Q 3:DIESEL ISD GROSS PRES FAIL VOLUME: 205.7 GALLONS ISD DEGRD PRES FAIL RELIEF VALVE: : NO le x. END ISD VAPOR LEAK FAIL s- 8:DIESEL PROD ISD VP PRES FAIL CATEGORY VAC SENSOR ISD VP STATUS FAIL PUMP #: ISD SETUP FAIL Q 3:DIESEL ISD HOSE ALARMS VOLUME: 110.4 GALLONS ALL:GROSS COLLECT FAIL RELIEF VALVE.: NO ALL:DEGRD COLLECT FAIL s 9:DIESEL VENT Q 3:DIESEL CATEGORY VAC SENSOR PUMP # LIQUID SENSOR ALMS 0 0:D1EESEL64..4 GALLONS ALARM HISTORY REPORT L 5:FUEL ALARM RELIEF VALVE: : NO L19:FUEL ALARM ---- IN-TANK ALARM - L23:FUEL ALARM s10:DISP 1-2 FM L 5:SENSOR OUT ALARM CATEGORY AIR PLOW METER T 2:91 L19:SENSOR OUT ALARM L23:SEI%SOR OUT ALARM sl.t :LISP 3-4 FM DELIVERY NEEDED CATEGORY AIR FLOW METER AUG 24. 2010 7:55 A s12:DISP 5-6 FM CATEGORY AIR FLOW METER sl3:DISP 7-6 FM CATEGORY AIR FLOW METER sI4:DISP 9-10 FM CATEGORY AIR FLOW METER sl5:DISP 5-6. VP CATEGORY VAPOR PRESSURE X END * * X `.SI"Ir iK'1 pit l'ItiiVlt HLHKI`'I ALARM HISTORY REPORT - ALHkM H[tiiuxt xrvn s 1 :07 TANK ANN_ J O� z ---- IN-TANK ALARM ---- COMMUNICATION ALARM ----- SENSOR ALARM - - SEP 16. 2010 12:57 PM L 1 :87 STP T 3:DIESEL STP SUMP jEN SOR OUT ALARM OVERFILL ALARM SEP 16, 2010 11 :18 AM MAY 25, 2009 9:10 AM FUEL ALARM SEP 16, 2010 10:00 All SENSOR OUT ALARM DEC 7. .2009 10:11 All --° SMARTSENSOR ALARM -- s 3:67 VENT NO VACUUM ALARM SEP 16, '2010 12:57 PM ;f * xx END XxXxX- . END X A - SMARTSENSOR IiLARM -- s 3:87 VENT VACUUM WARNING SEP 16, 2010, 12:58 PM' ALARM HISTORY REPORT ---- IN-TANK ALARM ----- T a: ALARM HISTORY-REPORT --= SENSOR ALARM --- SMARTSENSOR ALARM -- ANNULAR SPACE N s a:87-VAPOIR SENSOR OUT ALARM IVO VACUUM ALARM SEP 16, 2010 1116 AM SEP 16, 21!10 121::58 Pr I FUEL. ALARM SEP 16. 2010 9:56 AM SENSOR OUT ALARM * END * * DEC 7. 2009 10:11 AM. STOCKDALE FOOD MART. 5321 STOCKDALE HWY BAKERSFIELD CA 93309 SEP 16. 2010 1 :01 PM if * END x x SYSTEM STATUS REPORT s 1 COMMUNICATION ALARM s 3:VACUUM WARNING; s 9:NO VACUUM ALARM ALARM HISTORY REPORT - -- SENSOR .ALARM ----- L 3:91 STP STP SUMP SENSOR OUT ALARM SEP 16, 20110 11 : 18 AM FUEL ALARM SEP 16. 2010 9 '30 AM SENSOR OUT ALARM DEC 7, 2009 10:11 AM ALARM HISTORY REPORT• ALARM HISTORY RFJ-'0RT ��lu'� _. -- ' � -- SENSOR 'AI:AkM -- -- SENSOR ALARM --- SENSOR ALARM ----- --- --- L.10:87 FILL ANN L L 7:VENT—a:91 STP ANN ANNULAR SPACE' THER ;SENSORS ANNULAR SPACE Cs SENSOR OUT ALARM SENSOR OUT ALARM SENSOR OUT ALARM SEP 16, ?010 1 1 : 18 AM SEP 1.6, 2010 l l :l f1 AM SEP 16, 2010 11 :1:8 AM FUEL ALARM FUEL ALARM FUEL. ALARM SEP 16. 2010. 9:58 AM SEP 16, '?010 9:�i0 AM DEC 7, 2009 1,0:.21 AM 4 SENSOR OUT ALARM FUEL ALARM FUEL ALAW DEC 7, 2009 10:11 AM JAN 18, 2010 1 :16 PM SEP 15, 2010 10: 16 PM END END xx * END �c ALARM HISTORY REPORT ALARM HISTORY REPORT ALARM HISTORY REPORT ---" — SENSOR ALARM ----- ANNUL—' SENSOR ALARM — --- L11 91SENSSOR ALARM -----FILL L 5:DIESEL STP L ULANT ANN AR SPACE. PIPING SUMP STP SUMF OUT SENSOR OUT ALARM SENSOR OUT ALARM SENSOR OUT ALARM SEP 16, 2010 11 :18 AM SEP 16, 2010 11 :18 All 16, 2010. 11 :18 AM FUEL ALARM FUEL ALARM FUEL ALARM DEC 7. 2009 10:21 AM SEP 16. 2010 9:34 AM SEP 16, 2010 9:16 AM SENSOR OUT ALARM SENSOR OUT ALARM SENSOR OUT ALARM DEC 7, 2009 .1.0:11 AM DEC 7, 2009 10: 11 AM DEC 7. 2009 10:11 AM ii END ?� A END * * x * * END_ X X x A ALARM HISTORY REPORT ALARM HISTORY REPORT ALARM HISTORY REPORT -- SENSOR ALARM -- -- SENSOR ALARM -- -- -- SENSOR ALARM ---- L 9.:87 FELL — — L12'91. FILL ANN L 6:DIESEL STP ANN PIPING SUMP ANNULAR SPACE ANNULAR SPACE SENSOR OUT ALARM SENSOR OUT ALARM FUEL ALARM SEP 16, 2010 11 :18 AM SEP 16, 2010 11 :18 AM SEP 16. 2010 11 :48 AM FUEL ALARM FUEL ALARM SENSOR OUT ALARM SEP 16, 2010 10:02 APSE SEP 16, 2010 9:31 AM SEP 16. 2010 11 : 18 AM FUEL ALARM SENSOR OUT ALARM FUEL ALARM APR 11, 2010 10:57 PM DEC 71 2009 10:11 AM SEP 16. 2010 1:28 AM a ALARM HISTORY REPORT n a p a.vR a AQr vr.a =— SENSOR ALARM ---- — -- SE14SOR ALARM —_—✓�_7C�J ----- SENSOR ALARM --_-- L13:DIESEL FILL LI6:DISP 1,-2 ANN L19:DISP 54 PIPING SUMP ANNULAR SPACE . DISPENSER PAN SENSOR OUT ALARM SENSOR OUT ALARM SENSOR OUT ALARM, SEP 16. 2010 11 :16 AM SEP 16, 2010 11 :18 AM SEP 16. 2010 11 :18 AM FUEL ALARM FUEL ALARM FUEL ALARM SEP 16, 2010 9:28 AM SEP 16, 2010 10:27 AM SEP 16. 2010 10:28 AM SENSOR OUT ALARM FUEL ALARM FUEL ALARM DEC 7. 2009 10:11 AM DEC 7. 2009 10:12 AM ,IAN 21 . 2010 2:56 PM �i END �€ * * * END END ALARM HISTORY REPORT ALARM HISTORY REPORT ALARM HISTORY REPORT -- SENSOR ALARM ----- ----- SENSOR ALARM ----- ----- SENSOR ALARM ----- L14:DIESEL FILL ANN L.17:DISP 3-4 L20:DISR 5-6 ANN ANNULAR SPACE DISPENSER PAN ANNULAR SPACE SENSOR OUT ALARM SENSOR OUT ALARM SENSOR OUT ALARM SEP 16. 2010 11 :16 AM SEP 16. 201[1 11 :18 AM SEP 16. 2010 11 :18 AM FUEL ALARM FUEL ALARM FUEL ALARM SEP 16. 2010 9:28 AM SEP 16. 2010 10:31 AM SEP 16, 2010 10:21 AM FUEL ALARM SENSOR OUT ALARM FUEL ALARM FED 9. 2010 10:11 PM DEC ?. 2009, 10:11 AM DEC 7, 2009 10:14 AM * END x * * * END xxxX END X * xx9 ALARM HISTORY REPORT ALARM HISTORY REPORT ALARM HISTORY REPORT -- SENSOR ALARM ---_— -- SENSOR ALARM ----- ----, SENSOR ALARM ----- L15:DISP 1-2 LIB:DISP 3-4 ANN L21 :D1SP 7-8 DISPENSER PAN ANNULAR SPACE DISPENSER PAN SENSOR OUT ALARM SENSOR OUT ALARM SENSOR OUT ALARM SEP 16, 2010 11 :18 AM SEP 16, 2010 11 : 18 AM SEP 16, 2010 11 :18 AM FUEL ALARM FUEL ALARM FUEL ALARM SEP 16, 2010 10:32 AM SEP 16. 2010 10:31 AM SEP t6. 2010 10:23 AM FUEL ALARM FUEL ALARM SENSOR OUT ALARM SEP 16, 2010 10:27 AM DEC 7, 2009 10: 11 AM DEC 7. 2009 10:11 AM ALARM HISTORY REPORT tiLHRht HISTORY REPORT � ��^ ----- SENSOR ALARM ----- '— SMARTSENSOR ALARM. -- L22:DISP 7-8 ANN s 1 :87 TANK ANNULAR SPACE C;COMMUNICATION N ALARM SENSOR OUT ALARM NEP 16, 2010 10:35 AM SEP 16. 2010 11 :18 AM COMMUNICATION ALARM FUEL ALARM SEP 16, 201Q 10:16 AM SEP 16, 2010 10:29. All NO VACUUM ALARM FUEL, ALARM SEP 16, 2010 10:01 AM DEC 7, 2009 1011 AM * * END * END x ALARM HISTORY REPORT ALARM HISTORY REPORT --- SMARTSENSOR ALARM -- -- -- SENSOR ALARM ----- s 2:87 PROD L23:DISP 9-10 HIGH LIQUID ALARM DISPENSER PAN SEP 16, 2010 11 :48 AM SENSOR OUT ALARM SEP 16, 2010 1.1 :.18 AM HIGH LI6t 201 ALARM 16, 201U 11 :28 AM FUEL ALARM NO VACUUM ALARM SEP 16, 2010 10!00 AM SEP 16, 2010 11 :28 AM SENSOR OUT ALARM DEC 7, 2009 10:11 AM �c * END xrt END a{ ALARM HISTORY REPORT ALARM HISTORY REPORT -- SMARTSEf�OR ALARM. -- s 3:87 V1ENT -- SENSOR HLARM ----- HIGH LIQUID ALARM L24:DISP 9=10 ANN SEP 16. 2011 11 :44 AM ANNULAR SPACE HIGH LIQUID ALARM SENSOR OUT ALARM SEP 15, 2010 1128 AM SEP 16, 2010 11 :18 AM FUEL ALARM HIGH LIQUID ALARM SF.P 16, 2010 10:30 AM SEP 16, 2010 11 :15 AM FUEL ALARM SEP 16.2010 6:37 AM r-u-nm'I ►11 :5TORY REPORT ni.nrri ni,�ivnr iczrvai ���/rte --- SMARTSENSOR ALARM -- --- SMARTSENSOR ALARM s 4:87-VAPOR s ?:DIESEL-91 TANK ANN NO VACUUM ALARM HIGH LIQUID ALARM SEP 16. '?010 ]0:3Es Ahl SEP 16, 2010 11 :41 AM NO VACUUM! ALARM NO VACUUM ALARM SEP 16, 2010 10:22 AM SEP 16, 2010 11 :40 AM NO VACUUM ALARM 110 VACUUM ALARM SEP 16. 2010. 10: 19 SEP 16, 20110 9:18 AM * �€ END * END �i x ALARM HISTORY REPORT ALARM HISTORY REPORT -- SMARTSENSGk ALARM -- --- SPARTSENSGR ALARM -- s 5:91. VENT s B:DIESEL PROD HIGH LIQUID ALARM HIGH LIQUID ALARM SEP 1E, 20.10 9:52 AM SEP 16. 2010 12:06 PM HIGH LIQUID ALARM NO VA(;UUH ALARM . SEP 16, 2010 9:42 AM SEP 16. 2010 9:26 AM NO VACUUM ALARM NO VACUUM ALARM SEP 16. 2010 9:33 AM SEP 16, 2010 9:24 AM srt * END END \ AI..ARM HISTORY REPORT ALARM HISTORY REPORT H ---- SMARTSENSOR ALARM -- --- SMARTSENSOR ALARM -- s 6:91 PROD s 9:DIESEL VENT HIGH.LIQUID ALARM HIGH LIQUID ALARM SEP 16, 2010 9:52 AM SEP 16. 2010 12:08 PM HIGH LIQUID (iLARM HIGH LIQUID ALARM SEP 16, 2010. 9:48 AM SEP 16, 2010 12:06 PM NO VAC11U1°1 ALARM NO VACUUM ALARM SEP 16, 2010 9:45 AM SEP 16. 2010 12:05 PM r C) MONITOR CERT. FAILURE REPORT SITE NAME : STOCKDALE FOODMART DATE : 9/16/10 ADDRESS : 5321 STOCKDALE HWY TECHNICIAN: RICH ER S CITY: BAKERSFIELD SIGNATURE: THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS-, X-4/ Z6;c�?LA LABOR: PARTS INSTALLED : NAME : TITLE SIGNATURE : THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR 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 DOCUMENT HAS BEEN LEFT ON-SITE FOR YOUR CONVIENENCE.