HomeMy WebLinkAboutFMC 2011 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. If more than one monitoring system control panel is Installed at the facility,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 test date.
A.General Information
Facility Name: CIRCLE K 2701270 City: BAKERSFIELD CA Zip:93313
Site Address: 5634 STINE RD Contact Phone No: 834-8625
Date of Testing/Service: 01/20/2011
Facility Contact Person: JOHN-MANAGER
Make/Model of Monitoring System:TLS350 Work Order Number: 3180345 IIIlillllllll III IIII 31
B.Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced IE
Tank ID: 87 Tank ID: 91
X In-Tank Gauging Probe. Model: MAG PROBE E In-Tank Gauging Probe. Model: MAG PROBE
X Annular Space or Vault Sensor. Model: 409 Annular Space or Vault Sensor. Model: 409
X Piping Sump/Trench Sensogs). Model: 208 Piping Sump/Trench Sensor(s). Model: 208
Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model:
X Mechanical Line Leak Detector. Model: LD2000 X Mechanical Line Leak Detector. Model: LD2000
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
X Tank Overfill/High-Level Sensor. Model: FLAPPER Tank Overfill/High-Level Sensor. Model: FLAPPER
Other(specify equipment type and model in Section E on page 2). D Other(specify equipment type and model in Section E on page 2).
TanklD: TanklD:
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 Sensor(s). Model: Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model:
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
Tank Overfill/High-Level Sensor. Model: Tank OverfilUHigh-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 : 112 Dispenser ID: 3/4
7 Dispenser Containment Sensor(s) Model: 7 Dispenser Containment Sensor(s) Model:
X]Shear Valve(s). X Shear Valve(s)
�X Dispenser Containment Float(s)and Chain(s). X Dispenser Containment Float(s)and Chain(s).
Dispenser ID: 5/6 Dispenser ID: 7/8
Dispenser Containment Sensors) Model: 7 Dispenser Containment Sensogs). Model:
X❑'Shear Valve(s). Shear Valve(s).
X 'Dispenser Containment Float(s)and Chain(s). 71 Dispenser Containment Float(s)and Chain(s).
Dispenser lD: Dispenser ID:
Dispenser Containment Sensor(s) Model: Dispenser Containment Sensors). 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 verify that this information is correct.
and a'Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports,I have also attached
a copy of the(Check all that apply): ❑X System set-up X❑Alarm history report
Technician Name(print): ROBERT ALLEN Signature:
Certification No.: A20125 License.No.: 743160(Class'A'General Enginering Contractor License)
Testing Company Name:Tanknology Phone No.: (8 0)800-4633
Site Address: 11000 N. MoPac Expressway,suite 500,Austin,TX 78759 Date of Testing/Servicing: 01/20/2011
Monitoring System Certification Page 1 of 3 I IIIIIII II�IIII IIII 32 Based on CA form dated 03/08
IE
Monitoring System Certification
Site Address 5634 STINE RD Date of Testing/Service: 01/20/2011
D. Results of Testing/Servicing
Software Version Installed: 328.03
Complete the following checklist:
X Yes No• Is the audible alarm operational?
Q Yes No Is the visual alarm operational?
0 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?
X Yes D.No' N/A If alarms are relayed to a remote monitoring station,is all communications equipment(e.g. modem)operational?
For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment
❑x Yes ❑No• ❑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) ❑X Sump/Trench Sensors; ❑ Dispenser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑x Yes No
❑ Yes ❑No• ❑X N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.:no mechanical
overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill points(s)and operating
properly? If so,at what percent of tank capacity does the alarm trigger?
❑ Yes* ❑x 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- ❑x 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.
❑X Yes ❑No• Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable.
Q Yes ❑No• Is all monitoring equipment operational per manufacturers'specifications?
•In Section E below,describe how and when these deficlences were or will be corrected.
E. Comments:
Page 2 of 3 Based on CA form dated 03/08
Monitoring System Certification
Site Address: 5634 STINE RD Date of Testing/Service: 01/20/2011
F. In-Tank Gauging / SIR Equipment
❑ Check this box if tank gauging is used only for inventory control.
❑ Check this box if no tank gauging or SIR equipment is installed.
Check this box if no 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:
0 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?
OYes ❑No' Was accuracy of system water level readings tested?
X Yes ❑No Were all probes reinstalled properly?
❑X Yes 0 N•FWere all items on the equipment manufacturers'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 LLDs are not installed.
Complete the following checklist:
For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance?
Q_Yes ❑No' ❑N/A (Check all that apply)Simulated leak rate: X❑ 3 g.p.h❑0.1 g.p.h ❑0.2 g.p.h
FRI Yes ❑No Were all LLDs confirmed operational and accurate within regulatory requirements?
x Yes ❑No' Was the testing apparatus properly calibrated?
X❑Yes ❑No• ❑N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak?
❑Yes ❑No' ®N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak?
❑Yes, ❑No' ❑X N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected?
❑Yes ❑No.• 0 N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test?
❑Yes No 0 N/A For electronic LLDs,have all accessible wiring connections been visually inspected?
L'J Yes ❑No• Were all items on the equipment manufacturers'maintenance checklist completed?
`In the Section H,below,describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 3 Based on CA form dated 03/08
SWRCB,January 2002 Page 1 .
Secondary Containment Testing Report Form
This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the
appropriate pages of this form to report'results for all components tested. The completed form, written test procedures, and
printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: CIRCLE K 2701270 Date of Testing: 01/20/2011
Facility Address: 5634 STINE RD , BAKERSFIELD, CA, 93313
Facility Contact: JOHN - MANAGER Phone: (6 61) 834-8625
Date Local Agency Was Notified of Testing : 01/04/2011
Name of Local Agency Inspector(if present during testing): Ernie Madena
2. TESTING CONTRACTOR INFORMATION
Company Name: TANKNOLOGY, INC.
Technician Conducting Test: ROBERT ALLEN
'Credentials: CSLB Licensed Contractor SWRCB Licensed Tank Tester
License Type: A License Number: 743160
Manufacturer Trainine
Manufacturer Component(s) Date Training Expires
Incon STS 05/14/2011
3. SUMMARY OF TEST RESULTS
Not Repairs Not Repair
Component Pass Fail Tested Made Component Pass Fail Tested
Made
Spill Box 1 UNL FILL F ❑ ❑ ❑ 0 0 0 0
Spill Box 1 UNL FILL x Ell 0 0 F-11 ❑ 0 0
Spill Box 2 PRE FILL X ❑ ❑ 0 ❑ 0 ❑
Spill .Box 2 PRE FILL ❑ ❑ ❑ 0 ❑ 0 ❑
Spill Box 1 UNL VAPOR a ❑ ❑ ❑ El ❑ ❑
Spill Box 1 UNL VAPOR ❑ ❑ ❑ ❑ 0 ❑
Spill Box 2 PRE VAPOR X ❑ ❑ ❑ ❑ ❑ ❑ ❑
Spill Box 2 PRE VAPOR X 0 ❑ 0 0 0 I 0
0 0 0 O ❑ 0 ❑ ❑
0 0 0 0 0 0 0 0
0 0 0 0 0 0
0 17110 ❑ I Eli Ell 0
If hydrostatic testing was performed,describe what was done with the water after completion of tests:
Test water left on site in drum provided
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements
Technician's Signature: Date: 01/20/2011
SWRCB, January 2006
9. 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(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: CIRCLE K 2701270 Date of Testing: 01/20/2011
Facility Address: 5634 STINE RD , BAKERSFIELD, CA, 93313
Facility Contact: JOHN - MANAGER Phone: (6 61) 834-8625
Date Local Agency Was Notified of Testing : 01/04/2011
Name of Local Agency Inspector(if present during testing): Ernie Madena
2. TESTING CONTRACTOR INFORMATION
Company Name: TANKNOLOGY, INC.
Technician Conducting Test: ROBERT ALLEN
Credentials: CSLB Contractor X❑ICC Service Tech, ❑SWRCB Tank Tester ❑Other(Specify)A
License Number: 743160
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: El Hydrostatic ❑ Vacuum ❑ Other
'Test Equipment Used: Incon Equipment Resolution: .0020
Identify Spill Bucket By Tank 1 1 UNL FILL 2 1 UNL FILL 3 2 PRE FILL 4 2 PRE FILL
Number, Stored Product, etc.)
X❑Direct Bury ]Direct Bury ❑Direct Bury ❑X Direct Bury
Bucket Installation Type:
❑ Contained in Sump ❑ Contained in Sump ❑Contained in Sump ❑ Contained in Sump
Bucket Diameter: 11" 1111 11" ill,
Bucket Depth: 13" 13" 13" 13"
Wait time between applying 15min 15min 15min 15min
vacuum/water and starting test:
Test Start Time(TI ): , 11: 06am 11:24am 11:06am 11:24am
Initial Reading(RI ): 5.4100 5. 4102 5. 6805 5. 6800
Test End Time(TF ): 11:21am 11:39am 11:2lam 11:39am
Final Reading(R F ): 5.4091 5. 4096 5. 6801 5. 6800
Test Duration: 15min 15min 15min 15min
Change in Reading(R F -R1 ): .0009 .0 0 0 6 .0004 0
Pass/Fail Threshold or 0020 .0020 .0020 .0020
Criteria:
E€ate rti s }�}, Eglrc .E, 7tiSSd ;y t9} ;*,E} k,:ua,i, 3„GE i z"E21 g :,,tiEid!
, ri�Rv_{w �l. �,t[b �' }i,..
r Test esult. ! �:Pass,, ,}EFa►1f:��X 3;Pass ,, ,3 ,a�4,-. �; Pass �, ,} ail (it ,iPass Faila;
XI
P 1�'' k 1 a „ il�r1, a r ( n ��s t ! �1 s
._ "!�. - a '� EEO - ...._ .._ �„ i,w __.<.3a�t,.'
Comments 7 (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: �I�� Date: 01/20/2011
1 C♦�to 1.,.,,o .,...7«o..,.l.,r:..,.o .1..,,..t..,.««e.,�l.,«o.....«o♦o,.r:.,..f..ho..o«f'......,ea 1..,., ...,.,1:F.o.l ....,.�«.,..t.,« LT....,n.,o« 1.....,1«o.....«o...or♦�
SWRCB,January 2006
9. 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(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: CIRCLE K 2701270 DateofTesting: 01/20/2011
Facility Address: 5634 STINE RD , BAKERSFIELD, CA, 93313
Facility Contact: JOHN - MANAGER Phone: (6 61) 834-8625
Date Local Agency Was Notified of Testing : 01/0 4/2 011
Name of Local Agency Inspector(if present during testing): Ernie Madena
2. TESTING CONTRACTOR INFORMATION
Company Name: TANKNOLOGY, INC.
Technician Conducting Test: ROBERT ALLEN
Credentials CSLB Contractor a ICC Service Tech. 0 SWRCB Tank Tester E Other(Specify)A
License Number: 743160
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: a Hydrostatic El Vacuum Other
Test Equipment Used: I n co n Equipment Resolution:.0 0 2 0
MURNMRIMME
Identify Spill Bucket(By Tank 1 1 UNL VAPOR Z 1 UNL VAPOR 3 2 PRE VAPOR 4 2 PRE VAPOR
Number, Stored Product, etc.)
QX
Bucket Installation Type: Direct Bury XQ Direct Bury ]Direct Bury QX Direct Bury
❑Contained in Sump ❑ Contained in Sump ❑Contained in Sump ❑ Contained in Sump
Bucket Diameter: 11" lift lilt 11 '
Bucket Depth; is" 15" is" 151,
Wait time between applying 15min 15min 15min 15min
vacuum/water and starting test:
Test Start Time(TI ): 11:06am 11:24am 11:06am 11:24am
Initial Re ading(RI ): 5.0534 5.0528 4 . 9243 4 . 9233
Test End Time(TF ): 11:21am 11:39am 11:2lam 11:39am
Final Reading(RF ): 5.0527 5.0523 4 . 9233 4 . 9232
Test Duration: 15min 15min 15min 15min
Change in Reading(R F -R1 ): .0007 .0005 .0010 .0001
Pass/Fail Threshold or .0020 .0 0 2 0 . 0020 . 0 0 2 0
Criteria:
�;
.:a�}�_„ � >VV
i a �i dE� r4 ( k A{ r ... VAS
Wiestsuls � �Pass: 4 '�1atl _ M„�, Passr 11CaiI �,pih Pass � a�I , ���Pass�,� �a�ls,
'.'.. �.. ,E r,. .�
Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements.
Technician's Signature: Date: 01/20/2011
CM+o 1..,,... .,.,,1 .1......+..,.r.e.,N.. ........... 1.....,1 .o....:. o..r�
Work Order: 3180345
�e�1�{Nom►-M�tdar t-6►�07
Emergency Shut Off(ESO) &
I*ienser Emergency Shutoff VaWe (ESV)
ANNUAL TEST RECORD LOCATIONS AND TEST DATA
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Addrew cur.
Emmmff Shut Off&Q&Taft
On - in accordance with`ESA Vendor {3-21-05).(W,fim Vakm's Rail
e Dapartngarnt,es a pact of ammsi cmoqimw testier this eve teabtd the
Emmoncy 3hrmR O$CM switches iadua ted on this Ante�. lisped below
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On j_�y�ink with NFPA MIA this r�tesoed the a ftmat odosing feature
of tl a ispensu Emergency Sbutvff VALVE(S)MM located m the supply lftm at the base of each
individual island type dispenser indiicamd on the diagram below.Each device(#) in all,
would close.F' listed below: _
Disp•EmaNwey Mw Of IfNo,Provide ��
Val-(EM
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ON I
Mehmwaoe a Dow Called
Sak& p OrLOCNIM�d iho®mK Tmte�
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Tanknology Inc. 11000 N. MoPac Expwy#500,Austin,Texas 78759
•Tankwicogy
8501 N MOPAC EXPRESSWAY,SUITE 400
AUSTIN,TEXAS 78759
(512)451-6334
FAX(512)459-1459
TEST DATE:01/20/11 WORK ORDER NUMBER3180345
CLIENT:CIRCLE K STORES SITE:CIRCLE K 2701270
COMMENTS
Monitor Cert, Leak Detector, Spill Bucket, Impact Valve & e-stop. All tests passed.
PARTS REPLACED
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HELIUM PINPOINT TEST RESULTS (IF APPLICABLE)
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Printed 02/14/2011 08:14 ACRAMER
SITE DIAGRAM
i Tanknology
8501 N MOPAC EXPRESSWAY,SUITE 400
AUSTIN,TEXAS 78759
(512)451-6334
FAX(512)459-1459
TEST DATE:01/20/11 WORK ORDER NUMBER3180345
CLIENT:CIRCLE K STORES SITE: CIRCLE K 2701270
DUMP-
STER
v Z7
O_ 0
N m
4m
CANOPY ESO •
/EN cas
I F STP 0
pv
I zero
A
AIR1 V N
H2O E
F wt
mugggm
Printed 02/14/2011 08:14 ACRAMER
Work Order: 3180345
ALARM HISTORY REPORT
ALARM HISTORY REPORT
---- IN-TANK ALARM -----
---- IN-TANK ALARM -----
T 2:UNL-PREM
T 1:UNL-REG
HIGH WATER ALARM
CIRCLE K 2701270 HIGH WATER ALARM JAN 20. 2011 11:29 AM
5634 STINE RD. JAN 20. 2011 11:24 API
BAKERSFIELD, CA OVERFILL ALARM
OVERFILL ALARM JAN 20, 2011 11:42 AM
JAN 20, 2011 11 :41 AM
JAN 20, 2011 1 :31 PM DEC 21, 2010 4:36 AM LOW.PRODUCT ALARM
DEC 21, 2010 4:29 AM JAN 20. 2011 11 :24 AM
JAN 1. 2011 1 :15 AM
LOW PRODUCT ALARM
SYSTEM STATUS REPORT JAN 20, 2011 11 :21 AM HIGH PRODUCT ALARM
- - - - - - - - - - - - JAN 20. 2011 11 :42 AM
ALL FUNCTIONS NORMAL HIGH PRODUCT ALARM
JAN 20. 2011 11 :42 AM INVALID FUEL LEVEL
DEC 20. 2010 11 :37 Phl JAN 20, 2011 11 :26 AM
INVALID FUEL LEVEL PROBE OUT
JAN 20. 2011 11:21 AM JAN 20. 2011 11 :53 AM
JAN 20, 2011 11:25 AM
PROBE OUT JAN 20, 2011 11:22 AM
JAN 20. 2011 11 :56 AM
JAN 20. 2011 11 :20 AM HIGH WATER WARNING
ALARM HISTORY REPORT HIGH WATER WARNING JAN 20. 2011 11 :29 AM
----- SYSTEM ALARM ----- JAN 20, 2011 11:24 AM
PAPER OUT DELIVERY NEEDED
JAN 3, 2011 6:31 AM JAN 20. 2011 11:24 AM
PRINTER ERROR DELIVERY NEEDED DEC: 31. 2010 5:23 PM
JAN 3, 2011 6:31 AM JAN 20, 2011 11:22 AM
SERVICE NOTICE
JAN 19. 2011 12:01 PM LOW TEMP WARNING
JAN 20. 2011 11:23 AM
Tanknology Inc. 11000 N.MoPac Expwy#500,Austin,Texas 78759
Work Order: 3180345
ALARM HISTORY REPORT
----- SENSOR ALARM -----
L 1 :87 ANNULAR
ANNULAR SPACE
SENSOR OUT ALARM
JAN 20. 2011 9:41 AM
FUEL ALARM
JAN 20. 2011 9:37 A9
ALARM HISTORY REPORT
----- SENSOR ALARM -----
L 3:91 ANNULAR
ANNULAR SPACE
END * K M SENSOR OUT ALARM
JAN 20. 2011 9:41 AM
FUEL ALARM
JAN 20, 2011 9:31 AM
ALARM HISTORY REPORT
--- - SENSOR ALARM -----
L 1 :07 ANNULAR x x * * w END O 'vi m ri o
ANNULAR SPACE
SENSOR OUT ALARM
JAN 20, 2011 9:41 AM
FUEL ALARM
JAN 20. 2011 9:37 AM
ALARM HISTORY REPORT
----- SENSOR ALARM -----
L 4:91 TURBINE
STP SUMP
x x k' x END * k * X SENSOR OUT ALARM
JAN 20, 2011 9:41 AM
FUEL ALARM
JAN 20, 2011 9:29 AM
ALARM HISTORY REPORT
----- SENSOR ALARM -----
L 2:87 TURBINE
STP SUMP
SENSOR OUT ALARM
JAN 20. 2011 9:41 AM
FUEL ALARM
JAN 20, 2011 9:35 AM
Tanknology Inc. 11000 N.MoPac Expwy#500,Austin,Texas 78759
Work Order: 3180345
SYSTEM UNITS
U.S.
SYSTEM LANGUAGE
ENGLISH
SYSTEM DATE/TIr1E FORMAT
MON DD YYYY HH:MM:SS ,S1
CIRCLE K 2701270
5634 S71NE RD.
BAKERSFIELD, CA
SHIFT TIME 1 5:00 AM
SHIFT TIME 2 DISABLED
SHIFT TIME 3 DISABLED
CIRCLE K 2701270 SHIFT TIME 4 DISABLED
5634 STINE RD. COMMUNICATIONS SETUP
BAKERSFIELD. CA TANK PER TST NEEDED WRN - - - - - - - - - - - -
DISABLED
TANK ANN TST NEEDED WRN
JAN 20. 2011 6:26 AM DISABLED PORT SETTINGS:
LINE RE-ENABLE METHOD COMM BOARD : 1 (EDIM )
PASS LINE TEST RS-232 SECURITY
SYSTEM STATUS REPORT CODE : DISABLED
- - - - - - - - - - - LINE PER TST NEEDED WRN
ALL FUNC:T 1 ONS NORMAL DISABLED COMM BOARD 2 (RS-232)
LINE ANN TST NEEDED WRN BAUD RATE 9600
DISABLED PARITY ODD
STOP BIT l STOP
PRINT TG VOLUMES STOP LENGTH: 7 DATA
ENABLED RS-232 SECURITY
TEMP COMPENSATION CODE : DISABLED
VALUE (DEG F ): 60.0 COMM BOARD 3 (RS-232)
STICK HEIGHT OFFSET BAUD RATE 9600
CIRCLE K 2701270 DISABLED PARITY ODD
5634 STINE RD. ULLAGE: 90% STOP BIT : 1 STOP
BAYERSFIELD. CA DATA LENGTH: 7 DATA
H-PROTOCOL DATA FORMAT RS-232 SECURITY
HEIGHT CODE : DISABLED
JAN 20, 2011 8:2C AM DAYLIGHT SAVING TIME
ENABLED
START DATE AUTO TRANSMIT SETTINGS:
MAR WEEK 2 SUN
SYSTEM STATUS REPORT START TIME AUTO LEAK ALARM LIMIT
- - - - - - - - - - - - 2:00 AM DISABLED
ALL FUNCTIONS NORMAL END DATE AUTO HIGH WATER LIMIT
140V WEEK 1 SUN DISABLED
END TIME AUTO OVERFILL LIMIT
2:00 AM DISABLED
AUTO LOW PRODUCT
RE-DIRECT LOCAL PRINTOUT DISABLED
DISABLED AUTO THEFT LIMIT
DISABLED
EURO PROTOCOL PREFIX AUTO DELIVERY START
S DISABLED
SOFTWARE REVISION LEVEL AUTO DELIVERY END
VERSION 328.03 DISABLED
SOFTWARE# 346328-100-1) AUTO EXTERNAL INPUT ON
CREATED - 08.06.06.17.21 SYSTEM SECURITY DISABLED
CODE : 000000 AUTO EXTERNAL INPUT OFF
S=MOIIULEG 330160-004-a DISABLED
SYSTEM FEATURES: MAINTENANCE HISTORY AUTO SE14SOR FUEL ALARM
PERIODIC IN-TANK TESTS DISABLED DISABLED
ANNUAL IN-TANK TESTS AUTO SENSOR WATER ALARM
ISD DISABLED
TANK CHART SECURITY AUTO SENSOR OUT ALARM
DISABLED DISABLED
CUSTOM ALARMS
DISABLED
SERVICE NOTICE
ENABLED
DELIVERY OVERRIDE
ENABLED
MASS.,,DENSITY
DISABLED
Tanknology Inc. 11000 N.MoPac Expwy#500,Austin,Texas 78759
Work Order: 3180345
IN-TANK SETUP
T 1:UNL-REC; T 2:UNL-PREM
PRODUCT CODE A PRODUCT CODE B
THERMAL COEFF :.000700 THERMAL COEFF : .000700
TANK. DIAMETER 120.00 TANK DIAMETER 117.75
TANK PROFILE 4 PTS TANK PROFILE 4 PTS
FULL VOL : 14976 FULL VOL 11649
90.0 INCH VOL : 12232 88.3 INCH VOL 9710
60.0 INCH VOL : 7761 58.9 INCH VOL : 5995
30.0 INCH VOL : 2078 29.4 INCH VOL 2245
FLOAT SIZE: 4.0 IN. FLOAT SIZE: 4.0 IN,
WATER WARNING : 2.0 WATER WARNING 1 .5
HIGH WATER LIMIT: 2.5 HIGH WATER LIMIT: 2.5
RECEIVER SETUP: MAX OR LABEL VOL: 14976 MAX OR LABEL VOL: 11849
NONE OVERFILL LIMIT 13478 »
OVERFILL LIMIT 90
10664
HIGH PRODUCT 1495% HIGH PRODUCT 95,%
11256
DELIVERY LIMIT `y DELIVERY LIMIT 8%
748 947
LOW PRODUCT 1084 LOW PRODUCT 900
LEAK ALARM LIMIT: 99 LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 99 SUDDEN LOSS LIMIT: 99
TANK TILT 0.00 TANK TILT 0.00
PROBE OFFSET 0100 PROBE OFFSET 0.00
AUTO DIAL TIME SETUP:
SIPHON MANIFOLDED TANKS SIPHON MANIFOLDED TANKS
NONE TO: NONE Td: NONE
LINE MANIFOLDED TANKS LINE MANIFOLDED TANKS
TO: NONE TO: NONE
LEAK MIN PERIODIC.: 0% LEAK MIN PERIODIC: 0%
0
LEAK MIN ANNUAL 0% LEAK MIN ANNUAL 0'6
PERIODIC TEST TYPE PERIODIC TEST TYPE
STANDARD STANDARD
RS-232 END OF MESSAGE ANNUAL TEST FAIL ANNUAL TEST FAIL
DISABLED ALARM DISABLED ALARM DISABLED
AUTO DIAL ALARM SETUP PERIODIC TEST FAIL PERIODIC: TEST FAIL
- - - - - - - - - - ALARM DISABLED ALARM DISABLED
GROSS TEST FAIL GROSS TEST FAIL
ALARM DISABLED ALARM DISABLED
ANN TEST AVERAGING: OFF ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF TNK TST SIPHON BREAK:OFF
DELIVERY DELAY 2 MIN DELIVERY DELAY 2 MIN
PUMP THRESHOLD : 10.00% PUMP THRESHOLD : 10.00%s
Tanknology Inc. 11000 N. MoPac Expwy#500,Austin,Texas 78759
Work Order: 3180345
OUTPUT RELAY SETUP
R 1:87 SHUTDOWN
TYPE:
STANDARD
NORMALLY CLOSED
TANK 0: 1
LEAK TEST METHOD IN-TANK. ALARMS
- - - - - - - - - - - - T 1 :HIGH WATER ALARM
TEST ON DATE : ALL TANK T ]:LOW PRODUCT ALARM
JUN 6. 2008 LIQUID SENSOR ALMS
START TIME 12:00 AM
TEST RATE :0.20 GAL,HR L i:FUEL ALARM
DURATION 2 HOURS L 2:FUEL ALARM
L ]:SENSOR OUT ALARM
TST EARLY STOP:UISHBLED L 2:SENSOR OUT ALARM
L I:SHORT ALARM
LEAK TEST REPORT FORMAT L 2:SHORT ALARM
NORMAL ISD SITE ALARMS
ISD GROSS PRES FAIL
ISD DEGRD PRES FAIL
ISD VAPOR LEAK FAIL
ISD HOSE ALARMS
ALL:GROSS COLLECT FAIL
ALL:DEGRD COLLECT FAIL
ALL:FLOLJ COLLECT FAIL
R 2:91 SHUTDOWN
LIQUID SENSOR SETUP TYPE:
- - - - - - STANDARD
NORMALLY CLOSED
L 1:87 ANNULAR
TRI-STATE (SINGLE FLOAT) TANK M: 2
CATEGORY : ANNULAR SPACE
IN-TANK ALARM
T 2:HIGH WATER ALARM
L 2:87 TURBINE T 2:LOW PRODUCT ALARM
TRI-STATE (SINGLE FLOAT) T 2:PROBE OUT
CATEGORY SUMP
LIQUID SENSOR ALMS
L 3:FUEL ALARM
L 3:91 ANNULAR L 4:FUEL ALARM
TRI-STATE (SINGLE FLOAT) L 3:SENSOR OUT ALARM
CATEGORY : ANNULAR SPACE L 4:SENSOR OUT ALARM
L 3:SHORT ALARM
L 4:SHORT ALARM
L 4:91 TURBINE ISD SITE ALARMS
TRI-S ATE (SINGLE FLOAT) . ISD GROSS PRES FAIL
CATEGORY STP SUMP ISD DEGRD PRES FAIL
ISD VAPOR LEAK FAIL
ISD HOSE ALARMS
ALL:GROSS COLLECT FAIL
ALL:DEGRD COLLECT FAIL
ALL:FLOW COLLECT FAIL
R 4:FUEL ALARMS
TYPE:
STANDARD
NORMALLY OPEN
TANK it: NONE
LIQUID SENSOR ALMS
ALL:FUEL ALARM
Tanknology Inc. 11000 N.MoPac Expwy#500,Austin,Texas 78759
Work Order: 3180345
SMARTSENSOR SETUP
s i:DISP 1-2 AFM
ISD AIRFLOW METER MAP CATEGORY AIR FLOW METER
ID SERIAL NUM LABEL_ _ s 2:DISP 3-4 AFM
1-21590 -DISP 1-2 A CATEGORY AIR FLOW METER
2 21561 DISP 3-4 A s 3:DISP 5-6 AFM
3 21597 DISP 5-6 A CATEGORY AIR FLOW METER
4 21572 DISP 7-8 A
s 4:D1SP 7-8 AFM
ISD FUEL GRADE HOSE MAP CATEGORY AIR FLOW METER
1 2 3 4 s 5:DISP 1-2 VPS
FP MHH MHH MHH MHH AA CATEGORY VAPOR PRESSURE
------------------------
01 401 5D1 901 U U 1
02 402 502 902 U U 1
03 403 903 503 U U 2
04 404 504 904 U U 2
05 405 905 505 U U 3
06 406 506 906 U U 3
07 407 507 907 U U 4
08 40B 508 908 U U 4
LABEL TABLE
------------------------
1 : UNASSIGNED
2: BLENDS EVR/ISD SETUP
3: REGULAR
4: MID GRADE
5: PREMIUM
6: GOLD EVR TYPE: VACUUM ASSIST
7: BRONZE VACUUM ASSIST TYPE
8: SILVER HEALY VAC
9: BLEND2
10: BLEND4 NOZZLE A,-L RANGE
MAX: 1 .15 MIN: 0.95
VAPOR PROCESSOR TYPE
NONE
ANALYSIS TIMES
TIME: 9:00 AM
DELAY MINUTES: 1
PRO SETUP
PMG VERSION: 01 :01 ACCEPT HIGH ORVR:
DISABLED
VAPOR PROCESSOR TYPE ISD HOSE TABLE
NONE ID FP FL HL AA RR
-------------------------
PROCESSOR CONTROL LEVEL: 01 01 01 02 01 UU
NONE 02 02 02 02 01 UU
03 03 03 02 02 UU
04 04 04 02 02 UU
05 05 05 02 03 UU
06 06 06 02 03 UU
07 07 07 02 04 UU
08 08 08 02 04 UL
Tanknology Inc. 11000 N.MoPac Expwy#500,Austin,Texas 78759
Work Order: 3180345
CIRCLE K 2701270
5634 STINE RD CIRCLE K 2701270
BAKERSFIELD 5634 STINE RD
CALIFORNIA BAKERSFIELD
3180345 CALIFORNIA
3180345
01/20/2011 11:22 AM
01/20/2011 11:39 AM
SLK LEAK TEST REPORT
87SP1LL SUMP LEAK TEST REPORT
87SPILL
TEST STARTED 11:06 AM
TEST STARTED 01/20/2011 TEST STARTED 11:24 AM
BEGIN LEVEL 5,4100 IN TEST STARTED 01/20/2011
END TIME 11:21 AM BEGIN LEVEL 5,4102 IN
END DATE 01/20/2011 END TIME 11:39 AM
END LEVEL 5,4091 IN END DATE 01/20/2011
LEAK THRESHOLD 0,002 IN END LEVEL 5,4096 IN
TEST RESULT PASSED LEAK THRESMLD 0,002 IN
TEST RESULT PASSED
91SPILL
91SPILL
TEST STARTED 11:08 AM
TEST STARTED 01/20/2011 TEST STARTED 11:24 AM
BEGIN LEVEL 5.6805 IN TEST STARTED 01/20/2011
END TIME 11:21 AM BEGIN! LEVEL 5,6800 IN
END DATE 01/20/2011 END TIME 11:39 AM
END LEVEL 5.6801 IN Ertl DATE 01/20/2011
LEAK THRESHOLD 0,002 IN END LEVEL 5,6800 IN
TEST RESULT PAM LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED
87VAPOR
87VAPOR
TEST STARTED 11:05 AM
TEST STARTED 01/20/2011 TEST STARTED 11:24 AM
BEGIN LEVEL 5.0534 IN TEST STARTED 01/20/2011
END TIME 11:21 AM BEGIN LEVEL 5,0528 IN
END DATE 01/20/2011 END TIME 11:39 AM
END LEVEL 5,0527 IN END DATE 01/20/2011
LEAK THRESHOLD 0.002 IN END LEVEL 5,0523 IN
TEST RESULT PASSED LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED
91VAPOR
91VAPOR
TEST STARTED 11:06 AM
TEST STARTED 01/20/2011 TEST STARTED 11:24 AM
BEGIN LEVEL 4,9243 IN TEST STARTED 01/20/2011
END TIME 11:21 AM BEGIN LEVEL 4,9233 IN
END DATE 01/20/2011 END TIME 11:39 AM
END LEVEL 4,9233 IN END DATE 01/20/2011
LEAK THRESHOLD 0,002 IN ENO LEVEL d.9232 IN
TEST RESULT PASSED LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED
Tanknology Inc. 11000 N.MoPac Expwy#500,Austin,Texas 78759
Pp, manknoiogy
11000 N. MoPac Expressway,Suite 500
Austin,Texas 78759
Phone: (512)451-6334
Fax: (512)459-1459 Date Printed and Mailed: 02/14/2011
BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
INSPECTOR CRAIG PERKINS
1501 TRUXTUN AVE.
BAKERSFIELD, CA. 93301
Test Date: 01/20/2011
Order Number: 3180345
Dear Regulator,
Enclosed are the results of recent testing performed at the following facility:
CIRCLE K 2701270
5634 STINE RD
BAKERSFIELD, CA. 93313
Testing performed:
Leak detector tests
Monitor Certification
Secondary Containment-Spill Container
Sincerely,
Dawn Kohlmeyer
Manager, Field Reporting
� ^ TANKNOLOGY CERTIFICATE OF TESTING
8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759
TELEPHONE(512)451-6334 FAX(512)459-1459
PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT
TEST DATE: 01/20/11 WORK ORDER NUMBER: 3180345
CUSTOMER PO: Rex Abacan
CLIENT: CIRCLE K STORES SITE:CIRCLE K 2701270
495 E.RINCON,STE.150 5634 STINE RD
CORONA,CA 92879 BAKERSFIELD,CA 93313
REX ABACAN JOHN-MANAGER
(951)270-5193 (661)834-8625
TEST TYPE: TLD-1
Product Pipe Tightness Test Results
INN 3�u3ryE[t f 3y:: ,E.i2� .9r:". €; 3€ d! s 1 r .-€� 3 n :'t E s ,,,A,;l' it t^ t.ti j!i E)r
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T1-87 1 UNLEADED DW FIBERG PRESSURE Y
T2-91 2 PREMIUM DW FIBERG PRESSURE Y
Existing Line Leak Detector Test
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94 II LINE .: r I , yii. II, � l Ii � UFACIIItER =MODEL!! ' RESULT
MANUACtTURER IIAAODEL,# SE, AL# _ ,,RESUL I , re, € a ,1,a •,3
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T1-87 1 VAPORLESS MLD 08041484 P
T2-91 2 VAPORLESS MLD 09111129 P
) New Replacement Line Leak Detector Test
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For owner detailed report information,visit www.tanknology.com and select On-Line Reports-WRAP,or contact your local Tanknology office.
Tester Name:ROBERT ALLEN Technician Certification Number:3637843760
L
Printed 02/14/2011 08:14 ACRAMER
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
elp TenknokVy
TEST DATE: 01/20/11 8501 N MOPAC EXPRESSWAY,SUITE 400 WORK ORDER NUMBER: 3180345
AUSTIN,TEXAS 78759(512)451-6334
CLIENT: CIRCLE K STORES SITE: CIRCLE K 2701270
Tank ID: Ti-87 1 Tank manifolded: NO Bottom to top fill in inches:
Product: UNLEADED Vent manifolded: YES Bottom to grade in inches:
Capacity in gallons: 14,976 Vapor recovery manifolded: YES Fill pipe length in inches:
Diameter in inches: 92.00 Overfill protection: YES Fill pipe diameter in inches: 4.0
Length in inches: 527 Overspill protection: YES Stage I vapor recovery: DUAL
Material: Dw FIBERG Installed: ATG Stage II vapor recovery: ASSIST
CP installed on:
COMMENTS
.�, 6 {.>�..,1.>. E...,...{8£i b .p•.[si;xl v,...rx{ t j£.
TANKTEST RESULTS I)(I YfTest 7jMethtld _NONE N f LEAK DETECTOR TEST:RESULTS°` p}t p)# !I`ii#i TBSt%irtle
nv�.?»>�i (ieF:Yi�1Jf;'ai3Y�.., ..£.s s y....��SFi4#.�n,ii#iitiil��.f.,.',o #I#iU�s is<LytF�'•
PSI at tank bottom: New/passed Failed/replaced New/passed Failed/replaced
Fluid level in inches: L.D.#1 L.D.#1 L.D.#2 L.D.#2
LIFT/OFT: Make: VAPORLESS
Fluid volume in gallons: Model: rQD
Tank water level in inches: S/N: 08041484
Test time: NOT Open time in sec: 4.00
Number of thermisters: TESTED Holding psi: 29 NOT
Specific gravity: Resiliency cc: 150 TESTED
Water table depth in inches: Test leak rate ml/m: 189.0
Determined by(method): Metering psi: 18
Leak rate in gph: Calib. leak in gph: 3.00
Result: Results: PASS
COMMENTS COMMENTS
tYt's=&�?t tjS{S;lN, e3'tnC¢E?sE;E dPJ':p, ei};a f9 m-,:,:)r? 4f#?e;aEt 4.hih:'eE_;, rgy",F:qE.,,#, #;. .•t,k11: CE# 1 'R.!'.�7 t',a` . ...... w^«°+w,ei'";titttl
t a 'F..>R::1.
FJLLA '' E5 F RS1ltS: e t t '. y.: 0 ',{£ t�INEiITES7 RES�J LTS rt 11t E l :Test type xz,�E #a
•sk�l.'! { t'� S M FiUta 41 t 3 #I 7� 5 w,s£N f_ 3. gs ti 3�`F d #;':. F a i g s V d F! £',' £s
kll�ilul'':{ - rlax a'{(fi'h _�---alh. s.t;~ .9h�za1>.`=.g ..; [iNh 3},,,�>r :�a-.Ct�.xi i,.�a-;S;d
Test time:
Ullage volume: Material: Dw FIBERG
Ullage pressure: Diameter(in): 2.0
Results: Length(ft): 160.0
Test psi:
DATA FOR UTS-4T ONLY: Bleedback cc:
Time of test 1: Test time(min):
Temperature: NOT Start time: NOT NOT NOT NOT
Flow rate(cfh): TESTED End time: TESTED TESTED TESTED TESTED
Time of test 2: Final gph:
Temperature: Result:
Flow rate(cfh): Pump type: PRESSURE
Time of test 3: Pump make: FE PETRO
Temperature:
Flow rate(cfh): Impact Valves Operational: YES
COMMENTS COMMENTS
Printed 02/14/2011 08:14 ACRAMER
INDIVIDUAL TANK INFORMATION AND TEST RESULTS
Mr 713n
TEST DATE: 01/20/11 8501 N MOPAC EXPRESSWAY,SUITE 400 WORK ORDER NUMBER: 3180345
AUSTIN,TEXAS 78759(512)451-6334
CLIENT: CIRCLE K STORES SITE: CIRCLE K 2701270
E ' "tN : i -.
R*NFORMA7
. I-" h l :7W7,0 r TAN
Tank ID: T2-91 2 Tank manifolded: No Bottom to top fill in inches:
Product: PREMIUM Vent manifolded: YES Bottom to grade in inches:
Capacity in gallons: 11,849 Vapor recovery manifolded: YES Fill pipe length in inches:
Diameter in inches: 92.00 Overfill protection: YES Fill pipe diameter in inches: 4.0
Length in inches: 417 Overspill protection: YES Stage I vapor recovery: DUAL
Material: Dw FIBERG Installed: ATG Stage II vapor recovery: ASSIST
CP installed on:
COMMENTS
'.t�ksv - "—u,..._.
TANK tTEST)RE$ LTS, - ,TBtst ethod NONEli ,ii F i pp E,4K°DETECTOR TES S RESULTS 'l1Elli' T.est.:method: i 113
c��3i.. ,,� fi��,. .i_r sr,-
PSI at tank bottom: New/passed Failed/replaced New/passed Failed/replaced
Fluid level in inches: L.D.#1 L.D.#1 L.D.#2 L.D.#2
UFT/OFT: Make: VAPORLESS
Fluid volume in gallons: Model: MLD
Tank water level in inches: SIN: 09111129
Test time: NOT Open time in sec: 5.00
Number of thermisters: TESTED Holding psi: 25 NOT
Specific gravity: Resiliency cc: 125 TESTED
Water table depth in inches: Test leak rate ml/m: 189.0
Determined by(method): Metering psi: 19
Leak rate in gph: Calib. leak in gph: 3.00
Result: Results: PASS
COMMENTS COMMENTS
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>Ri r LINE TESTAESULTS"Ili,:l � ,t<��Test t "e TLD.dill€ I � }.,I,Eri i a .-.
U LLAQE,TEST RESULTS F:sE Mithad;:NONE I it YP.
�.. � �a i ri'�_.�r ,: -�.'�f liiii.?1lui;.n.� �dii�ll l�llm,aii
Test time:
Ullage volume: Material: Dw FIBERG
Ullage pressure: Diameter(in): 2.0
Results: Length(ft): 160.0
Test psi:
DATA FOR UTS-4T ONLY: Bleedback cc:
Time of test 1: Test time(min):
Temperature: NOT Start time: NOT NOT NOT NOT
Flow rate(cfh): TESTED End time: TESTED TESTED TESTED TESTED
Time of test 2: Final gph:
Temperature: Result:
Flow rate(cfh): Pump type: PRESSURE
Time of test 3: Pump make: FE PETRO
Temperature:
Flow rate(cfh): Impact Valves Operational: YES
COMMENTS COMMENTS
Printed 02/14/2011 08:14 ACRAMER