HomeMy WebLinkAboutFMC 2010 MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of California
Authority Cited: Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be
prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided
to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems
within 30 days of this date.
A. General Information VIII III VIII 37
Facility Name: #362 Fastrip#633 IE Bldg.No.:
Site Address: 6401 South H Street City: Bakersfield Zip: 93304
Facility Contact Person: Omero Garcia Contact Phone No.: 661-393-7000
Make/Model of Monitoring System: Veeder-Root TLS-350 Date of Testing/Servicing: 8/9/2010
B. Inventory of Ejuipment Tested/Certified
Check the appmpriale boxes to i icate specific equipment impecledlserviced:
Tank ID: 12000 gal.Regular Tank ID: 12000 gal.Super
[X] In-Tank Gauging Probe. Model:847390-107 in-Tank Gauging Probe. Model:847390-107
[x] Annular Space or Vault Probe. Model:794380-303 [X] Annular Space or Vault Sensor. Model: 794380-303
[x] Piping Sump/Trench Sensor(s). Model:794380-208 [x] Piping Sump/Trench Sensor(s). Model: 794380-208
L] Fill Sump Sensor(s) Model:794380-208 [X] Fill Sump Sensor(s). Model:794380-208
❑ Mechanical Line Leak Detector. Model: ❑ Mechanical Line Leak Detector. Model:
[X] Electronic Line Leak Detector. Model:WPLLD [, Electronic Line Leak Detector. Model: WPLLD
U Tank Overfill/High Level Sensor. Model:847390-107 U Tank Overfill/High Leval Sensor. Model: 847390-107
❑ Other(specify equip.type and model in Sec. E on Pg.2) ❑ Other(specify equip.type and model in Sec. E on Pg.2)
Tank ID:_12000 gal.Diesel Tank ID:
[x] In-Tank Gauging Probe. Model:847390-107 ❑ in-Tank Gauging Probe. Model:
[x] Annular Space or Vault Sensor. Model:794380-303 ❑ Annular Space or Vault Sensor. Model:
[x] Piping Sump/Trench Sensor(s). Model:794380-208 ❑ Piping Sump/Trench Sensor(s). Model:
U Fill Sump Sensors(s). Model:794380-208 ❑ Fill Sump Sensor(s). Model:
[] Mechanical Line Leak Decector. Model: ❑ Mechanical Line Leak Detector. Model:
[x] Electronic Line Leak Detector. Model:WPLLD ❑ Electronic Line Leak Detector. Model:
[x] Tank Overfill/High Level Sensor. Model:847390-107 ❑ Tank Overfill/High Level Sensor.Model:
❑ Other(specify equip.type and model in Sec. E on Pg.2) ❑ Other(specify equip.typs and model in Sec. E on Pg. 2)
Dispenser ID: 1 &2 Dispenser iD: 3&4
D
x] Dispenser Containment Sensor(s). Model: 794380-208 [x] Dispenser Containment Sensor(s). Model: 794380-208
[X] Shear Valve(s). [x] Shear Valve(s).
❑ Dispenser Containment Float(s)and Chain(s). ❑ Dispenser Containment Float(s)and Chain(s)
Dispenser ID: 5&6 Dispenser ID: 7&8
[x] Dispenser Containment Sensor(s). Model: 794380-208 [x] Dispenser Containment Sensor(s). Model: 794380-208
rx] Shear Valve(s). U 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,l have attached a copy of the report; (check all that apply) Ex]Sys Set-up U Alarm ' ry re ort
Technician Name(print): Bryan A Self Signature:
Certification No: 837501 License No:804904
Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930
Site Address: 1604 South H Street,Bakersfield,CA 93304 I IIIIIIIVIIIIII IIII 38 .Date of Testing/Servicing: 8/912010
IE
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?
• Yes No* Were all sensors visually inspected,functionally tested,and confirmed operational?
• 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)
Rx 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? ❑Sump/Trench Sensors[X]Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? [X] Yes; ❑ No;
L] Yes ❑ No* 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 visual and audible at
the tank fill point(s)and operating properly?If so,at what percent of tank capasity does the alarm
trigger? 90 %
❑ Yes* 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* [x] No Was liquid found inside any secondary containment systems designed as dry systems?
❑ Product; ❑ Water. If yes, describe causes in Section E,below.
x EYe No* Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports, if applicable.
R No* I 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:
F. In-Tank Guaging/SIR Equipment: E 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:
Lx] Yes ❑ No*I Has all input wiring been inspected for proper enter and termination,including testing for ground faults?
x Yes No*I Were all tank guaging probes visually inspected for damage and residue buildup?
x Yes No*I Was accuracy of system product level readings tested?
rxj Yes I No* Was accuracy of system water level readings tested?
x Yes No* Were all probes reinstalled properly?
L] Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H,below,describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): ❑Check this box if LLD's are not installed.
Complete the following checklist:
Lx] 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: E13 g.p.h.: 00.1 g.p.h.; E]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?
U Yes 7 No For machanical LLD's,does the LLD restrict product flow if it detects a leak?
N/A
❑ Yes No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak?
❑ N/A
❑ Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is
❑ N/A disabled or disconnected?
❑ Yes No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system
❑ N/A malfunction or fails a test?
❑ Yes No* For electronic LLD's, have all accessible wiring connections been visually inspected?
❑ N/A
x Yes No Were all items on the equipment manufacturer's maintenance checklist completed?
*In the section H,below,describe how and when these deficiencies were or will be corrected.
H. Comments:
HST
BAKERSFIELD CA,93304 SYSTEM SETUP` t
661-83147,09 ! - - - - - - -•- - - -
AUG 9, 2010,, 8:54 AM
i
AUG;_:-5"l 2010' 53 AM „
FASTRIP 326 SYSTEM UNITS ,
6401 S.H ST. SYSTEM STATUS'.-REPORT c U.S
BAKERSFIELD,CA93304 - .SYSTEM.LANGU(iGE
661—B31-4709 ALL FUNCTIONS'NORMAL
ENGLISH
.SYSTEM DATE/TlME FORMAT
AUG 9. 2010 6:00 AM INVENTORY REPORT a;MON DD.".YYYY HH:MM.-SS xM ;
INVENTORY REPORT FASTRIP 326. ;
T -1 :UNLEADED-- „ .; =6401 S-:H ST"`+
VOLUME 3098 GALS - ; BAKERSFIELD_CA93JQ4
T 1 :UNLEADED ULLAGE _. 8902' GALS _1 661-831-4709
VOLUME - 3848 GALS 90% ULLAGE— 7702 GALS _
ULLAGE = 8152 GALS TC `_VOLUME 3046' GAITS, ; t`SHIFT T.IME_1::
90% ULLAGE= 6952 GALS HEIGHT m 29.28 INCHES'j SHIFT TIME 2 rD'1SABLED
TC VOLUME 3785 GALS WATER voL 0-GAITS SHIFT TIME 3 DISABLED
- `
HEIGHT 34,29 INCHES WATER 0 00 INCHES, ,i SHIFT--;TI.ME 4 : DISABLED.-
WATER VOL - 0 GALS
TEMP-., 83•.7 DEG,.F
WATER = 0.00 INCHES E t `TANK PER TST NEEDED;.WRN
TEMP 83.0 DEG F r T 2,:PREMIUM # ;TANKHANN TST NEEDED WRN
VOLUME J=; 331:!1. GALS 'DISABL'ED.
T 2:PREMIUM ULLAGE j8689:GALS t
VOLUME 3408 GALS 9Q% ULLAGE= 7489 GALS LITNE .RE—ENABLE METHOD
TC- VOLUME _ 3252 _GALSr PASS LI.NE`T.EST ;
ULLAGE 8592 GALS. t . -
•HEIGHT r _ 30 ,72 INCHES;
90% ULLAGE- 7392 GALS q WATER VOL 14 GAI:B:'
TC VOLUME = 3358 GALS WATER. DINE `PER TST NEEDED WRN,
0 76 INCHES. :D ISAHLED
HEIGHT 31 .38 INCHES" �� L,INE 'ANN TST NEEDED WRN
TEMP �= 8I .�0 'DEG:F
WATER VOL = 14 GALS . ;;DISABLED
WATER - 0. INCHES
TEMP = 8.- . r DEG F T 3:D'I ESEL ,PR 1 NT.'TC.VOLUMES.
VOLUME Y_a 3622 GALS';' t ENABLED
T 3:DIESEL ULLAGE' �< 8378 'GALS !
VOLUME 3645 GALS 90%, ULLAGE='. 717,B GALS. - TEMP COMPENSATION
ULLAGE - 8355 GALS TC VOLUME 3575 GALS � • VALUE.- (DEG F' 60.0
HEIGHT x� , 32�.�E O dINCHEs a STICK HEIGHT OFFSET'
90% ULLAGE 7155 GALS- "WATER 14•GALS" DISABLED;
TC VOLUME = 3597 GALS t WATER-. 078 I NCHES I ULLAGE 90% -
HEIGHT = 32.95 INCHES + -
� TEMP 88 ,6 DEG.'F
WATER VOL = 14 GALS, rT H=PROT-OCOL DATA FORMAT.
WATER = -0.78 INCHES
TEMP = 88.6 DEG F HEIGHT'
t * * * * END * _*. -.* _•. DAYLIGHT SAVING TIME
r ENABLED
xEND x * y 'START DATE
MAR , 2 SUN
STAR TIME .
2.:00 AM:
t
''.END DATE ,
(. ", NOV WEEK I SUN
END T1HE
�. -2:00 AM
-RE—DIRECT LOCAL PRINTOUT
DISABLED
EURO PROTOCOL PREFIX
s
. 'SYSTEM-SECURITY
CODE :.,000000-
MAINTENANCE HISTORY
DISABLED
TANK.CHART SECURITY,
-D,ISABLED
CUSTOM ALARMS
` .-DISABLED
MASS/IJENSITY.,
DISABLED.
"COMMUN I CAT I�F7$
I N-TA NK''SETUP
T'2:PREM I UM
PORT SETTINGS: .'.PRODUCT CODE :;' 000700
T 4,:UNLEADED. :; E -THERMAL COEFF'
COMM BOARD 1 (RS-232) PRODUCT'CODE 1 TANK DIAMETER 96..00
BAUD RATE 9600 THERMAL COEFF . :.000700 TANK PROFILE I PT
NONE TANK,DIAMETER.•:- 96 00
PARITY FULL VOL 12000
STOP BIT 1 STOP a TANK PROFLLE;' •• 1 PT
DATA LENGTH: 8 DATA FULL VOL 12000
RS-232 SECURITY a BLOAT SIZE: 4:0 IN-
CODE : DISABLED ,_ 2.:0
FLOAT S.IZE 4.0 IN WATER WARNING
COMM BOARD 2 (RS-232) 1 3.0
t HIGH WATER LIMIT:
BAUD RATE : 9600 1 WATER WARNING` ' 2 0-,� ;
: IVONE HIGH WATER LIMIT:° 3 0, � �•.. f�1Ax-pR LABEL VOL: 12000. ,
STOP BIT : I STOP OVERFILL LIMIT
DATA LENGTH: B DATA MAX OR .LABEL VOL: 12000 10800
RS-232 SECURITY OVERFILL. LIMIT 90%' 90%.
{ ;.HIGH PROIIUCT
CODE : DISABLED 10800' f' 10800 i
HIGH PRODUCT 9p% '` DF�.IVERY LIMIT 15%
COMM HOARD : 3 (EDIM ) 10800, E 1800.
RS'-232 SECURITY I DELIVERY L I M I:T :150%
CODE DISABLED -;1800 ` : 1200
,: .LOW PRODUCT
LEAK ALARM LIMIT: 99
LOW PRODUCT , 1200 ' =; SUDDEN, .LIMIT; 99
AUTO TRANSMIT SETTINGS: LEAK"ALARM LLMIT: 99 TANK•TILT 8.,00
SUDDEN LOSS 'LIMIT: 99'_- �•- PROBE_OFFSET 0.00
AUTO LEAK ALARM LIMIT ! TANK'TILT :0.,00
DISABLED i PROBE .OFFSET. a.00
AUTO HIGH WATER LIMIT f."'SIp}{ON' MANIFOLDED TANKS
DISABLED T#: NONE
AUTO OVERFILL LIMIT SIPHON MANIFOLDED TANKS TO: -MANI'FOLDED TANKS
DISABLED f T_#; NONE T#; NONE `
AUTO LOW PRODUCT LINE MANIFOLDED'TANKS
DISABLED T#•: NONE`_
AUTO THEFT LIMIT ' LEAK.MIN PERIODIC: 1X `
DISABLED 1 120_.]
AUTO DELIVERY START t LEAK-.MI:N-PERIODIC: 120 t 1%
DISABLED LEAK MIN ANNUAL• ': 120
AUTO DELIVERY END y
DISABLED LEAK MIN'ANNUAL f%' } _
i'
AUTO EXTERNAL INPUT ON 120. �
DISABLED k p PERIODIC TEST TYPE
AUTO EXTERNAL INPUT OFF :STANDARD
DISABLED : PERIODIC TEST TYPE > ,
AUTO SENSOR FUEL ALARM STANDARD '' - - 'ANNUAL TEST FAIL
DISABLED ALARM DISABLED }
AUTO SENSOR WATER`ALARM ANNUAU TEST FAIL. i 1r
ALARM DISABLED
DISABLED ± PER.IODIC'TEST -FAIL
AUTO SENSOR OUT ALARM -ALARM DISABLED
DISABLED PERIODIC-TEST"FAIL-
..
ALARM DISABLED ', i T.FAIL
GROSS TES
ALARM DISABLED
GROSS TEST FAIL '
ALARM DI-SABLED ANN•.TEST'AVERAGING: OFF,:
ANN TE$T,.AVERAGING: OFF I PER TEST AVERAGING: OFF
PER TEST'AVERAGI�NG.: OFF TANK TEST NOTIFY: OFF; -
RS-232 END OF MESSAGE TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF.
DISABLED
TNK TST -SIPHON BREAK:OFF ! DEI:I VERY DELAY 1 MIN-
DELIVERY _DELAY 1 MIN .
-PUMP THRESHOLD � 10.00%
PUMP THRESHOLD :. 1.0.00%
r. ,
T 3:DIESEL LEAK.:TEST -METHOD -
'PRODUCT CODE 3 — — — — — — - _
THERMAL COEFF : .000450 TEST, ON`DATE : ALL TANK LIBUID SENSOR^SE_ TUP_
TANK DIAMETER 96.00 FEB '&,'.2007 -
TANK PROFILE 1 PT START TIME : DISABLED
FULL VOL 12000 TEST•RATE :0.20.GAL/HR L 1 :UNL STP
' DURATION 2 .HOURS ` TRI—STATE (SINGLE STP
FLOAT)
CATEGORY .: SUNfP
FLOAT SIZE: 4:0 IN. TST EARLY STOP'DISABLED F"
WATER WARNING 2.0 C LEAK TEST:REPORT, FORMAT L 2:U,NL .F,ILL
HIGH WATER LIMIT: 3.0 s TRI:_gTAT.E' ,(SINGLE'-FLOflT)
NORMAL CATEGORY PIPING SUMP
MAX OR LABEL VOL: 12000 w
OVERFILL LIMIT 90% '
10800 k I; 3:UNL;ANN
HIGH PRODUCT 90% TRI—STATE (SINGLE'FLOAT)
10800 CATEGORY. ANNULAR SPACE
DELIVERY LIMIT 15�
1800 1
LOW PRODUCT 1200 } L'4,:PREM STP
LEAK ALARM LIMIT: 99 1— TRI STATE' (SINGLE FLOAT)
SUDDEN LOSS LIMIT: 99 ' CATEGORY ANNULAR SPACE
TANK TILT 0.00 a—
PROBE OFFSET 0.00
L 5:PREM .F I LL
SIPHON MANIFOLDED TANKS ;TRI•=STATE_(SI FLOAT)
T#: NONE CATEGORY PIPING, SUMP
LINE MANIFOLDED TANKS
T#: NONE }
L 6:PREM ANN.
j -CATEGORYE•:-ANNUL•ARFSPACE
LEAK MIN PERIODIC: 1% .
120
LEAK MIN ANNUAL : 114
120 L •7:DSL STP
TR,I--.BTATE' (SINGLE CATEGORY STP'S�MPLOAT)
PERIODIC TEST TYPE
STANDARD i
L, B:DSL FILL
ANNUAL TEST FAIL TRI—STATE (SINGLE FLOAT)
ALARM DISABLED 4 CATEGORY : PIPING SUMP
PERIODIC TEST FAIL t L 9;DSL ANN
ALARM DISABLED
I TRI—STATE (SINGLE FLOAT)
GROSS TEST FAIL CATEGORY : ANNULAR SPACE
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF '. .I:10:DYST 1-2 FLOAT,)
TRI—STATE (SINGLE
TANK TEST NOTIFY: OFF CATEGORY DISPENSER PAN':i
TNK TST SIPHON BREAK.:OFF
DELIVERY DELAY 1 MIN L11 :DISP 3-4
PUMP THRESHOLD 10.00% TRI—STATE (SINGLE FLI- kk
�. CATEGORY D-I•SPENSER.PAN 1
',
L12:DISP 5;-6
TRI4BTATE (SINGLE:::FLOAT)
CATEGORY : DISPENSER PAN''
. .L13:DISP 7-8 ..
i' TR-I—STATE (SINGLE-.FLOAT I
CATEGORY :,DISPENSER PAN ,
OUTPUT RELAY SETUP SMARTSENSOR SETUP EVRiI,SD`SETUI?�-
- - - - - - _ - _ _ - _
R 1 :SHUT DOWN s I :PS 1-2 7
TYPE: CATEGORY,,VAPOR PRESSURE " EVR TYPE: VACUUM, ASSIST
STANDARD VACUUM ASSIST TYPE
NORMALLY CLOSED s 2:Fl1 1=2 HEAL1! VAC -
CATEGORY ' AIR FLOW"METER NOZZLE AiL RANGE.,
TANK �: 1 a 3-:FM 3-4, . MAX;: -1 .15 MLN: 0..95''
CATEGORY AIR FLOW METER'
LIQUID SENSOR ALMS
VAPOR`PROCESSOR _TYPE -
L 1 :FUEL ALARM s 4 FMS-6 - ,. NO. VAPOR PROCESSOR '
CATEGORY' AIR .FLOW METER
L 4:FUEL ALARM _.
L 7:FUEL ALARM s 5:FM.-7-8 .ANALYSIS-TIMES_L
L10:FUEL ALARM CATEGORY AIR FLOW..METER ` TIME:-: 10:00"AM'
L11 :FUEL ALARM. . . DELAY MINUTES 1
L12:FUEL ALARM
L13:FUEL ALARM
L 1 :SENSOR OUT ALARM ! ACCEPT'-:HdGH ORVR:
L 4:SENSOR OUT ALARM ; DISABLED
L 7:SENSOR OUT ALARM
L10:SENSOR OUT ALARM ISD 'HOSE-TABLE
L 1 1 :SENSOR OUT ALARM A D -FP� FL 7 HL AA RR -
L12:SENSOR OUT ALARM ----------------------"-_
L13:8ENSOR OUT ALARM r `01 33 . 01'; 02 01 UU
L 1 :SHORT ALARM f - _02 34.. 02 02 01 UU _
L 4:8HORT ALARM »—• . 03 ..•35 03 '02•, 02 UU
L 7:SHORT ALARM -04, '.00:- - 04- 02 02 UU
L10:SHORT ALARM 05 01 05 02 03 . UU
L11 :SHORT ALARM
06. 02 06. 02 03 UU
L12:SHORT,ALARM
L13:SHORT ALARM 07.. 03 ,07 02 .04 UU
OB 04 08 02 04 ' UU
ISD SITE ALARMS
ISD GROSS PRES FAIL `ISD AIRFLOW METER MAP
ISD DEGRD PRES FAIL ID 'SERIAL NUM LABEL }
ISD VAPOR LEAK FAIL ---
ISD VP PRES FAIL 9 I B759 FM 1-2
ISD VP STATUS FAIL i 2-875e FM- 3-4
ISD HOSE ALARMS 3 12988 FM5-6: ,.
ALL:GROSS COLLECT FAIL 4 8757 FM'7-8
ALL:DEGRD COLLECT FAIL L
ALL:FLOW COLLECT FAIL ISD FUEL GRADE-HOSE MAP
L
2-. , 3 . - 4
R 2:OVERF I LL ALARM
TYPE: FP MHH MHW Mkk MH-------
STANDARD 00+20;4' 304-904 5 U. 2
NORMALLY OPEN ' ' 01 .905 .205. 305 U. U 3`�
TANK p: NONE 02 206 306` 9.06 :U; U 3
03 207 307 91.75,-U, 4
::04 4209.,308 q08---5,-.U._,4,
IN-TANK ALARMS '33 201 301' 901 U. U' 'i
ALL:OVERFILL ALARM r' 34 202, 302 902. 5 U 1
ALL:HIGH PRODUCT ALARM , 35..203 303 903 5 U_ . 2
ALL:MAX PRODUCT ALARM r
r: LABEL..TABLE:
--_----------------------
1
ti : "UNASSIGNED
2: BLEND3 . _
i- 3: REGULAR
4 'MIDGRADE
6:: PREM I UM
6 c GOLD
7: BRONZE
8: SILVER
i 9:-HLEND2
10: BLEND4
-
j
PMC SETUP ALARM HISTORY REPORT ° -
—_ I N-TANK ALARM -- . ALAR °HI STORY REPORT
PROCESSOR CONTROL LEVEL: -- --- ''
NONE , : =--- I.N-TANK ALARM ----'
T 1:UNLEADED
SETUP DATA. WARNING.. T°'2:PREMI UM
f
IUL 25. 20'08-'Ill" :'14 AM i ' SETUP DATA WARNITNG.
HIGH WATER•ALARM JUI 25. .2008 11 :14 AM
AUG 11.. 2009-`9: -34'AM �: -
AUG ` 3 2009 '9".54 AM � AUG I OVERFILL ALARM .
AUG 12. . 2008' 1,0::54 AM AUG 1.1. . 2009 9:27 AM
_ _- JAN 10. 2009 7:40 PM
SOFTWARE LEVEL A . HIGH• PRODUCT ALARM
OVERFILL'ALARM•- -
SOFTWARE# 346327-100—E AUG "1. 2010 ' ,9:33,,:AM. {. -AUG, L1. 2009 9:34 AM
CREATED — 07.02.06.10.28 JUN 13.• 2010'--3:54 PM w AUG 11, 2009 9:27 AM
JUN B`: 2010 .5:31 AM- �AN. 10. ,2009 7.:40 PM ..
S—MODULE# 330160-004—e
SYSTEM FEATURES: HIGH. PRODUCT ALARM . N INVALID FUEL LEVEL, '
PERIODIC IN—TANK TESTS, AUG -1., 2010 9:33 AM � '•AUG 11. 2009. 9:25 AM
ANNUAL IN—TANK TESTS JUN 13: 2010. 3:54-.PM NOV. 24: 2008 11 :27 AM
ISD JUN .8. 2010 5::31- AM' (°
PMC INVALID FUEL 'LEVEL AUG 11- 2009 9:35 AM-
AUG : 7. 2010 1'21-14 PM AUG.:1 L. 2009' 9:24 AM
AUG 4._ 201.0 5.58 PM g , AUG 1.2: 2008 VO:18 AM
AUG 3: 2010 3:12- PM
PROBE,.OUT, DELIVERY,. NEEDED
( AUG 11. 2009 9:,36 AM. . APR 24, 2009 :11:29 AM`
AUG 11. 2Q09 '9:25 'AM
AUG 3. 2009 10.39.AM. 4 .. MAR, 15. 200008 9. .AM
11-:199:48 AM -
} Nov- 24. 2
a..
ALARM HISTORY REPORT HIGH WATER WARNING r
AUG 1 1. 2009 ' 9:-34' AM
----- SYSTEM ALARM --- AUG . 3. 2009 °9:54 AM:
PAPER OUT ; AUG 12: 2008 10:54 AM
AUG B. 2010 8:03 AM
PRINTER ERROR DELIVERY NEEDED
AUG 8, 2010 8:03 AM
AUG 7. 201Q 11:18 AM
.AUG 6. 2010 :9':54 -AM
AUG 4: '.201,0 4:58. PM
* * x END
I " MAX 'PRODUCT-,ALARM_
JUN _B 2008 1 :08 PM
j LOW TEMO"WARNING {
AUG 1.2.. 2008• 10,:43 AM
* * * END x AUG 12. 2008 10:38 AM }
i
- i
* * x x END X x 9 x N
At,AkM' NTSTORY REPOR"
---- IN-TANK ALARM ----- F ALARM HISTORY REPORT
----SENSOR ALAN ---- ALARM HISTORY REPORT _
T 3:DIEBEL L 2:UNL FILL.x ,. _-- SENSOR`'ALARM ----- -
SETUP DATA WARNING •PIPINGISUMP _ L 4:PREM STP
JUL 25, 2008 .1115 AM FUEL ALARM , ' ANNULAR'•SPACE`
JUN `."9. .2010 3151 PM FUEL ALARM
OVERFILL ALARM FUEL ALARM .J 19, 2010 8:37 PM
AUG 11. 2009 9:26 AM APR 22 2010 4:59 'AM } - F ,.ALARM
AUG 12, 2008 9:23 AM i JUL 19, 2010 8:25 PM
1 FUEL ALARM
LOW PRODUCT ALARM ;: APR'`1'2. 201'0 12.:.03. AM OUT.
. ,
AUG It. 2009 9:24 AM - 1, 9Et OR ALARM
„ AUG 11. 2009 9:21 AM
HIGH PRODUCT ALARM '
AUG 11. 2009 9:26 AM i
JUL. 25. 2008 11 :15 AM
JUL 6.02010 11 :35 AM t
JUL 6, 2010 10:29 'AM
JUL 2, 2010 9:25 AM �.: .
* END •
DELIVERY NEEDED *: * .. END,.x x
JUL 2, 2010 9:25 AM -
JUN 8. 2010 11 :48 AM
MAR 7, 2010 5:57 PM
LOW TEMP WARNING "
.JUL 6. 2.010 12:50 PM - - '
JUN 8, 2010 "11 :49 AM
ALARM HISTORY REPORT
SENSOR ALARM --- i
.ALARH HISTORY.REPORT. -.
L 3'.0- ANN- t -----'SENSOR ALARM ----- '
ANNULAR'BPACE 1 S:PREM FILL
SENSOR OUT ALARM PIP-I-,NG BUMP
AUG. 11. -'12009 .9:21 AM � ` SENSOR OUT ALARM
END AUG FUEL ALARM - �
MAY 13, 2010 . 9:23 AM
AUG 11, 2009 9:16 AM FUEL ALARM
MAY.,,12. 2010 2:59 PM ,
FUEL ALARM'
AUG ,12.;'2008 - 9:10 AM FUEL' ALARM ,.
j MAY "10•. 2010 1':24 `PM
i
ALARM 'HISTORY.REPORT 1'
----- SENSOR ALARM ----- END,x x x
L 1 :UNLBTP
STP SUMP
FUEL ALARM
JUL 19, 2010 8:34 PM
FUEL ALARM F.,
JUL 1. 2010 2:01 AM t
FUEL ALARM
JUN 16. 2010 4:01 AM , ...__
x x * x x END x x * 3(
ALARM HISTORY REPORT`. ,• x �. ;. : -
ALARM HISTORY REPORT
i "_ ALARM.HISTORY -REPORT `
� _•-°SENSOR ALARM --"-- �
-- SENSOR ALARM --- L B:DSL FILL -- "SENSOR ALARM -----
L 6:PREM_ ANN PIPING' SUMP "'
ANNULAR SPACE --SENSOR- OUT ALARM L10:AISP 1-2
SENSOR OUT ALARM AIJG, 5,::2010, 1-1 :43. AM DISPENSER!.PAN '
AUG 11, 2009 9:21 AM = FUEL ALARM
FUEL ALARM . FEB.- 15. 2010: 11 :21 AM
FUEL ALARM AUG 5 .2010 11:41- AM FUEL AUG 11, 2009 9:15 AM '
FUEL_ :ALARM'. AUG .11,,' 2009: -9:09--AM'
FUEL ALARM AUG 5..:..2010.1 1,;19:AM t,
AUG 12, 2008 9:09 AM FUEL ALARM
AUG 12: 2008. 9:10 AM
�E - END" �[ x x X. ! .
* * * x END
X x 9 END- M x ,x x x
{
ALARM HISTORY REPORT -
ALARM HISTORY REPORT
{ ----- SENSOR; ALARM ----- ALARM. HISTORY-REPORT
---=-. SENSOR ALARM ----- L 9:DSL ANN: t BELABOR ALARM -----
L 7:DBL BTP ANNULAR SPACE- L,---LSP OR, _
STP BUMP FUEL ALARM
FUEL ALARM JUL 22. 2010 -4:4 0,—AM DhSPENSER-"PAN`
JUL 19, 2010 11:00 PM 'FUEL
AUG 1ALA 009 9:10 AM
1 FUEL ALARM
SENSOR OUT ALARM JUL 19, 2010 6:01 AM
AUG It . 2009 9:21 AM FUEL"ALARM:
FUEL ALARM AUG A 2, .2008 9:11 AM
FUEL ALARM JUL 18. 2010 5.:,10 AM
AUG 11, 2009 9:d7 AM i' FUEL ALARM
JUL 25,� 2008 .11:27 AM,
rt �e x END W x * x x
x x x END x x . *..
a
ALARM HISTORY REPORT _
=--- IN TANK ALARM -- r T 2:PREMIUM
-- SENSOR ALARM ----- T '3:DIEBEL INVENTORY INCREASE
L12:DISP 5-6 DELIVERY `NEEDED
L DISPENSER PAN AUG 9, 2010 9.03 AM `TASE`
FUEL ALARM } AUG
AUG 11. 2009 9:10 AM _
VOLUME- .= 2866 GALS
FUEL ALARM HEIGHT, - 27..69 INCHES- �
AUG 12, 2008 9:12 AM '� WATER a -6:54 INCHES
FUEL ALARM TEMP- 80.6 DEG F
JUL 25. 2008 11 :27 AM
INCREASE END
T 3:DIESEL f' AUG 9. 2010 9:06 AM
INVENTORY•,INCREASE
VOLUME 9561 GALS
INCREASE-.START" HEIGHT °- 71 .33 INCHES
AUG 9: 2010 —9:03 AM WATER " ° . 1 .01. INCHEB.
TEMP _ 86..3 DEG F
-
- VOLUME. - 1382 GALS _
HEIGHT ° 16.57 INCHES
kk WATER ° 0.00, INCHES GROBS. INCREASE- 6695
* * END * * t TEMP: . ' 86:7 DEC; F TO,NET,INCREASE- 6560
INCREASE END i
,:. AUG 9. .201:0: 9406-AM
VOLUME °; 7543,GALS,
HEIGHT ° 57.76'. INCHES:
WATER ° 1 .17 1NCHES
TEMP 90:4, DEG F i t
ALARM HISTORY REPORT GROSS 'INCREA9E-; 61'61 )
TO NET INCREASE 6074 ---= IN-TANK ALARM------
----- SENSOR ALARM ----- T. 1' UNLEADEA_
L13:DIBP 7-8 HIGH WATER ALARM
DISPENSER PAN - AUG 9.- 2010 9:09 AM
FUEM
AUGLII1.A2AM 009 9:09 P i t q
AUG LARM
UG 1 9:32 AM ^•
i.
FUEL ALARM
AUG 12, 2008 9:4k AM i
iy T 1 :UNLEADED ---- IN-TANK ALARM -----
INVENTORY. I-NCREA9E � - T. +.:�t►�r FanRn, _... .._;_._,..,. .-. ':
HIGH WATER WARNING .
INCREASE START ? AUG 9.-.2010 -:9:09 AM
AUG 9. :2010 9:04'AM.
VOLUME • 4405 GALS - t
HEIGHT ° 37.90 INCHES
* END * * WATER 28.65 INCHES
TEMP' ° 83•.3_ DEG F
' -INCREASE•END f
AUG 9. 2010 9:06 AM , ----- SENSOR ALARM -----
L10:DISP. 1-2
VOLUME ° 101'84 GALS DISPENSE R .PAN
HEIGHT_ -75:96 INCHES FUEL ALARM
WATER °: 9.:Q7 INCHES` . AUG 9'. 2010- 9:23-AM:
TEMP ° .. 84.5 DEG F•-:'
f
GROSS INCREASE° 5779
TC_NET INCREASE- 5676 ' : .
----- SENSOR ALARM ----- -
L12:DISP 5-6 ----- -SENSOR ALARM•---- __-- SENSOR ALARM -----
DISPENSER PAN L1.1 :DISP 3-4 7,:DSL:•STP
FUEL ALARM DISPENSER'P.AN:: STP. SUMP ,
AUG 9, 2010 9:24 AM FUEL-ALARM FUEL ALARM
AUG.. 9 20'1.0 . 9.:25 'AM AUG:. 9,, 2010 9•:27 AM
----- SENSOR ALARM -----
L13:DISP 7-8 ----- BENSOR: ALARM, ----` �- ----- SENSOR-ALARM -----
DISPENSER PAN L .1 :,UNI:'STP - L• B:DSL FILL
FUEL ALARM STP SUMP PI-P..;ING SUMP
AUG 9, 2010 9:24 AM FUEL ALARM (: -FUEL ALARM
AUG 9, 2010 . 9•:26. AM AUG 9, 201'0,-9:27 AM
1
"
- SENSOR ALARM: ------ - SENSOR ALARM ----- "
L 4:P.REM STP_ - i
ANNULAR SPACE L 5-:PRE
FILL E
FUEL ALARM PIPING SUMP
AUG--'.9 2010 9:26 AM r FUEL ALARM
AUG 9:•2010. 9:28 AM
ALARM HISTORY -REPORT
,SENSOR`ALARM -----
-- SMARTSENSOR ALARM -- L 2:UNL:'FILL
s 1 'PS 1-2 PI.PING_ BUMP `
FUEL_:ALARM
20.10, 9:28 AM
tEND , :
`FASTRIP 326.,�. �-
H � l .
I` HAKERSFIELD,CA93304..
661-831-4709 j
AUG 9, 2010 9:30 AM y
SYSTEM STATUS.-REPORT t
- — -
T 1 :HIGH, WATER-ALARM
T 1 :HIGH WATER WARNING.
,1
-----
SENSOR ALARM — IN-,TANK ALARM ---- ALARM HISTORY REPORT:
L 9:DSL ANN i T 3:DIESEL
[ilA ANNULAR SPACE HIGH PRODUCT ALARM.. —. 'IN-TANK ALARM. ----- `
FUEL ALARM AUG 9. 2010 9:39 "AM '
UG 9:'•`2010 9:32 AM T'1 UNLEADED
SETUP=DATA WARNING
� JULs25 2008 '1 1.:1'4 AM
HIGH`WATER:=ALARM _
AUG',. 9'.—=2010 9:09 AM -
AUG`.;11':. 2009 9:34L AM
w.
AUG'--3.' 2009, 9:54":AM
----= SENSOR ALARM -----
----- SENSOR ALARM ----- --LII :DISP 3-4- �, OVERFILL ALARM
L 6:PREM A14N (: D.I SPENSER PAN AUG' 1 2010 9:33 AM
ANNULAR SPACE 1 SENSOR,OUT ALARM: x AUG' 11. .2010 9:54 PM
FUEL ALARM AUG 9. 20'1'0 9:42 AM`^ JUN:-; 8 2010 5:31 AM
AUG 9, 2010 9:33 AM
H'IGH`PRODUCta ALARM, '
AUG '9. 2010 9:37 'AM
AUG., 1, 2010 . 9:33 AM
JUN 13. 2010 3:54 PM
INVALID FUEL'.LEVEL
flUG 7. 2010 12:14-PM
_ ----- SENSOR ALARM -----' AUG . 4. 2010 5:58 PM '
-- SENSOR ALARM ----- L12:DISP 5—b 1 '. •AUG.. 3. 2010 3:12 PM
L 3:UNL A14N DLSPENSER PAN
PROBE OUT
ANNULAR SPACE SENSOR.-OUT ALARM z
FUEL ALARM AUG 9. 2010 9 42 AM AUG °I 1, '2009, 9' 36 'AM
AUG 9. 2010 9:34 AM ( AUG=-1�r1s� 2009 9 25 AM {
:AUG 3. -2009 :110139,
AM
( HIGH WATER WARNING
k. AUG 9. 2010 9:09 AM
AUG 1'1: 2009 9:34 AM
AUG 3', 2009 9:54 AM
bELIVERY NEEDED
----- SENSOR: ALARM'--_-- AUG 7. 2D10 11 :18, AM-
---- IN—TANK ALARM ----- 113:,DISP 7=8; ;' j' AUG, 6. 2010 9:54."AM ;
T ( :UNLEADED ..DISPENSER.PAN :AUG 4'. 2D10 4:58 PM
HIGH PRODUCT ALARM SENSOR' OUT ALARM
AUG 9. 2010 9:37 AM AUG 9- -2010 9':42 AM j ;MAX-PRODUCT ALARM
AUG, 9. 2010 9:37 AM 's
:JUN B. 2008 1.:08 PM" Y,
LOW TEMP-WARNING
AUG 12. 2008 10:43 AM
AUG 12. 2008 10:38 .AM
j _ t
---- IN—TANK ALARM ----- ; -----'SENSOR., ALARM' ----- .1
T I :UNLEADED L 9:DSL. ANN' . r
MAX PRODUCT ALARM ANNULAR SPACE:'
AUG 9. 2010 9:37 AM SENSOR OUT ALARM
AUG 9, 2010 9':42 AM
END
(
---- IN—TANK ALARM ----- t y 1
T 2:PREMIUM 1 ----- SENSOR ALARM ----- (,
HIGH PRODUCT ALARM L1O:DISP 1-2 i
AUG 9.2010 9:38 AM DISPENSER PAN-
j SENSOR OUT, ALARM,
AUG 9. .2D10 9:42 AM
ALARM HISTORY REPORT ` ALARM HISTORY'`REPORT t ALARM HISTORY REPORT
---- IN—TANK ALARM ----- -_ IN=TAN_X{ ALARM --=-- --= SENSOR ALARM -----
T 2:PREM I U1H j T 3:D I ESEL L 1 :UNL. STP
STP SUMP
SETUP DATA WARNING is FUEL' ALARM
JUL 25. 2008 11 :14 AM + SETUP DATA WARNING ? AUG- 9, 2010 9:26 AM
JUL 25, 2008411:15 AM. i
OVERFILL ALARM OVERI ILL'.AI:ARM �' '°.FUEL ALARM
AUG 1 1. 2009 9:27 AM {' AUG 1`1 2009 9:26-AM =••i JUL_19..-,,20.10 8:34 PM
JAN 10. 2009 7:40 PM AUG 12 2008`,194,23 AM a -
FUEL ALARM w
HIGH PRODUCT ALARM LOW`PRODUCT AI:ARM` J� 1:"201.0 '2:01 AM
AUG 9. 2010 9:38 AM AUG 11. 2009' 9`:24 AM
AUG 11, 2009 9:34 AM
AUG 11 , 2009 9:27 AM i _HIGH 'PRODUGT�.ALARM ;
INVALID FUEL LEVEL AUG 9, 2010 9:39 AM
AUG 11 . 2009 9:25 AM AUG 11: 2009 :9:26 AM
NOV 24. 2008 11 :27 AM JUL 25. 20D8. '11 :15 AM
•
k PRONE OUT
r.
PROBE OUT { JUL 6. 20.10-11 :35 •AM
AUG 11. 2009 9:35 AM JUL 6.• 20'10. 10.:29 AM * * * END
AUG 11, 2009 9:24 AM JUL 2. 201 Q:'-._9::25 AM
AUG 12, 2008 10:18 AM j -
�,
DELIVERY'-NEEDE'D
DELIVERY NEEDED AUG 9. 2010 9:03.AM"
APR 24, 2009 11 :29 AM JUL 2.. 20`1'0 9:25 AM
MAR 15, 2009 9:48 AM JUN 8.. 2910 48 AM,.!
NOV 24. 2008. 11 :
19 AM f. 1
4 t
LOW. TEMP WARNING
JUL 6. 2010::,12:50 PM
JUN 8. 2010. 1-1 :49-AM i ALARM' HISTORY REPORT.
SENSOR ALARM ------
L 2-:UNL..F I LL
i PIPING SUMP
FUEL. ALARM
° AUG 9.. •2010 9:28�AM
x * END
FUEL:.ALARM
I f: .JUN' 9'.: 2010 '3:51 PM
r * * * * `£N'D' FUEL ALARM.
f" APR 22, 2010. 4:59 AM .
ALARM HISTORY REPORT. I * x END
--- IN-TANK-ALARM -----
T 4:: f
. X� X x -END * .x x
ALARM HISTORY REPORT
-- SENSOR ALARM ----- ALARM HISTORY. REPORT ALARM HISTORY REPORT
L 3:UNL ANN
ANNULAR SPACE ----- SENSOR ALARM ----- i f- ----- SENSOR- ALARM -----
FUEL ALARM L 5`:PREM FILL L•-7:DSL ST-P -
AUG 9, 2010 9:34 AM PIPING-SUMP f �. . STP SUMP
FUEL ALARM,': FUEL ALARM
SENSOR OUT ALARM AUG 9. 20LO 9:28 AM �' AUG. 9. 2010 9:27 AM
AUG 11, 2009 9:21 AM
SENSOR OUT,ALARM # FUEL-ALARM
FUEL ALARM MAY 13. 2010 -9:,23:AM, . JUL .19.11 2010.- 11 :00 -PM
AUG 11. 2009 9:15 AM FUEL ALARM SENSOR OUT ALARM
'MAY'.12..:•2010 <2:59 PM AUG 1:1. 2009 9.21 `AM
1
* X x * END
'END .* * END * * X *
ALARM HISTORY REPORT
}
SENSOR ALARM ----- ALARM HISTORY`REP_ORT ALARM', HISTORY REPORT
L 4:PREM STP
ANNULAR SPACE ( SENSOR ALARM ----- --- ^SENSOW ALARM ----
FUEL ALARM L 6:PREM ANN r L .B:DSL FILL
AUG 9. 2010 9:26 AM { ANNULAR,SPACE PIPING SUMP.; .
FUEL ALARM; . FUEL ALARM
FUEL ALARM AUG .94 2010 '. 9:33 AM AUG , 9. 201-0, ' 9:27 AM
JUL 19, 2010 8:37 PM SENSOR�:OUT ALARM- SENSOR OUT ALARM
FUEL ALARM AUG 1'1, 2009 9:21 AM G AUG 5. 2010 11 :43 AM
JUL 19. 2010 8:25 PM FUEL' ALARM FUEL ALARM
,,.
AUG 11. - 9:-15 AM' - AUG 5. 2010. 1 1 :41 AM.
* xx �cEND *
4:
`'END x �c ` x x *.END * .
ALARM HISTORY REPORT
----- SENSOR ALARM ----- µ
L 9:DSL ANN __ w-- — ----
ANNULAR SPACE ALARM HISTORY `REPORT
SENSOR OUT ALARM ALARM,HISTORY REPORT t. --_'SENSOR- ALARM -----
AUG 9, 2010 9:42 AM LI3:.DISP:7-8'
-_ SENSOR-:ALARM —_--- i DISPENSER'PAN ,
FUEL ALARM L11 :DISP :3-4 -- .'SRWOR -OUT ALARM,
AUG 9, 2010 9:32 AM DI-SPENSER PAN ' AUG, 2010 9:42 AM
FUEL ALARM SENSOR'OUT ALARM ,-
JUL 22. 2010 4:10 AM
AUG, 9. 2010 _ 9:42 AM FUEL ALARM
FUEL ALARM AUG: 9. 2010 9:24 AM
AUG 9, 2010 ' -9t26`AM ,'- FUEL ALARM'
FUEL ALARM. AUG f+i `2009 9':`09
AUG 11. 2009 ' 9:;10 .AM .
x x x x x END
• i
END x, xxxx
x x x x, x END x x x x
a i -
•a-
t
t
ALARM HISTORY REPORT
----- SENSOR ALARM -----
L 10:D I SP 1-2 ;FA�:ARM. H I STORY REPORT
DISPENSER PAN
SENSOR OUT ALARM ALARM,•HISTORY."_REPORT i :----- SENSOR ALARM -----
AUG 9. 2010 9:42 AM
OTHER `SENSORS'
,
FUEL ALARM L12
AUG 9. 2010 9:23 AM DISPENSER PAN
FUEL ALARM RM
SENSOR-OLIT•ALA 9:42 AM
'
AUG, ,9. -2010 i
FEB 15. 2010 11 :21' AM
VUELAL
AUG 9.2010. 9:24 AM
� .
FUEL ALARM- '
'AUG 1.1. 2009 9:10 AM END
r
xxxxx END xxxxx ;
* x x A -x END x x x x
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(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: #362 Fastrip#633 1 Date of Testing: 8/09/2010
Facility Address: 6401 South H Street, Bakersfield, CA 93304
Facility Contact: Omero Garcia Phone: 661-393-7000
Date Local Agency Was Notified of Testing:
Name of Local Agency Inspector(f present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services,Inc.
Technician Conducting Test: Bryan A Self
Credentials: X CSLB Contractor X ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec)
License Number(s): CSLB#804904 ICC#248333762-UT
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic ❑Vacuum ❑Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket(By Tank 1 Regular 2 Super 3 Diesel 4
Number, Stored Product, etc.)
Bucket Installation Type: ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury
x Contained in Sump x Contained in Sump x Contained in Sump ❑Contained in Sum
Bucket Diameter: 12.00" 12.00" 12.00"
Bucket Depth: 14.50" 14.00" 14.75"
Wait time between applying 5 min. 5 min. 5 min.
vacuum/water and start of test:
Test Start Time(Ti): 9:00am 9:00am 9:00am
Initial Reading(Rj): 12.00" 12.25" 12.00"
Test End Time(TF): 10:00am 10:00am 10:00am
Final Reading(RF): 12.00" 12.25" 12.00"
Test Duration(TF—Tj): 1 hour 1 hour 1 hour
Change in Reading(RF-Ri): 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625"
Criteria:
Test Result. X Pass ❑Fail X Pass.. D-Fail X Pass: ❑Fail ❑ Pass ❑Fail
Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this re ort is true, accurate, and in full compliance with legal requirements.
Technician's Signature: ! Date: 8/9/2010
' State laws and regulations do not curr tly 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/operator for submittal to the local regulatory agency.
1. FACII.ITY INFORMATION
Facility Name: #362 Fastrip#633 1 Date of Testing: 8/09/2010
Facility Address: 6401 South H Street, Bakersfield,CA 93304
Facility Contact: Omero Garcia Phone: 661-393-7000
Date Local Agency Was Notified of Testing:
Name of Local Agency Inspector(cf present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bryan A Self
Credentials: X CSLB Contractor X ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Specify)
License Number(s): CSLB#804904 ICC#248333762-UT
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic ❑Vacuum ❑Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
'�".1J:Y IRVfmF.:.vdt'_..2:_A.�.. (.t'i,._zvx"...,e...iYN+R'Y[Lnt>I{tbbiAfClb+RF'rY,Sa�iG°+X.xr.`e'BeFOCrfin-1M1MY+r�'*PHRS3fiYSn,it Tir1YM"F. .S_'gbr_n
Identify Spill Bucket(By Tank 1 Regular Vapor 2 Super Vapor 3 4
Number, Stored Product, etc.)
Bucket Installation Type: ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury
x Contained in Sump x Contained in Sump ❑Contained in Sump ❑Contained in Sum
Bucket Diameter: 12.00" 12.00"
Bucket Depth: 14.50" 14.00"
Wait time between applying
vacuum/water and start of test: 5 min. 5 min.
Test Start Time(Ti): 9:00am 9:00am
Initial Reading(Rj): 12.00" 12.25"
Test End Time(TF): 10:00am 10:00am
Final Reading(RF): 12.00" 12.25"
Test Duration (TF—Tj): 1 hour 1 hour
Change in Reading(RF-Ri): 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625"
Criteria:
Test Result: X Pass ❑Fail X Pass ' ❑Fail ❑ Pass ❑Fail' ❑ Pass ❑Fail
Comments— (include information on repairs made prior to testing•, and recommended follow-up for failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this re ort is true,accurate,and in full compliance with legal requirements.
Technician's Signature: Date: 8/9/2010
State laws and regulations do not current require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.