HomeMy WebLinkAboutFMC 2010 1 i 1111 47 MONITORING SYSTEM CERTIFICATION
IE 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
r red for each monitoring system control l2anel by the technician who performs the work. A copy of this form must be provided
to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems
within 30 days of this date.
A. General Information
Facility Name: #367 Fastrip#640 Bldg.No.:
Site Address: 8001 White Lane City: Bakersfield Zip: 93309
Facility Contact Person: Omero Garcia Contact Phone No.: 661-393-7000
Make/Model of Monitoring System: Veeder-Root TLS 350 Date of Testing/Servicing: 7/22/2010
B. Inventorylof Equipment Tested/Certified
Check the appropriate zes to Indicate specific equipment Inspected/serviced:
Tank ID:12000 gal.Regular 1 Tank ID: 12000 gal. Regular 2
[x] In-Tank Gauging Probe. Model:847390-107 [x] In-Tank Gauging Probe. Model: 847390-107
[x] Annular Space or Vault Probe. Model:4201208 U Annular Space or Vault Sensor. Model: 794390-420
[x] Piping Sump/Trench Sensor(s). Model:4201208 [x] Piping Sump/Trench Sensor(s). Model: 794380-208
[X] Fill Sump Sensor(s) Model:794380-208 [x] Fill Sump Sensor(s). Model: 794380.208
DO Mechanical Line Leak Detector. Model:syphon [x] Mechanical Line Leak Detector. Model: FX1 V
❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model:
[x] 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.Super Tank ID: 12000 gal.Diesel
[z] In-Tank Gauging Probe. Mode1:847390-107 [x] In-Tank Gauging Probe. Model: 847390-107
L] Annular Space or Vault Sensor. Mode1:794390-420 [x] Annular Space or Vault Sensor. Model: 794390-420
[x] Piping Sump/Trench Sensor(s). Model:794380-208 [X] Piping Sump/Trench Sensor(s). Model: 794380-208
[x] Fill Sump Sensors(s). Model:794380-208 L] Fill Sump Sensor(s). Model: 794380-208
57 Mechanical Line Leak Decector. Model:FE PETRO [x] Mechanical Line Leak Detector. Model: FX1 DV
❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model:
L] Tank Overfill/High Level Sensor. Model:847390-107 L] Tank Overfill/High Level Sensor. Model: 847390-107
❑ Other(specify equip.type and model in Sec.E on Pg.2) ❑ Other(specify equip.typs and model in Sec.E on Pg.2)
1 14 • 1 16
Dispenser ID. 3& Dispenser ID._ 5&
I Dispenser Containment Sensor(s). Model: 794380-208 [x] Dispenser Containment Sensor(s).Model: 794380-208
[x7 Shear Valve(s). U Shear Valve(s).
❑ Dispenser Containment Float(s)and Chain(s). ❑ Dispenser Containment Float(s)and Chain(s)
Dispenser ID: 17&18 Dispenser ID: 19&20
L] Dispenser Containment Sensor(s).Model: 794380-208 [x] Dispenser Containment Sensor(s).Model: 794380-208
L] Shear Valve(s). U Shear Valve(s).
❑ Dispenser Containment Float(s)and Chains(s). ❑ Dispenser Containment Float(s)and Chain(s).
Dispenser ID: 21 &22 Dispenser ID: 23&24
[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).
*If the facility contains more tanks or dispensers,copy this form.Include information for every tank and dispenser at the facility.
C. Certification-I certify that the equipment identified in this document was inspected/services in accordance with the
manufacturers'guidlines.Attached to this Certification is information(e.g.manufacturers'checklist)necessary to varify that
this information is correct and a plot plan showing the layout of monitoring equipment.For equipment capable of generating
such reports,I have attached a copy of the report;(check all that apply) ❑X System Set, [Xj Al rm history report
Technician Name(print): Kristopher Karns Signature: A pt.✓t/�
Certification No: 834106 License No: 804904
Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930
Site Address: 8001 White Lane,Bakersfield,CA 93309 IIIIIIIIIIIIIIIIIIII 48 _Date of Testing/Servicing: 7/22/2010
IE II
D. Results of Testing/Servicing
Software Version Installed: 327.04
Complete the following checklist:
❑ Yes ❑ No* Is the audible alarm operational?
x Yes No* Is t e Visual alarm operational?
x Yes No* Were all sensors visually inspected,functionally tested,and confirmed operational?
x I Yes ❑ No* Were all sensors installed at the lowest point of secondary containment and positioned so that other
equipment will not interfere with their proper operation?
Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment(e.g.modem)
Hx N/A operational?
x 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 SensorsU Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? [X] Yes; ❑ No;
❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e. no
L]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* ❑ No Was any monitoring equipment replaced?If Yes,identify speci fic 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?
❑ Product; [x] Water.If yes,describe causes in Section E,below.
R FYeWas monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable.
No* Is all monitoring equipment operational per manufacturer's specifications?
*In Section E below,discribe how and when these deficiencies were or will be corrected.
E. Comments' I replaced the Regular I Syphon 208 Fill Sump sensor because the old one was broken.
Removed small amount of water from all 4 STP sumps.
We need to replace the Super relay. During the inspection the Super relay got stuck,I was able to unstick the relay and
we were able to finish the inspection,but the relay should still be replaced to assure proper opperation.
The Overfill light bulb wouldn't activate so I replaced the bulb and retested it to confirm that it was opperational.
F. In-Tank Guaging/SIR Equipment: [X] Check this box if tank guaging is used only for inventory control.
❑ Check this box if tank guaging or SIR equipment is installed.
This section must be completed if in-tank guaging equipment is used to perform leak detection monitoring.
Complete the following checklist:
L] Yes ❑ No* Has all input wiring been inspected for proper enter and term ination,including testing for ground faults?
x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
x Yes No* Was accuracy of system product level readings tested?
x Yes No* Was accuracy of system water level readings tested?
_[xl Yes No* Were all probes reinstalled properly?
Lx] Yes ❑ No*I Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H,below,describe how and when these deficiencies were or will be corrected.
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: E3 g.p.h.: 00.1 g.p.h.; ❑0.2 g.p.h.;
x Yes No* Were all LLD's confirmed operational and accurate within regulatory requirments?
x Yes No* Was the testing apparatus properly calibrated?
U Yes 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?
[x] N/A
❑ Yes No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is
[x] N/A disabled or disconnected?
❑ Yes No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system
U N/A malfunction or fails a test?
❑ Yes No* For electronic LLD's,have all accessible wiring connections been visually inspected?
Lx] 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:
Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors
I. Results of Vacuum/Pressure Monitoring Equipment Testing
This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of
this form must be included with the Monitoring System Certification Form, which must be provided to the tank
system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the
local agency regulating UST systems within 30 days of test date.
Manufacturer:Veeder-Root [Model- TLS-350 System Type: ❑ Pressure; ® Vacuum
Sensor ID
S-1 Component(s) Monitored by this Sensor: Regular Product Line
Sensor Functionality Test Result: ® Pass; ❑ Fail Interstitial Communication Test Result: ® Pass; ❑ Fail
Component(s)Monitored by this Sensor:
Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result: ❑Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail
Component(s)Monitored by this Sensor:
Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail
Component(s) Monitored by this Sensor:
Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑Pass; ❑ Fail
Component(s)Monitored by this Sensor:
Sensor Functionality Test Result: ❑ Pass; ❑ Fail Interstitial Communication Test Result: ❑ Pass; ❑ Fail
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 ❑No (/f no, describe in Sec. J, below)
J. Comments: Leak was introduced at the 3-way ball valve.
Page 4 of 4
' If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the
sensor,vacuum/pressure has been demonstrated to be communicating throughout the interstice.
UN-036A-1/1 www.unidocs.org Rev.01/26/06
FASTRIP 367 SYSTEM SETUP " BYBTEMISECURITY t
800.1 WHITE LANE - - - - = `, CODE, 000000 . _l
BAKERSFIELD CA,93309 JUL 22. 2010 '1 49 PM HISTORY l
MAINTENANCE
�DTSAELED
JUL 22, 2010 1 :49 PM
SYSTEM UNITS ;• .
'U.S.
. ,.;,� _. TANK CHART SECURITY .
.SYSTEM LANGUAGE_ : DISABLED'
SYSTEM STATUS REPORT � '.
ENGL_I_SH_.
SYSTEM'DATE/TI'HE FORMAT i
L22:FUEL ALARM _ - - - MON DD YYYY' HH:MM:SS xM. CUSTOM ALARMS
D IAHLED,..
FASTRIP,367
INVENTORY REPORT
8001 WHITE LANE,.. BERVICE,'NOTICE
BAKERSFItLD-CA,93309 DISABLED
T 1 :UNLEADED
VOLUME o 4079 GALS SHIFTS TIm 1 s . 0 AMA COUNTRY _
ULLAGE 7921 GALS ISO 3166 CO
€ 90�s ULLAGE 6721 GALS ; SHIFT°TIM$ 2 , b;IBL,ED
SHIFT'TIME 3kHLED 'T' ' CODE:.
TC VOLUME 4017 GALS , SHIFT TIME 4;,_xD SABLED
HEIGHT . 44.75 INCHE MASS/DENSITY
WATER VOL - 12 GALS { y MASS �.
TANK. PER'"fST NEEDED .WRN
WATER - 0.87 INCHES DISABLED
TEMP - 81 .7 DEG F - DISABLED
•: ,.-
4 TANK ANN TSt:,'EEDEP', RN`
DISABLED
T 2:UNLEADED 2
VOLUME - 4581 GALS =` LINE RN BL
ENAE METH4U,;,:
i ULLAGE - 7419 GALS PASS LINE'
90X ULLAGE- 6219 GALS LINE PER TST.. NEEDED..<WRN' .
TC VOLUME - 4512 GALS t
HEIGHT - 39.03 INCHES DISABLED. :
WATER VOL - 14 GALS LINE ANN-'TST.'NEEDED'r WW��-
WATER - 0.77 INCHES DISABLED. .
TEMP - 81 .4 DEG F pR I NT -'TO-.VOLUMES
ENABLED
T 3:PREMIUM =
VOLUME - 3086 GALS I TEMP COMPENSATION
i ULLAGE - 8914 GALS I VALUE {DEG F.,=} : 60:.0
90% ULLAGE- 7714 GALS .STICK,HEIGHT OFFSET
TC VOLUME 3038 GALS, DISABLED,
HEIGHT - 36.50 INCHES ULLAGE: 9096
WATER VOL - 12 GALS ;H-PROTOCOL DATA.FORMAT"
WATER m 0.87 INCHES i HEIGHT Tqp - 81 .7 DEG, F DAYL I GHT~SAV I NG T I PEE.
` •ENABLED,
T 4:DIESEL START DATE --^
VOLUME - 3446 GALS MAR., - ,WEEK 2.�rw S N.
ULLAGE - 8554 GALS START TI,ME
90% ULLAGE- 7354 GALS
TE
TC VOLUME - 3412 GALS
hK3V T
D" SLAV
HEIGHT - 39.53'i.IdISH ES WEEK 1
EN '° IME Y 3
WATER VOL 10 GALS' . :EN 00 AM
I R - X1..77 INCHES
J
RE-D I RECT` LOCf�Lx PR I NUT
I. 4 - EEG F T�O
DISABLED, :
* * -END x * * * * 'E O PROTOCOL-PREFIX M
V t
t ' d
T`Y UNLEADED 2
PRODUCT CODE 2
COMMUNICATIONS SETUP I — UP G THERMAL.'•COEFF . .000700 ,
— — — IN TANK SET TANK DIAMETER 96.00
— — _ _ — — — -. — - =- - ; TANK PROFILE -1 PT
T i :UNLEADED t
FULL VOL c; 12000
PORT SETTINGS: f PRODUCT CODE 1
THERMAL COEFF. }000700
COMM BOARD : 1 (EDIM ) TANK DIAMETER .120.00 FLOAT SIZE: 4.0 IN.
RS-232 SECURITY TANK -PROFIFLE'':� -`1 PT
CODE DISABLED FULL VOL `L2000 WATER WARRING 2.0
J,cs HIGH WATER LIMIT , 3.0
COMM HOARD 2 (RS-232) �` `� ti 7
BAUD RATE 9600 "' MAX OR LABEL: VOL',':, 1-2000_
PARITY ; NONE k,7 FLOAT S I ZEDS OVERFILL. LIMIT 90%
STOP BIT 1 STOP
j•WATER WARNI:NG:, y:2 .0 HIGH PRODUCT' 10950 r
DATA LENGTH: 8 DATA 'HIGH WATER LIMIT 3.0, 11400
I RS-232 SECURITY f ` DELIVERY LIMIT 10x _
CODE : DISABLED MAX OR-LABEL�:VOL 1 2000
OVERF I LL.L I M:IT`- �, 90%s , 1200
COMM BOARD 3 (RS-232) . 10800 ' LOW PRODUCT 1200
BAUD RATE 9600 HIGH PRODUCT 95� LEAK- ALARM LIMIT: 99
PARITY NONE 11400 t SUDDEN LOSS LIMIT: 99
STOP BIT 1 STOP DELIVERY LIMIT IOs6 1 TANK'TLLT 050
DATA LENGTH: 8 DATA ± 1200.
RS-232 SECURITY -PROBE OFFSET 0..00
'
t CODE : DISABLED j LOW PRODUCT 1200
LEAK ALARM LIMI'.T: 99 SIPHON MANIFOLDED TANKS
�. SUDDEN LOSS LIMIT: 99
AUTO TRANSMIT SETTINGS: ;TANK TILT' 3:•.25 ) LIkNEnMANIFOLDED TANKS
AUTO LEAK ALARM LIMIT PROBE OFFSET 0.00 ! Tg:: NONE
DISABLED
AUTO HIGH WATER LIMIT SIPHON MANIFOLDED' TANKS LEAK MIN PERIODIC: 1%.
DISABLED Tit: NONE 120
AUTO OVERFILL LIMIT LINE MANIFOLD.ED, TANKS
i DISABLED Tit: NONE LEAK MIN ANNUAL 1
j
AUTO LOW PRODUCT 1 s 1%,
DISABLED f 120
AUTO THEFT LIMIT ' 1 LEAK MIN PERIODIC: 1%6
DISABLED } 120 PERIODIC TEST TYPE.
i AUTO DELIVERY START ! STANDARD
DISABLED LEAK MIN ANNUAL' : 1�
AUTO DELIVERY END 120 i ANNUAL TEST FAIL
DISABLED - I
ALARM DISABLED
AUTO EXTERNAL INPUT ON ff
DISABLED f PERIODIC TEST TYPE PERIODIC TEST FAIL
AUTO EXTERNAL INPUT OFF j STANDARD ALARM DISABLED
DISABLED ;
AUTO SENSOR FUEL ALARM ANNUAL TEST FAIL ! GROSS TEST FAIL
DISABLED i ALARM DISABLED ALARM DISABLED
AUTO SENSOR WATER ALARM
DISABLED PERIODIC TEST- FAIL ANN TEST AVERAGING: OFF
AUTO SENSOR OUT ALARM ALARM DISABLED
PER TE$T AVERAGING: OFF
DISABLED j
I GROSS_ TESTALARM DISABLED TANK TEST NOTIFY: OFF ,
j ANN TEST AVERAGING: OFF
TNK TST SIPHON BREAK:OFF
{
! PER- TEST AVERAGING OFF' DELIVERY DELAY 1 MIN
TANK TEST NOTIFY: OFF PUMP THRESHOLD 10.00%6
t RS-232 END OF MESSAGE TNK TST SIPHON ,HREAK:OFF f
DISABLED
DELIVERY DELAY I MIN• {
10.00
PUMP THRESHOLD . :
1
T 3:PREMIUM I T 4 D IESELH --
i PRODUCT CODE 3 PRODUCT GODS ; 4 LEAK TEST METHOD
THERMAL METER : . 120.00 4 THERMAL COEFF :.000450
TANK DIAMETER 120.00 TANK DIAMETER to 20.00 TEST ON DATE : ALL TANK
TANK PROFILE 1 PT TANK PROFILE 1 PT ;OCT 9 2008 -
FULL VOL 12000 ! ;.START TIME .DISABLED
FULL VOL 12000 i ,' TEST RATE . :0.20 GAL/HR
FLOAT SIZE: 4.0 IN. i f'_DURATION 2 HOURS
:
FLOAT SIZE: 4.0 IN,,
TST EARLY STOP:DISAHLED-
WATER WARNING 2.0 z
HIGH WATER LIMIT: 3,0 WATER' WARN.ING
I HIGH WATER LIMIT.:-
IMIT. 3.0 ' I` LEAK 'TEST REPORT FORMAT
f. . NORMAL
MAX OR LABEL VOL: 12000 i.
OVERFILL LIMIT 90?/* MAX OR LABEL VOL: -12000 f i
10500 OVERFILL -,LIMIT .LIMIT 9090
HIGH PRODUCT 95°0 10800' '
11400 HIGH-PRODUCT. 11400
DELIVERY LIMIT 10% DELIVERY LIMIT 1095
1200 1200
LOW PRODUCT 1200 1.
LEAK ALARM LIMIT: 99 j LOW PRODUCT, 120909
SUDDEN LOSS LIMIT: 99 r
t SUDDEN LOSS 'LIMIT 99
TANK TILT 11 .50 LIBUID SENSOR
PROBE OFFSET 0,00 TANK.TILT 0.00 OR S
- I _ _ _
'PROBE OFFSET 0.00
SIPHON MANIFOLDED TANKS L. 1 :LINL ANN
;"'S I PH_ON MAN I FOLDED'TANKS TR t-STATE `(SINGLE FLOAT}
Ttt: NONE TO: NONE CATEGORY ANNULAR SPACE
LINE MANIFOLDED TANKS
Tic: NONE LINE-MANIFOLDED TANKS '
LEAK MIN PERIODIC! 1% L 2:UNL STP_ 1
LEAK MIN PERIODIC: 1� TRI-STATE (SINGLE FLOAT)
120 120. .� j CATEGORY : STP SUMP"
LEAK MIN ANNUAL LEAK MINANNUAL
120 i 120." L 3:UNL FILL '
1} TRI-STATE (S I.NGLE. FLOAT)
C` CATEGORY : P I P I NG'SUMP -
PERIODIC TEST TYSTANDARD PERIODIC 'PEST TYPE
ANNUAL STANDARD. "! L 5`UNL 2 STP
N L TEST FAIL ! TRI STATE {SINGLE FLOAT)
ALARM DISABLED i ANNUAL TESALAR .L t i 4 CATEGORY STP -SUMP
ALARM DISABLED' !
PERIODIC TEST FAIL pERiODIC TEST FAIL
ALARM DISABLED L 6:UNL 2 STP ANN
ALARM DISAHLEI)• NORMALLY CLOSED '
GROSS TEST FAIL F ' CATEGORY : ANNULAR SPACE.-:'.
ALARM DISABLED 1 GROSS TEST FA'I`L
ALARM,'�DISABLED
ANN TEST AVERAGING: OFF ANN TEST 'AVERAGING: . OFF �.
PER TEST AVERAGING: OFF j
PER TEST,"AVERAG�I NG OFF' "� i- L T:UNL `2 T f U
E TRI-STATE (SINGLE FLOAT) . {
TANK TEST NOTIFY: OFF ' '' j CATEGORY- : PIPING SUMP.
TANK TEST: NOTIFY: t OFF !
TNK TST SIPHON BREAK:OFF '' � '
TNK•TST` SIPHON-BRHAK;'OFF
+ � L S:UNL 2 ANN FILL
DELIVERY DELAY 1 MIN ' ;..1 NORMALLY CLOSED t
PUMP THRESHOLD 10.00:0 PUMP TRY SHOE5 ': 1 .00% } .CATEGORY ANNULAR 'SPACE
PUMP THRESHOLD : 10:0090
L 9tUNL 2 ANN
DUAL.POINT HYDROSTATIC
CATEGORY : ANNULAR SPACE
LIO:PREM ANN
TRI"-STATE (S 1 NGLE "FLOAT).
j CATEGORY. ANNULAR SPACE i
L1l:PREM. STP
TRI-STATE (SINGLE FLOAT)
CATEGORY STP SLAP t
L 12;PREM FILL 1 A R.,NL.D 1
TRI-STATE (SINGLE FLOAT) OUTPUT RELAY SETUP TYPE: CONTROL OUTPUT f
CATEGORY PIPING SUMP , " - - _ Y TANK-it 1
R 1 :POS SHUT OFF
L13:DSL ANN {' TYPE: LIQUID SENSOR ALMS
TRI-STATE (SINGLE FLOAT) NORMALLY j ALL:FUEL ALARM
CATEGORY ANNULAR SPACE i ALL:SENSOR OUT ALARM
TANK'tt: 1 ALL.:SHORT_'ALARM
ISD SITE ALARMS
L14:DSL STP LIQUID SENSOR ALMS ; "ISD. GROSS PRES--FAIL
TRI-STATE (SINGLE FLOAT) :,..
CATEGORY STP SUMP L 1 :FUEL.ALARM ! .ISD DEGRD PRES FAIL ALARM
L '2:FUEL' ISD VAPOR LEAK FAIL L 3:FUEL ALARM ISD VP- PRES FAIL
-
L15:DSL FILL i L 5:FUEL ALARM kt -ISD VP STATUS FAIL f
TRI-STATE (SINGLE FLOAT) L 9'!FUEL 'ALARM, 1
CATEGORY : PIPING SUMP LIO:FUEL ALARM• ' ISD HOSESS RMS' FAIL
L11;:FUEL ALARM �` ,
L13:FUEL ALARM. �` -:.. ^. °� { ALL:DEGRD COLLECT FAIL
L 16:D I SP 13-14 ; L 14:FUEL ALARM ,t_;•r ALL:FLOW'COLLECT FAIL 1
TRI-STATE (SINGLE FLOAT) L 16':.FUEL ALARM,e
CATEGORY : DISPENSER PAN (. LI7:FUEL' ALARh�1 R 4:OVERFILL ALARM
L18 FUEL ALARM ° .'TYPE
L19:FUEL,ALARM -STANDARD
L20:FUELrALARM i NORMALLY OPEN
L17:DISP 15-16 L21 :FUEL- ALARM NS .TANK 0: NONE }
TRI-STATE (SINGLE FLOAT) L 1 :SEOR:OUT ALARM
CATEGORY : DISPENSER PAN L 2:SENSOR �OUT ALARM I i
L 3:SENSOR OUT ALARM
L 5:SENSOR OUT ALARM I IN-TANK ALARMS-
L 9:SENSOR OUT ALARM ALL:OVERFILL,ALARM
L19:DISP 17-18 L10:SENSOR .OUT ALARM ! ALL:HIGH PRODUCT ALARM
TRI-STATE (SINGLE FLOAT) j L11_:SENSOR .OUT ALARM ( AI,L;MAX PRODUCT ALARM
CATEGORY : DISPENSER PAN L'13:SENSOR OUT ALARM R 5:INTERNBL ALARM
i L14.:SENSOR OUT .ALARM
L16:SENSOR OUT ALARM TYPE:
L17:SENSOR OUT ALARM. MOMENTARY !
L19:DISP 19-20 L16:SENSOR OUT ALARM 1 NORMALLY OPEN
TRI-STATE (S'INGLE FLOAT) { LI9:SENSOR OUT ALARM
CATEGORY : DISPENSER PAN ! L20':SENSOR OUT- ALARM LIAUID SENSOR ALMS f
L21 :SENSOR OUT ALARM .ALL:FUEL ALARM
i` L I :SHORT ALARM
L 2':SHORT ALARM ALL:SENSOR OUT ALARM
` ��
L20:DISP 21-22 L 3:SHORT ALARM x ALL:SHORT-ALARM
TRI-STATE (SINGLE FLOAT) L '5:,SHORT ALARM'
CATEGORY : DISPENSER PAN 1 L 9:SHORT ALARM
..L10:SHORT ALARM•,-_ f
L1.1 :SHORT' 'ALARM
L21 :DISP 23-24 L13:SHORT ALARM--
TRI-STATE (SINGLE FLOAT) LI'4:SHORT ALARM
CATEGORY : DISPENSER PAN I L36:SHORT :ALARM
r. L17:SHORT ALARM
L tB:SHORT ALARM - 4
L19:SHORT ALARM f
L22:VENTBOX L20:SHORT ALARM
TRI-STATE (SINGLE FLOAT) ! L21 :SHORT ALARM '
CATEGORY PIPING SUMP ISD SITE ALARMS
ISD GROSS PRES FAIL
ISD DEGRD PRES FAIL
ISD VAPOR LEAK FAIL
LSD VP PRES.FAIL
ISD VP STATUS' FAIL f'f
1 ISD HOSE ALARMS 4
ALL:GROSS COLLECT FALL
ALL:DEGRD COLLECT FAIL
1 ALL:FLOW COLLECT FALL.
PUMP SENSOR SETUP
S 1 :UNLEADED i
TANK 0: 1
DISPENSE MODE:
STANDARD
_R B:ANNUNCIATOR
TYPE: i SMARTSENSOR SETUP EVR/ISD SETUP
STANDARD
NORMALLY CLOSED s 2:UNL 2 LINE
TANK #: NONE CATEGORY VAC SENSOR f i EVR,TYPE,: VACUUM ASSIST
PUMP #: i s VACUUM' ASSIST TYPE.
I R 3:UNLD I- .. HEALY VAC • 1
IN-TANK ALARMS VOLUME:_ 150.0- GALLONS
ALL:LEAK ALARM RELIEF VALVE: NO NOZZLE AL RANGE
ALL:HIGH WATER ALARM MAX:, 1 .15 MIN: 0.95
ALL:OVERFILL ALARM s 8:ATM i
ALL:LOW PRODUCT ALARM ' -CATEGORY, ATM.P-SENSOR '.'"VAPOR PROCESSOR TYPE
ALL:SUDDEN LOSS ALARM 510-FM 13-14 � NONE
ALL:HIGH PRODUCT ALARM t i.
ALL:INVALID FUEL LEVEL 2 CATEGORY `"ATR FLOW METER
ALL:PROBE OUT ANALYSIS TIMES
ALL:HIGH WATER WARNING sll :FM,.15-16 TIME: 10:00 AM
ALL:DELIVERY NEEDED CATEGORY' AIR FLOW METER DELAY: MINUTES: I
ALL:MAX PRODUCT ALARM a12:FM 17- LB
ALL:GROSS TEST FAIL
ALL:PERIODIC TEST FAIL CATEGORY 'A I•R FLOW, METER'`.f -ACCEPT HIGH ORVR
ALL:ANNUAL TEST FAIL DISABLED
ALL:PER TST NEEDED WRN sl3:FM 19-20 _
ALL:ANN TST NEEDED WRN CATEGORY AIRFLOW METER ISD HOSE TABLE
ALL:PER TST NEEDED ALM �, ID FP FL HL AA RR
ALL:ANN TST NEEDED ALM s-14:FM, 21-22 -
ALL:TANK TEST ACTIVE CATEGORY AIR T OW METER 1 01 01 13 02 01 " UU
ALL:NO CSLD IDLE TIME f 02 02 -14 02- '01 UU
i ALL:TANK SIPHON BREAK sl5:FM: 23-24 03. 03 15 02 02 UU j
ALL:CSLD INCR RATE WARN CATEGORY AIR FLOW-METER + 04= 04 16 02 02 UU
ALL:A000_CHART CAL WARN 05 05. - 17 02 03 UU
j ALL:RECON WARNING s16:PS 17-18 "06 06 18, 02 03 UU
ALL:RECON ALARM CATEGORY VAPOR PRESSURE' 1 07 .07 1.9 02 04 UU
ALL:LOW TEMP WARNING ! 08" 08 20 02 04 UU
09 09 21 02 05 UU
ALL:MISSING TICKET WARN 10- 10 _22. ..02 05. -UU.
{ ALL:GROSS FAIL LINE TNK i" 11 11 23 '02 06 UU
i ALL:DELIVY DENSITY WARN F 12 12 24 02 06 UU
LIQUID SENSOR ALMS '
ALL:FUEL ALARM ISD-AIRFLOW METER MAP
ALL:SENSOR OUT ALARM ID' SERI"AL NUM LABEL
ALL:SHORT ALARM ! ---- -------------------
1 1" 8618. -FM 13 7.1.4
ISD SITE ALARMS { 2 8611 FM`15-16
ISD STAGE I WARN 3 .15453 FM. 17-18
ISD GROSS PRES WARN 4 8615 FM'19-20 .
ISD GROSS PRES FAIL 5 9525 FM 21-22
ISD DEGRD PRES WARN 6 8629 FM 23-24
ISD DEGRD PRES FAIL
ISD VAPOR LEAK WARN
ISD VAPOR LEAK FAIL ISD FUEL GRADE. HOSE MAP
ISD VP PRES WARN 1 2 3 4
ISD VP PRES FAIL FP MHH.MHH°MHH MHH AA
ISD VP STATUS WARM ---"----"'-----------
ISD VP STATUS FAIL 1 01 301 901 .201 U U 1-
MISSING RELAY SETUP ; 02 202 302 902 U U 1
MISSING HOSE SETUP 03 203 -303 903 -U U -2
MISSING TANK SETUP 04 204 304 904 U U 2
MISS VAPOR FLOW MTR 05 205...305._905 5 U 3
MISS VAPOR PRES SEN } 06 206 306 -906 5 U 3
MISSING VP INPUT 07''207 307 '907 U U 4
ISD SETUP WARN 06 208 308 908 U U 4
ISD SETUP FAIL 09 209 309 909 U .0 5
ISD SENOR OUT WARN 10 210 "310 910 U U 5
ISD SENSOR OUT FAIL 11 211 311 911 5 U 6
12 212 312 912-5 U 6
ISD HOSE ALARMS j
ALL:GROSS COLLECT WARN
ALL:DEGRD COLLECT WARN' # LABEL TABLE
ALL:DEGRD COLLECT FAIL f �1 UNASSIGNED
ALL:FLOW COLLECT WARN
ALL:FLOW COLLECT FAIL 2: BLEND3._- .
3: REGULAR
ALL:AIRFLOW MTR SETUP 4: MID GRADE
5 PREMIUM
GOLD
' 7:" BRONZE
8: SILVER•
*=•9: BLEND2'
1o: 9LEND 4
PMC SETUP ALARM HI STORY -REPORT
-�
PMC- VERBIO-R""01 .02 ----- SENSOR ALARM =--- ALARM-HISTORY REPORT {
L 2:UNL STP _-=-- SENSOR--ALARM
VAPOR PROCESSOR TYPE STP 'SUMP t
NONE,... FUEL ALARM t STP�82 STP
JUL..22; 2010 12.14 PM ( FUEL ALARM
PROLE :CONTROL LEVEL:
NONE {', FUEL ALARM JUL 22. :2'010 PM
{ APR 21. -2010'. 10:21 AM- FUEL :ALARM;
_._�_...... a�._ FUEL. ALARM. ..
{ JUN 1'8 201.0 Vt.:27 PM �
JAN 17, 2010 3:46"PM--.. FUEL ALARM _
7..''.2010, 4:58' AM
SOFTWARE REVISION LEVEL '
VERSION 329.00 {
SOFTWARE# 346329-100-A
CREATED - 08. 10.09.17.08
S-MODULEO 330160-004-a- j x x x * x END x x x x *'
SYSTEM FEATURES: ( w x x,-END x x x x x
PERIODIC IN-TANK TESTS
ANNUAL IN-TANK TESTS t
ISD
t t
ALARM HISTORY REPORT
i ----- SENSOR ALARM ,ALARM. HISTORY REPORT i
ALARM HISTORY REPORT L 3:UNL -FILL ----- SENSOR ALARM -----
PIPING SUMP i L 6:UNL 2 STP ANN
- SENSOR ALARM ----- FUEL ALARM } ANNULAR SPACE {
L I :UNL ANN JUL 22, 2010 12:49 PM I FUEL ALARM
ANNULAR SPACE JUL 22,, _2010 1 :40 PM i
FUEL ALARM ( FUEL' ALARM -
JUL 22, 2010 12:50 PM APR 201_. 2010 10:43 PM FUEL
FUEL ALARM FUEL ALARM i
MAY-_'&20'10,-.10:30 PM
MAY 4, 2010 11 :05 PM R FEB 27.- 2010 2:59 P14 Fes; ALARM {
FUEL ALARM i { APR 21, 2010 10:50 AM -
AUG I1. 2009 9:57 AM
+ i I
I ,
i
x x x x x END x x x x x j
x x x x x END x x x x x
x x x x x END x x x x x
1 ,
i
t
1
1
t :t
f
rAA STORY. REPORT
ALARM HISTORY REPORT'
ALARM HISTORY REPORT
2 FILL ----- L 9 UNL°:2' °ANN SENSOR ALARM -----
R ALA -_--- SENSOR,ALARM -----
UMP ANNULAR SPACE L11:PREM STP
RM STP SUMP
2010 1 :00 PM LOW LIQUID ALARM F ALARM
JUL 22.• 2010 1 :04 PM UT ALARM JUL 22. .9010 12:30 PM
2010 12:57 PM HIGH LIQUID ALARM #;,.
JUL__22. 201.0 .12:52 PM FUEL:; ALARM
FUEL ALARM I f JUL -92, 2010 12:1.1 PM
DEC 24. 2009 12:00 AM LOW LIQUID ALARM � -
JUL 22. 2010 12:52 PM FUEL ALARM
€ JUL 30, 2009 10:53 AM
1
xxxxxEND xxxxx
Jxxxx. .xENDxxxx . xxxxENDxxxxx
i
i
ry
j f
1 4•
7
t
ALARM HISTORY REPORT
i ALARM HISTORY REPORT } ALARM HISTORY REPORT
----- SENSOR ALARM -----
L B:UNL 2 ANN FILL ----- SENSOR ALARM -----
ANNULAR SPACE L10:PREM ANN ------SENSOR ALARM -----
FUEL ALARM ANNULAR SPACE L12.:PREM FILL
JUL 22. 2010 1 :41 PM FUEL ALARM PIPING SUMP
JUL 22', 2014-12:4.9 PM FUEL .ALARM
FUEL ALARM ; JUL 22, 2010. 12:48. PM
JUL 30. 2009 10:16 AM FUEL ALARM FUEL ALARM
FUEL ALARM MAY 4, 201'0 11 :29 PM JUL 30, 2009 9:41 AM .
FEB 17. 2009 10:08 AM FUEL ALARM
JUL 30. 2009. 10:53 AM
- � I
t
tt ixxxxxENDxxxxx
x x x x x END x x x x x I
x x x x x .END x x x x x
i
{1
i
SAL_.. r + .,• ,� . ,, .• ,
ALARM HISTORY REPORT i," ALARM_.H I STORY.REPQ ' ;_ # --- SENSOR ALARM" ----
' # L17':DISP 15=16
----- SENSOR ALARM ----- ----- SENSOR,.�Pd:ARM DISPENSER PAN -.
L13:DSL ANN i L15:DSL' Fl. : `" ` SENSOR OUT ALARM
ANNULAR SPACE PIPING SUMP , ; JUL 22. 2010 12:45 PM
FUEL ALARM FUEL ALARM t --
JUL 22. 2010 12:48 PM ""` JUL 22, 2010 12:47 PM FUEL ALAS
JUL-.22,0 2010 12:19 PM
FUEL ALARM FUEL ALARM
JUL 30. 2009 10:09 AM. JUI- 30. 2009 10:53 AM 1 -FUEL ALARM
FUEL ALARM ( JUL 30." 2009 9:46 AM
JUL 30., 2009; 9:39 'AM
i
y
4
x END x
l � xxxxxENDx * � � � ,
x x x x x END x x x x x
i
t ,
ALARM HISTORY REPORT
ALARM HISTORY REPORT
----- SENOR ALARM ----- ALARM HISTORY REPORT SENSOR ALARM -----
L14:DSL STP
STP SLAP -- —_ SENSOR ALARM ----- DISPENSER SE 17-18
FUEL ALARM DISPENSER PAN "
JUL 22, 2010 12:10 PM L16.:DISP 13-14 FUEL ALARM'
} DISPENSER PAN " - JUL 22, 2010 12:18 PM
FUEL ALARM FUEL ALARM
JUL 22.- 201:0. 12:20 PM FUEL ALARM
JUL 30, 2009 10:53 AM
JUL 30. 2009 9:44 AM
FUEL ALARM JUL 30.2009 9:52 AM FUEL ALARM
JUL 30. 2009 9:38 ,AM
FUEL ALARM JUL 30:' 2009 9:43 AM
JUL 30, 2009: 9:47 AM 1
t
x x x x x END x x x x x
xxxxxENDxxxxx
xxx -x`"x `END xxxx '.
t
ALARM HISTORY REPORT ALARM HISTORY.-REPORT 4 } ,SMARTSENSOR.ALARM --
-- SENSOR ALARM ----- ---- ! ; s 2':UNL 2.LIAL
L19:DISP 19-20 ---'— SENSOR ALARM — HIGH LIQUID ALARM
DISPENSER PAN L21 :DISP 23-24 ; JUL' 22'. 2010 .2:01. PM
FUEL ALARM ; DISPENSER PAN
JUL 22. 2010 12:25 PM l SENSOR, OUT ALARM ;
i
JUL 22. 20T0 12:45 PM ! '`ALARM
j JULL30, 2009--10:00 AM i FUEL ALARM'` i
JUL 22. 2010 12:41' PM
FUEL ALARM r FUEL ALARM j
APR 1. 2009 2:34 PM JUL 30. 2009 10,:03 AM
1 ---- IN—TANK ALARM ----- !
E T:2:UNLEADED 2
s PROBE`OUT,
:j JUL.22. 2010 2:03 PM
xEND * xx WEND Xxxxx
---- -IN—TANK ALARM -----
T,3:PREMIUM
PROBE OUT
JUL 22: 2010 2:03 PM
ALARM HISTORY REPORT ! ALARM HI'STORY' REPORT
----- SENSOR ALARM ----- --__ SENSOR ALARM -----
L20:DISP 21-22
DISPENSER PAN j L22:VENTHOX -- -
FUEL ALARM PIPINGlSUMP IN—TANK ALARM
22. 2010 12:39 PM t FUEL ALARM T 4:DIESEL
JUL 22, 2010 . 1 :46 PM PROBE OUT
FUEL ALARM JUL 22, 2010 2:03 PM " ..
FUEL ALARM:
JUL 30, 2009 10:01 AM 1 :42 PM;
JUL 22. 2010 .
t t
----,IN—TANK' ALARM -----
T 4:DIESEL
* x END * * = -HIGH PRODUCT, ALARM
x * * X •END--*`x * *'* ## JUL 22, 2010 2:07 PM
' R
---- IN=TANK ALARM --°—
T 4:DIESEL i
--- ` --SMARTSENSOR ALARM OVERFILL ALARM 4
s 2:UNL 2 LI-NE JUL 22. -,2010 2:07 PM
NO VACUUM ALARM
JUL 22, 2010. 2:01 :PM �
E
1 _
T 4:AIESEL T 3?:,PREMIUM
INVENTORY INCREASE f ---- IN-TANK ,ALARM ----- 'INVENTQRY :.INCREASE
T 4:DTESEL t
t" PROBE-OUT; INCREASE START
INCREASE START JUL 22. 2010 2:13 PM JUL 22. 201-0 2:18 PM 1
JUL 22. 2010 2:06 PM
VOLUME o 8256 GALS i - 'HE _
9698 GALS.
j HEIGHT - 78.01 INCHES - fi�'WATER = = - 90._40 INCHES.
WATER - 1 .01 INCHES � i i' WATER ' 0:00' INCHES
TEMP - 95.7 DEG F TEMP 94.8 DEG F_
INCREASE END
INCREASE END 1 JUL 22. 2010 2:21 PM
JUL 22, 2010 2:09 PM
T 3:PREMIUM i VOLUME - 11061 GALS
VOLUME - 11434 GALS INVENTORY INCREASE - HEIGHT. " m104.14 INCHES
HEIGHT -108.78 INCHES i WATER. 0.00 INCHES
1 WATER 0.00 INCHES INCREASE-START
{ TEMP m 95.7 DEG F i JUL 22. 2010 2:14 PM TEMP - 95:0 DEG F
VOLUME = 7261 GALS
s GROSS INCREASE- 3176 HEIGHT = 69.95 ,I.NCHES GROSS INCREASE- 1363
' TC NET INCREASE- 3125 WATER 1 .95 1NC.HES TC NET INCREASE 1329
TEMP. m 94.8 DEG F
INCREASE�END . .,:- .
JUL 22, 2010 217 PM
i
VOLUME - 10739-GALS ;
HEIGHT -100.57 1NCHES
WATER - 0.00 INCHES Y
TEMP - 94.7 DEG F '
FASTRIP 367 GROSS INCREASE-- 3478 -- SENSOR ALARM -----
8001 WHITE LANE TC NET INCREASE- 3395 r .L. N 2 FILL
BAKERSFIELD CA-93309 PIPPING SUMP
f FUEL: ALARM. ,
JUL 22. 2010 2:30 PM
JUL 22. 2010 2:11 PM
i
SYSTEM STATUS REPORT (i '
- - - - - - - - - i I 4
T 4:HIGH PRODUCT ALARM I
s 2:HIGH LIQUID ALARM FASTRIP 367
_ 1
-- IN-TANK ALARM ----- I•.800.1. WHITE LANE
T 3:PREMIUM BAKERSFIELD CA.93309 'A
OVERFILL ALARM
'JUL 22, 2010 2:19 PM
i JUL 22. 2010 2:35 PM
( - SYSTEM STATUS REPORT -
ALL FUNCTIONS-NORMAL
- IN-TANK ALARM -----
T 1 :UNLEADED
HIGH PRODUCT ALARM ---- IN-TANK ALARM -----
JUL 22, 2010 2:11 PM ( T 3:PREMIUM
} PROBE.,OUT
+} JUL 22, '2010 2.20 PM
I { I
I ---- IN.-TANK ALARM -----
{ T 1 :UNLEADED
HIGH PRODUCT ALARM
JUL 22.2010 2:35 PM
---- IN-TANK ALARM -----
T 2:UNLEADED 2
HIGH PRODUCT ALARM
JUL. 22. 2010 2:12 PM j
i
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: 9367 Fastrip#640 1 Date of Testing: 7/22/2010
Facility Address: 8001 White Lane, Bakersfield,CA 93309
Facility Contact: Omero Garcia Phone: 661-393-7000
Date Local Agency Was Notified of Testing: 6/23/2010
Name of Local Agency Inspector(f present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials': X CSLB Contractor X ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Specify)
License Number(s): CSLB#804904 ICC#5264406-UT
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic ❑Vacuum ❑Other
Test Equipment Used: Lake Test Equipment Resolution: .0625"
Identify Spill Bucket(By Tank 1 Regular 1 2 Regular 2 3 Super 4 Diesel
Number, Stored Product, etc.
Bucket Installation Type: ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury
X Contained in Sump X Contained in Sump X Contained in Sump X Contained in Sum
Bucket Diameter: 12.00" 12.00" 12.00" 12.00"
Bucket Depth: 13.00" 15.25" 14.25" 13.15"
Wait time between applying 5 min. 5 min. 5 min. 5 min.
vacuum/water and start of test:
Test Start Time(Tj): 12:00 pm 12 :00 pm 12 :00 pm 12 :00 pm
Initial Reading(Rj): 1 9.75" 12.25" 11.00" 10.50"
Test End Time(TF): 1:00 pm 1:00 pm 1:00 pm 1:00 pm
Final Reading(RF): 9.75" 12.25" 11.00" 10.50"
Test Duration(TF—Tj): 1 hour 1 hour I hour 1 hour
Change in Reading(RF-Rj): 0.00" 0.00" 0.00" 0.00"
Pass/Fail Threshold or .0625" .0625" .0625" .0625"
Criteria:
Test Result: X Pass ❑Fail X Pass ❑Fail X Pass []Fail X Pass ❑Fail
Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements.
Technician's Signature: ,�.T/1�,u.� Date: 7/22/2010
' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
ri U
S
•MMPUAX[IWIT10"rMC V Invoice No.: 23473
#367 Fastrip #640
8001 White Lane
Bakersfield, CA 93309
Repairs completed: I replaced the Regular 1 Syphon 208 Fill
Sump sensor, and the Overfill light bulb.
Required Repairs, Still Pending: During the inspection the
Super relay got stuck. I was able to unstuck the relay and we were able to
finish the inspection, but we still need to replace the relay to insure proper
operation.
Technician Name: KQ 15 AAWS
Signature: 444,E
Date: g/aa/i0