HomeMy WebLinkAboutFMC 2009 ' 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 IIIIIIIIIIIIIIIIIIII 29
Facility Name: Shell (Brookside Market) 1E Bldg. No.:
Site Address: 8803 Camino Media Blvd. City: Bakersfield Zip: 93311
Facility Contact Person: Matt Jeffries Contact Phone No.: 661-758-3072
Make/Model of Monitoring System: Veeder-Root TLS-350 Date of Testing/Servicing: 01/30/2009
B. Inventory of Equipment Tested/Certified
Check the approp,iate boxes to io cafe specittc equipment inspected/serviced:
Tank ID: 20000 gal.Regular Tank ID: 12000 gal.Super
[X] In-Tank Gauging Probe. Model:847390-107 [x] In-Tank Gauging Probe. Model:847390-107
[x] Annular Space or Vault Probe. Model:794380.420 [x] Annular Space or Vault Sensor. Model:794380.409
[x] Piping Sump/Trench Sensor(s). Model:794380-208 [x] Piping Sump/Trench Sensor(s). Model: 794380-208
[J Fill Sump Sensor(s) Model:794380-208 [X] Fill Sump Sensor(s). Model:794380-208
[J Mechanical Line Leak Detector. Model:FX1y [x] Mechanical Line Leak Detector. Model: FX1y
❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model:
[x] Tank Overfill/High Level Sensor. Model:847390-107 [X] Tank Overfill/High Leval Sensor. Model: 847390-107
❑ Other(specify equip.type and model in Sec. E on Pg. 2) ❑ Other(specify equip.type and model in Sec. E on Pg.2)
Tank ID: 8000 gal.Diesel Tank ID:
[x] In-Tank Gauging Probe. Model:847390-107 ❑ In-Tank Gauging Probe. Model:
Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model:
U Piping Sump/Trench Sensor(s). Model:794380-208 ❑ Piping Sump/Trench Sensor(s). Model:
[x] Fill Sump Sensors(s). Model:794380-208 ❑ Fill Sump Sensor(s). Model:
[x1 Mechanical Line Leak Decector. Model:FX1DV ❑ Mechanical Line Leak Detector. Model:
❑ Electronic Line Leak Detector. Model: ❑ 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: 314
n 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: 516 Dispenser ID: 718
[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 Chains(s). ❑ Dispenser Containment Float(s)and Chain(s).
Dispenser ID: Dispenser ID:
❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model:
❑ Shear Valve(s). ❑ Shear Valve(s).
❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s).
*If the facility contains more tanks or dispensers,copy this form. Include information for every tank and dispenser at the facility.
C. Certification -I certify that the equipment identified in this document was inspected/services in accordance with the
manufacturers'guidlines.Attached to this Certification is information(e.g.manufacturers'checklist)necessary to varify that
this information is correct and a plot plan showing the layout of monitoring equipment.For equipment capable of generating
such reports,I have attached a copy of the report; (check all that apply) Ex]S t-u x Alarm history report
Technician Name(print): Matt Tumor Signature:
Certification No: 836313 License No:804904
Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930
Site Address: 8803 Camino Media Blvd,Bakersfield,CA 93311 Date of Testing/Servicing: 01/30/2009
1111111 IIIII III IIII 30
IE
D.Results of Testing/Servicing
Software Version installed: 327.04
Complete the following checklist:
Lx] Yes ❑ No* Is the audible alarm operational?
4YesNo* Is the Visua alarm operational?
No* Were all sensors visually inspected,functionally tested,and confirmed operational?
U 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?
Ej 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? [xj Sump/Trench Sensors[X]Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? El Yes; ❑ No;
U 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? L90 %
❑ 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* ❑ No Was liquid found inside any secondary containment systems designed as dry systems?
x Product; r--i Water. If yes,describe causes in Section E,below.
x * Was monitoring system set-up reviewed to ensure roper settings?Attach set-up reports,if applicable.
x=Yes No* Is all monitoring equipment operational per manufacturer's specifications?
*In Section E below,describe how and when these deficiencies were or will be corrected.
E. Comments: Upon arrival,STP sump sensors were not installed at the lowest point of the sumps.Correction was made
on site and sensors were positioned correctly at the bottom of the sumps.
Removed approximately 5.5 gallons of water/product mixture from Regular STP Sump.
Removed approximately 7.0 gallons of water/product mixture from Super STP Sump.
Removed approximately 5.25 gallons of water/product mixture from Diesel STP Sump.
F. In-Tank Guaging/SIR Equipment: [XJ 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:
U Yes ❑ No* Has all input wiring been inspected for proper enter and termi nation,including testing for ground faults?
x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
Fj Yes No* Was accuracy of system product level readings tested?
x Yes No* Was accuracy of system water level readings tested?
L[x] Yes No* Were all probes reinstalled properly?
U 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:
[xj 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.: ❑0.1 g.p.h.; 00.2 g.p.h.;
_[xj Yes No* Were all LLD's confirmed operational and accurate within regulatory requirments?
x Yes No Was the testing apparatus properly calibrated?
❑ Yes No For mac amca LLD's,does the LLD restrict product ow it detects a leak?
N/A
❑ Yes No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak?
Cx] 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?
U N/A
Lxj 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:
_EgURfTY
f CODE : '000000 '
I NTENAWFE H I STORY
t DISABLED
SYSTEM—SETUP — — — — — TANK CHART SECURITY
JAN 30.: 2009 6:41 AM (,' DISABLED
BROOKSIDE MARKET • } CUSTOM ALARMS
8803 CAMINO MEDIA j SYSTEM UNITS a DISABLED
BAKERSFIELD CA 93308 U.S. F
SYSTEM LANGUAGE
MASS/DENSITY
ENGLISH !
JAN 30, 2009 8:41 All ! DISABLED DATE/TIME FORMAT
i M014 DD YYYY HH:MM:SS xM !
SYSTEM STATUS REPORT BROOKSIDE MARKET
8803 CAMINO MEDIA _
ALL FUNCTIONS IJORMAL BAKERSFIELD CA 93308
COMMUNICATIONS SETUP
I(JVENTORY REPORT — —SHIFT TIME l 2:00 AM
SHIFT TIME 2 DISABLED
T 1 :UNLEADED SHIFT TIME 3 : DISABLED PORT SETTINGS:
VOLUME 1707'7 GALS SHIFT TIME 4 DISABLED
ULLAGE = 3005 GALS COMM BOARD : 1 (EDIM )
90 ULLAGE= 996 GALS I TANK PER TST NEEDED WRN RS-232 SECURITY
TC VOLUME - 17068 GALS DISABLED CODE : DISABLED
HEIGHT =141 .10 INCHES TANK ANN TST NEEDED WRN
WATER VOL = 15 GALS DISABLED COMM BOARD 2 (RS-232)
WATER = 0.77 INCHES BAUD RATE 9600
TEMP = 60.7 DEG F LINE RE—ENABLE METHOD PARITY NONE
PASS LINE TEST STOP BIT 1 STOP
LINE PER TST NEEDED WRN DATA LENGTH: B DATA
T PREMIUM RS-232 SECURITY -
VOLUME = 9909 C:ALS DISABLED CODE : DISABLED
ULLAGE 2132 GALS LINE ANN TST NEEDED WRN
90% ULLAGE- 927 GALS DISABLED
TC VOLUME = 9895 GALS PRINT TC VOLUMES AUTO TRANSMIT SETTINGS:
HEIGHT = 97.78 INCHES a
WATER VOL - 0 GALS E(VABLED AUTO LEAK ALARM LIMIT
i WATER = 0.00 INCHES DISABLED
TEMP = 61 .9 DEG F TEMP COMPENSATION AUTO HIGH WATER LIMIT
VALUE (DEG F ): 60.0 DISABLED
STICK HEIGHT OFFSET AUTO OVERFILL LIMIT j
T 3:DIESEL DISABLED DISABLED
VOLUME = 4344 GALS ULLAGE: 90% AUTO LOW PRODUCT
ULLAGE = 3683 GALS DISABLED
90% ULLAGE= 2880 GALS H—PROTOCOL DATA FORMAT AUTO THEFT LIMIT
TC VOLUME = 4332 GALS HEIGHT DISABLED
HEIGHT - 67.87 INCHES DAYLIGHT SAVING TIME AUTO DELIVERY START
WATER VOL - 0 GALS ENABLED DISABLED
WATER = 0.00 INCHES START DATE AUTO DELIVERY END
TEMP n 65.5 DEG F APR WEEK I SUN DISABLED
' START TIME AUTO EXTERNAL INPUT ON
2:00 AM DISABLED
END x END DATE AUTO EXTERNAL INPUT OFF
OCT WEEK 6 SUN DISABLED
END TIME AUTO SENSOR FUEL ALARM
2:00 AM DISABLED
AUTO SENSOR WATER ALARI 1
RE—DIRECT LOCAL PRINTOUT DISABLED
DISABLED AUTO SENSOR OUT ALARM
DISABLED
EURO PROTOCOL PREFIX
S
RS-232 END OF MESSAGE
DISABLED
I N_TANK :SETU1>— — — — — — k
T 2:PREMIUM T 3:DIESEL
T 1 :UNLEADED PRODUCT CODE 2 PRODUCT CODE 3
PRODUCT CODE I q THERMAL COEFF : .000700 THERMAL COEFF : .000450
THERMAL COEFF : .000700 TANK DIAMETER 127.50 TANK DIAMETER 127.50
TANK DIAMETER 127.50 TANK PROFILE 1 PT TANK, PROFILE 1 PT
TANK PROFILE 1 PT FULL VOL 12041 FULL VOL 8027
FULL VOL 20082
FLOAT SIZE: 4.0 IN, FLOAT SIZE: 4.0 IN,
FLOAT SIZE: 4.0 IN.
WATER WARNING : 2.0 WATER WARNING 2.0
WATER WARNING : 2.0 i HIGH WATER LIMIT: 3.0 HIGH WATER LIMIT: 3.0
HIGH WATER LIMIT: 3.0
MAX OR LABEL VOL: 20062 MAX OR LABEL VOL: 12041 ! MAX OR LABEL VOL: 8027 i
OVERFILL LIMIT 90% OVERFILL LIMIT 90%
OVERFILL LIMIT 90% 10837 7224
18073 HIGH PRODUCT 95% HIGH PRODUCT 95%
HIGH PRODUCT 95%
11
19078 DELIVERY LIMIT 109 DELIVERY LIMIT 7110%
DELIVERY LIMIT 10% 1204
802
2008 1
LOW PRODUCT 500 s LOW PRODUCT 500
LOW PRODUCT 500 ,
LEAK ALARM LIMIT: 99 LEAK ALARM L1h11T: 99 LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 50 SUDDEN LOSS LIMIT: 50 SUDDEN LOSS LIMIT: 50
TANK TILT 0.00 TANK TILT 0.00 TANK TILTo 0.00
PROBE OFFSET 0.00 PROBE OFFSET 0.00 PROBE OFFSET 0.00 i
i
SIPHON MANIFOLDED TANKS SIPHON MANIFOLDED TANKS SIPHON MANIFOLDED TANKS
TO: NONE TO: NONE TO: NQNE
LINE MANIFULDED TANKS LINE MANIFOLDED TANKS LINE MANIFOLDED TANKS
TO: NONE
TO: NONE � Tit: NONE *
i
LEAK MIN PERION C: 10% LEAF: MIN PERIODIC: 101/0 LEAK MIN PERIODIC: 10%
2008 1204 802
ry . = LEAK MIN ANNUAL i 0°i LEAK MIN ANNUAL 10%
_cFii{,.Ct.I N: MCi ; :2 1204 sot
PERIODIC TEST TYPE PERIODIC TEST TYPE PERIODIC TEST TYPE
STANDARD STANDARD STANDARD
ANNUAL TEST FAIL ANNUAL TEST FAIL ANNUAL TEST FAIL
ALARM DISABLED ALARM DISABLED ALARM DISABLED
PERIODIC TEST FAIL PERIODIC TEST FAIL PERIODIC TEST FAIL
ALARM DISABLED ALARM DISABLED ALARM DISABLED
GROSS TEST FAIL GROSS TEST FAIL GROSS TEST FAIL
ALARM DISABLED
ALARM DISABLED ALARM DISABLED
ANN TEST AVERAGING; OFF ANN TEST AVERAGING: OFF ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF PER TEST AVERAGING: OFF PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF TANK TEST NOTIFY: OFF TANK. TEST NOTIFY: OFF
TNh TST SIPHON BREAJC:OFF TNK TST SIPHON BREAK:OFF TNh TST SIPHON BREAK:OFF
DELIVERY DELAY 15 MIN DELIVERY DELAY 15 MIN DELIVERY DELAY 15 MIN
PUMP THRESHOLD 10.00% PUMP THRESHOLD 10.00% PUMP THRESHOLD 10.00`x:
. OUTPUT RELAY SETUP
LEAK TEST METHOD L 6:91 FILL -
- _ _ _ TRI-STATE (SINGLE FLOAT) R 1 :87 STP
TEST ANNUALLY ALL TANK CATEGORY : OTHER SENSORS TYPE:
DEC WEEK 2 WED STANDARD
START TIME 2:30 AM NORMALLY CLOSED
TEST RATE :0,20 GAL/HR
DURATION 2 HOURS L 7:DIESEL STP TANK b: 1
TRI—STATE (SINGLE FLOAT)
TST EARLY STOP:DISABLED CATEGORY : STP SUMP
LIQUID SENSOR ALMS
j LEAK TEST REPORT FORMAT L I :FUEL ALARM
{ ' ENHANCED L 8:DIESEL FILL L 2:FUEL ALARM
TRI-STATE (SINGLE FLOAT) L 3:FUEL ALARM
CATEGORY : OTHER SENSORS L 9:FUEL ALARM
LIO:FUEL ALARM
1. . L11 :FUEL ALARM
L12:FUEL ALARM
Tkl-STATE (SINGLE FLOAT) ISD SITE ALARMS
LIQUID CATEGORY : DISPENSER PAN ISD GROSS PRES FAIL
_SE/VSGR SETUP ISD DEGRD PRIES FAIL
_ ISD VAPOR LEAK FAIL
TR7-87 ANlVULAR Y 1 L10:DISP 3-4 ISD HOSE ALARMS
I CATEGOATE <SINGI,E F ATJ TRI-STATE (SINGLE FLOAT) ALL:GROSS COLLECT FAIL
CATEGORY • ANNULAR LO CATEGORY DISPENSER PAN ALL:DEGRD COLLECT FAIL
SPACE
R2:91 STP
i L 2;87 STP L 1 1 :D I SP 5-6 /STANDARD
TRI-STATE (Sltur,LE F TRI-STATE (SINGLE FLOAT) NORMALLY CLOSED
CATEGORY STP SuIPLOHT) CATEGORY DISPENSER PAN
- TANK 0: 2
6
L 3:Cr7 FILL
CFRiT-STATE (SIhIGLE F L12:DISP^7-8 LIQUID SENSOR ALMS
EGORY LOATH TRI-13TATE '(SINGLE -FLOAT)
OTHER SENSORS L 4:FUEL ALARM ! ,
CATEGORY :'DISPENSER PAN L 5:FUEL ALARM
L 6:FUEL ALARM
r L q; L 9:FUEL ALARM
TL 1 TIESEL ANNULAR LIO:FUEL ALARM
CATEGORYE (SINGLE LII :FUEL ALARM
FLOAT) L12:FUEL ALARM
ANNULAR SPACE
ISD SITE ALARMS �.
ISD GROSS PRES FAIL I
TR s-9I E P( ISD DEGRD PRES FAIL
' CATE ORy SINGLE FLOAT) ISD VAPOR LEAP FAIL
STP SUMP
ISD HOSE ALARMS
ALL:GROSS COLLECT FAIL
ALL:DEGRD COLLECT FAIL
R 3:DIESEL STP
TYPE:
STANDARD
NORMALLY CLOSED
TANK 0: 3
LIQUID SENSOR ALMS
L 4:FUEL ALARM
L 7:FUEL ALARM
L 8:FUEL ALARM
L12:FUEL ALARM
SNIHRTSENSOR ISD FUEL GRADE HOSE MAP
S8TUp 1 2 3 4 f
FP MHH MHH MHH MHH AA ;
{ CATEGORP IA 2F17 Oi 101~901 201-U�U-y k-`-
FLOW METER 02 102 902 202 U U 4
2:DISP 3_4 03 103 903 203 U U 1
CATEGOp , FM 04 104 904 204 U U I ALARM HISTORY,' REPORT
AIR FLOW METER 05 105 905 205 U U 2
3•DISP 5_6 FM 06 106 906 206 U U 2 ----- SENSOR ~
CATEGORY 07 107 407 207 3 U 3 L 2:07 STP : ALARM
AIR FLOW METER 08 !08 908 208 3 U 3 8TP SIJIHP °
s 4:DISP 7-6 FM
CATEGORY AIR FLOW METER LABEL TABLE
_
s 5:PRESS SENSOR 1 :-UNASSIGNED -+----�-
CATEGORY VAPOR Pp
Eti$URE 2: BLEN03
3: REGULAR
4: MID GRADE
5: PREMIUM
7' BRONZE * " END
8: SILVER ; i
9: BLEND2
` 10: BLEND4
f
r
i
I
ALAF.I`1 HISTORY REPORT
EVP.:ISD SETUP SENSOR ALARM
PMC SETUP i L -3:87 FILL
OTHER SENSORS
EVR TYPE: VACUUM ASSIST PROCESSOR CONTROL LEVEL:
VACUUM ASSIST TYPE NONE
HEALY VAC
NOZZLE A/L RANGE
MAX: 1 .15 MIN: 0,95
VAPOR`PROCESSOR TYPE
NO VO POR 'PROCESSOR
END x x
ANALYSIS TIMES SOFTWARE REVISION LEVEL
+ TIME: 9:59 AM VERSION 327.04
J DELAY MI( UTES: 1 SOFTWAREO 346327-100-E
CREATED - 07.02.06.10.28
4 {
ACCEPT HIGH ORVR: S-MODULEq 3301bt]-004-a
DISABLED SYSTEM FEATURES:
PERIODIC IN-TANK TESTS
j ISD NOSE TABLE ANNUAL IN-TANK TESTS
I- FP FL -- AA RR-- PMC ALARM HISgTOR f REPORT
01 01- 01~-02- 04 UU SENS`O
02 02 02 02 04 UU L R PLARM
ANNULAR
--__
03 03 03 02 O1 OU 4:91-DIESEL APIULAR -
04 04 04 02 01 UU ANNULAR SPACE
05 05 05 02 02 UU
06 06 06 02 02 UU
07 07 07 02 03 UU
08 08 06 02 03 UU
ISD AIRFLOW METER MAP ALARM HISTORY REPORT
ID SERIAL NUM LABEL
------------------------ ----- SENSOR ALARM ---
1 8129 DISP 3-4 F L 1 :87 ANNULAR
2 13413 DISP 5-6 F ANNULAR SPACE
3 8132 DISP 7-8 F
4 0130 DISP 1-2 F
ALARM HISTORY REPORT
----- SENSOR ALARM -----
L 5:91 STP ALARM HISTORY REPORT
STP SUMP x 3i i ii iE END x
----- SE14SOR ALARM ------
L B:DIESEL FILL
OTHER SENSORS
END n 1
ALARM HISTORY REPORT
x A E14D x w w oE
----- SENSOR ALARM -----
LII :DISP 5-6
DISPENSER PAN
1
i
ALARM HISTOR; REPORT
i
----- SENSOR ALARM ---_-
L 6:91 FILL ALARM HISTORY REPORT
OTHER SENSORS * x END f ri
----- SENSOR ALARM ----- I
L 9:DISP 1-2
DISPENSER PAN
i
ri END
� 1
ALARM HISTORY REPORT
x x END x
----- SENSOR ALARM -----
L12:DISP 7-8 l
D I SPEIVSER PAN
t
i
ALARM HISTORY REPORT
-- SENSOR ALARM -----
L ?:DIESEL STP ALARM HISTORY REPORT
STP SUMP * ri END x
----- SENSOR ALARM ----- -
LIO:DISP 3-4
DISPENSER PAN ,
----- SENSOR ALARM -----
L 5:91 STP
c;ENyR ALARM ----- ; STP SUMP
r' L $:DIESEL FILL ----- SENSOR ALARM ----- FUEL ALARM
OTHER SENSORS L 6:91 FILL JAN 30, 2009 9:17 AM
SENSOR OUT ALARM OTHER SENSORS
JAN 30. 2009 10:02 AM SENSOR OUT ALARM
JAN 30. 2009 10:02 AM
i
u I -- -- SENSOR ALARM -----
tt L 6:91 FILL
t ' ----- SENSOR ALARM --- OTHER SENSORS
L 3:87 FILL ----- SENSOR ALARM ----- FUEL ALARM
OTHER SENSORS L 7:DIESEL STP :7, JAN 30, 2009 9:19 AM
SENSOR OUT ALARM S'I'P SUMP
JAN 30, 2009 10:02 AM SENSOR OUT ALARM
JAN 30. 2009 10:02 AM
f ----- SENSOR ALARM -----
L 4:91-DIESEL ANNULAR
-- SENSOR ALARM - f ANNULAR SPACE
L 5:91 STP - _---- SENSOR ALARM ---- FUEL ALARM
j` STP SUMP L 1 :87 ANNULAR JAN 3D, 2009 9:20 AM i
1 SENSOR OUT ALARM ANNULAR SPACE
JAN 30. 2009 10:02 AM ; SENSOR OUT ALARM
JAN 30. 2009 10:02 AM
f
i
-- SENSOR ALARM ----- I
I
-'--- SENSOR I. 1 :'87 ANNULAR ..
L 4:91-D ALARM ----- ANNULAR "8PACE -
IESEL ANNULAR ----- SENSOR ALARM ----- 4 FUEL• ALARM'
ANNULAR SPACE ( L 2:87 STP JAN 30. 2009 9:20 AM
SENSOR OUT ALARM 1 STP SUMP
JAN 30. 2009 10:02 AM SENSOR OUT ALARM
i JAN 30, 2009 10:02 AM
i
t
1
j
? � BROOKSIDE MARKET
--- SEI4SOR ALARM -----
L 3:87 FILL ----- SENSOR ALARM ----- r 8603 SFIELD MEDIA E
OTHER SENSORS BAKERSFIELD GA 93308
FUEL ALARM L SPE SE 1-2
JAN 30, 2009 9:21 AM I DISPENSER PAN
FUEL ALARM ; JAW 30. 2009 9: 13 AM
JAN 30, 2009 9:31 AM
I
SYSTEM STATUS REPORT
ALL FUNCTIONS NORMAL
SENSOR ALARM ------ ' +
L 2:87 STP -__-- SENSOR ALARM -----
STP SUMP L. 9:AISP
FUEL ALARM DISPENSER PAN
JAN 30, 2009 9:22 All 1 FUEL ALA M
JAN .30, 2009 9:32 All
i ----- SENSOR ALARM -----FILL
OTHER7SENSORS
4 SENSOR OUT ALARM
}}
JAW 30. 2009 9:43 AM
- SENSOR ALARM -----
L 7:DIESEL STP ----- SENSOR ALARM
STP SUMP LII :DISF 5-6
FUEL ALARM DISPENSER PAN
JAN 30. 2009 9:24 AM ; ! FUEL ALARM
!( JAN 30. 2009 9:35 AM
----- SENSOR ALARM -----
L 4:91-DIESEL ANNULAR
ANNULAR SPACE
SENSOR OUT ALARM
JAN 30, 2009 9:43 All
i
----- SENSOR ALARM -----
L12:DISP 7-8 ----- SENSOR, ALARM
DISPENSER PAN L1I :DISP 5-6
j FUEL ALARM DISPENSER PAN
JAN 30, 2009 9:28 AM FUEL ALARM !
JAN 30. 2009 9:35 AM
----- SENSOR ALARM -----
L 5:91 STP
STP SUMP'
SENSOR OUT ALARM
JAN 30, 22009 9:43 AM
--- - SENSOR ALARM ----- .
L10:DISP 3-4 ----- SENSOR ALARM ----- ;
DISPENSER PAN L B:DIESEL FILL
FUEL ALARM OTHER SENSORS
JAN 30, 2009 9:29 AM FUEL ALARM
JAN 30. 2009 9:40 All
----- SENSOR ALARM -----
L 6:91 FILL
OTHER SENSORS
SENSOR OUT ALARM
JAN 30. 2009 9:43 AM
- SENSOR ALARM ----- ! ----- SENSOR ALARM ----- OUTPUT RELAY SETUP
L 1 :87 ANNULAR LII :DISP 5-6 g - - - - - - - - - - - -
ANNULAR SPALfi DISPENSER PAN
SENSOR OUT ALARM SENSOR OUT ALARM R 1 :87 STP
JAN 30. 2009 9:43 AM JAN 30, 2009 9:45 All TYPE:
STANDARD
t NORMALLY CLOSED
j TANK a: 1
LIQUID SENSOR ALMS
L I :FUEL ALARM
L 2:FUEL ALARM
STP.SUMPEt+RTPLAktW ----- CISPENSER7FA ALARM ----- LIO:FUEL ALARM
SENSOR OUT ALARM S N L11 :FUEL ALARM �
JAN 30. '2009 9:44 AM
SENSOR OUT ALARM L12:FUEL ALARM
JAN 30. 2009 9:45 AM
ISD SITE ALARMLS
ISD GROSS PRES FAIL
ISD DEGRD PRES FAIL
ISD VAPOR LEAK FAIL
ISD HOSE ALARMS
ALL:GROSS COLLECT FAIL
ALL:DEGRD COLLECT FAIL
----- SENSOR ALARM ----- ----- SENSOR ALARM -
L 2:87 STP LI0:DISP 3-4 ---- R 2:.91 STP i
STP SUMP i DISPENSER PAN TYPE: r
SENSOR OUT ALARM SENSOR OUT ARM
JAN JAN 30. 2009 9:44 AM JAN 30. 2009 9:45 At°I NORMAL'L'Y-CLOSED
TANI! 0: 2
( LIQUID SENSOR ALMS
L 4:FUEL ALARM
L S:FUEL ALARM
L 6:FUEL ALARM
L 9:FUEL ALARM
-- SENSOR ALARM ----- BkUU}:SIDE MARKET L10:FUEL ALARM
L 8:D 1 ESEL FILL 8803 CAM I NU MEDIA L 1 I :FUEL ALARM
OTHER SENSORS BAKERSFIELD CA 93308 L12:FUEL ALARM
SENSOR OUT ALARM
JAN 30. 2009 9:44 AM ISD SITE ALARMS
JAN 30. 2009 9:46 AM ISD GROSS PRES FAIL
ISD DEGRD PRES FAIL
ISD VAPOR LEAK FAIL
SYSTEM STATUS REPORT ISD HOSE ALARMS
- - - - - - _ _ ALL:GROSS COLLECT FAIL
L 7:SEhl.SOR OUT ALARM ALL:DEGRD COLLECT FAIL
L 8:SENSUP OUT ALARM R 3:DIESEL STP
----- SENSOR ALARM ----- TYPE:
L 9:DISP 1-2 STANDARD
DISPENSER PAN NORMALLY CLOSED
SENSOR OUT ALARM
JAN 30, 2009 9:45 AM TANK 0: 3
LIQUID SENSOR ALMS
L 4:FUEL ALARM
L 7:FUEL ALARM
L 8:FUEL ALARM
L12:FUEL ALARM_
_.-TANK 0: 2
LIQUID SENSOR ALMS
L 4:FUEL ALARM
F L S:FUEL ALARM
OUTPUT RELAY SETUP L 6:FUEL ALARM
- - - - - - - - - - - - L 9:FUEL ALARM
LIO:FUEL ALARM
R l :87 STP ; L11 :FUEL ALARM
TYPE: L12:FUEL ALARM
STANDARD L 4:SENSOR OUT ALARH
NORMALLY CLOSED L a:SENSOR OUT ALARM
TA*,' L 6:SENSOR OUT ALARM
i L 9:SENSOR OUT ALARM
LtO:SENSOR OUT ALARM
LII :SENSOR .OUT ALARM
LIQUID SENSOR ALMS L12:SENSOR OUT ALARM
L I :FUEL ALARM
L 2:FUEL ALARM ISD SITE ALARMS
L 3:FUEL ALARM ISD GROSS PRES FAIL
L 9:FUEL ALARM ISD DEGRD PRES FAIL
LIO:FUEL ALARP? ISD VAPOR LEAK FAIL
LII :FUEL ALARM
L12:FUEL ALARM ISD HOSE ALARMS
L ' 'SENSOR OUT ALARM ALL:GROSS COLLECT FAIL
L ``SENSOR OUT ALARM ALL:DEGRD COLLECT FAIL
L 3:SENSOR OUT ALARM
L 9:SENSOR OUT ALARM R 3:DIESEL STP
L10:SENSOR OUT ALARM TYPE:
L11 :SENSOR OUT ALARM STANDARD
L12:SENSOR OUT ALARM NORMALLY CLOSED
18D SITE ALARMS TA14K u: 3
ISD GROSS PRES FAIL
ISD DEGRD PRES FAIL
ISD VAPOR LEAK FAIL LIQUID SENSOR ALMS
ISD HOSE ALARMS L 4:FUEL ALARM
ALL:GROSS COLLECT FAIL L 7:FUEL ALARM
ALL:DEGRD COLLECT FAIL L L12:;FUEL ALARM
FUEL ALARM
R 2:91 STP L 4:SENSOR OUT ALARM
TYPE: L 7:SENSOR OUT ALARM
STANDARD L 8:SENS-3R OUT ALARM
NORMALLY-CLOSED L12:5ENSOR,.OUT ALARM
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: Shell (Brookside Market) Date of Testing: 1/30/2009
Facility Address: 8803 Camino Media Blvd.
Facility Contact: Matt Jeffries Phone: 661-758-3072
Date Local Agency Was Notified of Testing : 1/22/2009
Name of Local Agency Inspector(if present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Matt Turner
Credentials: x CSLB Contractor x ICC Service Tech. SWRCB Tank Tester Other(Specify)
License Number(s): 804904, 8004564-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 Test#1 4 Diesel Test#2
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" 12" 12" 12"
Bucket Depth: 14.5" 11.0" 14" 14"
Wait time between applying 5 min. 5 min. 5 min. 5 min.
vacuum/water and start of test:
Test Start Time(Ti): 9:15 am 9:15 am 9:15 am 9:15 am
Initial Reading(Rj): 8.5" 8.25" 7.5" 7.5"
Test End Time(T* 10:15 am 10:15 am 10:15 am 10:15 am
Final Reading(RF): 8.5" 8.25" 6.0" 7.5"
Test Duration(TF—Ti): 1 hour 1 hour 1 hour 1 hour
Change in Reading(RF-Rj): 0.00" 0.00" 1.50" 0.00"
Pass/Fail Threshold or 0.0625 0.0625 0.0625 0.0625
Criteria:
Test Result: x Pass Fail x Pass Fail Pass x Fail x Pass Fail
Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests)
Following Diesel Spill Bucket FAIL, replaced spill bucket and retested. Test#2 PASSED.
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information conta'ied in this report is true,accurate,and in full compliance with legal requirements.
Technician's Signature: Date: 1/30/2009
State laws and regulations do not currently require testing to be performed by a qualified contractor. However,local requirements
may be more stringent.