HomeMy WebLinkAboutFMC 2011 MONITORING SYSTEM CERTIFICATION 09
For Use By All Jurisdictions Within the State of California IE
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
Facility Name: Shell (Brookside Market) Bldg.No.:
Site Address: 8803 Camino Media Blvd. City: Bakersfield Zip: 93311
Facility Contact Person: Matt Jeffries Contact Phone No.: 661-496-7006
Make/Model of Monitoring System: Veeder-Root TLS-350 Date of Testing/Servicing: 01/18/2011
B. Inventory of Equipment Tested/Certified
Check the appropriate uses to Indicate specific equipment inspectedlw,,Iced:
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: 794380-420
[x] Piping Sump/Trench Sensor(s). Model:794380-208 [x] Piping Sump/Trench Sensor(s). Model: 794380-208
[x] Fill Sump Sensor(s) Model:794380-208 U Fill Sump Sensor(s). Model: 794380-208
[x l Mechanical Line Leak Detector. Model:FX1 V [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:OPW-6I-SO U Tank Overfill/High Leval Sensor. Model: OPW-6I-SO
❑ 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:
[x] 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:
[x] Mechanical Line Leak Decector. Model:FX1 DV ❑ Mechanical Line Leak Detector. Model:
❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model:
[x] Tank Overfill/High Level Sensor. Model:OPW-6I-SO E] 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: 112 Dispenser ID: 3/4
M 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: 516 Dispenser ID: 718
[x] Dispenser Containment Sensor(s).Model: 794380-208 Lx] Dispenser Containment Sensor(s).Model: 794380-208
t [x] Shear Valve(s). U Shear Valve(s).
❑ Dispenser Containment Float(s)and Chams(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) Q SV, Set-up (x]Alarm sto re ort
Technician Name(print): Bryan A Self Signature:
Certification No: B37501 License No: 804904
Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930
Site Address: 8803 Camino Media Blvd,Bakersfield,CA 93311 'late of Testing/Servicing: 0111812011
IIIIIIIIVIIIIIIIIII 10
IE
D. Results of Testing/Servicing
Software Version Installed: 327.04
Complete the following checklist:
Cx] Yes ❑ No* Is the audible alarm operational?
x Yes No* Is the Visual alarm operational?
x I Yes I I No* Were all sensors visually inspected, functionally tested, and confirmed operational?
Yes 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?
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? U Sump/Trench Sensors[X]Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? [X] 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? 90 %
❑ Yes* ❑ No Was any monitoring equipment replaced?If Yes, identify specific sensors,probes,or other equipment
replaced and list the manufacturer name and model for all replacement parts in Section E,below.
❑ Yes* No Was liquid found inside any secondary containment systems designed as dry systems?
❑ Product; ❑ Water. If yes,describe causes in Section E,below.
Lx_I Yes I I No* I Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable.
LxJ Yes 1 0 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' I replaced both the Diesel and the Super fill sump sensors 794380-208. 1 also Replaced the Diesle S.B.
F. In-Tank Guaging/SIR Equipment: 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 termination,including testing for ground faults?
x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
x Yes D No* Was accuracy of system product level readings tested?
x Yes No* Was accuracy of system water level readings tested?
rxj Yes No* Were all probes reinstalled properly?
E 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: Lx]3 g.p.h.: ❑O.I g.p.h.; 70.2 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?
❑ Yes No For mac amca 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?
Lx] 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 7 No* For electronic LLD's,have all accessible wiring connections been visually inspected?
U 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:
SYSTal SETUP
00MHUNI CAT IONS•SETUP
JAN 48, 200 8.'34 AM - - - - - - -
BROUS I DE MARKET Pon-qEtt,!NGs:,
8803 'CAM I ND MED'i A 9.'WEM UNITE;
BAKERSFIELD C4 93308 U.S, COMW 60ARD 1' (EDIK
"t-EM R!:-0-2.,SErURTtY -
aNGLISW 'ODE - b §49LED
2011 8:34 AM SYSTEM VATE/TI,HE FORMAT
MON 1)D; Y�W HH:MH:S9, ;Y;m C"�BOARD; :- 2 4RS-231)
GAUD�,,p -
AT E,
900)09 IbE MARkIETI Pw.TY :NONE;
SYSTEM STATUS REPORT, 6803 F4MINO MED'IA STOP BIT !�T6P
gtF I tl_b�;C4 13308
BAKE DATA-LENGTH!",8 '6ATA
ALt FUNCTIONS NORMAL
Cbbt 61'SABLED
I NVEPITORY RUORT SHIPT T(HE f �2,-'00 AM
SH,lVt TIME 2
SHIFT tLMt :3* D-I)&I)Ltl) .AUTO TRANSMIT SETTINGS'
T I :UNLEADED SHIFT' TIME bISA 'Eb
VOLUME 15958 GALS -AUTO.- Z%Z ALAFM .L,IMfT
ULLAGE 4124 CAL$ TANK i.PER TS1. NEgDED !URN biSABLED ".
' 0' U-L G.E -A T6:''H Q All'
,E ;'AU TGR,WA1,80 L
T o� v 15961 GALS 'TANK ANN, TST NEEDED WRN 1 1:AUTO A L b�.. ., -1 - -j:T
HEIGHT 94.49 INCHES �,Dt§AgL96, AUTO"' ' OVEi "ILL 11-IMIT
WATER voL `7 GALS Dlj_. '.,L ."''
WATEP. F33 INCHES LINE RE-ENASLE METHOD PRODUCT
TEMP 59.7 bw p L-14 tiif, D
AUTO;THEt" Limi-Y
Ll PIE' PEWTST` NF81)EIVWRN D,I SABLED
T 2:PREMIUi Zll 6AALED, AUTO 'DEUVVY 79TAR-T
AUTO
VOLUJ,iE• - 10207 GALS 'Ll NE� ANN; TST NEEDED WRN �4 'ED
ULLAoe 01
- 11334 �;ALS 'El(SAgLtlil kAOTO,.:)EL IVERY ,END
qDy ,ULLAGE 629 GALS
, ' DIS ABLED
.E D TO V6_U�8 10202 CAS PR VOLUMES AUTO
ERNAI INPUT,ON.
HEIGHT -100-71 1 PICHES ENkBi-r!) D I BAB-m
,WAM VOL - 19 CAM AUTO`:-EX MKAL:INPUT OFF
WATER - 0.77 INCHES TEMP COMPENSATION WSABLED "
TEMP 60;7 DEC F' VALU9 (.tiF-(j F 60:0• 'AUT,6t$ENSOR_PU9L ALARM
STI'OK •HE'J' F D;ISAB ,ED
.OKT, 6 'F80" L , '"
-'ril'SABLED. AUT�. SEN90R- WATERT,ALARM
T 3:DlgSEL ULL� 4QN DISABLED
VOLliflE - .3561 CALL AUTO SENSOR OUT ALARM ULLAGE - 4466 GALS H�MOTOWL. DATA FORHAV 1)18�1)415
909 ULLAGE- 3663 GALS HEI Gl#
TO VOLUlE - 3595 GALS DAN'LIGHT SAVING T-WE
'HEIGHT - 58.1orINCHES ENABLED
WATER VOL - 0 GALS -91TIM.W DATE WATER ft 0-q0 INCHES WMY, I SUN
TEMP a
63.7 DEG F ,START T
".2:;00 f�mf
EP16 mtt
I" 'K 1( END -OCT WEE: 6 SUN F,3-232 ,END ,OF'MESSAGE'
END -T.I ME 1)1 SABLED,
"AM,
.RE'-UPECT 'LWAL PRINTOUT
'8URO PWTOW- L PREF04
etZTEM-SECUR I TV'
CODE *.. ac000b
MAINTENANCE' HIST09i'
'TANK; CHA$T SEOUPiTY
DiSkmtil
'.'GUSTOM, ALAPK9
D,1109LEb,
11 i'9AI3LED
I N-TANY SETUP T 2:PREMI UM: T'3:D,1ES8L
` - - - - - PRODUCT CODE 2 WlillC;T (-'-ODE 3.
THERMAL;COEFF : .:0007Q0 NbOlAL' tOEF,F' : •000450,
T 1 :UNLEADED TANK D IAMETRR TANK DIAMETER (27-:515
PRODUCT CODE I TANK PROFILE 1 PT.` TANK ,PPOOILE' t: PT
THERMAL COUP : .006100 �FULL.'VOL. 120.41 FULL-'VOL `; !'027
TANK. DIAMETER .127.50
-fAhK'. PROFI LE I PT
FULL VOL. 20082 FLOAT S I CE,: 4-01 LN., FLOAT'S 1'213':' 4.0 I.N.
WATER.WARN ING 2.0, WATER'.WARNING 2'0.0-FLOAT ,siu: 4.0 IN. HIGH WATER LIMIT: 3.A� H.IGH WATER LIMIT': 3,0'
WATER WARNING 2.0 MAK'OR LABELAjOL: 1'9041 MAX,,OR LABEL VOL:' 8027
'H t GH WATER LIMIT,:- 3.0 OVERFILL L I M1 T, 90=t, OVERF:11L
L I'MI T 901
1;0807 7224
,.MAX OR LABEL VOL: '20082 i1GH PRODUCT ItGH PROL401 45?OV£RFI LL L I M I T 90%
t X39, 7625.
18073 1551.19ERY. 1,1"1117 : 10Y. ' y,
H I r;H PRODUCT 95: a DELIVERY' L-1'11I T 1?0
1'20:4 502
19078
DELIVERY L'1M:'1T 1010 LOW PRODUCT : 500: LOW,PRODUOT 500
2008 LEAK ALARM L 1 M 1 T 99; LEAs. ALr�Rw ;L 1 M I`t' O9:
LOW PFODUC:T 500 SUDDEN LOSt� L 1 rpl,I T4' 50` SUDDEN LG$s LIMIT: 60
TANK 7 i 1 T' i..,G4. TANK TAI LT p.,150
` PRO3E, OF G LEK ALARM LIMIT: 9.9 P 61JE'OFFFET 0.'00
SUDDErd LOSS
LIMIT: 50
TriNK. TILT 0:00
PROBE OFFSET 0:00 ,I`PHON I IAN I POLDED 'RANKS $1,
I,PHON MAN,I FOIrDE1?`T-AN
TO,: HiOlId TO NONE
S 1.PHON MHN 1 EO;1 DED. TANKS' U NE 'MAN(FOLDED''TA.NKS L I NE 'MAN IFOLDI,rD IANK�3
TI►:: NONE T,p_. IaON6
TO: NONE_
L'1 NE MANIF.OLDED TANKS
'TO: NONE LEAK MIN PERI'ODfQ: I'OIS LEAK MIN PERd:0D:1C a,ON,
. 1 2'04' 6152.
-LEAK MI.N PERIODIC: 1'0% LEmY MIN .NNNUAL 1,004. LEAK MIN ANNUAL. ; I,M
200103 1204 802
-LEAK' III N ANNUAL I'=
2008 PER 1'OD I C: TEST TYPE: PE171061,G TEST TYPE
sTAN13ARD -:STANDARD
PER I OD.I C: TEST TYPE ANNUAL TEST FATL.,,. ANNL(AL TEST•FA I;L.
8TA14DARD AI ARM( ,D,I Sl?fi1 b'C► ALARra''D LSABLED.
ANNUAL. TEST FAIL PER1 OD,I G TEST.1FA I L PER LOD 1 C TE.gT"FA'I,IL
ALARM Ill'SADL:ED AI.AI�M 0[;SAI3LED f1LARM: iISABLED.
PERIODIC TEST FA 1 L. Gl?OSS"r> 5T ,PA I 1 GROSS..TEST: FA I G, .
ALARM DISABLED ,'ALARM Df M31 EQ.. ALAR(I �G I SABLM
GROSS TEST FAIL ANN TEST AVtkAdING:' 0FE' ANN TEST. AVERAGING: OFF'
HLARM D 18ABLED PER TEs1 AVERA6 N6:. OFF PEi TEC37. AVI RAC:(IVG: OFF
A14N TEST AVERAGl,NG OFF. TANK TEST
IV TANK TEST NOTIFV" OFF;
PER 'TEST' AVERAGIN!J: 'OFF OI
Ttv> TST'`5I'I?MOrJ, f1FE I�, vFF TNK, TST'y1:P.HON BREAK-:,OFF
TANk: TEST NOTIFY: OFF
11ELt VERIf D4LAY : 15, 11,1,111 DJEO VER`� t ELA`! 15 MIN
T1VK TST �'IPH'JN HIS£Ak:':OFF FsUNP TFIRE5ki4LD: 10..00.10 PUMP`T.,HRESNOLD 1,0.011°e.
DELIVERY DELAY 1.5 MIN
PUMP THRESHOLD 10.00y-
LEAK TEST .CIETHOD`
TEST•ANNUALI:Y: ALL 'TANK
''DEt WEE'1t` 2' 'WED., ...
START :T1+1E 2.:30,AM:
TES`f RATE 0.,20�..:GALiNR
DWRAT I-ON i 2' IiOURS
TST EHRLY.STOP ,D:ISABLED.
1 EH1 t RST.REPORT''FORMAT'
fi!!t1,�ANCED
1 DSEPJSGRSETUP
- - - -
- - - OUTPUT RELA`! SETUP
L I :87 ANNULAR R 1 :87 STP
TRI-:STATE (SINGLE FLOAT) TYPE: cA*IARTSENf;OR SETUP
CATEGORY : ANNULAR SPAi:E STANDARD - - - - - - - - - - - -
NORMALLY CLOSED
s 1 :D l SP 1-� FI.1 '
L 2:8 7 STP
TANK 0' 1 CATEGORY AIR FLOW PIETER
TRI-STATE c S I Ni:;I.0 FLOAT) 3 2:D ISP 3-4 Fhl
CATEGORY : STP $UmP LIQUID SENSOR ALMS CATEGORY AIR FLOW PIETER
L I :FUEL ALARM s �:GISP 5-6 FM
L 3:87 FILL L c:FUEL AUiRM C:ATEGORY AIR FLOW PIE"TER
TRI-STATE (SINGLE FLOAT) L 9:FUEL ALARM
C:ATEr;ORY : OTHER SENSOR`S L I 0:FUEL ALARM a a:D I SP 7-8 FM
L11 :FUEL ALARM
L12:FUEL ALARM CATEGORY AIR FLOW METER
L 1 :SENSOR OUT ALARM
L 2:SENSOR OUT ALARM s 5:PRES!t3 SENSOR
L 4:91-DIESEL ANNULAR CATEGORY VAPOR PRESGURE
TRI-STATE (SINGLE FLOAT) L 9:SENSOR OUT ALARM
CATEGORY : ANNULAR SPACE LIO:SENSOR OUT ALARM
LII :SENSOR OUT ALARM
L12:SENSOR OUT ALARM
ISD SITE ALARMS.
L 5:91 STP ISD GROSS PRES FAIL
TRI-STATE (SINGLE FLOAT) ISD DEC-RD PRES FAIL
CATEGORY : STP SUMP ISD VAPOR LEAK FAIL
L 6:91 FILL 1 SD HOSE ALAPPIS
TR 1 ALL:GROSS COLLECT FAIL
� rt .
CATEGORY : OTHER :TENSORS ALL:DEuRD COLLET=T FAIL
R 2:91 STP
TYPE:
L +:DIESEL STP STANDARD
TRI-STATE (SINGLE FLOAT>
NORMALLY CLOSED
CATEGORY : STP SUMP TANK 4: 2
L S:D 1 ESEL FILL LIQUID SENSOR ALPIS
TRI-STATE (SINGLE FLOAT) L 4'FUEL ALARM
CATEGORY : OTHER SENSOR: L 5:FUEL ALFiRM
L 9:FUEL ALARM
LIG:FUEL ALARM
L 9:D15P 1-3 LII :FUEL ALARM
L12:FUEL ALARM
TRI-STATE (SINGLE FLOAT) L 4:SENSOR OUT ALAR11
CATEGORY : DISPENSER PAN L S:SENSOR OUT 'ALARM
L 9:SENSOR OUT ALARM
LIO:SENSOR OUT AL.ARH
LIC):DISP 3-4 LlI :SENSOR OUT ALARM
L12:SENSOR OUT ALARM
TRI-STATE (SINGLE FL(N�T.)
CATEGORY : DISPENSER PAN is[, SITE F+LARP98
ISD GROSS PRES FAIL
ISD DEGRD PRES FAIL
LI1 :DISP ,-E ISD VAPOR LEAF FAIL
TRI-STATE (SINGLE FLOAT, ISD HOSE ALARMS
i:ATEGOR:' DISPENSER PAN ALL:GROSS COLLECT FAIL
ALL:DEGRD COLLECT FN 1 L
R 3:DIESEL STP
L12:DISP 7-8 TYPE:
TRI-STATE (SINGLE FLOAT i STAI&+ RD
CATEGORY : U I SPEPISER PAP) NORMALL';' CLOTTED
TANK 0: 3
LIGU1D SEVISOR ALMS
L 4:FUEL ALARM
L 7:FUEL ALARM
L 1 2=FUEL ALARM
L I:SENSOP OUT ALARM
L 7:SENSOR OLIT ALARM
L12:SENSOR OUT ALARM
AL✓iRM HISTORY' REPORT
Pt-1C; SETUP
----- -
PROCESSOR CONTROL LEVEL: ---- 1 tJ-TµNK ALARM
EVR TYPE' VA(_.UU1 ASSIST NONE T 2:PRBh11 UM
VACUUM ASSIST TYPE
HEAL`f VAC; OVERFILL ALARM
JAN 17, 201'1 11 :06 AM
M)ZZLE A/L RANGE JAN 13. 2011 9:46 AM
MAX: 1 .15 MIN: 0.95 DEC 3, 2010 9:53 AM
VAPOR. PRO(:ELK' TYPE HIGH PROGUG7 ALARM
NO VAPOR PROCESSOR DEC 28. 2009 9:35 AM
OCT 29. 2009 .5:32 AIM
AIVALYS,15 TIMES SOFTWARE REVISION LEVEL DEC 18.. 2008 1.0::43 AM
TIME: 10:00 AM VERSION 32'7..0'4
TIME: 10:00 A 1 SOFTWAR80 546327-1'00-8
DELAY CREATED - 07.02.06.10.28
ACCEPT HIGH 0�1fR: S-MODULEtt 3 0i6o-004-s
SYSTEM FEATURES:
DISABLED PER 1 OD I G IN-TAME TESTS
ANNUAL 1N-TANK, TESTS
ISD HOSE TABLE ISD
ID FP FL HL AA RR PMC
01 01 O1 02 04 UU fi r: '3F A END 'x, sc R' k
02 02 02 02 04 UU
a3 03 03 02 01 UU
04 04 04 02 01 UU
05 05 D5 02 02 UU
06 06 06 02 02 OU
07 07 07 02 00 UU
08 08 08 02 03 UU
1 SG A 1 RFLONi METER MAP
µLAFM HISTORY RE PIr T
iG SERIAL NUM LABEL_ ---- IN-TAi0: ALARM -- --
1 x31'25-- ----DISP 3-4 F ALAPH HI.S•1JR;'' REPGRT
2 1.3413 DiSP 5-6 F T 1 :UNLEAEE(J
---- I'N-TAfVf; ALARM -----
3 8132 D I SP 7-8 F OVERT:l LL :ALARM
4 8180 D I SP 1_2 F JAN .17. "Oil 17 ::08 AM T 3;:D I ESEI,
JAM C3, 2011 9:29 AM
ISG FUEL GRADE HOSE I f, 201.1 .1025 041 OVERFILL ALARM
r JUL- 22, 2010 '9:49 AM
1 t 3 4 H 1(�H PRODUCT HLr+kP1 NAY 21 , 200 2:56 PH
FP-MHH-IMHH-1MHH I_1HH-HAY-- NOV 4. '2010 6:30 AM APR, 12, 2010 1'0:43 AM
01 101 901 201 U U 4 SEF'' 25. 2010 4 '27 AM
02 102 902 ^02 U U 4 JUL 27, 201;0 6:-25, PM H1:GH PRODUC.f ALARM'
03 103 903 203 U U I JUL 2, '2008, 1:25 PM
04 104 904 204 U U 1
05 105 905 205 U U 2
'06 106 906 206 U U 2
07. 107 907 207 3 U 3
08 100 900 200 3 U 3
LABEL TABLE
r
1 : UNASS C;
INED
2: BLENC13 ` x E(uG ii 3t it -it
3: RErULAR �i END
4; MID GRADE
'5: PREMIUM
6': GOLD
7: BRONZE
8: SILVER
9: BLEND2
10: BLEND4
ALARM HISTORY REPORT ALOPM HISTORY REPORT ALARM HISTORY. REPORT
----- SENSOR ALARM ---- - -- SENSOR ALARM - --_ ----- l�ENSOR 14AOI --
L 1 :67 ANNULAR L 3:87 FILL, L 5:91 STP
A1414ULAR SPACE OTHER SENSORS STP SUIMP
SENSOR OUT ALARM FUEL ALARM SENSOR OUT ALARM
JAW 28. 2010 9:29 FPM JAN 28, 2010 It :35 t-l-1 JAN 28. 2010 9:29 AM
FUEL ALARM FUEL ALARM FUEL ALARM
JAN 28. 4010 9:28 AM JAN 28. 2010 11 :35 AM JAN 29, 2010 9:20 AM
SENSOR OUT ALARM FUEL ALARM FUEL ALARM
JAN 19. 2010 9:30 All JAN 28, 2010 11:30 AM JAN 19. 2010 10:12 NM
x r ; 'A END 3t k a s x a = R ENE' d at fi i$, x k K END # iF
ALARM HISTORY REPORT ALARM HISTOWI REPORT ALARM HtST412`l REPORT
-- SENSOR ALARM ----- ----- SENSOR ALARM -- -- _.__- 8RNSOR ALARM -----
L 2:87 STP L 4*91-DIESEL ANNUI.FIR L 6:91 FILL
STP SUMP ANNULAR SPACE 0TVAER SENSORS
SENSOR OUT ALARM 8114SOR OUT ALARM SENSOR our ALARM
.IAN 28. 2010 9:29 Art JAN 28. 2010 4:29 Wl JAN 28. 2010 9:29 'Art
FUEL ALARM FUEL ALARM FUEL ALARM
JAN 28, 2010 9:19 AM JAN 28, 2010 9:27 AM JAN 28, 2010 9:26 HM
FUEL ALARM SENSOR OUI' ALARM SENSOR OUT ALARM
JAN 19. 2010 9:41 HMI JAtl 19. 22010 9:31 k-1 JAN 1'9. 201'0 9:30 Am
END K A Y. ENO sE 'r ie i Q h Sd A w END w
ALARM HISTORY P.EPORT ALARM HISTORY REPORT
-- SERGOR ALARM -- -- -- SENSOR R19 -----
L B:DIESEL FILL R ALA
W1
S
OTHER SENSORS DISPEI�EP PAN-
SENSOR OUT ALARM SEsNSOR.OUT ALAR1h
JAN 28, 2010 9:..9 AM JAN 29. 2010 9:29 All
ALARM N1STOPY REPORT
FUEL ALARM
JAN 28, 2010 9:26 AM FUEL ALARM — :-- SENSOR ALARM -----
JAN 28.. 2010 9:.21 HI L)2:DISP 7-6
FUEL ALARM SENSOR OUT ALARM 61SPEWER PAN
JAN c8• 010 9:24 AM SENSOR OUT ALARM
JAN 19. 2010 9:10 AM JAN 28, 2010 9:29 AM
FUEL ALARM
JAN 28, 2010 9:22 AM
FUEL; 'ALARM
JAM 19. 2010 10,:25 Ail
is k n ENE
w ii END. * f• R
ALARM HISTORY REPORT ALARM HISTORY REPORT
r -- SENSOR ALARM
L 9:DISP 1-2 ----- -- SENSOR. ALARM
Lll :D1S E S R -----
DISPENSER PAN DISPENSER PAtd
SENSOR OUT ALARM SENSOR OUT ALARM
JAM 28. 2010 9:�9 Art JAN 28. 2010 9:29 rVl
FUEL ALARM
JAN 28, 2010 9:21 AM FUEL^ALARM
201.0 5:23 All
BEPISOR OUT ALARM SENSOR OUT ALARM
i
JAN 19. 010 9:30 Am JAN 19. 2010 9:30 Hhl
t ri END' l io n
ENLr.
T 2:PREM[UM
-rte I N-TANY. ALARM ---" 1 WeNTOR`: i NCREASE
I :UNLEADED I INVENTORY IN
'ROBE OUT 1 NVENTORY 1 tvt`A.EF►S1:
INCREASE START
(AN 18. 201 1 9:1 1 AM l NCf2F..ASE START Ja14 18$ 2614 9:'24 Hr1
JAI'S 03. 2011 9:1:3 Art
T 2: [NVALIt1 FUEL LEVEL '
VOLUME - 11454 GALS. VOLUME 4778 GALS
HE[uHT - 70.81 INCHES HEIGHT a 53.17 INCHES
WATER - 22.02 1 NGHP-S WATER - 45.78, 1 NCHES
TEMP - 58'..7 UEG F TEMP - 53.2 DEG F
INCtREASE END INCREuSE END
---- IN-TANK ALARkl ----- JAN I8.• 2011 J:'.n Ah J/:1N 181. 20IJ 9.41 AM
T 2:PREII I Uil
PROBE OUT VOLUME t3191 GALS VOLUME - 7548 GALS
JAN 18, 2011 9'17 AM HEIGHT - 79.62 1 NCHE9-- HEIGHT 76.20' I.NGHES
WATER - Id 100 I�NGHES WATER - 0:.92 'J NrHEt
TEMP 58.3 DEC F TEMP 52•19 PEG F
CROSS INCREASE- 1737 GROSS 1NGREASEs 2730
TO NET TPICREASE- 1.742 TO NET I NCREASEb '2744
---- 1N-TANK ALARM ---`-
T 2,PREM i UM
INVALID FUEL LEVEL
JAIL 18; 401 f 9:18 All
_- 88wiok ALARM ----- tiROOKSI.GE MARKET
L B:D 11 E,SEL F 1 LL '8603 CAM I NO ME01 A
OTHER SENSORS HAKERSFIELA CA 93308
SENSOR OUT ALARM
�- IN-TANS ALAPI.1 --- - ,IAN t 8 201 1 '9:29 AM
T�n:GIaim. JAN .1'8• 2011 9:41 A11
Pt ODE OUT.
JAN 18. 2011 1, 9:19 Oki
SYSTEM STATUS REPORT
L B:FUEL-ALARM - - - - -
L 8*18SEL FILL
_ OTHER SENISOR:3
-- 1 P1-Ts;Ni µLr�F.r°l ----- SENSOR OUT ALf&'l
T 2:i>P.Cirl i UM JAN i 8. 2011 9:39 NI1
wlr;Fl WATER ALAkm
JAN 18. 2011 9:22 Art
-- ISO SITE ALARI
i Stl GROSS WE; WARN
JAN '16 2011 1:0.'02 kM
----- Stl`20R f4ARI.1 -----
IN-THM1: gLHkl`I -- - L 8:D1ESEL FILL
T -- 111r11,Ur�I OTHER SENSORS
RICH WATER' WARNING JAN S.A20
:JAN 1`9; 2011 9:22 Art JAN 18. .O1-t 9:40 AI�1
BROOKS]DE MARKET'
7' 3:DIESEL 8803 CAM INO MEDIA
1 WE14TORY I NGPEASE BAKEh'SF I ELD CA 93308
IW.:REASE START ----- SENSOR ALARM — JAN I8, 2011 10:36 AM
JAN 18. 2011 9:20 AM L 4:91—D I ESEI. ANNULAR --
VOLUME - 2701 GALS ANNULAR SPACE
HEIGHT A 47.18 INCHES FUEL ALARM
WATER - 35.62 INCHES JAN 18. 2011 10:30 (-IM SYSTEM 'STATUS REPORT
—
TEh1P - 63.5 DEC F L 6:FUEL ALARM
INCREASE END ISD GROESS PRES WAR14
JAN 18. 2011 10:03 AM
VOLUME - 5789 GALS
HE 1 r.:HT - 86.38 INCHES
WATER - 0.00 INCHES
aANNUL ALARM
TEI'1P - 51 .3 DEC F ---
L-1 :07 ANNULAR
ANNULAR SPACE
GROSS INCREASE- 3088 FUEL ALARM
TG NET INCREASE= 31 15 JAM 18. 201 1 !0::�I rN°1
----- SENSOR ALARM -----
L►I :DISP 5-6
DISPENSER PAN
FUEL ALARM
JAN 18. 2011 10:40 AM
--�-- SEr15c3R HLwRi1 -----
L 3:87 FILL
OTHER SENSOR;
-- SENSOR ALARM ----- FUEL ALARM
L-6:91 FILL JAN 16. 2011 10:32 AM
OTHER SENSORS ----- SENSOR ALARM -----
iUEL ALARM
JAN 18. 2011 10:17 HI'1 L 5:DISPENSER I R P A
p1v
FUEL ALARM
JAN 18, 2011 10:41 AM
----- SENSOR ALARM -----
L 2:87 STP
STP SUMP
—- SENSOR (ALARM — FUEL. riLARM
L 7:I)I ESEL STP JAN IS- !Oil 10:33 AM
STP SUIP — SENSOR ALARM -----
FUEL ALARM L10 DISP 3-4
JAN ►8. 2011 10'24 All DISPENSER PAN
FUEL ALARM
JAM 19, 201I 10:42 AM
----- SENSOR ALARM -----
L 8:DIESEL FILL
OTHER SENSORS ----- SENSOR ALARM -----
FUEL ALARM L12:DISP 7-8
JAN 18. 2011 10:26 riM DISPENSER PAN
FUEL ALARM
JAN I8. 2011 10:42' AM
---- SENSOR Af-i01 --~--
L 5:91 STP
STP SUMP
FUEL ALARM
JAN IS. 201 1 10:27 AI'1
• seoa cr�rrrr�MF�r rA ._--_ ��
BAKERSFIELD CA 9330,
BROOKS IDE MARKET
JAN 18. 2011 10:45 Ahl 8803 CAMINO MEDIA
BAKERSFIELD t:A 93306
----- SENSOR ALARM -----
L B:DIESEL FILL
S,,-'REM STATUS REPORT .IAN 19. 2911 10:45 AM OTHER SENSORS .
SENSOR, OUT ALARM
L 6:FUEL-ALARM - - - JAN 18, 2011 10:45 MM
I SD (;ROSS PRE$ WARN SYSTEF'1 STATI.IS REPORT
L I :SENSOP. OUT ALARM
L 2:SENSOR, OUT ALARI^1
L 3:SENSOR OUT ALARM
L 6:FUEL ALARM BROOKSIDE MARKET
8803 C'AM I NO PIED I A
L 7:SENSOR OUT ALARM BAKERSFIELD CA 93308
----- SENSOR ALARM -- -- ISD GROSS PRES WARN
1. 1 :87 ANNULAR 'JAN 18, 2011 10:.15 AM
ANNULAR SPHC'E
SE14SOR OUT ALARM
JA" 18. 2011 10:45 AM SYSTEM STATUS REPORT
L I :SENSOR OUT ALARM -
L 2:SENSOR OUT ALARM
L :3:SENSOR OUT ALARM
----- :TENSOR ALARM -----
L 3:87 FILL L 4:SENSOR OUT ALARM
--�-- SENSOR ALAR11 ---••- OTHER SENSORS
L 7:DIESEI. STP SENSOR OUT ALARM L 5:SENSOP, OUT ALARM
STP SUMP JAN 18. 2011 10:45 µti
(SENSOR OUT MLARM L o:SENSOR OUT MLARM
.JAN 1S. 2011 10:45 All L 7:BENSOR OUT ALARM
L 8:SENSOP. OUT ALARM
ISD GROSS PRES WARN
----- SENSOR ALARM -----
L 4:91-DIESEL ANNULAR
-- SENSOR FALAP.M ----- ANNULAR SPACE
L 2:8? STP SENSOR OUT ALARM
STP SUMP JAN 18. 2011 10:45 All
SENSOR OUT ALr RM
JAN 18, 2011 1 0:45 At'1
-—-- SENSOR ALARM -----
L 6:91 FILL
OTHER SENSORS
FUEL ALARM
JAN 18. 2011 10:46 Am
----- SENSOR +ALARM - ---
L 5:91 STP
STP SUMP
SENSOR OUT ALARM
JAN 1B. 2011 10:45 AM
----- SENSOR ALARM -----
L 6:91 FILL
OTHER SENSOR;
SENSOR OUT ALARVI
JAN I8. 2011 10:45 AM
BROOliS I DE rihARi(FT
BPOOYS 1 DE MARXET 8803 CAM I NO MEDIA
8803 rAM I N0 19BL)7 A BAKERSF 1 ELD CA 93308
BAY.EPSF 1 ELI) CA 93308
JAN 18. 2011 10:58 AM
JAM 18, '01 1 t 0:5U AM
SYSTEM STATUS REPORT
SYSTEM STATUE REPORT _ _ _ _ - .. ._ _ _ _
- - - - T 2:OVERFILL ALARM
L 6:FUEL ALARM
L 6:FUEL ALARM
-- IN-TANK ALARM -----
T 2:PR>1NiUM T 2:PREMIUM
HIGH PRODUCT ALARM INVENTOR>! INCREASE
JAN I8. 2011 10:52 AM
INCREASE. START
JAN 16, 201.1 10:52 #*1
VOLUME - 7510 GALS
HEIOHT a 76.22 INCHES
WATER, a 0.91 INCHES
TEMP a 52.2 DEG F
I N-ThiNK ALARM ----- i Nr'REASE END
T 2:PREil i UM JAN 1.8: 2011 1 1 :00 AM
OVERFILL. ALARM
JAN 18, 2011 10:53 NM VOLUME - 11839 GALS
HEIGHT -121 .58 INCHES
WA'T'ER - 0.00 INCHES
TEMP 4 52.1 DEG F
GROSS INCREASE- 4329
TC NET INCREASE- 4353
BROOKS I DE MARKET
8803 CAMINO NEDIA
BAKERSFIELD CA A3308
.34-)N 18. 201l 11 :30 Kl
SYSTEM STATUS REPORT
L 6:FUEL-ALARM• w Y
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. FACILITY INFORMATION
Facility Name: Shell Date of Testing: 1/18/2011
Facility Address: Camino Media Blvd.
Facility Contact: Matt Jeffries Phone: 661-496-7006
Date Local Agency Was Notified of Testing: Ernie Medina
Name of Local Agency Inspector(f present during testing): 1/20/2011
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services,Inc.
Technician Conducting Test: Bryan A Self
Credentials: 0 CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec)
License Number(s): CSLB# 804904 ICC# 8022804-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 l 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: 13.00" 13.00" 13.00"
Bucket Depth: 12.00" 12.00" 12.00"
Wait time between applying 5 Min. 5 Min. 5 Min.
vacuum/water and start of test:
Test Start Time(Ti): 9:00am 9:00am 9:45am
Initial Reading(Rj): 9.25" 10.00" 9.75"
Test End Time(TF): 10:00am 10:00am 10:45am
Final Reading(RF): 9.25" 10.00" 9.75'
Test Duration(TF—Ti): 1 Hour 1 Hour I Hour
Change in Reading(RF-Rj): 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625' 0.0625' 0.0625"
Criteria:
Test Result: X Pass ❑Fail X Pass ❑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 report is true,accurate,and in full compliance with legal requirements
Technician's Signature: Date: 1/18/2011
State laws and regulations do not currently require testing to be performed by a qualified contractor.However, local requirements
may be more stringent.
z
1.
1. TLS 350
2. 208 Sump Sensor
3. 420 Annuar Sensor
4. Tank ATG
5. PLLD
2. 2.
2.
2.
2. 2.
5. 5.
STP STP
2.
4.
2.
5.
STP
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4. �
O O
O
3.
3.