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HomeMy WebLinkAbout2008 MAJOR MOD,E File # f�OY� -d41Z Date Rec. Permit # C6 cn cn Z 5 "❑ ❑ Commercial Hood Sys. ❑ ❑ Fire Alarm Sys. ❑ ❑ Fire Sprinkler Sys. ❑ ❑ , Spray Finish Sys. Address: z Bus. Name: C1 V fir\( II/IZ 34-, 1,3 ,�5ft L_L_ (:26vC_� ` 8 7J c) I-) (i p ry 56 YYnP — g Bldg. Sq. ft. ❑ Calculation Bldg. Sq. Ft. UST ❑ ❑ Other: 111111111111 ---- � 16 IE 111111 , FAX Transmittal COVER SHEET FIRE DEPARTMENT PREVENTION SERVICES 1501 Truxtun Avenue, 1st Floor, Bakersfield, CA 93301 Business Phone (661) 326 -3979 • FAX (661) 852 -2171 TO: Ted Stephensen NO. OF PAGES: 2 COMPANY: Belshire Environmental FAX NO.: 949 460 -5210 DATE: September 10, 008 FROM: Karol Kohler COMMENTS: Pursuant to your phone request, following is the approved permit application for the modification of facility: Chevron #203576 B. A K `E W S. F I FAX Transmittal COVER SHEET FIRE DEPARTMENT PREVENTION SERVICES 1501 Truxtun Avenue, 1st Floor, Bakersfield, CA 93301 Business Phone (661) 326 -3979 • FAX (661) 852 -2171 TO: Ted Stephensen NO. OF PAGES: 2 COMPANY: Belshire Environmental FAX NO.: 949 460 -5210 DATE: September 10, 008 FROM: Karol Kohler COMMENTS: Pursuant to your phone request, following is the approved permit application for the modification of facility: Chevron #203576 1125 Coffee Rd MTM -0412 Should you need any other information, you may contact me at the number above. Have a nice day, Karol 949 I � �U� S'zro J ' VSELSWRE ENVIRONMENTAL - VICES,. INC Scope of Work Facility: CHEVRON 203576 1125 COFFEE RD BAKERSFIELD, CA Date: 6/24/2008 Job Number: 0 Estimate No: 1004 Contact: . M e: 0a.. •Raj:;, Wh �"I�""•"v��.':�, "':�;�;! . :�,; ,. , Co�lipaity. 'BeI AB3�' � . shireEn'vironn•ienf �Cerfiti$r1' �, , Ltifi�r�.Tiaiir d.;ixiska11 ; ,. . CA -179 wiE e:En 13?5 On R Pst'31, 2010 i/ r._7 IT'T'_.- <--- ------------ (-- ' ?':! 0Y37SY"._._._ _y....7...._.........----...._. L........._L ............. --.:.. _.. TlR fif:7HIiCHr-............__..... State Of California ' Q CONTRACTORS STATE LICENSE BOARD ' 1 consum "' ACTIVE LICENSE a N nrcat,. 80531`3 Emlq. CORP BELSHIRE ENVIRONMENTAL SERVICES INC'--- ---(s) A H AZ Eap4.9 -Oa. 05/31 /2010 POLICYHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE. FUND CERTIFICATE OF WORKERS' COMPENSATION. INSURANCE ISSUE DATE: 04 -01 -2008 GROUP: OOD428 POLICY NUMBER 0000276 -2008 CERTIFICATE ID: 304 CERTIFICATE EXPIRES: 04-01 2009 04 -01- 2008/04 -01 -2009 PROOF OF, EVIDENCE ONLY 25971 TOWNE CENTRE DRIVE. LAKE FOREST CA 92810 SG . JOB: WAIVER OF SUBROGATION AVAILABLE UPON REQUEST This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation4by the Fund except upon 36 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. ry This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy fisted herein. Notwithstanding any requirement term or condition of any contract or other document with respect to which this certificate of .insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - KAREN CASS, PRIES - EXCLUDED. ENDORSEMENT #1600 - LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04 -01 -2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER BELSHIRE ENVIRONMENTAL SERVICES, INC, SG 25371 TOWNE CENTRE DR FOOTHILL RANCH CA 92610 M0410 PRINTED : 03 -18 -2008 (REV,2.05) ' - SG ACORD., CERTIFICATE OF LIABILITY INSUIFtANCE Qs;i7;2oa$ PRODUCER (94.9)857 -4500 FAX (949)857 -4800 Millennium Risk Management & Insurance Services License # OCI3480 5530 Trabuco Road Irvine, CA 90275 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE Ih Belshire Environmental Services, Inca DBA: B. E,S.I 25971 Towne Centre Drive Foothill Ranch, CA 92610 INSURER A: Zurich American Insurance Company INSURER B: Steadfast Insurance Company INSURER C: INSURERD: INSURER E: COVERAGES. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE-POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLI EFF TIVE DATE M DDrYY POLICY EXPIRATION DATE MMIDD _ LIMITS GENERAL LIABILITY LO 4916038 -06 06/14/2008 06/14/2009 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) S 100,000 CLAIMS MADE OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & AOV INJURY $ 1,000,000 A GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 1,000,000 POLICY X JEST LOC - AUTOMOBILE LIABILITY ANY AUTO RAP 4916042 -06 06/14/2008 06/14/2009 COMBINED SINGLE LIMIT (Ea accident) 8 1,000,000 X BODILY INJURY (Per person) 8 A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X. BODILY INJURY (Pet accident) $ X MCS -90 POLLUTION LIABILITY X PROPERTY DAMAGE (Per accident) $ X I CA -9948 'AGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EAACC 8 ANY AUTO S AUTO ONLY: AGG EXCESS LIABILITY SEO 5337678 -04 06/14/2008 06/14/2009 EACH OCCURRENCE S 5,000,00 X OCCUR FI CLAIMS MADE AGGREGATE S S,000,000 $ B X DEDUCTIBLE $ RETENTION S 10,00 8 WORKERS COMPENSATION AND TORY LIMITS I I ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT 8 E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ oTHER ontractors PEC 4916039 -06 06/14/2008 06/14/2009 $1,000,000 Aggregate Limit - B rofessional &. ollution Liability_ DESCRIPTION OF OPERATIONS ILOCATIONStVEHiCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS ertificate Holder is named Additional Insured as respects General Liability per endorsement -GL- 1175 -A CW (09/03) X10 day notice of cancellation in the event of non - payment of premium CERTIFICATE HOLDER ADDITIONAL INSURED, INSURER LETTER: .r*** *Proof /Evidence Only****** CANCELLATION .SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TH PANY, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRES AT TION 1988 The ER Series Alcryn Reducers and Test Reducers are used to,step.:down . ,from secondary to primary pipe sizes. Tfie Test Reducers are available with or without an air valve and can be used to test the interstitial space- between the secondary and primary piping for leaks. All fittings come with. .required. band clamps and with or without air test valves. b i : • stun � - _ � v .escnptro "'R . ce - b ER 1.9x1.9 1.9 1.9 Alcryn Reducer $12.78 ER 1.9x1.9A 1.9 1.9 Alcryn Reducer with air test $18.28 ER 2.61x2.38LCX 2.61 2.38 Reducer forAmeron 2" LCX $19.74 ER2.61x2.38LCXA 2.61 2.38 Reducer forAmeron 2" LCX, with airtest $25.24 ER 3.5x2.4 3.5 2.4 Alcryn Reducer $16.25 ER 3.5)2.4A 3.5 2.4 Alcryn Reducer with air test $21.75 ER 4.5x3.5 4.5 3.5 . Alcryn Reducer $1%9.74 ER 4.5x3.5A 4.5 3.5 Alcryn Reducer with air test $25.24 El 3" CDS 3.0 N/A Alcryn 3" Corrugated Duct Seal $4.50 El 4" CDS 4.0 N/A Alcryn 4" Corrugated Duct Seal $5.40 El 6" CDS 6.0 N/A Alcryn 6" Corrugated Duct Seal - $6.80 14 The SB Series Pellethane Split Repair Boots are used inside the sump "to encapsulate or replace leaking penetration fittings. Split Inserts -. °L LISTE=D (SI Series) are ordered separately and are used in the boots in order to bring the boot to specific pipe dimensions. SBL3.SLP t SBS4131.4 SBS4B1.4ANGLE SBL3.5 SBXXL8.8x6.8x4.6 15 0 -0 > ,P Double 1t0" O.D. - 9" I.D. SBXXL8.8x6.8x4.6 Split repair boot that is large enough to encapsulate $ 210.60 Extra Large SBXXL8.8x6.8 most large sized entry fittings $ 210.60 (XXL) SBXXL8.81 $ 210.60 Extra large 8.5" O.D. - 6" I.D. SBXL6.8x4.6 Split repair boot that will encapsulate small to medium $ 162.00 sized entry fittings or replace 10 studded entry (XL) SBXL3:5 fittings. . 162.00 SBXL2.5LP Low profile split repair boot that is designed to $ 162.00 replace an existing 10 studded entry fitting. This boot SBXL4.5LP has a total height of 225 ". $ 162.00 Large 7.4" O.D. - 5' I.D. SIB L2.5 Split repair boot that will encapsulate small entry $ 135.00 fittings. (L) S131-3.5 Split repair boot that will encapsulate small entry $ 135.00 fittings. S13 L3.5LP Low profile split repair boot that is designed to $ 135.00 replace an existing 8 studded entry fitting. This boot has atotal height of 2.25'. SBL4.5 Split repair boot that will encapsulate small entry $ 135.00 . fittings. SBL4.8x1.9x1.4 Split repair boot for dual supply /return lines for. $ .162.00 generator sites. M edium 5.5" O.D. - 33' I.D. SIB M 3.5 Split repair boot for applications where there is no $ 108.00 (M) S13 M2.5 fitting installed. $ 108.00 SBM2.0 4 $ 108.00 Small 3.5" O.D. -1.5' I.D. SBS4B t4 Split repair boot that is designed to replace an $ 81.00 (S) existing 4 studded entry fitting or wherethere is no fitting. SBS4I3t4ANGLE Split repair boot that is designed to replacean $ 81.00 existing 4 studded entry fitting or wherethere is no fitting. This fitting has a 60 degree angle molded into the boot to enable it to accommodate repairs where . the conduit is entering the sump at up to 40 degrees. t SBS4131.4 SBS4B1.4ANGLE SBL3.5 SBXXL8.8x6.8x4.6 15 0 -0 > Note: We can supply both curved and flat seals for all sump surfaces. If using the curved seal make sure you rotate the mounting ring to conform to the inside curvature of the sump.. 1. Using Acetone, clean the surfaces around the boot that needs to be repaired so that it is free from dirt and oil. 2. Select the split flat or curved mounting ring seal and slip it over the white ring. Spread the mounting ring apart and position it over the pipe. 3. After-cleaning the split edge of the mounting ring with acetone apply a bead of Blue Seal glue to the Blue pellethane edge and use a band clamp to keep it together while the glue cures. (the white Poly does not need to bond) Allow forty minutes for the glue to set up. ■ r ■ ■ ■ : r : ■ ■ r- ■ r ■ : : : r : : : ■ ■ ■ r ■ r N r r ■ ■ : ■ .r r ■ M ■ ■ ■ : : : r r r ■ ■ r ■ 4. Liberally apply a bead of sealant material on the surface of- the ring to be attached to the inside of the sump wall. The ring will already be over the pipe 5. Position the mounting ring against the inside sump wall, over- the existing, leaking penetration and insert the first Tech screw. 6. Fully tighten all Tech screws, checking that a uniform bead of sealant is squeezed out along the outer edge of the mounting ring. 7. Position the split boot over the pipe and apply a bead of glue to the cut edge. The cut edge must be cleaned with Acetone before applying the glue. Loosely, position clamps on the boot to hold the two glued edges in place. - 8.Run a bead of the glue onto the outside surface of the mounting ring, where the boot is going to rest. Always make sure that the fill tubes are at 12 o'clock. Install the clamp and tighten the bonded boot to the mounting ring. 9. Leaving the pipe side clamp loose, (to allow. the air out) completely fill the repair boot Neatly wipe away any excess sealant on the sump wall or the pipe and tighten all clamps to finish. We always suggest a hydrostatic (can be started immediately the boot is filled) or vacuum test to check that the repair has been correctly installed October 14, 2004 Note: We can supply both curved and flat seals for all sump surfaces. If using the curved seal make sure you rotate the mounting ring to conform to the inside curvature of the sump. 1. Using Acetone, clean the sump surface around the boot that needs to be repaired so that it is free from dirt and oil. Remove the nuts of the existing boots, cut away the old boot and cut all bolts off. 2. Select the split flat or curved mounting ring seal depending on whether it is a flat or curved sump and slip it around the two halves of the mounting ring. Spread the ring apart and position it over the pipe. Clean the edge of the Pellethane ring sleeve with acetone and then use.the blue seal glue to bond it together. Use the split boots large band damp to hold the bonded ring together for 40 mins. 3. Hold the ring against the sump . wall in its correct position. Drill a 118° pilot hole through each hole in the ring clear through the sump wall and the backing ring in the outside of the sump. : : : ■ ■ ■ r : : : : : r : ; r : u 4. Liberally apply a bead of sealant material on the surface of the ring. to. be attached- to the inside of the sump wall. The ring will already be bonded together and hanging over the pipe 5. Position the mounting ring against the inside sump wall, where the existing, leaking penetration used to be and insert the first Tech screw into the pilot hole. 6. Fully insert and screws, checking bead of sealant along the outer mounting ring. r f r ■ ■ ■ ■ ■ : : ■ : : : M r r : : : : : tighten all Tech ; that a uniform squeezed out edge of the ■ 7. Position the split boot over the pipe and apply a bead of glue to the cut edge. The cut edge must be cleaned with Acetone before applying the glue. Loosely position clamps on the boot to hold the two glued edges in place. : ■ 8. Once the glue has dried (forty minutes) run another bead of the glue onto the outside surface of the mounting ring, where the boot is going to rest. Always make sure that the fill tubes are at 12 o'clock. Install the clamp and tighten the bonded boot to the mounting ring 9. Leaving the pipe side clamp loose (to allow the air out) completely fill the repair boot. Neatly wipe away any excess sealant on the sump wall or the pipe and tighten all clamps to finish.. We always suggest, a hydrostatic (can be started immediately the boot is filled) or vacuum test to check that the repair has been correctly installed October 14, 2004 __ --gym RECSHURE s = 'ENVIRONMENTAL rM A -! � SERVICES, INC. Site Map Location Name: _ _ yid . Z) -1 Date: SESI# Address:. r� Cross Street: City: State: &11 Scope: izc--)- - � =�Zvo I VNI I , SWRCB, January 2002 Page of Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency. 1. FACTLITV INFORMATION Facility Name: Chevron# 203576 Date of Testing: . Facility Address: 1125 Coffee Road, Bakersfield, CA 93308 Facility Contact: Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if preseni during testing): SB989 3 Year Test 2. TESTING CONTRACTOR INFORMATION Company Name: Belshire Environmental Services, Inc. Technician Conducting Test: v Credentials: ® CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester License Type: A - General Engineering Contractor License Number: 808313 Manufacturer Training Manufacturer Component(s) Date Training Expires Available upon request 3. SUMMARY OF TEST RESULTS Component Pass Fa Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made Tatik Annulars 0 0 0 0000 ❑ ❑ ❑ ❑ 0000� ❑ 2 ❑ ❑ oa�■r.� ❑ 0 D ❑ Secondary Pipe ►: ❑ 0 1 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 0 0 0 Turbine Sump ❑ ❑ 11 0 0 ❑ D 0 0 0 0. 0 0 0 0 /� UDC e, % ❑ ❑ ❑ , iMT lE %1. ?/i 4�n�,�1 ,fin /� ❑ ❑ ❑ ❑ ❑❑ ❑❑ 1 0 1 0 1 0 1 0 If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: (/ Date: noni�� 0000 0000� oa�■r.� Spill ►: -000 ❑❑ ❑❑ 1 0 1 0 1 0 1 0 If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: (/ Date: SWRCB, January 2002 4. TANK ANNULAR TESTING Page of Test Method Developed By: ❑ Tank Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ® Vacuum ❑ Hydrostatic ❑ Other (Sped) Test Equipment Used: Test plugs, venturi pump and gauges Equipment Resolution: 0.5% of span Is Tank Exempt From Testing ?' Tank # I �1 Tank # V le:�— Tank # Tank # 77 ❑ Yes �N�o ❑ Yes No ❑ Yes o - ❑ Yes ❑ No Tank Capacity: Tank Material: FRP 4gjo Other FRP tee Other FRi ee Other FRP Steel Other Tank Manufacturer: Product Stored: 87 89 91 D Other 8 89 91 D Other 87 89 1 D Other 87 89 91 D Other Wait time between applying pressure /vacuum/water and starting test: 10 minutes 10 minutes 10 minutes 10 minutes Test Start Time: Initial Reading (RO: 16 (eG D . < Test End Time: , ` Final Reading (RF): G Test Duration: f Change in Reading (RF -R): Pass/Fail Threshold or Criteria: No Det5sUble Loss No Det table Loss No Det table Loss No Detectable Loss Test Result: ass ❑ Fail Pass ❑ Fail ss . ❑ Fail ❑ Pass ❑ Fail Was sensor removed for testing? es ❑ No ❑ NA es ❑ No ❑ NA Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? yes ❑ No ❑ NA ' es ❑ No ❑ NA es ❑ No ❑ NA El Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed.tests) 'Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containmen testing. f California Code of Regulations, Title 23, Section 2637(a)(6)) SWRCB, January 2002 7 TIN1nF,R- 1lTCPF.NCFR f (11V i ATNMFNT lTTil['1 7`FCTTNf; Page . of Test Method Developed By: ❑ UDC Manufacturer N Industry . Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum N Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +1- 0.002" UDC Manufacturer: UDC # /O UDC # UDC # UDC # v / UDC Material: UDC Depth: q �� Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested'/j G Does turbine shut down when UDC sensor detects liquid (both product and water)?' I ❑ Yes ❑ No [DNA ❑ Yes ❑ No N NA ❑ Yes ❑ No N NA ❑ Yes ❑ No N NA Turbine shutdown response time N/A N/A N/A N/A Is system programmed for fail - safe shutdown? ❑ Yes ❑ No X NA ❑ Yes ❑ No I,� NA ❑ Yes ❑ No ❑ NA l] Yes ❑ No ❑ NA Was fail -safe verified to be o erational ?' ❑ Yes ❑ No NA ❑ Yes ❑ No NA El Yes [I No El NA ❑Yes [I No ❑ NA Wait time between applying pressure /vacuum/water and starting test 30 minutes ' 30 minutes 30 minutes 30 minutes Test Start Time: y /, Initial Reading (Ri): COZIM 6310,9- ('W 6 7 'Test End Time: j/ W-IT , X ,r //. A907 Final Reading (RF): Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF -R,): Pass/Fail Threshold or Criteria: +/-0.002" +/- 0.002" +1-0.00211 +/- 0.002" Test Result: ❑ Pass Fail ❑ Pass KFail ❑ Pass D Fail ❑ Pass D Fail Was sensor removed for testin ? Yes ❑ o ❑ NA Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? Yes ❑ No ❑ NA Yes [I No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Comments —(include information on repairs made prior to testing, and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. If the entire depth of the UDC is not tested, specify how much was tested. If the answer to an of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SNVRCB LG -160) SWRCB, January 2002 7. TINDER- DTSPFNSFR rONTATNMRNT a Dn TF,STTNG Page _ of Test Method Developed By:. ❑ UDC Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: p Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +1- 0.002" UDC # UDC # UDC # U UDC Manufacturer: UDC Material: UDC Depth: ' Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested Does turbine shut down when UDC sensor detects liquid (both product and water)'? ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA Turbine shutdown response time N/A N/A N/A N/A Is system programmed for fail- safe shutdown ?` ❑ yes ❑ No O NA ❑ Yes [].No [9 NA ❑ Yes ❑ No ANA ❑ Yes ❑ No fly NA Was fail -safe verified to be o erational ?` [I Yes ❑ No W NA ❑Yes ❑ No NA ❑Yes ❑ No NA ❑Yes ❑ No ,0 NA Wait time between applying pressure /vacuum/water and starting test 30 minutes 30 minutes a 30 minutes ° i 30 minutes ! r Test Start Time: Q Initial Reading (RI): Test End Time: ;PeW .' %',7o Final Reading (RF): �� Q op- l Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF -R): .0{�CJ _0 771—D.0190 - 0.0o0_, _ .00 ' DO 0- QO Pass/Fail Threshold or Criteria: +/_ 0.002" +/- 0.002" ;W--0.002- +j--6.0021' Test Result: Pass Fail ❑ ass JXFail JirXss D Fail BIP9ss ❑ Fail Was sensor removed for testing? Y ❑ No 13 NA O'YSs ❑ No ❑ NA No ❑ NA e No ❑ NA Was sensor properly replaced and verified functional after testing! yes ❑ No ❑ NA Yes ❑ No ❑ NA r6es ❑ No ❑ NA 04es ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow - p for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. ' If the entire depth of the UDC is not tested, specify how much was tested. If the answer to W of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) SWRCB, January 2002 8. FILL RISER CONTAiNI ANT SUMP TESTING Page — of Facility is Not Equipped With Fill Riser Containment Sumps Fill Riser Containment Sumps are Present, but were Not Tested Test Method Developed By: ❑ Sump Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" u Fill Sump # Fill Sump # . Fill Sump # Fill Sump # Diameter: -Surnp Sump Depth: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested Sump Material: Wait time between applying pressure /vacuum /water and starting test: 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: Initial Reading (RO: Test End Time: Final Reading (RF): Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF -R,): Pass/Fail Threshold or Criteria: +!_ 0.002" +/-0.002" +/-0.002" +/- 0.002" Test Result: ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Is there a sensor in the sump? ❑ Yes ❑ No ❑ Yes . ❑. No ❑ Yes ❑ No ❑ Yes ❑ No Does the sensor alarm when either product or water is detected? ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA Was sensor removed for testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. SWRCB, January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page _ of Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ Spill/Overfill Containment Boxes are Present, but were Not Tested'p Test Method Developed By: ❑ Spill Bucket Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Specify) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" Spill Box # Spill Box #1 Spill Box # -i Spill Box # -f Bucket Diameter: Bucket Depth: / Wait time behveen applying pressure /vacuum/water and starting test: 30.minutes r 30 minutes i` 30 minutes 30 minutes Test Start Time: 011 10-7 Initial Reading (RO: '>f�%�ort F�7,pT 67?e3 1 tj AOO -QQ� Test End Time: �,• ,� ,' /� .,/� , Final Reading (RF): �j s"3�6 SQ S.3a Test Duration: 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min, Change in Reading(RF -R,): f o0p0 ' 0.000 `0.0031 �1?.a�3� 0.000 —0. o3 Od j)-N) I- 0.l.?03 Pass /Fail Threshold or Criteria: +J- 02" +/- 0.002" +/- 0.002" +/-0.00211 Test Result: Wfass ❑ Fail ❑ Pass Fail ❑ Pass Fail ❑ Pass Fail Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) o'� r SWRCB; January 2002 9_ SPILL /OVF.R1R11.1. (7ONTATN.MF.NT ROXF.S Page - of Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ Spill/Overfill Containment Boxes are Present; but were Not Tested p Test Method Developed By: ❑ Spill Bucket Manufacturer ®.Industry Standard ❑ Professional Engineer ❑ Other (Sped) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0,002" Spill Box # qj Spill Box # 1:7- i3 q1 Spill Bog # Spill Box # Bucket Diameter: Bucket Depth: Wait time between applying pressure/vacuum/water and starting test: 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: ve, Jzw,i Initial Reading (Rf): Test End Time: Final Reading (RF):33 S %�- Test Duration: 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min Change in Reading (RF -R,): ` ®, �� S �o �p ni -COON oxooO Pass/Fail Threshold or Criteria: +/- 0.002" +/- .002" +/- 0.002" +/- 0.002" Test Result: ❑ Pass Fait ass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) BEL:SHIRE' I ENVIRONMENTAL Scope of Work SERVICES, G'VG Facility: CHEVRON 203576 1125 COFFEE RD BAKERSFIELD, CA Date: 6/24/2008 Job Number: 0 Estimate No: 1004 Contact: •'t 265'.'j3;�itiie.'DrltiE'• 4 �. � ; w W. lue- ]ihetech `rti ' =5bbp' isle ;"?i3{Y 67 S:v2b8: Corligy. 'Be shire: Envi 'A$2' .Ceijf(gyi' ronmental Certiiip;T min d hi'SkalTer: � ' i Cauiyt;. C?c_119' �17ieta r.• ? §•on: A g4lst'8 #� 2010 � P:: ��•�-- -.........__..._.._ -more rt. Y.—_..------.....__..__...._ c. r _.rT..cr-r-�-- ---- - °.._.._...._ _- ._....._-f----- T?11m3af ®INLIMM 5 A State a Caliiomla w 1 CONTRACTORS STATE LICENSE BOARD a ' �M M ACTIVE LICENSE co .. $08313 CORP BELSHIRE ENVIRONMENTAL SERVICES INC""' ei..ab�i..u1 A HAZ 05/31/2010 POLICYHOLDER COPY SG SVAT5 P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE - FU N ® CERTIFICATE OF WORKERS' COMPENSATION. INSURANCE' ISSUE DATE: 04 -01 -2008 GROUP: 000426 POLICY NUMBER: 0000276 -2008 CERTIFICATE ID: 304 CERTIFICATE. EXPIRES: _ 04-01-2009 04 -01- 2008/04 -01 -2009 PROOF OF, EVIDENCE ONLY SG . JOB: WAIVER OF SUBROGATION AVAILABLE 25971 TOWNE CENTRE DRIVE UPON REQUEST LAKE FOREST'CA 92810 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation4by the Fund except. upon 36 days advance written notice to' the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement term or condition, of any contract or other document with respect to which this certificate of insurance may be Issued or to which it may pertain, the insurance afforded by the policy described herein is. subject to all the terms, exclusions, and conditions, of such policy. t:ORIJZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - KAREN.CASS, PRIES - EXCLUDED. ENDORSEMENT 11600 - LARRY MOOTHART,'SEC, TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04 -01 -2004 IS ATTACHED 70 AND FORMS A PART OF THIS POLICY. EMPLOYER SELSHIRE ENVIRONMENTAL SERVICES, INC. SG 25971 TOWNE CENTRE DR' FOOTHILL RANCH CA, 92610 M0410 (Rev:2 osl PRINTED c 03 -18 -2008: ACORV a CERTIFICATE OF LIABILITY INS' U"NCE T DATE(MMIDDl YY) 06/ll/2008 PRODUCER (949)$57 -4500 FAX (949)857 -4800 Millennium Risk Management & Insurance Services License # OC134$0 5530 Trabuco Road Irvine, CA .90275 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE Ih` > Belshire Environmental Services; Inc. DBA: B. E. S.I 25971 Towne Centre Drive Foothill Ranch, CA 92610 INSURER A: Zurich American Insurance Company INSURER B: Steadfast Insurance Company INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE.POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE M DD1YY POUCYEXPIRATION DATE MMMD LIMITS GENERAL LIABILITY GLO 4916039 -06 06/14/2008 06/14/2009 EACH OCCURRENCE $ 1,000,0001 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) S ' 100,000 CLAIMS MADE A OCCUR MED EXP (Any one Person) $ 5,000 PERSONAL & ADV INJURY S 1,000,000 A GENERAL AGGREGATE $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 1,060,000 POLICY X PRO- JEC T M LOC AUTOMOBILE LIABILITY ANY AUTO BAP 4916042 -06 06/14/2008 06/14/2009 COMBINED SINGLE LIMIT (Ea ecrJdent) $ 1, 000 00 X BODILY INJURY (Perperson) $ A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X. BODILY INJURY (Per accident) S X MCS -90 POLLUTION LIABILITY X PROPERTY DAMAGE (Per accident) $ X CA -9948 AGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG S ANY AUTO $ EXCESS LIABILITY SEO 5337679-04 06/14/2008 06/14/2009 EACH OCCURRENCE $ 5, 000 , 000 X OCCUR CLAIMS MADE AGGREGATE $ 5, 000, oO B s' X DEDUCTIBLE $ RETENTION S 10,00 S WORKERS COMPENSATION AND . TORY LIMITS T EMPLOYERS'L�IBIUTY - E.L. EACH ACCIDENT S EL.DISEASE - EAEMPLOYEE $ E.L. DISEASE - POLICY LIMIT S OTHER PEC 4916039 -06 06/14/2008 06/14/2009 $1,000,000 Aggregate Limit B �ontractors rofessional & ollution Liabilit DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES/D(CLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS ertificate Holder is named Additional Insured as respects General Liability per endorsement -GL- 1175 -A CW,(09 /03) ­10 day notice of cancellation in the event of non- payment'of premium CERTIFICATE HOLDER ,:.- °-VProof /Evidence Only****** (7197) INSURER LETTER: CANCELLATION .SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO 09LJGATION CR UABiLI T Y OF ANY KIND UPON TH PANY, ITS AGENTS OR REPRESENTATIVES. . AUTHORIZED REPRES AT r/ 7 ©ACORD•CORPORATION 1988 n10 The ER Series Alcryn Reducers and Test Reduvers ar-e used to step doWn . ..from. secondary to primary pipe yes. The Test Reducers are available with or without an air valve and can be used to test the interstitial .space between the secondary and primary piping for leaks. All fittings come with. required band clamps and with or without air test valves. AV 10. sans. :i 4§�^�.....' t • .earl .ptro '� Y' ♦ y, 01' View ./�}� . J� a - ER 1.9x1.9 1.9 1.9 Alcryn Reducer $12.78 ER 1.9x1.9A 1.9 1.9 Alcryn Reducer with air test $18.28 ER 2.61x2.38LCX 2.61 2.38 ReducerforAmeron 2" LCX $19.74 ER 2.61x2.38LCXA 2.61 2.38 Reducer forAmeron :2 "LCX with air test $25:24 ER 3.5x2.4 3.5 2.4 Alcryn Reducer $16.25 ER 3.5x2.4A 3.5 . 2.4 Alcryn Reducer with a!( test $21.75 ER 4.5x3.5 4.5 3.5 .. Afdryn Reducer $19.74 ER 4.5x3.5A 4.5 3.5 Alcryn Reducer with air test $25.24 El 3" CDS 3.0 N/A Aicryn 3" Corrugated Duct Seal $4.50 El 4" CDS 4.0 N/A Alcryn 4" Corrugated Duct Seal $5.40 El 6" CDS 6.0 1 N/A Alcryn 6" Corrugated Duct Seal $6.80 AV 10. The SB Series PellethAfie Split Repair Boots are used inside the s Mp'to encapsulate or replace leaking penetration fittings. Split Inserts: LISTED (Sl Series) are ordered separately and are used in the b6ot§ in order to. bring the boot to specific pipe dimensions. SBL3.5LP S.BXXL8.8x6.8x4.6 .15 I Double 110" O.D. - 9" I.D. SBXXL8.8X6.8x4.6 Split repair boot that is large enough to encapsulate $ 210.60 Extra Large SBXXI-8.8x6.8 most largesized entryfittings $ 210.60 (XXI-) SBXXL8.8 $ 210.60 Extra Large 8.5" O.D. - 6" I.D. SBXL6.8x4.6 Split repair boot that will encapsulate small to medium $ 162.00 ISBXL2.5LP sized entry fittings or replace 10 studded entry (X Q SEIXI-3.5 fittings. $ 162.00 Low prof He split repair boot that is designed to - $ 162.00 replace an existing 10 studded entry fitting. This boot SBXL4.5LP has a total height of 2.26. $ 162.00 Large 7.4" O.D. - 5" I.D. SB 1-2.5 Split repair boot that will encapsulate small entry $ 135.00 fitting§. W SBL3.5 Split repair boot that will encapsulate small entry $ 135.00 fittings. S13 L3.5LP Low profile sp [it repair boot that is designed t o $ 135.00 replacean existing 8 studded entry fitting. This boot has a total height of 225'. S13L4.5 Split repair boot that will encapsulate small entry $ 135.00 fittings. S,BL4.8x1.9x14 Split repair boot for dual supply/return lines for. $ .162.00 generator sites. -- M ed lurn 5.5" O.'D. - 3.6' I.D. SB M 3.5 - ---- Split repair boot f o r applications where t. here is no $ 108.00 (M) SIB M 2.5. fitting installed. $ 108.00 SB M 2.0 r 10840 Small 3.5" O.D. - t5" I.D. SBS4Bt4 Split repair boot that is designed to replace an $ 8100 (S) existing 4 studded entry. fitting or Wherethere is no fitting. SBS4131AANGLE Split repair boot that is designed to replace an $ 8t00 existing 4 studded entry ry fitting or where there is no fitting. This fitting has a 60 degree angle molded into the boot to enable it to accommodate repairs where the conduit is entering the sump at up to 40 degrees. S.BXXL8.8x6.8x4.6 .15 I Note: We can supply both curved and flat seals for all sump surfaces. If using the curved seal make sure you rotate .the mounting ring to conform to the inside curvature of the sump. 1. Using _ Acetone, clean the surfaces around the boot that needs to be repaired so that it is free from dirt and oil. 2. Select the split flat or curved mounting ring seal and slip it over the white ring. Spread the mounting ring" apart and position it over the pipe. 3. After cleaning the split edge of the mounting ring with acetone apply a bead of Blue Seal glue to the Blue pellethane edge and use a band clamp to keep it together while the glue. cures. (the white Poly does not.need to bond) Allow forty minutes for the glue to set up. r' r R M ■ ■ R ■ ■ ■ ■ r ■ ■ ■ : r : r ■ : : : : ■ ■ r r r r . ■ : ■ ■ ■ r : r LA 4. Liberally apply a bead of sealant material on the surface of the ring to be attached to the inside of the sump wall. The ring will already be over the pipe 5. Position the mounting ring against the inside sump wall, over the existing, leaking penetration and insert the first Tech screw. 6. Fully tighten all Tech screws, checking that.a uniform bead of sealant is squeezed out along the outer edge of the mounting ring. 7. Position the split boot over the pipe and apply a bead of glue to the cut edge. The cut edge must be cleaned with Acetone before applying the glue. Loosely position clamps on the boot to hold the two glued edges in place. r ■ r ■ : ■ ■ ■ ■ ■ ■ : ■ r ■ ■ ■ r ■ r : : : ■ y : : r ■ r r ■ r ■ : : 8.Run a bead of the glue onto the. outside surface of the mounting ring, where the boot is going to rest. Always make sure that the fill tubes are at 12 o'clock. Install ' the clamp and tighten the bonded boot to the mounting ring. 9. Leaving the pipe side clamp loose (to allow the air out) completely fill the repair boot. Neatly wipe away any "excess sealant on the sump wall or the pipe and tighten all clamps to finish. We always suggest a hydrostatic (can be started immediately the boot is filled) or vacuum test to check that the repair has been correctly installed October 14, 2004 Note: We can supply both curved and flat seals for all sump surfaces. If using the curved seal make sure you rotate the mounting ring to conform to the inside curvature of the sump. 1. Using Acetone, clean the sump surface around the boot that needs to be repaired so that it is free from dirt and oil. Remove the nuts of the existing boots, cut away the old boot and 'cut all bolts off. 2. Select the split flat or curved mounting ring seal depending on whether it is a flat or curved sump and slip it around the two halves of the mounting ring.. Spread the ring apart and position it over the pipe. Clean the edge of the Pellethane ring sleeve with acetone and then use the blue seal glue to bond it together. Use the split boots large band clamp to hold the bonded ring together for 40 mins. 3. Hold the ring against the sump . wall in its correct position. Drill a 1/8° pilot hole through each hole in. the ring clear through the smp wall and the backing ring in the outside of the sump. r : : : : : ■ r Y VA r : r 8. Once the glue has dried 4. Liberally apply a bead of ; (forty minutes) run another bead sealant material on the surface of ; of the glue onto the outside the ring, to be attached to the ■ inside of the sump wall. The ring surface of the mounting ring, w where the boot is going to rest. ill already be bonded together and hanging over the pipe � Always make sure that the fill tubes are at 12 o'clock. Install w r ; the clamp and tighten the ■ bonded boot to the mounting ring : e r msdn are 1115a idUir saadw. ineu 9. Leaving the pipe side clamp the pilot hole. : loose (to allow the air out) a r completely fill the repair boot. ■ ■ Neatly wipe away any excess 7. Position the split boot over the pipe r r r ■ ■ sealant on the sump wall or the _ edge. The cut edge must be cleaned pipe and tighten all clamps to a r ■ finish.. We always suggest a Loosely position clamps on the boot hydrostatic (can be started : immediately the boot is filled) or : vacuum test to check that the repair has been correctly installed 6. Fully insert and tighten all Tech ; screws, checking that a uniform bead of sealant is squeezed out along the outer. edge of the ■ mounting ring. ' ■ r 7. Position the split boot over the pipe r r r ■ ■ and apply a bead of glue to the cut edge. The cut edge must be cleaned with Acetone before applying the glue. Loosely position clamps on the boot to hold the two glued edges in place, r ® October 14, 2004 ENBELSHIRE VIRONMENTAL SERVICES, INC Site. Map Location Name: Y! -14 Date: BE$i#: . Address: Was Cross Street: � City: Ar) State: Scope: rev. 10 /15/03 SWRCB, January 2002 Page ` of Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for-all components tested. The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency. 1. FACTT.TTV TNFnRMATInN Facility Name: Chevron# 203576 1 Date of Testing: Facility Address: 1125 Coffee Road, Bakersfield, CA 93308 Facility Contact: Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (ifpresent during testing): SB989 3 Year Test 2_ TFCTTNfi' VnNTRACTnR TNFnRMATInN Company Name: Belshire Environmental Services, Inc. Technician Conducting Test: Credentials: ® CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester License Type: A - General Engineering Contractor License Number: 808313 Manufacturer Training Manufacturer Component(s) Date Training Expires Available upon request 3_ STIMMARV OF TFST RESULTS If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR - CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: (/ Date: i O % Secondary • ► MM0� ��QO 0000 aoo�■ - a ►; oo aoo■o■ ooQ� 0000! UMMIN 000� °�■v°°a ©' an�o� o000 o - — — - - — - on 0 M If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR - CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: (/ Date: i 1 SWRCB, January 2002 Page _ of 4. TANK ANNULAR TESTING Test Method Developed By: ❑ Tank Manufacturer N Industry Standard ❑ Professional - Engineer ❑ Other (Specify) Test Method Used: ❑ Pressure ® Vacuum ❑ Hydrostatic ❑ Other (Spec) Test Equipment Used: Test plugs, venturi pump and gauges Equipment Resolution: 0.5% of span Is Tank Exempt From Testing ?' Tank # Wank # Tank # q1 Tank # ❑ Yes No ❑ Yes ErNo ❑ Yes o ❑ Yes ❑ No Tank Capacity:, Tank Material: FRP tee Other FRP teel Other FRIf jee Other FRP Steel Other Tank Manufacturer: Product Stored: 87 89 91 D Other 8 89 91 D Other 87 89 1 D Other 87 89 91 D Other Wait time between applying . pressure /vacuum/water and starting test: 10 minutes A minutes 10 minutes 10 minutes Test Start Tune: Initial Reading (RJ: ©. Jar Test End Time: Final Reading (RF): �. G Test Duration: Change in Reading (RF -Rj): © �1 Pass/Fail Threshold or Criteria: No Dete ble Loss No De t table Loss No Det table Loss No Detectable Loss Test Result: ass ❑ Fail Pass ❑ Fail . ss . ❑ Fail ❑ Pass ❑ Fail Was sensor removed for testing? es ON o ❑ NA es ❑ No ❑ NA grYes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? Yes El ❑ NA es ❑ No ❑ NA es ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) 'Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containmen testing. f California Code of Regulations, Title 23, Section 2637(a)(6)1 SWRCB, January 2002 Page of 4 Cii !'()Ni] A i2 V PTPF. TFCTiNC - Test Method Developed By: ❑ Piping Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) , Test Method Used: ® Pressure ❑ Vacuum ❑ Hydrostatic [] Other (Specify) Test Equipment Used: Test reducer boots, air compressor and gauges Equipment Resolution- 0.5 % of span Piping Material: Piping Run # Piping Run # Piping Run # Piping Run # ' Piping Manufacturer: Piping Diameter: Length of Piping Run: Product Stored: 87 9 91 D Other 89 91 D Other 87 89 D Other 87 89 91 D Other Method and location of i in -run isolation: Reducer Boots/Fittings Reducer Boots/Fittings Reducer BootsNittings Reducer Boots/Fittings Wait time between applying pressure/vacuum/water and starting test: 10 minutes 10 minutes 10 minutes 10 minutes Test Start Time: z Initial Reading (Rj): �/ ° / Test End Tune: Final Reading (RF): Test Duration: Change in Reading (RF -RI): Pass/Fail Threshold or Criteria: No detecn Loss No detec le Loss No detec le Loss No detectable Loss Test Result: Pass ❑ Fail Ff Pass ❑ Fail @rPass ❑ Fail Cl Pass ❑ Fail . Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) SWRCB, January 2002 - Page of 6. 1 PIPING SUMP TESTING Test Method Developed By: ❑ Sump Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum ®Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" Sump # Sump # Sump # Sump # Sump Diameter: % Sump Depth: Sump Material: Height from Tank Top to Top of Highest Piping Penetration: !� Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested' i Does turbine shut down when . sump sensor detects liquid (both product and water) ?' ❑ Yes ❑ No ®NA ❑ Yes ❑ No. ®NA ❑ Yes ❑ No ®NA ❑ Yes ❑ No ® NA . Turbine shutdown response time NIA N/A N/A N/A Is system programmed for fail -safe shutdown ?' ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA El Yes ❑ No ® NA ❑ Yes ❑ No O NA Was fail -safe verified to be o erationat ?' El Yes ❑ No ®NA ❑ Yes ❑ No ®NA ❑ Yes 0 No ®NA ❑ Yes ❑ No ®NA Wait time between applying pressure /vacuum/water and starting test: 30 minutes `� `1 30 minutes l' 30 minutes / r' 30 minutes Test Start Time: f A j0. Initial Reading (Rj): 3S-X2 j -om- Test End Tune: ,3 �,�jjfy / /3sf� //-X/woo Final Reading (RF): .35�'ir s�7�/ Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF -Ri): '0.000 --0.00N 70.001t 0.000 "MO N. — .00 Pass/Fail Threshold or Criteria: +/- .002" +/- 0.002" +/- 0.002" +/-0.002" Test Result: ss ❑ Fail ❑Fail ❑ ass Fail ❑ Pass ❑ Fail Was sensor removed for testing? 9'Y!jg No. ❑ NA Z'�'e!g No D NA 01Y " ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? Yes ❑ No ❑ NA Yes ❑ No ❑ NA Cryes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Cbniments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. ' If the entire depth of the sump is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk(*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG -160) t i i SWRCB, January 2002 7. TTNDF,R- DF�PF.NCF.R r0NTATNMFNT t mr) TESTING. Page ^ of Test Method Developed By: ❑ UDC Manufacturer ® Industry Standard , ❑ Professional Engineer ❑ Other (Spec) Test Method Used:. ❑ Pressure ❑ .Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" UDC # /Q UDC # UDC # / UDC # UDC Manufacturer: v 6 UDC Material: UDC Depth: Height from UDC Bottom to Top of Highest Piping Penetration: /� O Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested' / C Does turbine shut down when UDC sensor detects liquid (both product and water)?' ❑ Yes .❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA Turbine shutdown response time N/A N/A N /A. N/A Is system programmed for-fail- safe shutdown ?' ❑ Yes ❑ No f M NA ❑ Yes ❑ No W NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was fail -safe verified to be operational?* ❑ Yes ❑ No 0 NA ❑ Yes ❑ No f W ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Wait time between applying pressure /vacuum/water and starting test 30 minutes s ' 30 minutes / / 30 minutes 30 minutes Test Start Time: , ,• !� Initial Reading (Ri): C.O l f AQ l0 7 Test End Time: // 30 �' i9i! �✓ / /f6/h Final Reading (RF)' L-26 ( l Test Duration: 15 min. 15 min. 15 min. 1 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF -RI): , ©� S 3 , t;fl - o D I i Pass/Fail Threshold or Criteria: +/- 0.002" +/- 0.002" +/-0.002" +/- 0.002" Test Result: ❑ Pass Fail ❑ Pass Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Was sensor removed for testing Yes ❑ 14o 10 NA J4 Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA 1 ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? Yes ❑ No ❑ NA 'Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for jailed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) SWRCB, January 2002 7- TTNnF.R_T)TRPF.NRFR CnNTATNMF.NT tTmm TFRTTNf. Page of Test Method Developed By: ❑ UDC Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum M Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" 71,4n UDcturer: U UDC# UDC# UDC# UDl: UDC Depth: Height from UDC Bottom to Top of Highest Piping Penetration: Q Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC. Tested i� 41Q �. i l Does turbine shut down when UDC sensor detects liquid (both roduct and water)?* [:]Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ®NA ❑ Yes ❑ No ®NA Turbine shutdown response time NIA N/A N/A N/A Is system programmed for fail- safe shutdown?* ❑ yes ❑ No (M NA ❑ Yes ❑ No RNA ❑ Yes El No PQ NA El Yes ❑ No jg NA Was fail -safe verified to be erational ?� ❑Yes ❑ No NA ❑Yes ❑ No j� NA ❑Yes ❑ No 1?J NA ❑Yes ❑ No �j NA ait time between applying rwpor4essure/vacuum/water and starting test 30 minutes ! 30 minutes e P 30 minutes e i 30 minutes ! r Test Start Time: - • f 100 /.' ,� •�� �• ;sue .�► ,O Initial Reading (RI): Q Q Test End Time: 7W cQ_ �;P_Z Final Reading (RF): J' D l" Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. A min. Change in Reading (RF -R�: p.000 .��03 — a 0077 �.0 0 "0. 00 Q- 000P 00 0. o0 l Pass/Fail Threshold or Criteria: +/_ 0.0021.' +/-0.002-, - 0.002" + .002" Test Result: D Pass Fail '0 ss Fail ss Fail OlPgss ❑Fail Was sensor removed for testing? Y ❑ No NA e [I No ❑ NA No ❑ NA e No . ❑ NA Was sensor properly replaced and verified functional after testin ? yes ❑ No ❑ NA Yes ❑ No ❑ NA Yes ❑ No ❑ NA 04es ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work.. ' If the entire depth of the UDC is not tested, . specify how much was tested. If the answer to ggy of the questions indicated with an asterisk(*) is "NO" or "NA ", the entire UDC -must be tested. (See SWRCB LG -160) L J SWRCB, January 2002 8. FILL RISER CONTAINMENT SUMP TESTING Page _ of Facility is Not Equipped With Fill Riser Containment Sumps Fill Riser Containment. Sumps are Present, but were Not Tested Test Method Developed By: ❑ Sump Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Sped) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution:. +/- 0.002" Fill Sump # Fill Sump # Fill Sump # Fill Sump # Sump Diameter: Sump Depth: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested Sump Material: Wait time between applying pressure /vacuum/water and starting test: 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: Initial Reading (RO: Test End Time: Final Reading (RF): Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF -Rj): Pass/Fail Threshold or Criteria: +/- 0.002" +/-0.002" +/-0.002" +/- 0.002" Test Result: ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Is there a sensor in the sump? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Does the sensor alarm when either product or water is detected? ❑ Yes ❑ No U NA ❑ Yes ❑ No ®NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA Was sensor removed for testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA .❑ Yes ❑ No ❑ NA ❑ Yes p No ❑ NA Was sensor properly replaced and verified functional after testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. i SWRCB, January 2002 9. SPILL /OVERFILL CONTAINMENT BOXES Page _ of` Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ Spill/Overfill Containment Boxes are Present, but were Not Tested ❑ Test Method Developed By: ❑ Spill Bucket Manufacturer N Industry Standard ❑ Professional Engineer ,❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Specify) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" Bucket Diameter: Spill Box # -( Spill Box # q Spill Box # Spill Box # -' Bucket Depth: Wait time between applying pressure /vacuum/water and starting test: 30 minutes i 30 minutes 30 minutes 30 minutes Test Start Time: �,Q�/,1fj O o� �� O-9 Initial Reading (R�: 96R�3a- d�7af 5 ?63 dal Fzt/ Test End Time: Final Reading (R,:): 0Pj ,� , Q . s. 3i Test Duration: 15 min '15 min 15 min 15 min 15 min 15 min 15 min 15 min Change in Reading(RF -R,): i" m00e 0.000 `"O.00 ;3� —0.0Af 0.000 1-0.0304-0.0033- f 0b003 Pass /Fail Threshold or Criteria: 02" +1-0.002" +/- 0.002" - +/-0.002" Test Result: ass ❑ Fail 0 Pass Fail ❑ Pass Fail ❑ Pass KFail Comments — (include information on repairs made prior to testing, and recommended follow -up for,failed tests) I S WRCB, January 2002 Page of 9_ SP1T.T,HIV .RF11J. CnNTATNMF.NT R(IXFS Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ Spill/Overfill Containment Boxes are Present, but were Not Tested ❑ Test Method Developed By: ❑ Spill Bucket Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: incon Sump Tester Equipment Resolution: +/- 0.002" qj Spill Box # �=- 13 C11 Spill Box # Spill Box # Spill Box # Bucket Diameter: Bucket Depth: Wait time between applying pressure/vacuum/water and starting test: 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: Initial Reading (R[): Test End Time: Final Reading (RF):33 S ��- Test Duration: 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min Change in Reading (RF -R,): Pass/Fail Threshold or - Criteria: +/- 0.002" +/- .002" +/- 0.002" +/- 0.002" Test Result: ❑ Pass Fail GKPass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Comments -(include information on repairs made prior to testing, and recommended follow -up for failed tests) BELSHN.I. MR,EE IV / SERI*iSNC T . L' Scope of Work Facility: CHEVRON 203576 1125 COFFEE RD BAKERSFIELD, CA Date: 6/24/2008 Job Number: 0 Estimate No: 1004 Contact: } -7 77 A State Of California 1 CONTRACTORS STATE LICENSE BOARD li ��...r ACTIVE LICENSE c Affain m wd., CORP EM :.;. 808313 ENVIRONMENTAL BELSHIRE SERVICES INC , cwab��a1 A HAZ ® . mow.... or. 05W/2010 POLICYHOLDER COPY SG STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION. INSURANCE' ISSUE DATE: 04-01 -2008 GROUP. 000428 POLICY NUMBER: 0008276 -2008 CERTIFICATE ID: 304 CERTIFICATE EXPIRES: 04 -01 =2009 04 -01- 2008/04-01 -2009 PROOF OF, EVIDENCE ONLY SG . JOB: WAIVER OF SUBROGATION AVAILABLE 25971 TOWNE CENTRE DRIVE UPON REQUEST LAKE FOREST CA 92810 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California'Insurance Commissioner to the employer named below for the policy period indicated. This policy is not. subject to canceliation4by the Fund except upon 38 days advance written notice to the employer. We will also give you 30 days advance notice should_ this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - KAREN CASS, PRIES - EXCLUDED. ENDORSEMENT #1600 - LARRY MOOTHART, SEC, TRES - EXCLUDED. ~_ ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04 -01 -2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER BELSHIRE ENVIRONMENTAL SERVICES, INC. SG 25$71 TOWNE CENTRE DR FOOTHILL RANCH CA 92610 M0410 PRINTED 03 -18 -2008 ACC3RD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDONY) 7Y 06/17/2008 PRODUCER (949)8S7 -4500 FAX (949)SS7 -4800 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Millennium Risk Management & Insurance Services License # OC13480 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 5530 Trabuco Road LIMITS Irvine, CA 90275 INSURERS AFFORDING COVERAGE 1h Belshire Environmental Services, Inc. INSURER A: Zurich American Insurance Company DBA: R.E.S.I INSURER B: Steadfast Insurance Company 2597], Towne Centre Drive INSURER C: Foothill Ranch, CA 92610 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED 13ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE-POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLI FFF THE DATE M DD POLICY EXPIRATION DATE MM/DD LIMITS GENERAL LIABILITY GLO 4916038 -06 06/14/2008 06/14/2009 EACH OCCURRENCE $ 1, 000, 00,0 FIRE DAMAGE (Any one fire) S 100,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR MEO EXP (Any one person) $ 5,()00 PERSONAL 8 ADV INJURY S 1,000,000 A ' . GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG S 11000,000 POLICY M PRO- LOC JECT - AUTOMOBILE LIABILITY ANYAUTO oAP 4916042 -06 06/14/2008 06/14/2009 COMBINED SINGLE LIMIT (Ee accident) S 1,000,000 X BODILY INJURY (Per person) S A ALL OWNED AUTOS SCHEDULED AUTOS HIRED, AUTOS NON -OWNED AUTOS X. BODILY INJURY (Per accident) S X X MCS-90 POLLUTION LIABILITY PROPERTY DAMAGE (Per accident) S X I CA -9948 AGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO S AUTO ONLY: AGG EXCESS LIABILITY . EO 5337678 -04 06/14/2008 06/14/2009 EACH OCCURRENCE $ S'000,000 X OCCUR M CLAIMS MADE AGGREGATE S S'000' 000 $ B X DEDUCTIBLE S RETENTION S 1(),000 S WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' UABIUTY E.L. EACH ACCIDENT S EL DISEASE - FA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT S OTHER ontractors PEC 4916039 -06 06/14/2008 06/14/2009 $1,000,000 Aggregate Limit B rofessional & ollution Liability DESCRIPTION OF OPERATIONSILOCAT IONSNERICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS ertificate Holder is named Additional Insured as respects General Liability per endorsement -GL- 1175 -A CW (09/03) >--10 day notice of cancellation in the event of non - payment of premium CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: 4 **=*Proof /Evidence Only * * *** CANCELLATION .SHOULD ANY OF THE ABOVE DESCR18ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LFABFIJ TY OF ANY KIND UPON TH PANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRES AT 25-S(7/97) ©ACORD CORPORATION 1988 The ER Series Alcryn Reducers and Test Reducers are used to step. down . .,from, secondary to primary pipe yes. The Test Reducers are available with or without air air valve and can be used to test the interstitial .space between the secondary and primary piping for leaks. All fittings come with, required band clamps and with or without air test valves. 14 K w. v :esc :ptro ER 1.9x1.9 1.9 1.9 Alcryn Reducer $12.78 ER 1.9x1.9A 1.9 1.9 Alcryn Reducer with air test $18.28 ER 2.61)Q.38LCX 2.61 2.38 ReducerforAmeron 2" LCX $19.74 ER 2.61 )Q.38LCXA 2.61 2.38 Reducer forAmeron 2" LCX with air test $25:24 ER 3.5X2.4 3.5 2.4 Alcryn Reducer $16.25 ER 3.5x2.4A 3.5 2.4 Alcryn Reducer with air test '$21..75 ER 4.5X3.5 4.5 3.5 . Alcryn Reducer $.19.74 ER 4.5X3.5A 4.5 3.5 Alcryh Reducer with air test $25.24 El 3 ". GDS 3.0 - N/A Alcryn 3" Corrugated Duct Seal $4.50 El 4" CDS 4.0 N/A Alcryn 4" Corrugated Duct Seal $5.40 El 6" CDS 6.0 N/A Alcryn 6" Corrugated Duct Seal $6.80 14 K The S13 Series Pellethaine Split Repair Boots are used inside the 'to encapsulate or replace 1ealdng!penetr&tion fittings. Split Inserts.r. sump CITED I . (Sl Series) are ordered separately and are used in the boots in order to ` .O F-7-71 bring the boot to specific pipe dimensions. S131-3.51-P WE M Me 11 M M�esq , 3 M Double ItO" O.D. - 9" I.D. SBXXL8.8x6.8x4.6 Split repair boot that is large enough to encapsulate. $ 210.60 Extra Large SBXXL8.8x6.8 most large sized entry fittings $ 210.60 (XXL) SBXXL8.8 $ 210.60 Extra Large 8.5' O.D. - 6" I.D. SBXL6.8x4.6 Split repair boot that will encapsulate small to medium $ 162.05- (XL) SBXI-3.5 sized entry fittings or replace 10 studded entry fittings. $ 162.00 SBXL2.5LP Low profile split repair boot that is designed to $ 162.00 SBXL4.5LP replacean existing.10 studded entryfitting. This boot has a total height of 225". $ 162.00 Large 7.4" O.D. - 5" I.D. S131-2.5 Split repair boot that will encapsulate small entry $ 1335.0 fittings. S131-3.5 Split repair boot that will encapsulate small entry $ 135.00. fittings. SBL3.5I-P Low profile split repair boot that Is designed to $ 135.001 replace an existing 8 studded entry fitting. This boot has a tot a[ height of 225". SBL4.5 Split repair boot that will encapsulate small entry $ 135.00 fittings. SBL4.8x1.9xt4 Split repair boot for dual supply/return lines for. $ .162.00 g enerato r sites. M ed iurn 5.5* O.D. - 33' I.D. SB M 3.5 Split repair boot for applications where there is no $ 108.00 M SB M 2.5 fitting installed. $ 108.00 S13 M 2.0 t $ 108.00 Small 3.6' O.D. - t5' I.D. S13 S4 B 1.4 Split repair boot that is designed to replace an $ Mo (S) - existing 4 studded entry fitting or Where there is no fitting. MS41314ANGM- Split repair boot that is designed to replacean $ 8to0 existing 4 studded entry ry fitting or wherethere is no fitting. This fitting has a 60 degree angle molded into the boot to enaW it to accommodate repairs where the conduit is entering the sump at up to 40 degrees. Sl3)OCL8.8x6.8x4.6 15 Note: We can supply ,both curved and flat seals for all sump surfaces. . If using the curved seal make sure you rotate the mounting ring to conform to the inside curvature of the sump. 1. Using Acetone, clean the surfaces around the boot that needs to be repaired so that it is free from dirt and oil. 2. Select the split flat or curved mounting ring seal and slip, it over the white ring. Spread the mounting ring apart and position it over the pipe. 3. After cleaning the split edge of the mounting ring with acetone apply a bead of Blue Seal glue to the Blue pellethane edge and use a band clamp to keep it together while the glue cures. `(the white Poly does.not need to bond) Allow forty minutes for the glue to set up. : ■ ■ : : : ■ : ■ : : : : : ■ : ■ ■ ■ ■ ■ ■ ■ ■ r : ■ 4. Liberally apply a bead. of sealant material on the surface of the ring to. be attached to the : inside of the sump wall. The ring will already be over the pipe 5. Position the mounting ring against the inside sump wall, over the existing, leaking penetration and insert the first Tech screw, 6. Fully tighten all Tech screws, checking that a uniform bead of sealant is squeezed out along the outer edge of the mounting ring. 7. Position the split boot over the pipe and apply a bead of glue to the cut edge. The cut edge must be cleaned with Acetone before .applying the glue. Loosely position,'clamps on the boot to hold the two ® glued edges in place. : ■ : : ■ : : i : : : : r ■ ■ r ■ ■ r ■ : 8.Run a bead of the glue onto the outside surface of the mounting ring, where the boot is going to rest. Always make sure that the fill tubes are at 12 o'clock. Install the clamp and tighten the bonded boot to the mounting ring. 9. Leaving the pipe side clamp loose (to allow the air out) completely fill the repair boot. Neatly wipe away any excess sealant on the sump wall or the pipe and tighten all clamps to finish. We always suggest a hydrostatic . (can be started immediately the boot is filled) or vacuum test to check that the repair has been correctly installed October 14, 2004 Note: We can supply both curved and flat seals for all sump surfaces. If using the curved seal make sure you rotate the mounting ring to conform to the inside curvature of the sump. 1. Using Acetone, clean the sump surface around the boot that needs to be repaired so that it is free from dirt and oil. Remove the nuts of the existing. boots, cut away the old boot and cut all bolts off. 2. Select the split flat or curved mounting ring seal depending on whether it is a flat or curved sump and slip it around the two halves of the mounting ring. Spread the ring apart and position it over the pipe. Clean the edge of the Pellethane ring sleeve with acetone and then use the blue.seal glue to bond it together. Use the split boots large band damp to hold the bonded ring together, for 40 mins. 3. Hold the ring .against the sump , wall in its correct position. Drill a 1/8° pilot hole through each hole in the ring clear through the sump wall and the backing ring in the outside of the sump. : ■ : ■ ■ ■ ■ : : r ■ : : ■ : : : : : r 4. Liberally apply a bead of sealant material on the surface of the ring. to be attached' to the inside of the sump wall. The ring will already be bonded together and hanging over the pipe 5. Position, the mounting ring against the inside sump wall, where the existing, leaking penetration used to be and insert the first Tech screw into the pilot hole. 6.' Fully insert and tighten all Tech screws, checking that a uniform bead of sealant is squeezed out along the outer edge of the mounting ring. ■ VA 7. Position the split boot over the pipe and apply a bead of glue to the cut edge. The cut edge must be cleaned with Acetone before applying the glue. Loosely position clamps on the boot to hold the two glued edges in place. r R r r , R r ■ v r : : r ■ : r' VA y.' , J• SHIRE ENVIRONMENTAL A;W = SERVICES, INC. Site Map Location Name: Date: BESW Address: C� Cross Street: City: State: Coll Scope: rev. 10/15/03 SWRCB, January 2002 Page of Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for 'all components tested. The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency. 1. FAirmiw wFORMATmN Facility Name: Chevron# 203578 Date of Testing: Facility Address: 1125 Coffee Road, Bakersfield, CA 93308 Facility Contact: Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (ifpresent during testing): SB989 3 Year Test 2. TESTYNG CONTRACTOR INFORMATION Company Name: Belshire Environmental Services, Inca Technician Conducting Test: Credentials: n CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester License Type: A General Engineering Contractor License Number: 808313 Manufacturer Training Manufacturer Component(s) Date Training Expires Available upon request 3. SUMMARY OF TEST RESULTS OEM Component zm� FBI Secondary Pipe I wmm mom aoo� a000 0000 nnu�� :: m Spill Bucket, If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements i Technician's Signature: (/ Date: SWRCB, January 2002 4. TANK ANNULAR TESTING Page _ of Test Method Developed By:. ❑ Tank Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ® Vacuum ❑ Hydrostatic ❑ Other (Spec) Test Equipment Used: Test plugs, venturi pump and gauges Equipment Resolution: 0.5% of span Is Tank Exempt From Testing ?' Tank # Tank # Tank # Tank # ❑ Yes No ❑ Yes No ❑ Yes o ❑ Yes ❑ No Tank Capacity: Tank Material: FRP tee Other FRP teel Other FR ee Other FRP Steel Other Tank Manufacturer: Product Stored: 87A@ 91 D Other 8 89 91 D Other 87 89 ft D Other 87 89 91 D Other Wait time between applying pressure /vacuum/water and starting test: 10 minutes 10 minutes 10 minutes 10 minutes Test Start Time: Initial Reading (R): (�L O. Uelt Test End Time: , Final Reading (RF): G Test Duration: Change in Reading (RF -RI): Pass/Fail Threshold or Criteria: No e" le Loss No D!Lptable Loss Octable Loss No D!L No Detectable Loss Test Result: ass ❑ Fail Pass ❑ Fail ss ❑ Fail ❑ Pass ❑ Fail Was sensor removed for testing? es ❑ No ❑ NA es ❑ No ❑ NA G911y, es ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? yes ❑ No ❑ NA es ❑ No ❑ NA es ❑ No ❑ NA - ❑ Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) I I t i Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containmen testing. {California Code of Regulations, Title 23, Section 2637(a)(6)) 1 SWRCB, January 2002 Page _ of S. SECONDARY PIPE TESTING Test Method Developed By: ❑ Piping Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ® Pressure ❑ Vacuum ❑ Hydrostatic ❑ Other (Spec) Test Equipment Used: Test reducer boots, air compressor and gauges Equipment Resolution: 0.5% of span Piping Material: Piping Run # Piping Run # Piping Run # Piping Run # Piping Manufacturer: Piping Diameter: Length of Piping Run: Product Stored: 8!& 91 D Other 89 91 D Other 87 89 D Other 87 89 91 D Other Method and location of i in -run isolation: Reducer Boots/fittings Reducer Boots/Fittings Reducer Boots /Fittings Reducer Boots/Fittings Wait time between applying pressure/vacuum/water and starting test: 10 minutes 10 minutes 10 minutes 10 minutes Test Start Time: Initial Reading (Rj): Test End Time; //' -ZIr e" Final Reading (RF); s Test Duration: — Change in Reading (RF -RI): Pass/Fail Threshold or Criteria: No detec Loss No de tec le Loss No detec le Loss No detectable Loss Test Result: Vvpass ❑ Fail ePass ❑ Fail @rPass ❑ Fail ❑ Pass ❑ Fail Comments —(include information on repairs made prior to testing, and recommended follow -up for failed tests) SWRCB, January 2002 Page of 6. PIPING SUMP TESTING Test Method Developed By: ❑ Sump Manufacturer • ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +1- 0.002" Sump Diameter: Zfiass ❑ Fail Sump # Sump # Sump # Sump # % 15 min. 15 min. 15 min. ' Sump Depth: 15 min. 15 min. Change in Reading (RF -R,): `�,�G`D Sump Material: .Qfl �„QQf? ,(}�}� y •OD Height from Tank Top to Top of Highest Piping Penetration: !p Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested' Does turbine shut down when sump sensor detects liquid (both product and water)?* ❑ Yes ❑ No ® NA ❑ Yes ❑ No. ® NA ❑ Yes ❑ No ®NA ❑ Yes ❑ No ®NA Turbine shutdown response time N/A N/A N/A N/A Is system programmed for fail -safe shutdown ?* ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA Was fail -safe verified to be operational?* ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No N NA ❑ Yes ❑ No ® NA Wait time between applying pressure /vacuum/water and starting test: 30 minutes 30 minutes ell 30 minutes / f 30 minutes Test Start Time: Initial Reading (Rj): j3 3S3J,2 ,S 6�a!" M Test End Time: / /,:�9A / /.i� /x',?My SY* AI-,M� Final Reading (RF): ?J-2no +/-0.002" +/- 0.002" +/-0.002" Test Result: Zfiass ❑ Fail s ❑ Fail ❑ yass Fail Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. ' 15 min. 15 min. 15 min. Change in Reading (RF -R,): `�,�G`D -�,DflQ .Qfl �„QQf? ,(}�}� y •OD Pass/Fail Threshold or Criteria: +/- .002" +/-0.002" +/- 0.002" +/-0.002" Test Result: Zfiass ❑ Fail s ❑ Fail ❑ yass Fail ❑ Pass ❑ Fail Was sensor removed for testing? Z'Yeo No ❑ NA es.0 No ❑ NA Y ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testine? yes ❑ No ❑ NA RrYes ❑ No ❑ NA CrYes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing and recommended follow -up for failed tests) Sensor functionafity was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. ' If the entire depth of the sump is not tested, specify how much was tested. If the answer to arty of the questions indicated with an asterisk(*) is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160) �T i SWRCB, January 2002 7. UNDER- DISPENSER CONTAINMENT (UDC) TESTING Page of Test Method Developed By: ❑ UDC Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" mom EM UDC # /O UDC # UDC # UDC # UDC Manufacturer: e UDC Material: UDC Depth: 9 �i Height from UDC Bottom to Top of Highest Piping Penetration: O// Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested'/j Does turbine shut down when UDC sensor detects liquid (both product and water)?* ❑ Yes ❑ No ® NA ❑ Yes ❑ No M NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA Turbine shutdown response time N/A N/A N/A N/A Is system programmed for fail- safe shutdown ?' ❑ Yes ❑ No )1 NA ❑ Yes El No W NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was fail -safe verified to be operational?* ❑ Yes ❑ No It NA ❑ Yes ❑ No LONA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Wait time between applying pressure /vacuum/water and starting test 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: , , Initial Reading (Ri): .6' l (o_0Q (0 MV Test End Time: ,y /Y Final Reading (RF): .. Test Duration: 15 min— min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF -RI): " „O K S 3 M p U' o D 'i Pass/Fail Threshold or Criteria: +/-0.00211 +/- 0.002" +/- 0.002" +/- 0.002" Test Result: ❑ Pass Fail ❑ Pass Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Was sensor removed for testing? W Yes ❑ J4 Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? Yes ❑ No ❑ NA VYes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. If the entire depth of the UDC is not tested, specify how much was tested. If the answer to ggy of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) SWRCB, January 2002 7. UNDER- DISPENSER CONTAINMENT (UDC) TESTING Page of Test Method Developed By: ❑ UDC Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +1- 0.002" U UDC # UDC # UDC # UDC Manufacturer: UDC Material: UDC Depth: ' Height from UDC Bottom to Top of Highest Piping Penetration: A9 L Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested Does turbine shut down when UDC sensor detects liquid (both product and water )9* ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA op ❑ Yes Cl No ® NA ❑ Yes []No ®NA Turbine shutdown response time N/A N/A N/A N/A Is system programmed for fail - safe shutdown ?* ❑Yes ❑ No 0 NA ❑Yes ❑ No G$ NA Q Yes El No ANA ❑Yes ❑ No NA Was fail -safe verified to be operational?* [I Yes [I No W NA El Yes ❑ No IM NA ❑Yes ❑ No I'f NA ❑Yes ❑ No Jd NA Wait time between applying pressure /vacuum/water and starting test 30 minutes ! 30 minutes Or .0 30 minutes e i 30 minutes ! e ' Test Start Time: a -W /.' .per Al Initial Reading (RI): J7- Q Test End Time: �j�� /Y 'ip7 V, Final Reading (RF): 3 l Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF -R,): 60 .0 (.,3 —0.Q01? —D.O f 9s '°p. 00,,7 0 ' M. 00 D. 00 Pass/Fail Threshold or Criteria: +/- 0.0021.' +/- 0.002" 40.002" + eg.00211 Test Result: Pass Fail D ass Fail ss D Fail B5PAss 0 Fail Was sensor removed for testing? Y ❑ No NA e ❑ No ❑ NA No ❑ NA e No ❑ NA Was sensor properly replaced and verified functional after testing ? yes ❑ No ❑ NA Yes ❑ No ❑ NA Yes ❑ No ❑ NA es Q No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. ' If the entire depth of the UDC is not tested, specify how much was tested. If the answer to gay of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) ,I �1 SWRCB, January 2002 8. FILL RISER CONTAINMENT SITMP TESTING Page of Facility is Not Equipped With Fill Riser Containment Sumps Fill Riser Containment Sumps are Present, but were Not Tested Test Method Developed By: ❑ Sump Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" -Sump Diameter: Fill Sump # Fill Sump # Fill Sump # Fill Sump # Sump Depth: Height from Tank Top to Top of _Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested Sunip Material: Wait time between applying pressure /vacuum /water and starting test: 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: Initial Reading (RO: Test End Time: Final Reading (RF): Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF -R,): Pass/Fail Threshold or Criteria: +/- 0.002" +/-0.002" +/- 0.002" +/- 0.002" Test Result: ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Is there a sensor in the sump? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Does the sensor aiarm,when either product or water is detected? ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA Was sensor removed for testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No El NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. 11119,137 SWRCB, January 2002 Page of 9. SPILL /OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes Cl Spill /Overfill Containment Boxes are Present, but were Not Tested ❑ Test Method Developed By: ❑ Spill Bucket Manufacturer N Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Specie) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" Bucket Diameter: Spill Box # Spill Box # Spill Box # Spill Box # 76) It Bucket Depth: Il It Wait time between applying pressure /vacuum/water and starting test: 30 minutes 1 30 minutes /` f 30 minutes ! 30 minutes 1 11 l Test Start Time: Initial Reading (Rj): r'��%�� �7Sf 67?63 Test End Time: ,All Final Reading (RF): j57j�;)6 Test Duration: 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min Change in Reading(RF -R,): d000 0.000 `"0..063 Qxxaf —D.000-? - oo• Pass /Fail Threshold or Criteria: +� 02" +1-0.00211 +/-0.002" +/-0.002" Test Result: ass ❑ Fail ❑ Pass XFaij ❑ Pass Fail ❑ Pass Fail Comments — (mclude information on repairs made prior to testing, and recommended follow -up for failed tests) SWRCB, January 2002 Page _ of 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ Spill/Overfill Containment Boxes are Present, but were Not Tested ❑ Test Method Developed By: ❑ Spill Bucket Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" Spill Box # j3 Spill Box # C11 Spill Box # Spill Box # Bucket Diameter: /a Bucket Depth: Wait time between applying pressure/vacuum/water and starting test: 30 minutes ! 30 minutes 30 minutes 30 minutes Test Start Time: Initial Reading (R,):%S'/ 37 a� Soy Test End Time: 0%f �J• ' ,M Final Reading (RF): Test Duration: 15 min 15 min 15 min 15 min 15 min 15. min 15 min 15 min Change in Reading (RF -Rj): S "oo � 0 �� 0 -0 ©t�� 10.0c,00 Pass/Fail Threshold or Criteria: .—[).bog +/- 0.002" +/-0.002" +/- 0.002" +/- 0.002" Test Result: 0 Pass Fail G6ass ❑ Fail ❑ Pass ❑ Fail 0 Pass 0 Fail Comments— (include information on repairs made prior to testing, and recommended follow -up for failed tests) _ _ / BELSH/RE. ENI/�RONMENTL Scope of Work — SERVICES !NG s Facility: CHEVRON 203576 1125 COFFEE RD BAKERSFIELD, CA Date: 6/24/2008 Job Number: 0 Estimate No: 1004 Contact: Location General Work to be performed i I Al I ''i 2b5'.Blligjg, �. • t1I8ft12: �te h 'yis' �m t ? 36 67S''t�20�: �• Bati1: Bets A air ;r r tlu e:Hnvironmeintal Ceitifi�r:_T. �d installer A.. ! •om ?t inw._. • lu - __.... - _ rnvrlrs-_.,.._........__._...__ L.......__ L_........._--_.....- 'Tmtrraaprar- ...._._...__..... 2" ®® ®®I State Of California c9(� CONTRACTORS STATE LICENSE BOARD L..bb_.' ACTIVE LICENSE a 1 Aar, wms.w.*.w 808313 CORP BELSHIRE ENVIRONMENTAL SERVICES INC-— p• -:tea, A HAZ ��^' °^ 05131 /2010 POLICYHOLDER COPY SCE STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE' ISSUE DATE: 04- Oi-2008 GROUP: 000426 POLICY NUMBER: 0000276 -2008 CERTIFICATE ID: 304 CERTIFICATE EXPIRES- 04 -01= 2009.. 04 -01- 2008/04 -01 -2009 PROOF OF, EVIDENCE. ONLY SG . JOB: WAIVER OF SUBROGATION AVAILABLE 25971 TOWNE CENTRE DRIVE UPON REQUEST LAKE FOREST CA 92610 This is to certify that we have issued a valid Work_ ers' Compensation insurance .policy in a form approved by the Calif ornia.Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation4by the Fund -except upon 3p days advance written notice. to_ the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration, This certificate of insurance is not an insurance policy and does, not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement term or condition of any contract or other document with respect to'which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditlons, of such policy. THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS:. $1,000,000 PER OCCURRENCE.. ENDORSEMENT #1600 - KAREN CASS, PRIES - EXCLUDED. ENDORSEMENT #1600 - LARRY MOOTHART, SEC, TRES - EXCLUDED, ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04 -01 -2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER. BELSHIRE ENVIRONMENTAL SERVICES, INC, SG. 25871 TOWNE CENTRE DR FOOTHILL RANCH CA 92810 PRINTED : 03-18 -2008 (REV,2-QS) M0410 ACQRD CERT'IFICAT'E OF LIABILITY INSURANCE =oDA6T/Ej(7/2008 *y POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PRODUCER (94.9)857 -4500 FAX (949)857 -4800 'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION. Millennium Risk Management & Insurance Services License # OC13480 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 5530 Trabuco Road tJM1T5 Irvine, CA 90275 INSURERS AFFORDING COVERAGE. Ih' Bel shire Environmental Services; Inc: INSURER A: 'Zurich American Insurance Company DBA: B.E.S.I INSURER B: Steadfast Insurance Company 25971 Towne Centre Drive INSURER C: Foothill Ranch, CA 92610 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE.POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLI EFF TIVE DATE M DD POLICY EXPIRATION DATE MM/DD tJM1T5 GENERAL LIABILITY GLO 4916038 =06 06/14/2008 06/14/2009 EACH OCCURRENCE s 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) a ]LOO, 000 CLAIMS MADE I OCCUR N ED EXP (Any one person) $ S,00 PERSONAL & ADV INJURY $ 1. 00O 0O A GENERAL AGGREGATE E 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 1,000 000 POLICY M PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO SAP 4916042 -06 06/14/2008 06/14/2009 COMBINED SINGLE LIMB (Ea accident) $ 11000,000 X BODILY INJURY (Per person) S A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NO"WNED AUTOS X. BODILY INJURY (Per accident) $ X MCS -90 POLLUTION LIABILITY X PROPERTY DAMAGE (Per accident) $ X CA -9948 'AGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EAACC S ANYAUTO S AUTO ONLY: AGG EXCESS LIABILITY SEO 5337679-04- 06/14/2008 06/14/2009 EACH OCCURRENCE S 5,000 000 :K OCCUR FI CLAIMS MADE AGGREGATE S S , O00 , 00 s B X DEDUCTIBLE 5 RETENTION S 10,000 g WORKERS COMPENSATION AND EMPLOYERS' L(ABIUTY A TORY LtM{TS. ER E.L. EACH ACCIDENT 5 E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT .S OTHER ontractors EC 4916039-06. 06/14/2008 06/14/2009 $1,000,000 Aggregate Limit B rofessional & ollution Liability DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ertificate Holder is named Additional Insured as respects General Liability per endorsement -GL- 1175 -A CW (09/03) 10 day notice of cancellation in the event of non - payment of premium CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION .SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY ' OF ANY KIND UPON TH PANY, ITS AGENTS OR REPRESENTATIVES, •`- = '°Proof /Evidence Only''* ** *y` AUTHORIZED REPRE %S /AT" The ER Series Alcryn Reducers and Test Reducers are used to step.down . from. secondary to primary pipe yes. The Test Reducers are available, with or without art air valv6 and can be used to test the interstitial .,space between the secondary and primary piping for leaks. All fittings come with. eequired band clamps and with or without air test valves. Webslte: www.blue hnetechrfologies com • _E.rna►I sales @blue= hnetechnotogies 14 ER 1.9x1.9 1.9 1.9 Alcryn Reducer $12.78 ER 1.9x1.9A 1.9 1.9 Alcgn Reducer with air test $18.28 ER 2.61x2.38LCX 2.61 2.38 ReducerforAmeron 2" LCX $19.74 ER 2.61x2.38LCXA 2.61 2.38 Reducer forAmeron 2" LCX with air test $25:24 ER 3.5X2.4 3.5 2.4 Alcryn Reducer $16.25 ER 3.5x2.4A 3.5 2.4 Alcryn Reducer with air test $21.75 ER 4.5x3.5 4.5 3.5 . Aloryn Reducer $19.74 ER 4.5x3.5A 4.5 3.5 Alcryn Reducer with air test $25.24 EI 3" GDS 3.0 N/A Alcryn 3" Corrugated Duct Seal $4.50 El 4" CDS 4.0 NIA Alcryn 4" Corrugated Duct Seal $5.40 EI 6" CDS 6.0 N/A Alcryn 6" Corrugated Duct Seal $6.80 Webslte: www.blue hnetechrfologies com • _E.rna►I sales @blue= hnetechnotogies 14 The S13 -Series Pellethaine Split Repair Boots are used inside the Z - sump'to encapsulate or replace lealdng' penetrcition fittings. Split, Inserts.:-, .. ! ' ... oIT LED (SI Series) are ordered separately and are'used in the boots in order to. :';' bring the boot to specific pipe dimensions. SBL3.SLP SBUBIA Ilk ZBS4131AANGLE SBXXL8.8x6.6x4.6 15 ��AMAUNIAM . MRM- Double 1t0w O.D. - 9" I.D. SBXXL8.8x6.8x4.6 Split repair boot that is large enough to encapsulate $ .210.60 Extra Large SBXXL8.8x6.8 most large sized entry fittings $ 210.60 Sl3XXL8.8 $ 210.60 _(XXL) Extra Large 85" O.D. - 6" I.D. SBXL6.8x4.6 Split repair boot that will encapsulate small to medium $ 162.00 sized entry fittings or replace 10 studded entry I (XL) SBXL3.5 - $ 162.00 fittings. . SBXL2.5LP Low profile split repair boot that is designed to $ 162.00 replace an existing 10 studded entry fitting. This boot SBXL4.51P has a total height of 225". $ 162.00 Large 7.4" O.D. - S' I.D. SBL2.5 Split repair boot that will encapsulate small r entry $ 135.00 fittings. W SBL3.5 Split repair boot that will encapsulate small entry $ 135.00 fittings. SIB URP Low profile sp lit repair boot that is designed t a $ 135.00 replace an existing 8 studded entry fitting. This boot has a total height of 226'. SIBL4.5. Split repair boot that will encapsulate small entry $ 135.00 fittings. SBL4.8x1.9xt4 Split repair boot for dual supply/return lines for. $ .162.00 generator sites. M ediurn 5.5* O.D. - 3.5' I.D. SIB M 3.5 Split repair boot for applications where there is no $ 108.00 (M ) SBM2.5 fitting installed. $ 108.00 SB M 2.0 $ 108.00 Small 33' O.D. - t5" I.D. SBS4Bt4 Split repair boot that is designed to replace an $ MOO existing 4 studded entry fitting or Wherethere is no fitting. SBS41314ANGLE. Split repair boot that is designed to rephicean $ 8t00 existing 4 studded ant ' ry fitting or wherethere is no fitting. This fitting has a 60 degree angle molded into the boot to enable it to accommodate repairs where the conduit is entering the sump at up to 40 degrees. SBUBIA Ilk ZBS4131AANGLE SBXXL8.8x6.6x4.6 15 Note: We can supply both .curved and flat seals for all sump surfaces. If using the curved seal make sure you rotate the mounting ring to conform to the inside curvature of the sump. 1. Using Acetone, clean the surfaces around the boot that needs to be repaired so that it is free from dirt and oil. 2. Select the split . flat or curved mounting ring seal and slip it over the white ring. Spread the mounting ring apart and position it over the pipe. 3. After cleaning the split edge of the mounting ring with acetone apply a bead of Blue Seal glue to the Blue pellethane edge and use a band clamp to keep it together while the glue cures. (the white Poly does not need to bond) Allow forty minutes for the glue to set up. r ■ ■ ■ : : r : ■ ■ : : : : r : r : r ■ ■ ■ ■ ■ : ■ r r : : u 4. Liberally apply a bead of sealant material on the surface of the ring to be attached to the inside of the sump wall. The ring will already be over the pipe 5. Position the mounting ring against the inside sump wall, over the existing, leaking penetration and insert the first Tech screw. 6. Fully tighten all Tech screws, checking that a uniform bead of sealant is squeezed out along the outer edge of the mounting ring. 7. Position the split boot over the pipe and apply a bead of glue to the cut edge. The cut edge must be cleaned with Acetone before .applying the glue. Loosely position clamps on the boot to hold the two glued edges in place. r ■ ■ ■ ■ r M ■ : : : : : : ■ ■ r r : : 8. Run a bead of the glue onto the outside surface of the mounting ring, where the boot is going to rest. Always make sure that the fill tubes are at 12 o'clock. Install the clamp and tighten the bonded boot to the mounting ring. 9. Leaving the pipe side clamp loose (to allow the air out) completely fill the repair boot. Neatly wipe away any excess sealant on the sump wall or the pipe and tighten all 'clamps to finish. We always suggest a hydrostatic (can be started immediately the boot is filled) or vacuum test to check that the repair has been correctly installed October 14, 2004 Note: We can supply both curved and flat seals for all sump surfaces. If using the curved seal make sure you rotate the mounting ring to conform to the inside. curvature of the sump. 1. Using Acetone, clean the sump surface around the boot that needs to be repaired so that it is free from dirt and oil. Remove the nuts of the existing boots, cut away the old boot and cut all bolts off. 2. Select the split flat or curved mounting ring seal depending on whether it is a flat or curved sump and slip it around the two halves of the mounting ring. Spread the ring apart and position it over the pipe. Clean the edge of the Pellethane ring sleeve with acetone and then use the blue.seal glue to bond it together. Use the split boots large band clamp to hold the bonded ring together for 40 mins. 3. Hold . the ring against the sump . wall in its correct position. Drill a 1/8", pilot hole through each hole in the ring clear through the sump wall and the backing ring in the outside of the sump. r r r : r : : : : ■ r ■ r ■ ■ ■ ■ ■ : : : : : : ■ : : ■ ■ 0 NA 4. Liberally apply a bead of sealant material on the surface of the ring, to be attached to the inside of the sump wall. The ring will already be bonded together and hanging over the pipe 5. Position the mounting ring against the inside sump wall, where the existing, leaking penetration used to be and insert the first Tech screw into the pilot hole. ■ r ■ ■ ■ 8. Once the glue has dried (forty minutes) run another bead of the glue onto the outside surface of the mounting ring, : where the boot is going to rest. Always make sure that the fill tubes are at 12 o'clock. Install the clamp and tighten the bonded boot to the mounting ring r ■ ■ r ■ r ■ ■ 6. Fully insert and tighten all Tech screws, checking that a uniform bead of sealant is squeezed out along the outer edge of the ■ mounting ring. ■ 7. Position the split boot over the pipe : and apply a bead of glue to the cut edge. The cut edge must be cleaned with Acetone before applying the glue. Loosely position clamps on the boot to hold the two glued edges in place. October 14, 2004 9. Leaving the pipe side clamp ■ loose (to allow the, air out) r completely fill the repair boot. Neatly wipe away any excess : sealant on the sump wall or the pipe and tighten all clamps to : finish.. We always suggest a : hydrostatic (can be started immediately the boot is filled) or Vacuum test to check that the : r r repair has been correctly installed - ■ 6. Fully insert and tighten all Tech screws, checking that a uniform bead of sealant is squeezed out along the outer edge of the ■ mounting ring. ■ 7. Position the split boot over the pipe : and apply a bead of glue to the cut edge. The cut edge must be cleaned with Acetone before applying the glue. Loosely position clamps on the boot to hold the two glued edges in place. October 14, 2004 DOELS111RRE -�'_�`- 'ENVIRONMENTAL p � m 94— w SERVICES, PVC. Site Map Location Name: 90 I.YS-1 Date: SESW. Address: C� Cross Street: City: State: Scope: C, -,�. 9 . G Q 0. O-I,CJ-- SWRCB, January 2002 Page of Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems.. Use the appropriate pages of this form to report results for all components tested. The completed form, written test.procedures, and printouts from tests (if applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency. 1. FACILITV INFORMATION Facility Name: Chevron# 203576 Date of Testing: Facility Address: 1125 Coffee Road, Bakersfield, CA 93308 Facility Contact: Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (ifpresent during testing): SB989 3 Year Test 2. TESTING CONTRACTOR INFORMATION Company Name: Belshire Environmental Services, Inc. Technician Conducting Test: Credentials: ® CSLB Licensed Contractor D SWRCB Licensed Tank Tester License Type: A - General Engineering Contractor License Number: 808313 Manufacturer Training Manufacturer Component(s) Date Training Expires j Available upon request 3. SUMMARY OF TEST RESULTS - - - - - -- ...... .... -- — — Firs - - -- — — . . o .. Secondary 0�0! 0000 o s o� = "nova nova nova � on■�o■ oo��, nnoo� 000��■ Spill Bucket -- - mono - -- - m000 If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance. with legal requirements Technician's Signature: (/ Date: i r . S WRCB, January 2002 Page _ of 4. .TANK ANN ff.AR TRATING Test Method Developed By: ❑ Tank Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ® Vacuum ❑ Hydrostatic ❑ Other (Spec) Test Equipment Used: Test plugs, venturi pump and gauges Equipment Resolution: 0.5% of span Is Tank Exempt From Testing ?' Tank # Tank # Tank # Tank # ❑ Yes No ❑ Yes No ❑ Yes o ❑ Yes ❑ No Tank Capacity: Tank Material: FRP tee Other FRP teel Other F ee Other FRP Steel Other Tank Manufacturer: Product Stored: 87)@ 91 D Other 8 89 91 D Other 87 89 1 D Other 87 89 91 D Other Wait time between applying pressure /vacuum/water and startin g test: .10 minutes 10 minutes 10 minutes 10 minutes Test Start Time: Initial Reading (RJ: (�G ©. 4 Test End Time: ` Final Reading (RF): — G Test Duration:.. Change in Reading (RF -Ri): Pass/Fail Threshold or Criteria: No DetS.Oable Loss No De table Loss No Det table Loss No Detectable Loss Test Result: 21fass ❑ Fail Pass ❑ Fail ss ❑ Fail ❑ Pass ❑ Fail Was sensor removed for testing? es ❑ No ❑ NA es []No ❑ NA Yes ❑ No ❑ NA []Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? yes ❑ No ❑ NA es No F1 NA es ❑ No ❑ NA ❑ Yes ❑ No El NA COMMentS — (include information on repairs made prior to testing, and recommended follow -up for failed tests) Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containmen testing. {California Code of Regulations,. Title 23, Section 2637(a)(6)) { i i SWRCB,. January 2002 Page _ of S- CF.(-0NnARV PTPV TVRTTKG Test Method Developed By: ❑ Piping Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ® Pressure ❑ Vacuum ❑ Hydrostatic ❑ Other (Specify) Test Equipment Used: Test reducer boots, air compressor and gauges Equipment. Resolution: 0.5% of span Piping Material: Piping Run # Piping Run # Piping Run # Piping Run # Piping'Manufacturer: . Piping Diameter: Length of Piping Run: Product Stored: 87 & 91 D Other 89 91 D Other 87 89 D Other 87 89 91 D Other Method and location of i in -run isolation: Reducer Boots /Fittings Reducer Boots/Fittings Reducer Boots /Fittings Reducer Boots /Fittings Wait time between applying pressure/vacuum/water and starting test: 10 minutes 10 minutes 10 minutes 10 minutes Test Start Time: Z4—' O w Initial Reading (Rj): Test End Time: o; ,' Final Reading (RF): Test Duration: Change in Reading (RF- Ri): Pass/Fail Threshold or Criteria: No deter Loss No deter le Loss No deter le Loss No detectable Loss Test Result: Pass ❑ Fail Pass ❑ Fail Pass ❑ Fail ❑Pass ❑Fail Comments —(include information on repairs made prior to testing, and recommended follow -up for failed tests) �w SWRCB, January 2002 Page _ of 6_ .PTPTNG RTTUP TFATTNG Test Method Developed By: ❑ Sump Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure p. Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester' Equipment Resolution: +/- .0.002" . Sump # Sump # Sump # Sump # rSump iamete r: I epth: Sump Material: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested' ' Does turbine shut down when sump sensor detects liquid (both product and water) ? ❑ Yes ❑ No ® NA ❑ Yes ❑ No. ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA Turbine shutdown response time N/A N/A N/A N/A Is system programmed for fail -safe shutdown ?' ❑ yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ®NA Was fail -safe verified to be operational?* 0 yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ®NA Wait time between applying pressure /vacuum/water and starting test: 30 minutes �' .� 30 minutes s® e' 30 minutes / l 30 minutes Test Start Time. Initial Reading (Ri): -f.V ffew Test End Time Final Reading (RF): Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF-R,): "C.f}Co 0,00N —0. Doi —0-00o)-0.003,;d .D© Pass/Fail. Threshold or Criteria: +/- .002" +/-0.002" +/- 0.002" +/- 0.002" Test Result: ss ❑ Fall ❑ Fail ❑ Pass XFail ❑ Pass ❑ Fail Was sensor removed for testing? es No El NA es No El Y ❑ No ❑ NA ❑Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? yes ❑ No ❑ NA Yes ❑ No ❑ NA EfYes ❑ No ❑ NA ❑ Yes ❑ No' ❑ NA Comments — (include information on repairs made prior to testing and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. If the entire depth of the sump is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk ( *) is "NO" or "NA'.', the entire sump must be tested. (See SWRCB LG -160) _ �T SWRCB, January 2002 7. UNDER= DISPENSER CONTAINMENT TESTING Page _ of Test Method Developed By: ❑ UDC Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Ineon Sump Tester Equipment Resolution: +/- 0.002" UDC Manufacturer: UDC # /O UDC #. / UDC # UDC # a / UDC Material- UDC Depth: Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested Does turbine shut down when UDC sensor detects liquid (both product and water)?* ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA ❑ Yes ❑ No ®NA ❑ Yes ❑ No ®NA Turbine shutdown response time N/A N/A N/A N/A Is system programmed for fail- s afe shutdown?* ❑ yes ❑ No W NA ❑ Yes ❑ No ft� NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was fail -safe verified to be operational?* ❑ Yes ❑ No NA ❑ Yes ❑ No [f NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Wait time between applying pressure /vacuum/water and starting test ' . 30 minutes 10e. 30 minutes / . :,/ 30 minutes 30 minutes Test Start Time: , - . /. Initial Reading (RI): 6' 3 / 7 Test End Time: / a/h Final Reading (RF): MAE. a G Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF-RI): — .C) S 31 —0.0 fl Orb-014i Pass/Fail Threshold or Criteria: +/-0.00211 +/- 0.002" +1-0.00211 +/-0.00211 'Test Result: ❑ Pass Fail ❑ Pass Fail ❑ Pass . ❑ Fail ❑ Pass ❑ Fail Was sensor removed for testing? W Yes ❑ No 10 NA J4 Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? Yes ❑ No ❑ NA VYes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. If the entire depth of the UDC is not tested, specify -how much was tested. If the answer to any of the questions indicated with an asterisk ( *) is. "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) SWRCB, January 2002 7_ TINTIF.R..TNCPF.N.q R rONTATNMRNT tTlnf'.1 TESTING Page ____ of Test Method Developed By: ❑ UDC Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum M Hydrostatic ❑ 'Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +1- 0.002" . UDC Manufacturer: 7UDC U UDC # UDC # UDC # Material: UDC Depth: ' Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested' Does turbine shut down when UDC sensor detects liquid (both product and water),? ` ❑ Yes ❑ No ®NA ❑ Yes ❑ No ® NA ❑'Yes ❑ No ®NA ❑ Yes ❑ No ® NA Turbine shutdown response time N/A N/A N/A N/A Is system programmed for fail - safe shutdown ? ❑ Yes El No 0 NA 171 Yes El No IN NA ❑ Yes ❑ No 14 NA C] Yes ❑ No RNA Was fail -safe verified to be o erational ?` ❑ yes ❑ No W NA ❑ Yes ❑ No 19 NA ❑ Yes ❑ No 21 NA ❑ Yes ❑ No fill NA Wait time between applying pressure /vacuum/water and starting test 30 minutes ! 30 minutes e P 30 minutes ° e 30 minutes r Test Start Time: ' �1 _ad , f A 14, /4>1161- ,jj Initial Reading (RI): fA © Q df 0 Test End Time: �Q% /y ,� A �7,' r.%� Final Reading (Rr): Test Duration: 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. 15 min. Change in Reading (RF -RO: —0.o604 hn_©303 tr 0077 `a.0( 913 -moo-2 roxcop —()-000 -0-0001 Pass/Fail Threshold or Criteria: +/-0.0021.1 +/- 0.002" - 0.002" + 002" Test Result: 11 Pass XFaif ❑ ass Fail ss Fail 95p9ss ❑ Fail Was sensor removed for testing? Yfts ❑ No TD NA e ❑ No ❑ NA No ❑ NA e No ❑ NA Was sensor properly replaced and verified functional after testing? yes ❑ No ❑ NA Yes ❑ No [] NA Yes ❑ No ❑ NA es ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. ' If the entire depth of the UDC is not tested, specify how much was tested. If the answer to ggy of the questions indicated with an asterisk ( *) is "NO or "NA ", the entire UDC must be tested. (See SWRCB LG- 160)a�1�4 SWRCB,.January 2002 Page _ of S. FILL RISF,R CONTAINMFNT SiTMP TESTING Facility is Not Equipped With Fill Riser Containment Sumps Fill, Riser Containment Sumps are Present, but were Not Tested Test Method Developed By: ❑ Sump Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" Fill Sump # Fill Sump # Fill Sump # Fill Sump # Diameter: -Sump Sump Depth: Height from Tank Top to Top of Piping Penetration: -Highest Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to -testing: Portion of Sump Tested Material: -Sump Wait time between applying pressure /vacuum /water and starting test: 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: Initial Reading (RO: Test End Time: Final Reading (RO: Test Duration: 15 min. 15 min. 15 min: 15 min. 15 min. 15 min. 15 min. 15 min. LChange in Reading (RF -R,): Pass/Fail Threshold or Criteria: + /.. 0.002" +/-0.002" +/- 0.002" +/- 0.002" Test Result: Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Is there a sensor in the sump? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Does the sensor alarm when either product or water is detected? ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA I ❑ Yes ❑ No ® NA ❑ Yes ❑ No ® NA Was sensor removed for testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and v erified f after testing? El Yes ❑ No ❑ NA F1 Yes ❑ No El NA El Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA COMMent5 — (include information on repairs made prior to testing, and recommended follow -up for failed tests) Sensor functionality was not confirmed. This procedure is not part of the Secondary Containment Testing scope of work. 4 Q & Vtn 4- Pnr)/A-_)DecJ L 0 +' i VI 4-i' l f � Vw\4 i k'yA /L 4- ,_\dM/fr SWRCB, January 2002 9. SPILL /OVERFILL CONTAINMENT BOXES Page _ of Facility is Not Equipped With Spill/Overfill Containment Boxes El Spill/Overfill Containment Boxes are Present, but were Not Tested ❑ Test Method Developed By: ❑ Spill Bucket Manufacturer ® Industry Standard p Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure . ❑ Vacuum ® Hydrostatic ❑ Other (Specify) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" Spill Box # Spill Box #1 Spill Box # -( Spill Box # 1 Bucket Diameter: Bucket Depth: Wait time between applying pressure /vacuum/water and starting test: 30 minutes l l 30 minutes r Poe 30 minutes 30 minutes Test Start Time:. O,CAOV Initial Reading (RO: 363/ m/gl ? �? Test End Time: �,• � y ,� ,' �+J -,Z Final Reading (RF): �7 9A7/11 Test Duration: 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min Change in Reading (RF-R,): .00e -000 �� 0 �E1.0 �� -0.000 �0. 030d —D.00 3 '0d003 Pass /Fail Threshold or Criteria: 2 02" +/-0.002" +/-0.002" +/-0.002" Test Result: Wfass ❑ Fail ❑ Pass YLFgLil ❑ Pass Fail 11 Pass kFail Comments (include information on repairs made prior to testing, and recommended follow -up for failed tests) r S WRCB, January 2002. Page _ of _ 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ Spill/Overfill Containment Boxes are Present, but were Not Tested ❑ Test Method Developed By: ❑ Spill Bucket Manufacturer ® Industry Standard_ ❑ Professional Engineer ❑ Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum ®,Hydrostatic ❑ Other (Spec) Test Equipment Used: Incon Sump Tester Equipment Resolution: +/- 0.002" Spill Box # Spill Box # qt Spill Box # /�7 j3 Cl Spill Box # 11 Bucket Diameter: Bucket Depth: Wait time between applying ,pressure /vacuum/water and starting test: 30 minutes 30 minutes 30 minutes 30 minutes Test Start Time: Initial Reading (R,): Test End Time: , • /xw 011A l,, ' �j, f� l Final Reading (RF): ;V33 S W_ Test Duration: 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min Change in Reading (RF -R1): "®. bo 'Qo �j OH", 0 -000)1 10.ouo Piss/Fail Threshold or Criteria: +/= 0.002" +/- .002" +/- 0.002" +/- 0.002" Test Result: ❑Pass Fait s ❑Fail 11 Pass . []Fail ❑Pass ❑Fail Comments —(include information on repairs made prior to testing, and recommended follow -up for failed tests)