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Home My WebLink AboutSLOUNIFLOW_FS1 Admin iRC3926i Color_0159_001 (2)_RedactedBliss, Matheson From: James Ferris Sent: Tuesday, April 19, 2022 3:39 PM To: Bliss, Matheson Subject: RE: Cold Start Inspector Bliss, The cold start didn't solve the problem and it looks like we might need to replace the ECPU. Is a permit required for the ECPU replacement? If so what is the cost? Jae Ferris (DECO Inc 714-279-2690 ext 316 From: James Ferris Sent: Tuesday, April 5, 20221:18 PM To: Bliss, Matheson <mblisstaslocity.org> Subject: RE: Cold Start Mr. Bliss, Thank you we will submit requested pa perwork to you Jae Ferris IDECO Inc 714-279-2690 ---- Original message ------ From: "Bliss, Matheson" <mbliss0slocitv.org> Date: 4/5/2213:08 (GMT-08:00) To: James Ferris < n_ Subject: Re: Cold Start Hi James, Yes you can proceed. I will not be available to witness the cold start. Please submit a work order or other documentation stating the sensors were tested/passed for positive shutdown/ failsafe and ESO is functional. Thanks, Matheson Bliss Hazardous Materials Coordinator Fire Department Fire Prevention E mblissCa)siocilv.or0 T 805.781.7383 C 805.540.4413 slocity.org From: James Ferris > Sent: Tuesday, April 5, 2022 12:53:41 PM To: Bliss, Matheson <mbliss0slocity.ore> Subject: Cold Start ,This message is from an External Source. Use caution when deciding to open attachments, click links, or respond. Good Afternoon, 1 will be at the UPS San Luis Obispo facility at 36015acramento Dr. San Luis Obispo Ca. 93401 on Thursday 04/07/22 at 11am to conduct a Cold Start on the VeederRoot. Please let me know if it is ok to proceed Thank you Jae Ferris IDECO Inc 714-279-2690 CAUTION: This email originated from outside of the company. Do not click links or open attachments unless you recognize the sender and know the content is safe. NEVER enter your email address and password if requested by any website. Appendix VI Underground Storage Tank Monitoring System Certification Form TYPE OF ACTION E] Installation ® Repair ❑ 12 Month 1. FACILITY INFORMATION CERS ID 10416094 Certification Date 4/20/2022 Facility Name UPS San Luis Obispo Facility Address 3601 Sacramento Dr City San Luis Obispo ZIP Code 93401 2. SERVICE TECHNICIAN INFORMATION Company Performing the Certification IDECO Inc Phone 714-279-2690 Mailing Address 431 W. Blueridge Ave. Orange, Ca. 92886 Service Technician Performing Test James Ferris Contractorfrank Tester License Number 744619 ICC Number 8206987 ICC Expiration Date 11/17/2023 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date Veeder Root 04/24/2022 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST I hereby certify that the monitoring system is operational in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2638; that required supporting documentation is attached; and all information contained herein is accurate. Service Technician Signature Date 04/20/2022 Total # of Pages CERS = California Environmental Reporting System, GPH = Gallons Per Hour, ID = Identification, ICC = International Code Council, LLD = Line Leak Detector, NA = Not Applicable, SW = Single - Walled, UDC = Under -Dispenser Containment, UST = Underground Storage Tank, VPH = Vacuum/Pressure/Hydrostatic Page 1 of 6 Underground Storage Tank Morrrtoring System Certiftcatim. Form 5. MONITORING SYSTEM AND PROGRAMMING A separate Monitoring System Certification Form must be prepared for each control panel. Make of Monitoring System Model of Monitoring System Software Version Installed Control Panel Control Panel VeederRoot TLS350 327.00 Attach the post -certification reports if the monitoring system is capable of generating Yes No NA either, 0 Monitoring System Set-up ® Alarm History Report All monitoring equipment is operational per manufacturer's specifications? Secondary containment systems are free of damage, debris, or liquid? ❑ ❑ Are the audible and visual alarms operational? ❑ ❑ All sensors have been: 1) visually inspected for wiring kinks, breaks and residual ® ❑ ❑ buildup on floats; and 2) tested for functionality and confirmed operational? Are all sensors installed to detect a release at the earliest opportunity in the ❑ ❑ ❑ secondary containment? The monitoring system set-up was reviewed, and proper settings confirmed? ® ❑ ❑ Was the monitoring control panel's backup battery visually inspected, functionally ® ❑ tested, and confirmed operational? Does the flow of fuel stop at the dispenser if a release is detected in the under - dispenser containment? Does the turbine automatically shut down if the piping secondary containment El El ❑ monitoring system fails to operate or is electrically disconnected? Does the turbine automatically shut down if the piping secondary containment monitoring system detects a release? Which sensors initiate positive shut down? ❑ ❑ Check all that apply) Sump rl UDC If monitoring system alarms are relayed to a remote monitoring center, is all ® ❑ ❑ communication equipment operational? Describe all answers marked "No" or `Fail" and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 2 of 6 -, Underground Storage Tank Mohmoring System Certification roan 6. SENSOR TESTING RESULTS List only sensors tested on date of this certification. List "Sensor ID" as labeled in system programming. Additional copies of this page maybe attached to accommodate all sensors tested. SensorlD Sensor Model Component(s) Monitored Pass Fail L1 794380-302 Diesel Annular Sensor El ❑ L2 794380-208 Turbine Sump Sensor El ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ In 0 ❑ ❑ ❑ 0 ❑ on ri ❑ ❑ ❑ ❑ ❑ Describe all answers marked "No" or "Fail" and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 3 of 6 Underground Storage Tank Monitoring System Certification Form 7. LINE LEAK DETECTOR TESTING Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) Simulated release rate verified: (Check all that apply.) 3 GPH 0.1 GPH 0.2 GPH Yes No NA Has the testing apparatus been properly calibrated? ❑ ❑ For emergency generator tank systems, does the LLD create an audible and visual alarm when a leak is detected? ❑ ® ❑ For mechanical LLDs, does the LLD restrict the flow through the pipe when a release is detected? El® ❑ For electronic LLDs, does the turbine automatically shut off when a release is detected? El For electronic LLDs, does the turbine automatically shut off if any portion of the monitoringsystem is disabled or disconnected? ❑ ❑ ❑ For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a tightness test? ❑ ❑ ❑ For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? ❑ ❑ ❑ Were all items on the equipment manufacturer's maintenance checklist completed? ® ® ❑ Were all LLDs confirmed operational within regulatory requirements? ❑ ❑ ❑ LLD ID LLD Model Lines Monitored Pass Fail ❑ In ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Describe all answers marked `No" or "Fail" and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 4 of 6 Underground Storage Tank Mot „coring System Certification c;orm 8. IN -TANK GAUGING TESTING Check this box if tank gauging is used only for inventory control. ❑ Check this box if NO tank gauging equipment is installed. Do not complete this section if either box is checked. Yes No NA All wiring has been: 1) visually inspected for kinks, breaks and proper entry and termination; and 2 tested for around faults? ❑ ® ❑ Were all in -tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely, functionally tested, and confirmed operational? ❑ ® ❑ Was accuracy of system's product level readings tested? ❑ ❑ ❑ Was accuracy of system's water level readings tested? ❑ ❑ ❑ Were all probes reinstalled properly? 01 ❑ 117 Were all items on the equipment manufacturer's maintenance checklist completed? ❑ ❑ ❑ Probe ID Probe Model Tanks Monitored Pass Fail Diesel Mag 1 Diesel 0 ❑ 0 ❑ ❑ ❑ ❑ ri 9. COMMENTS Describe all answers marked "No" or "Fair and proposed remedy. List all monitoring equipment either replaced or repaired. Page 5 of 6 ALARM HISTORY REPORT ---- IN -TANK ALARM - T I:DIESEL HIGH PRODUCT ALARM APR 20. 2022 3:23 PROSE OUT APR 20, 2022 8:36 APR 20. 2022 8:22 x xxxx END RRxxx ALARM HISTORY REPORT -- SENSOR ALARM - L 1:ANNULAR SPACE ANNULAR SPACE LOW LIQUID ALARM APR 20. 2022 8:29 HIGH LIQUID ALARM APR 20, 2C22 8:29 LOW LIQUID ALARM APR 20, 2022 6:26 x x x x x END x x x x x ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 2:TURBINE SUMP STP BUMP FUEL ALARM APR 20, 2022 8:17 SENSOR OUT ALARM APR 20, 2022 0:11 1J Appendix VI Underground Storage Tank Monitoring System Certification Form TYPE OF ACTION ® Installation ® Repair ® 12 Month 1. FACILITY INFORMATION CERS ID 10416094 Certificafion Date 09-17.2021 Facility Name UPS - SAN LUIS OBISPO Facility Address 3601 SACRAMENTO DR. City SAN LUIS OBISPO CA ZIP Code 9--4 2. SERVICE TECHNICIAN INFORMATION Company Performing the Certification (DECO, INC Phone (714) 279-2690 Mailing Address 7306 COLDWATER CYN., 117, NORTH HOLLYWOOD, CA 91605 Service Technician Performing Test RICH POQUETTE Contractor/Tank Tester License Number 744619 ICC Number 8817853 ICC Expiration Date 11.4-2022 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date VEEDER ROOT - (C23197) 08-15-2023 VMI LDT-890 - (4546) 10.29.2021 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST I hereby certify that the monitoring system is operational In accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2638, that required supporting documentation is attached; and aft information contained herein Is accurate. Service Technician Signature Date 09. 7.2021 Total # of Pages r CERS = California Environmental Reporting System, GPH = Gallons Per Hour, ID = Identification, ICC = International Code Council, LLD = Line Leak Detector, NA = Not Applicable, SW = Single - Walled, UDC = Under -Dispenser Containment, UST = Underground Storage Tank, VPH = Vacuum/Pressure/Hydrostatic Page 1 of 6 Underground Storage Tank Monitoring System Certification Form 5. MONITORING SYSTEM AND PROGRAMMING A separate Monitoring System Certification Form must be prepared for each control panel. Make of Monitodng System Model of Monitoring System Software Version Installed Control Panel Control Panel VEEDER ROOT TLS360 327.00 Attach the post-cer6ricabon reports if the monitoring system is capable ofgenerattng either; ® Monitoring System Set-up ❑ Alarm History Report Yes No NA All monitoring equipment is operational per manufacturer's specifications? ® ❑ Secondary containment systems are free of damage, debris, or liquid? In ❑ Are the audible and visual alarms operational? All sensors have been: 1) visually inspected for wiring kinks, breaks and residual ® ® ❑ buildup on floats; and 2) tested for functionality and confirmed operational? Are all sensors installed to detect a release at the earliest opportunity in the El secondary containment? The monitoring system sat -up was reviewed, and proper settings confirmed? ® ❑ ❑ Was the monitoring control panel's backup battery visually inspected, functionally tested, and confirmed operational? Does the flow of fuel stop at the dispenser if a release is detected in the under - dispenser containment? Does the turbine automatically shut down if the piping secondary containment m ❑ ❑ monitoring system fails to operate or is electrically disconnected? Does the turbine automatically shut down if the piping secondary containment monitoring system detects a release? Which sensors initiate positive shut down? ❑ ❑ ❑ Check all that a I Sum UDC If monitoring system alarms are relayed to a remote monitoring center, is all El communication equipment operational? Describe all answers marked 'No" or Fail" and proposed remedy in Section 9. List all monitoring equipment eithermplaced ormpaired in Section 9 Page 2 of 6 Underground Storage Tank Monitoring System Certification Form 6. SENSOR TESTING RESULTS List only sensors tested on date of this cerN9ca9on. List °Sensor ID" as labeled in system Programming. Additional copies of this page maybe attached to accommodate all sensors tested. Sensor ID Sensor -Model Component(s) Monitored Pass Fail Ll 302 ANNULARSENSOR 0 ❑ L2 208 TURBINE SENSOR ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ In ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ In In Descnbe all answers marked "No" or °Fail" and pmposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 3 of 6 Underground Storage Tank Monitoring System Certification Form 7. LINE LEAK DETECTOR TESTING - PM Check this box if line leak detectors ARE NOT installed. (Do not complete this secticn.) Simulated release rake verified: (Check all that apply.) 3 GPH 0.1 GPH 0.2 GPH Yes No NA Has the testing apparatus been properly calibrated? El ® ❑ For emergcy generator tank systems, does the LLD create an audible and visual enand alarm when a leak is detected? El 0 in For mechanical LLDs, does the LLD restrict the flow through the pipe when a release is detected? 171 © ❑ For electronic LLDs, does the turbine automatically shut off when a release is detected ❑ For electronic LLDs, does the turbine automatically shut off f any portion of the monitorin system is disabled or disconnected? ❑ ❑ For electronic LLDs, does the turbine automatically shut off if any portion of the monitoringsystem malfunctions or fails a lightness test? ❑ ❑ For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? ❑ ❑ Were all items on the equipment manufacturer's maintenance checklist completed? ® ❑ Were all LLDs confirmed operational within regulatory requirements? 0 El ❑ LLD ID LLD Model Lines Monitored Pass Fail DIESEL MLLD VEEDER ROO' DIESEL ® ❑ ❑ ❑ ❑ ❑ In ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Describe all answers marked Woo or °FeiP and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 4 of 6 Underground Storage Tank Monitoring System Certification Form 6. IN -TANK GAUGING TESTING Check this box if tank gauging is used only for inventory control. ❑ Check this box if NO tank gauging equipment is installed. Do not complete this section if either box is checked. Yes No NA All wiring has been: 1) visually inspected for kinks, breaks and proper entry and termination; and 2 tested for around faults? ❑ ❑ ❑ Were all in -tank gauging probes visually inspected for damage and residue buildup to ensure that floats move free) functional) tested. and confirmed o eratbna�? ® ❑ Was accuracy of s stem's product level readings tested? m ❑ ❑ Was accuracy of system's water level readings tested? ® ❑ ❑ Were all probes reinstalled properly? ® ❑ ❑ Were all items on the equipment manufacturer's maintenance checklist completed? ® I 0I ❑ Probe ID Probe Model Tanks Monitored Pass Fail DIESEL MAG 1 DIESEL 171 ❑ ❑ ❑ ❑ ❑ ❑ ❑ S. COMMENTS Describe all answers marked "No" or 'Fail"and proposed remedy. List all monitoring equipment eitherreplaced orrepaired. Page 5 of 6 Underground Storage Tank Monitoring System Certification Form Date site plan was prepared: Na site plan has been prepared that shows all required information, you may Include d, rather than this page, with yourMonitonng System Certification Form. The site plan must show the genera/ layout of tanks and identify locations of the monitoring panel, and all leak detection equipment and monitoring locations. Include O'30�Q 'fit mttq Appendix Vlll Underground Storage Tank Spill Container Testing Report Form TYPE OF ACTION m Installation El Repair ® 12 Month 1. FACILITY INFORMATION CERS ID 10416094 Test Date 09-28-2021 Facility Name UPS San Luis Obispo Facility Address 3601 SACRAMENTO City SAN LUIS OBISPO ZIP Code 93401 2. SERVICE TECHNICIAN INFORMATION Company Performing the Test IDECO, INC Phone 714-279-2690 Mailing Address 7306 COLDWATER CYN. #7 NORTH HOLLYWOOD, CA 91605 Service Technician Performing Test RICH POQUETTE Contractodiank Tester License Number 744619 ICC Number ICC Expiration Date 8817853 11.04.2023 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certi#cations Expiration Date DPW - (100833) 09-22-2023 4. TEST PROCEDURE INFORMATION Test Procedures Used Components Tested PEI 1200 DIESEL FILL SPILL BUCKET " 6. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST I hereby certify that each spill container was tested in accordance with California Code of Regulations, tide 23, division 3, chapter 16, section 2637.1; that required supporting documentation is attached; and all information contained herein Is accurate. 1 understand that test procedures shall be made available upon request by the governing authority. Service Technician Signature I Date 09.28-2021 Total # of Pages 3 CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council Page 1 of 2 Underground Storage Tank Spill Container Testing Report Form S. SPILL CONTAINER'DETAILS. Test Method Developed by ® Manufacturer 0 Industry Standard Ip Professional Engineer Test Type O Pressure El Vacuum Ip Hydrostatic Tank lD DIESEL Spill Container Manufacturer: POMECO Method of Cathodic Protection m Nonmetallic m Nonmetallic El Nonmetallic ❑ Nonmetallic Other ® Other 0 Other m Other Is the spill container minimum capacity five gallons excluding Yes Yes ip Yes El Yes riser volume? ® Ne m No` El No* ❑ No' Method to keep spill container 0 Drain rl Drain IJ Drain ip Drain empty O Pump m Pump El Pump O Pump Other ❑ Other 0 Other Other Spill Container Test Results ® Pass m Pass in p Pass ❑ Pass Fail Fail F3 Fail r3 Fail Tank lD Spill Container Manufacturer: Method of Cathodic Protection O Nonmetallic ❑ Nonmetallic ❑ Nonmetallic p Nonmetallic Other Other Other Other Is the spill container minimum capacity two gallons excluding m Yes p Yes ip Yes ❑ Yes riser volume? 0 No' IJ No` p No' ❑ No* Method to keep spill container ® Drain ❑ Drain p Drain ❑ Drain empty ® Pump ❑ Pump ip Pump ip Pump Other El Other Other Other Spill Container Test Results El Pass ❑Pass Pass ❑ Pass Fail Fail I] Fail Fail 8. COMMENTS Describe all answers marked "OMer," aNq' or "Fail" and each proposed remedy. • Mark here if: ® Spill ill containers do not have a minimum capacity of five gallons and require replacement. Additional copies of this page may be attached. Page 2 of 2 UPS MCRAME14TO SON WIS OBISPO 1-714-279-2690 0928v2021 10:43 AM SUMP LEAK TEST REPORT DEL TEST STARTED 10:28 AM TEST STARTED 09282821 BEGIN LEVEL 7.091 IN END TIME 10+43 AM END DATE 09/292021 ETU LEVEL 7.6393 IN LEAK THRESHOLD 0.002 IN TEST RESLI.T PASSED Appendix IX Underground Storage Tank Overfill Prevention Equipment Inspection Report Form TYPE OF ACTION ® Installation E) Repair m 36 Month 1. FACILITY INFORMATION CERS 10 10416094 Inspection Date 09-17-20r Facility Name UPS SAN LUIS OBISPO Facility Address 3601 SACRAMENTO City SAN LUIS OBISPO, CA ZIP Code 93401 2. SERVICE TECHNICIAN INFORMATION Company Performing the Inspection IDECO, INC. Phone 714.278-2890 Mailing Address 73Ufi COLDWATER CYN., 07, NORTH HOLLYWOOD, CA 91805 Service Technician Performing Inspection RICH POQUETTE ContractorlTank Tester License Number 744619 [CC Number 8817859 Expiration Date 11-04-2022 3.. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date OPw - (1008m) 09-22.2023 VEEDER ROOT - (C23197) 08-16.2023 4. INSPECTION PROCEDURES INFORMATION Inspection Procedures Used Components Inspected PEI 1200 SHUT OFF FLOW a AIV ALARM 6. CERTIFICATOERVICE TECHNICIAN CONDUCTING INSPECTION I hereby certify that the OPE was inspected in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637.2; that required supporting documentation is attached; and all information contained herein is accurate. I understand that test procedures shall be made available upon request by the governing authority. Service Technician Signature Date 09-17-2021 Total # of Pages 5 CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council, OPE = Overfill Prevention Equipment Page 1 of 2 Underground Storage Tank Overfill Prevention Equipment Inspection Report 6. OVERFILL PREVENTION EQUIPMENT DETAILS Tank ID (One OPE per column) DIESEL ❑ Yes ❑ Yes DIESEL ❑ Yes In Yes Are both vent and tank riser piping secondarily contained? ®No ❑ No m No ❑ No OPE Model What is the OPE response when Shut off Shut off Shut off Shut off activated? Flow Flow Flow Flow (Check all that apply) ❑ Restricts ❑Restricts ❑ Restricts ❑ Restricts Flow Flow Flow Flow ❑ Audible ❑ Audible In Audible ❑ Audible Alarm Alarm Alarm Alarm ❑ Visual ❑ Visual El Visual ❑ Visual Alarm Alarm Alarm Alarm Are flow restrictors installed on vent piping E) Yes' U] Yes* In Yes' Yes" that may interfere with the OPE operation? ❑ No ❑ No ❑ No ❑ No At what level in the tank is the OPE activate?Inches from bottom of tanWhat rs, is the percent capacity of the l94 Eonto which the OPE activates? s%99.9% LONo Is the OPE in proper operating cond Yes Yes' Yes` respond when the stored substance ❑ No❑ No . ❑ No reaches the designated regulatory level? 7. SUMMARY OF TESTING RESULTS OPE Inspection Results ❑ FaiPasIs I� Fail Pass PaFails ❑ Pass ❑Fail 8. COMMENTS Describe all answers marked "No" or "Fail" and proposed remedy. List all monitoring equipment either replaced or repaired. ' Mark here if: ❑ Flow restrictors interfere with overfill prevention and equipment repairs required. Additional copies of this page may be attached. Attach tank chart(s), measurements, calculations, and In -Tank Setup report(a) Page 2 of 2 XERXES@ CORPORATION Dipstick Calibration chart for 12,000 Gallon - 8' Diameter DINT -II Tank DIPSTICK READING ' " GALLONS 0IP67ICK RBAOING 1 GALLONS DIPS= REAMS I1IFSTIGK REAMING �';vu ,1 GALLONS OIP5110K RUMG ll, 1 :..... DIPSTICK READING GALLONS S629 51 3/a- 6973 50.718' "am GB' 9466 76-1/6" 10496 84-1/4' 11264 _ 43314" 51-716' soon 60` , a290 ' 66.1/6` 9484 76-1/4' 10510 84.318' 1121f 437/8- 52' -7014 1 60.1/8' 6&1/4' 9501.. 76-318' .10524 84-12' 11283. 41' Lin 52-IIB' `"'7034 600.1/4- ^8347 V' 68.3/e' 9518 76712' y 0538 . 54.5/8' 'lint 49-1l8' - 712 52-1/4' 7054 60.35' 68-1/T 95M ]&5/S' 10552 M-WV 11300 41-1/4' "'6 52-3/80 7075 50.12' 'SM7 68-SW 9553 76.34• 10566 8471B- 11306 44.3/8' 7 52-12" " 7095 60.51E' 8386 68.314' 9576' 7&7/8" 10580 BS 11317 04L2' 52-51B- 716 . 60-3/4• "94 66-7/6" 9567 -10593 ' 6&1l0• 1IM5 44- 8' ; 52.3146 '8'7 60.7 '•'8424 69• ` 9604 77.11W 106C7 85-//4' 11333 44 ' 1 156 61` 8443 69-1/8" 9621 n-114' 10621 M.36' 11341 6 1-1 69-11421 963B 77-318' 10G34. 12' - 1134 -I4' Wo M.W MFid 77-12- 10648 MIMI /1357 4' M17 KI- l. 10661 11365 45.1/4• 6899 533/B' M38 61-12' 8520 69-&8° -9688 77-WV 10674 W-7)W 11373 4&av 5919 53124 7258 61-5/8' 8539 69.314" 9705 n-718' 10686 86' 11380 As.11Z 5940 53-5/e' M78 61-314' 8559 69.7/6" 9722 78' 10701 Mile* 11387 45- 5061 3-3/4' -7298 61-7/B' SS76 70- 7 B 78-1/8' -10714 S&1/d' 11395 I15.3W 5962 53-7/8' 7319 62.-Moo 70-IM 9755 78-1/4' 10727 SSI3W ll402 - / ' 7qq9 701114' 9M 7&3/B" 107Q f 6&12' ildlJ409 IA''6023 4-JA- 62-114. loom 70. 79-12• 10753 86-SW 9411416 54-1/4- -: M 62.8- 7o-W !9B04 76-5/B' 10766'; 6&3(4' ,, 1f42z 54-318' :V 400'. 6Y-12' 1 ` 7G-518' '.:owl 763'a' 16n9. 66-7/6' Im429 420':R6�41AX ' 70.3/4" "'.9837 7&7/B' 1W91 - 8T 5, 1108' 70-7/S' "19854 79- _ 0804' 67-IM' 2 -3/ ' 71' :: 9870 79-1/8' 10817!' 87AW :1144B ` ag' 148 54.7/8' '-480 .98.. 71-IM' '1/ 886 79-1/4' 1029.S 67-SS• :11454' p4&* 6169• "9 71-114• 11903 79-3/B' 10842 : B7-02' ` '11 9 'g6l&) 55-Im" "7520' 71-3/8' ' 9919 79-12' 10854" 87.6/8• 11465 '9,£!6210' 55=114" 75a0• 71-M" 9935 ]9-5/0' B74 - 11471 ' = 'fi231 55-31B' 75W -IIIIN 0 71-5/8' 9951 79-3/4' 40879 57-7/9' 11478 16251. 55-12' 7581' "`8839 71.3/4' B9fi7 ]9-7/8' 1D891 68• 1148 ' =':'62M 55-5/8' 7601' h6857 71=71W Dom W. /0903I 66.1/e' 11486 47- •14ja B3' 55-34' -7621 '!'U70 M' -9999 8-01M 10915' 88-1/4- 11491 47-3/4' I1'.6314 55-7/e' 7641": 8894 72-1A1' IM15 8&1/4' I 27 AS.". 11495 47.75' 6331 56' ]861e' 8912 MAW 10031 80-&6' 10939' B&12' 11499 48• 48-IW 48.1/4• 45.3/8' 48-12' ae-5/8' 48-314' 48-7/8' 49` !'.'6355 ':�6376 6396 :"641] ' •I 64m d 6458 °`f"n 6500 -20 •f:.-6541 56-1I8' 56-1W M-319' S6-12' 56-5i8' 6-314' 56-718' 57" 57-118" 57-114' 1 7681 7700 mo 7740 nfi0 0780 7600 7820 7840 7859 . 84-1/4' 64."' 64-1W 61-SW 64.314' 644/9' 65' 654/8" 65-114" 65-318' '.8931 '6949 BM7 ,8986 ' �.9004 9022 low 9059 `n 095 . M-3/S' 72-12' 7z-5/8' M-314' MIMI 73' 73-11W 73-1/4• 73-&B' 73i ' 1004A _19062 IW78 10093 a0109 '<10140'. '101N : 10171 tOle 80.12' eo-sle' 80-3/4' 80.715' 81' i 81-1/4' 81-3/e• 81-1/2' 61-518" 0974 10985':'. imp89.151' tl008; 11=3 -' 88-5/B' ee- a• S9&7/8' 89 69.114' 89IM. 12' 8Bd/8' BBa/4- 11504 u567 11511 lisle 11518 115M item 11 11627 11527 /9-1/4' 49-3/8' Y::8562 i h6582 57-3I6' 57-10 '. 7879 ^. 7899 65-12' 665/8' 8113 r. 0131, 73- 8'"10202 73-3/4• I 1@1]. 81-3l4' 81-75' ".T1 11076 49-12' _ 6603 57-5i8' 7919 65 314' 73-7/6' 10232 82' 49-SW -� SP34- 098 65-7/6. _'9149' Alln,. 74" IM47 82-10 19-3/4' 57-]18' 88' e1B5 " ]41/8' 1D262 62.1W P;41107 48.71W 6665 sB• 7978 6 1/8' 74-1/4• ''. 10277 82-318' I' 1111 56-I/B' 7997 66.1/4" 74- ', 1D292 82-IM50-118m 16706' S8.1/4" 807' 66 we- 92M 74-12• 1'I':lOM 82- :`11361 -1/4' °6 58- 6" " 0 7 6 -12' 74-SV 322 82.81 ' I":41f49." e-1/2' e" 9274 4-y 82. I'•11169 C 1179 li0.314' 6809111169 58718' Bits 6T 1 -7 75-IS• IOMI 83-114• Mal 504/8' 6829 59' 8134 8]-1/8' '9344 75-1/4` 103s5 633'S• 51' 6650 59.11B' 8154 67-174` '.YIR362 75- B" 1U410 6&1 ` 51-1/8• 6670 59-114' 8173 67.4 " 37B 75.7 104E4 63.5NI' 6IAW 6891' 59-318' - 8193 67.12' ] 75.5/B' A0439 83314' 51318' - •6911 5912• B2f2 : W-5/8' F-9 414 ]5-314' 10453 B3.7/6" " 51-12' 6932 59-SIB' 8232 8]-3/4'+8432 ]5418` 1D46] 84 'n24B 51-5/8' 6952 59-3/4' U51 67-71W We 70" 10/82 84 1/B' 11AST0 NIB129RS) T1: DIESEL -UPS SAN LUIS OBISPO - 09/1712021 Overfill Prevention Equipment Inspection Worksheet Obtain the following kdan notlonham the tankOar0 Tank dla meter (td) : 90 Inches Tank Cepedir l: 11.527 gallons Obtain the follovMg measurements: Riser length irl): 42 Inches Flapper amlvatlon depth )fd): 52 Inches 9 Activation level from unit uP (M: 10 Inches (n. fd-rl) Actiwtion lave[ from unit blttom(tb): 80 irdaes (tb•td-U) AchratIMCaprtitY(ach 10,922 gellans (Tank volume at his IevN on the bank there) Acnvatan C808CRY Parcenroge(All 94.5 % (AP=acttc) Overfill Alarm Obtain the following hafatmatlon farm tIr tank Chair Tank Capacity (MI: 11.527 gallons Obtain the hAawin g metsanmmts: Acdsaton level tram tank bottom(tb): 75 inches (Slide float undl the alarm activates and measure) Calculation Workakam: Aellvatbn Capon(ac): 101366 ganom (fankvolume at tb level on the tankchart) Activation CaMdW Pereentage(API: 89.9 % IAP=MItc) IDECO Inc, �•.�.:e_ �4:.5. Service Report # 187620 FACILITY NAME: UPS DATE: 9/24/2020 FACILITY ADDRESS: 3601 Sacramento Dr. STARTTIME: 09,00 San Luis Obispo, CA. 93401 END TIME: 12:00 FACILITY PERSONNEL: ADDITIONAL REPAIR TIME: SIIG Rfy�2L'SAME 4� Daniel Frisbee SITE RSPRa3SN1'A]9V83TGNATVRE TyxMigian COMPANY: IDECO Inc. Daniel Frisbeeo,, ,: "" ADDRESS: 7306 Coldwater Cyn., 87 Signature North Hollywood, CA 91605 PHONE: (818) 452-9931 - (OFFICE) (818) 452-9935 - (FAX) PASS / FAIL REPORT VAPOR RECOVERY TESTING: TP-201.3 - Pressure Deoav WD TP-201.3C - Tie Tank Teat Exhibil4- Requirml with PD(YET) --- Exhibil 9-Raqulmd with PO(W y) ----- EtlIbh 4 - Gan Air Saparatcr(Healy) --- TP-201.18 / M me 1 -Toque T"01.10 I Phase l - Dmp Tube (SmIPNt TP-2al.1 D / Phaw 1 - Dap Tube (Flapper) TP-201.1 E I Pnwsre Vwwm VW Valve/Zrero --- ExhIW 5- Liquid Removal (LR) TP401.4 - Dynamlc Back Promm (DO) MelhWolny 6 - Vent Bbckam Eahbit 6- Rwured with DB Exhbit T-N=W BV Exhdt 5- Vapor M Liquid Vdume Rath (VA) OmWear Vacuum Taal (VP 1000-ME) Exhibit 9-ISO Opn flity(Heay) Exhibit 10 - INCON ISO Operability (Healy) Exhibit B- Hymomrbon Sanwr(VST Pmcaeeot) — Exhlblt9-Pm sorA atlon(VST Processor) Exhibit 10- Vapor Pressure Senwr Verd tlon(VE ---- ExMft 11 - Pasha OperaNliy (VET Polisher) Exhibit 12 - Hydmmdvn Emlmlons (VST PoNher) Exhibit 14 - Healy Clean Nr Sepaatot (VST) FAIM 16-LIquE Cm ation Trw(LCT)(VST) EMU 17- ISO Vapor Flow MabrOpeRWiry (VST) EVR MelNenance Healy/ VST- Weekly, Guarlerly A Annual Inspection OTHER UST TESTING: Montlor (:BMICmM Spill swiml Teel AM Teal Tnnk Te¢r une leer — SwOMaq Comanment Twt(669" Designated OpaWr R461 Traning endla Inspection OTHER OTHER Comments k Parts -Monitor Certification and spillbox testing pass initial. -Testing was witnessed by San Luis Obispo Fire Dept inspector Matt Callahan. UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM IPa a f wai This form must De wed to document testing and servicing of underground slomge tank (UST) monitoring equipment. A copy of Nis form must be provided W the UST surer or operator. The owner or operator must submit a copy of this form to the local agency ulatin Me USTs within W days of the date of the monitoring system certification. I. FACILITY INFORMATION CERS ID Dale of Monlbring Syelan Cerlif tlon 10416094 1 9/24/2020 Business Name (Same as Fatirey Name or DSA- obp Business Aa) Belong a UPS Business Site Assets Cdy ZIP Coda 3601 Sacramento Dr. San Luis Obispo, CA 93401 It. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of Company Pertannllg the Cemmetlon Phone a IDECO INC (714) 278-2690 Naling Address 7306 COLDWATER CYN STE 7, NORTH HOLLYWOOD, CA 91605 Name of UST series Technician PMormirg me Cencoarm (Prot as mom on Ma/CC Cerllacebdn) Daniel Frisbee coMreIXor/ Tank Tesler Licenses IGG CeNflratlona ICC Gemitl®tlm FFxpimtlOn Data 744619 8175605 3/14/2021 filion1loding System Tishirm ad Cereficalum L/sf see vie confesLions E iretlm Date Veeder Root B34994 1/12/2022 ICC 3/14/2021 OSHA I 6/1212021 Va orless (VMI) #2717 1 51312022 III. RESULTS OF TESTING/SERVICING ImMuffe and ream Me following reports Ifthe monitoring equipment is capable of generating either. System Set-upAlarm Mato Report Y N NA Was any monitoring equipment replaced? 0 El (h'Ye;'Idenfay Me edleceavxtarn nod and fill the manulacturerantl modN lw as aovnmf Msecaon lVEebe) Was damage, debris, or liquid found inside any secondary containment systems? El (If'Yea-deapbe coact wet burnt in sedan lV beaus) Is Is all monitoring equipment operational per manufacturers specifications? pf'No,"tlesraibe whYM sedan lvoebel IV. COMMENTS r dretlarl M use Me aeceon, Oaaplee Mw antl whwrMeissws were pwlaae cm�acled. -Testing passed, and witnessed by San Luis Obispo Fire Matt Callahan. V. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby Certify that the equipment identified In this document was Inspected/serviced In accordance with California Code of Regulations, Title 23, Division 3, Chapter ta, Section 2638 and all information contained herein as true and accurate. Attached to this certification is Inf ametlgn (e.g., manufacturers' checklists, monitoring system set-up, alarm history report, stc.) necessary to verify Mat this information and the aft plan elevated the layout of UST s st m Is om te and accurate. UST Servos Techmoan Signature Daniel Frisbee°N1e1yNg"ro " ` °°• Dal< Y02AW.2013: CaiS=Caifwriaervuammlel Peeving Sy&an, ID=naalmlblICC=lnmatlomlri�deGouul, Y=Yee N=No, Me=RkAPdlrade UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM IPwe2ofa) VI. INVENTORY OF EQUIPMENT CERTIFIED A separate Morikoring Syselat Cer iecafion Form mustbe Prepared Gar modr monNorin s stem control d. Make of Monitoring System CWWN POW Mosel of Mondonng System Veeder Root Control Panel SaMvane Vermion Installed TLS-350 325.02 Check Unslyproorraft Wise ro indicet9 Stlecifle enrldMenif In ted/servieed. Monitorima Device Used I Device Model # Monitorin Device Used I Device Model # TANK ID: TT Diesel B lank number stored e TMK ID: S Isnknumber evaree eta. ❑ In -Tank Gauging (SW Tank) ❑ InTank Gelding (SWTeMg O Annular Spoon or Vault Sensor 1 794380.303 ❑ Annular Specearvwa Sensor ❑ VPH Sensor ❑ VPH Sensor Product Piping Product Piping (7 Mectankal LLD FX1 DV ❑ 101wM1aniral LLD ❑ Dechorio LLD ❑ eecManic LLD ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ® sump Sensor 794380-208 ❑ Sump smear ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) FIII Piping FIII Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Swear ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vero Piping Vent Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Ssnsor(Sump) ❑ VPH Sensor (Sump) Vapor Recovery Piping Vapor Recorory Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Pip m) ❑ Sump Sera ❑ Sump Swear ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Monitoring Device Used Device Model # Monitoring Devise Used Device Model # TANK ID: 18y fork numbs Noretl sk:) TANK ID: (By IwknumWr aNad evp ❑In -Tank Gauging (SW Tank) ❑InTanh Govei (SWTaNg 7S ❑ Annular Saco or Vault Sensor ❑Annular mcrVaun Semen ❑ VPH Sensor ❑VPH swear Product Piping Product Pipits ❑ Mwlunkal LLD ❑ kYCM1aniral LLD ❑ Decocric LLD ❑ Electronic LLD ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sear ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) FIII Piping FIII Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor Wlph ❑ Sump Swwr ❑ Sump Sensor ❑ VPH Sensor (Sump) I ❑ VPH Sensor (Sump) Vam Piping Vent Piping ❑ VPH Sensor (PlPing) ❑ VPH Senwr (Piping) ❑ Sump Sensor ❑Sump Sweor ❑ VPH Senaor(SumP) I ❑ VPH Sensor (Sump) Vapor Recavery Piping Vapor RecoveryPiping ❑ VPH Samw (Piping) ❑ VPH Sensor (Plpng) ❑ Sump Sensor ❑ Sump Sensor ❑ WH Sensor (Sump) 1 ❑ VPH Sensor (Sump) ID = Idada�nl S W = SYgIa4W 1a.1. W H = Vwum4rmaaeHytlT�c, LLD = W s Imk OeHrbr UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page a or a) Monitorino Device Used UaAce Martel # lamnitoring Device Used Device MoEel # VENT I TRANSITION SUMP to: VENTI TRANSITION SUMP ID: ❑ SUMP Sensor ❑ SUMP Sauw ❑WH Senwr ❑WH Sarver UDC 10: 1-2 DIESEL uoc 10: 0 Electronc Semor 001 ❑ Decwnc Senso r tlb ❑ Meniral Dwca ❑ Mectanlcal Device ❑ WH Sensor ❑ WH Senior UDC 10: uoc lm ❑ Electronic Sensor ❑ Elearonc Sensor ❑ MCGmncal Device ❑ Mwbaniwl Device ❑ WH Sensor ❑ WH Semor UDC ID: UDC 10: ❑ Elxhonc Ssmor ❑ Eleoeonc Sensor ❑ M Bnical 0ol ❑ Mxtranical Device ❑ WH Sensor ❑ WH Semor UDC ID: UDC 10: ❑ Elecronc Sam or ❑ Dectronc Senwr ❑ MCMenirol Devim ❑ Mechanical Devim ❑ WH Sensor ❑ WH Semor OUrr MonitweO ComppneMlD: ORlar MonNoMcom➢oneMlO: 0 ouler(Spwirym wshan Vn.) 1 332504-001 '7 toll ❑ Oltrer(SpecpyIn RI ourrMgnagre#com➢enantl0: Darr Mon#om#coon onent lot ❑ OIIrr (SpxMin sealipn VII.1 ❑ Qher Mpecav in wciion yul O rhlonitwe#ComponentlD: 0dmrMcmHoMCompcneMlO: ❑l r(Specdy in secllon VII) [lOmer(SpemWlnwction Vll) InUu#elMormanon lorewryunMrgrourgswmgebnk componentmon#oreaeymle mon/bangaysfem caneolpanx #mamonNw/rrg aysbm ewer# rrlmaMloramore co anenfs lhan Mla /won xcpmmpeaM atl#Itlonal tp wo/mese 6e MbcheC. VII. COMMENTS Uw mis wc#on tD pmNDe addWonal wmmeMa about the inwntory c/Me equipment carhaad.. ID=IWnMm5n,WH=VaoMnAwamaHy]meak UDC-UMer-0lpemrC roman/ UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM IPa sore Vill. MONITORING SYSTEM AND PROGRAMMING This section mustbe aompiabd Ha manhoringpenel is used to Perform leak deNCHon moMbring. Y N NA Arethe visual and audible alarms operational? © ❑ Wire all eenwre viaaly inspected for NnM and brats In Me cables and for residual buildup M ensure Mel floes move family, fundlonally ended, and conferred operational? O ❑ ❑ Were all senora Installed al lowest point of secondary containment and positioned an Mat odew aulpmerit will not Intended with Meir ro system O ❑ ❑ Wee monitMng system sat -up rMewsdbwants Popes sesngsi y( Lj ywsme monitaing panel's backup bettary vluelly Impacted, NrxgMelly tabled end coMrm�apeslion&? Q U boas tie flcvr W fuel stop 9 Ma disposal g aask is delecld in the undeMispenser containment? U ❑ Wee the turdm autanalically shut down if Me piping secondary containment monitoring system fails s operate or is elechmally documented? © El El Wes the Mmine automataly shut dash if Me piping secondary containment monitoring system dea is a leak? eeneera initial Imgiva eM1W daxn? (Coact ad Mat aPoy.) ❑X Sum ❑ Undd-0i wr Containment ® El El4MiM If seems ere relayed M a remote monitoring station, is all communications aupmem(e.g., modem) operational? L01 I % Forany am~ of "N" above, describe M Segdmf IXhowand when these deficiencies were WMII de corrected. IX. COMMENTS X. IN -TANK GAUGING TESTING Clwck this bar if fork gauging be used only far imrensry contml. (Do Trot avrpkea Mina section) ❑CM1eck this box if NO tank gauging spuipment is lnstalled.(Do nofcondawa Mly aectlon.) This section must be conbateleciff In -bank u is used to nrform leak detection monitodn. Y N NA Has ail input vdhng been inspected W kinks ant basks in Me ®Na and Mr proper why and terminumon, includlrg sslirg for round faults? ❑ ❑ ❑ Were all in -tank gauging probes vsually inspected Mr damage and rasNue buildup to Made that Hoed move fray, fmnctonally teffie and confirmed operators? ❑ ❑ ❑ Was aauraty One w's product level readirga sated? ❑ Was sc uraey 0 systMns Water liwel readings tested? ❑ Were all probes minaslled properly? ❑ ❑ ❑ Were all items on Me auipment manufacturers mainlnance checklist completed? ❑ ❑ ❑ For any answer of "N" above, describe in Section XI how and when these deficiencies were or will be corrected. XI. COMMENTS ca� UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Pages of a) XII. LINE LEAK DETECTOR TESTING ❑ Clack this Lux if line leak directors(LLD)am NOT insrlted. Pa, not ownplew th9 seaski This section must be compliment ti r r ns are homeland. Y N NA Was a leek amulaledW verify LLD pedormence? hyreck as that apply) Simulated leak cote verified: ®3GPH ❑0.1 GPM ❑0.2 GPH ❑ ❑ Was the testing appealus property clabrated? ❑X ❑ ❑ For emergency generator tecA systems, does the LLD crease an orange anal Nsual All when aleak is detected? ❑ X For resonant el LLDs, dose Me LLD heard the fiaw through the Pipe wren a leek is tletedad? X For Nectmnlc LLOs, now Me lull eubmatirally shutaewlr in a leak is deanced? X For electronic LLDs, dams Me turnlre automatically shut off lfary pinion of Me monitoring staem is Managed err disconnected? ❑ ❑ For electronic LLDe, does Me Wrbirw aatanaticelly shut oRRers, poMon ofihe monlhXlnp system naNnmorta wfais stand? ❑ ❑ X For electronic LLDs, hate all accessible airing connection been visually inspected far kinks and IX s? ❑ ❑ ixi Were allitems on Me equipment manufactuleis Maintenace Greckllst compii ❑X ❑ ❑ Were all LU s confirmed operational vYMin regulatory requinemew? I❑X ❑ ❑ Far any answer of "N"above, describe in St a to Xlg how said when Mere Issues were OF wili be corrected. XIII. COMMENTS XIV. VACUUM I PRESSURE i HYDROSTATIC MONITORING EQUIPMENT TESTING X Cirackthls Oars VPH monitoring is NOT used. (tb trot ogmpleh MU secfbn.) This saetion must be completed 9 VPH monlhuing is used to perlarm leek defecdon mmelicaing. System Type (Mark at Mat apply.) ❑ Vacuum ❑ Pressure ❑ Hydmsla c Sermr ID Componel MonlWred By This Sensor Sensor Functionality Test Iperetltlal Communication TOY Pass ❑ Fall Pa ss Fell ❑ Pass ❑ Fai ❑.Pam ❑ Fey ❑ Pass ❑ Pat LJ Pass ❑ Fat ❑ Pan ❑ Fell ❑ Pass ❑ Fat ❑ Pau Fell ❑ Pass ❑ Fat ❑ Pan ❑ Fes ❑ Pass ❑ Fail ❑ Pan ❑ FYI ❑ Pau ❑ Fall ❑ Pan ❑ FYI ❑ Pau ❑ Fall ❑ Paw ❑ FYI ❑ Pass El Fail ❑ Pass ❑ FYI I ❑ Pau ❑ Fail ❑ Paw El Fai I ❑ Pau ❑ Fat Pam Lj FYI I ❑ Paw ❑ Fat Haawulntemti mmmunicetionverikcd? ❑Slmula L kat FarEMsof MelMh Ual Space U Vlkual Inspection Other Twcrrbm Me method In section XV below Gaune Westhavacuum mmsswernbredboWWng levels Mall interstranspeces? UYw No Oearrl0e Me macron in axLbnXVaeba. Formy answer of "Fail"above, describe in Seething XV how and when these Issues arew or will be corrected. XV. COMMENTS DPH=GabaPerHar,Y=YuN= No, Nk=NdlpplsW,VPH=VaPrwNPreuswHyfpdalk, ID=kernel VMI LDT-890 Test Form Test Information Date: 9/24/2020 Test Company: IDECO Inc Telephone: 714)279-2690 Contact: SitelD: Address: 3601 Sacramento Dr. City: San Luis Obispo. CA. State CA Zip: 93401 Type of Test Equipment WI M-880 Submersible Pump Identification MFG: Rao Jackal Model# WA S/N# NIA Leak Detector Identification MFG: Red Jacket Model If FX1DV 5/N# Replacement Leak Detector Identification MFG: Model # 5/N # Line Conditions Type of Pipe: riberpiass ow Diameter of Pipe: 2' Burial Depth of L. D: WA Date of last Iine Test WA Test Conditions Kind of fuel DEL Kind of fuel Length of pipe Approa 15' Length of pipe 1. Operating Pump Pressure 26 PSI 1. Operating Pump Pressure 2. GPH Test Race: @10 PSI 3.0 2. GPH Test Rate: @10 PSI 3. Static tine Pressure (Pump Off) 18 PSI 3. Static Line Pressure (Pump Off) 4. Bleedback Test (Pump Off) 25 ml 4. Bleed back Test (Pump Off) S. Step -through time to full flow 45 SEC S. Step -through time to full flow 6. Leak detector stays in leak search 6. Leak detector stays in leak search Position with a 3 GPH leak VeS Position with a 3 GPH leak 7. Was leak detector adjusted No 7. Was leak detector adjusted Kind of fuel Length of pipe 1. Operating Pump Pressure 2. GPH Test Rate: @10 PSI 3. Static Line Pressure (Pump Off) 4. Bleedback Test (Pump Off) 5. Step -through time to full flow 6. Leak detector stays In leak search Position with a 3 GPH leak 7. Was leak detector adjusted Kind of fuel Length of pipe (.Operating Pump Pressure 2. GPH Test Rate: @10 PSI 3. Static Line Pressure (Pump Off) 4. Bleedback Test (Pump Off) 5. Step -through time to full flow 6. Leak detector stays In leak search Position with a 3 GPH leak 7. Was leak detector adjusted 255E: '=N?r-a L'RI Srl'a!-NIENF: :115 OBIS: fO4 44 A 7194 1 ^EP d-. ll-^ 19::3 d,n'I'ETt Ewuh R4M ". Jlr'S •RM �ryj-N L%iNING I SABIePQ N LI OBI?PD STIR 441 Tl : i an 74. 12O 17=3t W:^N SINTLS .iEP)RT p 9:«LA>ei CLEHR JMRRI IC. INVIINT_R: REF'RT T i:_:DPE_ LET7. 1_.." INCME:' . U-0 T='P I1'VC F . R R. EIS R R 0 R Y' 5L•a I'm SETUP � ii. Ama 17:36 - 8Y67 ?- UN: P3 U.�, c.31J1 LmpluuAu� SW'L1f - dY`T DMTE TIME -lRMAI Ik`N __ 1"r P, HH:Ml:.38 56o1 aSF.�'RAarN -o Dl: SAN LL:d OB:SPO 8025 `44 ':9q M{FT TLIL + I ' X M� 2HtFT TI'lE L or: HBLEL SHIFT TIIE ' rli aw ��Dp 941rT TIHC R i Dii-l.po TZ PER "+ NEEXll IIR4 u 'IMta' P£i TFT nFi:E- ..RN rANX• ?C TNNN PER :iT NE :iEL, •;17 :-MW - 30 18MAIPn TET �u T��e� URN ''NE RE-ENPB:° r=-,_ar F^ l LINE TE.? .:,%L F=R 72: NEEED URN =T W;CDF. w N _ "JN JIFSET'3.0 -:EEC 2 &IJ4I y I'tE ,..+HOC I ftN A)• LNd L LRINTOUT BUBO PMlTCOL {ACFt, CLDD0M AL -RN IAEEx DIERO.ED �VrMUNTJATIORfF EE:U1• WILT RBiI'i K".e: t:o" B"OD RATE >al STOP BIT I [10F DATA 1xIq ": 7 DATr RS-21A EfiJJRIT'. 00"" : T:BABLEJ O(AL TiPE Tore DIAL. TONE INCERVAL; 12 WRIVEB' B:TLO , D RIVEMEA ROOT -:FMB+ I RRC-vk repE: b000 F.RER NO: Rm. N0: 5 CEO �'-Tlmk* IIQM REPORT; CFF ALTO Dim TInB SETUP: 1 S: =TER RJJT 3:ATL LiMlY DiA- TIME 4:51 P- Rec=:VER REPORTS: W. -'02 E'.D ➢F, MEbP+M;E DISMVLL M170 DLAL ALARM SERIb_ l:vEEDLR ROOT (FTQI L:QUID 3 NWR ALM ALL:FUEL ALARM .d_ .SHORT:eEHMORNLNRM ALAW ZWATER ALARM MLEINHTLR JUT ALARM HICH LIOLID ALARM L;LOwJ :IQVI➢ ALARM ;Low WARNING RE=EIVE.R ALA" PEPVICE RF"RT WARN nL4WI MFAR WR1NM �.ti PROD�i: 1 1 T'�pMr•L .'.OErr .C-aann 1 E14�SMILEn =GCS r JLL WL il5.^ 3.0 I': N VOL n )SO4 46•r, 1i;" VOL 1 6023 ... IIC: v)L 1 1364 WATER u-mlw 1.pp W Hla TM LIMIT-1 `w Vk lelHti VOL: :1527 EPWILL Llml: 104yW Nld++ YSOLUCf :' 103Tn DELP"EkY L➢Il r I 1152 PRODUKT Lu00 5 LFRk .+: a,M L^- 9ut'LEN :.M LII'.'�. M I00 ILi..79F' 0.00 PARO�PE O OAD _LM% rinN]FOL:'F:L :.:NkF t: W14E LI M`c MAWIPOLOE TAWS TO: eME LEAY. n1M PERIODICL R LAMS MIN •)NNUAL I EYrIROla TW TVM "Ica ANIv 4 :_= i:• or PYk5ODI0 .NN TE9T AY'ERP'`.I'�ur I .=F PER 1ro '=F TW TIDY' NR'r1FYL ON TW TeT 91PHON SREiAPON�II YRt `[MLPUMP 9M �� : '� L*Y TEST 1E7+ P3T lYYNi) Tfl TN 1 1 SbN START Far TEm 1 00 x1 TE9'. •Ot] ru< I•.Fu+71C•a i cR8 k_.qg 1~nT EAELr MrMl.a✓ELE- LLv TOT FOWW KRIWL LLaUIG MeA tsF%P b„➢0I TH R)GROS L:ATIC -A-E CRY : ANNULAR :4aC--v -:TTUR�EI NE SWO? 'PTEviR :TE � FLOAT)m sump UU"UT:RELAY =UP F I:;_R811E 9M�':501Jt. ;ANG1R0 lVJi: Wfy: CLA:'=D LIO.t: 9EN9t1R ALMS L. ::?UEL ALa&' L 2:=UE. ALAR9 I :6EM30ROUT H:.+RM OUT -�4R ki RM 3601 BPLRlVolvo aa•N f5 Wapo aus sn VLa- aEP ?a. a@2 1314C �y SrSTCH 9MTLM iiPORT }� }SpL1LAW CLEF.4 a Nlm :wi96:..K'RwAlro"TSi i. SNN Lila OalaPO 9O5 54.4 919e dIM? 24. 2020 1CWC a: d.- - !. ELWRl' o 3:h : h .all 11G 1fA.'E%T.1Rt RFATtT TGLIME- 53a0 GALS LLL4aF W GRi3 504 0 :AGE- -494 'VIP = VGLpa a 5318 GALS NEIGI4; a 4I.N TNCNER +WTER VOL - 0 4RTER 3.00 NNW rim 'd.0 Mci F a a a a aL1c%. aaa as PLAIM MIRMY M'TYI' - tN-T4W RL:YiI'I - T tt£TE7RT. LFk. P':RY jLN ". 2020 E:00 LE: 21- an 14 e:oo u,?FTC NLPRI aP.r l4. rulN :_:2.T .>W PRIVICT sL.rtW "sEP la. 201a to::s M[OR PROLOCT -ow >EP Ia. lull 'a:a. cW M" 2oi° t�.5E I NVrL'.B FEEL U. M EEF IJ. 2ALF 10:24 PR06E Oul G1s 1U SEP u. -. T F3.lYa1Y NEETEO :u la• 'ori 1J:� •.. ,.a a a area a aaa J42" HMTM RP20R: - JLI� M.:_uP7 L I tnihLll 4 SVA= Q,ASPACE 14MD ALARM is .4. 202o 10:41 IIL:::.t:aUlo Wshr 6'14 �4. 2G_G 13:41 WR LI .11^ mt. " FEP 24. 2u4j 10:a3 a ala:aa soak* a Y AIA11P A0IrB RY REPORT SENIOR PLaaR - t. :T.FaTRE alnr aTP a" -sZ- 44. 2C20 lu:3_ FUEL + AWI UNDERGROUND STORAGE TANK SECONDl %;ONTAINMENT TESTING REPORT F . RM (page tote) Type of Action ❑ Installation Test ❑ Repair Test ❑ Sht Month Test ® 36 Month Test I. FACILITY INFORMATION CERS ID Date of Secondary Containment Test 3/24/2020 Business Name (Same as Facility Name or DBA-Doing Business As) UPS San Luis Obispo Business Site Address 3601 Sacaramento City San Luis Obispo 21P Code 93401 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Pedoming the Test(Pnnt as shown on the ICC Comorcabon) Rickey Binger Phone# (805)540 - 7114 EA. ConneaorReNx Teeter License # 902034 ICC Certification # 8452629 K.0 C"Mace n Expiration Data 4/17/2021 III. SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS Tank to: (By tank number, stored product, eta) ADSL 6 C D Tank Containment Tightness Test Result Pass ❑Fail NA ❑Pass Q Fail ❑ NA Pass ❑Fail ❑ NA Cl Pass El Fail ❑ NA Product Piping Containment Tightness Teel Result 0 Pass D Fail 0 NA D Pass 0 Fail 0 NA D Pass D Fail DNA ❑ Pass D Fail D NA Communication Test Result ❑ Pass D Fail M NA ID Pass 0 Fail D NA D Pass D Fail 0 NA ❑ Pass D Fail D NA Rarneta Fill Piping Comalrenal Tightness Test Result ❑ Pass 0 Fail 0 NA D Pass D Fail D NA D Pass D Fail DNA ❑ Pass D Fail D NA Communication Test Result ❑ Pass 0 Fail 0 NA D Pass 0 Fail D NA D Pass D Fail DNA ❑ Pass ❑ Fail DNA Vent Piping Containment Tightness Test Result ❑ Pass 0 Fail 0 NA 0 Pass D Fail D NA 0 Pass D Fail D NA ❑ Pas D Fail D NA Communication Test Result ❑ Pass 0 Fail 0 NA D Pass D Fail D NA D Pass D Fail D NA ❑ Pass ❑ Fail DNA Vapor Recovery Piping Containment Tightness Test Result ❑ Pass 0 Fail 0 NA D Pass ❑ Fail 0 NA 0 Pass 0 Fail DNA ❑ Pass 0 Fail D NA Communication Test Result ❑ Pass 0 Fail 0 NA ID Pass 0 Fail 0 NA 0 Pass D Fail 0 NA ❑ Pass D Fail DNA Turbine I Product Piping Sump Tightness Test Result 0 Pass D Fail D NA ❑ Pass D Fail 0 NA ❑ Pass D Fail DNA ❑ Pass 0 Fail C Fill Riser Sump Tightness Test Result ❑ Pass D Fail ®NA D Pass ❑Fail DNA ❑ Pass D Fail D NA ❑ Pass D r Vent I Transition Sum ID: a b Tightness Test Result ❑ Pass D Fail 0 NA ❑ Pass D Fail DNA ❑ Pass D Fail 0 NA ❑ Pasr uoc ID: 1 1/2 Tightness Test Result ® Pass 0 Fail D NA ❑ Pass D Fail D NA ❑ Pass 0 Fail 0 NA C UDC to: 6 g Tightness Test Result ❑ Pass 0 Fail 0 NA D Pass 0 Fail D NA 0 Pass 0 Fail ❑ r' VDCID: 9 io 11 Tightness Test Result ❑ Pass D Fail D NA D Pass 0 Fail D NA D Pass D Far All kerns marked "Fall" or "N/A"mustbe explalned/n thelrreepeodve "COMMENTS" seetlon. IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING T I hereby certify that the secondary containment was tented in accordance with California C division 3, chapter 16, section 2637 and all the Information contained herein Is accurate. UST Service Technician Signature 4, C� CERS a California Environmental Reporting System, ID = Identification, UST a Underground storage tank, ICC . NA = Not applicable, UDC = Under -dispenser containment _ NDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page z of e) V. TANK CONTAINMENT TESTING INFORMATION Manufacturer Identify Tank ID Iran section III for each Manufacturer A B❑ C❑ D❑ A❑ BE] Co D❑ -Test Method Used: ❑ Manufacturer Guidelines: (Specify) ❑ Industry Code or Engineering Standard: (Specify) ❑ Engineered Method: (Specify) Affeeh the testing procedures and all documenfedon required to detemdne the results. # ofAttached Pages Tank Containment Testing Tm mg end Certihce4om (List applicable cedificalions) Expiration ih5e VI. COMMENTS Provide any addilional connnents here. Brine filled annulars. VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION Manufacturer Identify Tank ID hom section III far each Manufacturer AO B❑ C❑ D❑ A❑ B❑ Co D❑ Teel Method Used ® Manufacturer Guidelines: (Spedfy) 1 Hr test 5.5 PSI pressure ❑ Industry Code or Engineering Standard: (Specify) ❑ Engineered Method: (Specr/y) AMach the tesdn required g procedures end all documentation ulretl ro dehvmins the resume. # of Attached Pages Product Piping Containment Testing Training and Certificatium (List appicedfikaatians.) Expimhon Date Inkae@iel Communication Vedtication Method Used: VIII. COMMENTS Pri any additional comments here. IDaldentification UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 3 of a) REMOTE1TESTING Manufacturer Identify Tank IDfrom dlon III for each Manufacturer A B❑ C❑ D❑ A❑ B❑ GO D❑ Teat Method Used: ❑ Manufacturer Guidelines: (Specify) ❑ Industry Code or Engineering Standard: (Specify) ❑ Engineered Method: (Specify) Afbeh the heading propadurs and NI tloeumentefian ragW�atl hedafamlm ba mulls. # of Attached Pages Remote Fill Piping Containment Tenting Training and Certifications(Usf apickab/e derfifioeHona) Expiration Date Interstitial Communication Verification Method Used: X. COMMENTS Provide any vadifforal comments hare. XI. VENT PIPING CONTAINMENT TESTING INFORMATION Manufacturer Identify Tank ID from section III for each Manufacturer A❑ B❑ c❑ Do A B❑ C❑ D❑ Test Method Used'. ❑ Manufacturer Guidelines: (Specify) ❑ Industry Code or Engineering Standard: (Specify) ❑ Engineered Method: (Specify) Affsch the testing proeadurae and as dooumenfedon required he deterfnbe the rsWls. If i fidtached Pages Vent Plping ContainmentTesting Trelning and Certifications (List applicable srfdlcat ons.) Expiration Date Interstitial Communication Verification Method Used: XII. COMMENTS Provide any additional comments here. ID = Identification .NDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 4ot6) XIII. VAPOR RECOVERY PIPING CONTAINMENT TESTING INFORMATION Manufacturer Ida nti Tank ID from section III }ar each Manufacturer A❑ B❑ C❑ D❑ A❑ B❑ CO D❑ Teat Method Used: ❑ Manufacturer Guidelines: (Specify) ❑ Industry Code or Engineering Standard: (Specify) ❑ Engineered Method. (Specify) Attach the tasting procedures andalt documentation required to determine the results. # of Attached Pages Vapor Recovery Piping Containment Testing Training and Certifications (Listapplicabte certifications.) Expiration Date Interstitial Communication Vedfication Method Used: XIV. COMMENTS Provide any addiionat comments here. XV. TURBINE I PRODUCT PIPING SUMP TESTING INFORMATION Manufacturer Ida nti TanklD hom section 111 breach Manufacturer A® IS C❑ D❑ A❑ B❑ C❑ D❑ Teet Method Used: 15 min test with incon ® Manufacturer Guidelines: (Specify) ❑ Industry Code or Engineering Standard: (Specify) ❑ Engineered Method: (Spacily) Attach the sharingro9 pnueduros and all tloeumenfatton ulredto determine the masks. # of Attached Pages Turbine / Product Piping Sump Testing Training and Certification (List applicable certifications) Expiration Date XVI. COMMENTS Provide any additional cnmmer#s here. ID = Identification UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (pages of a) XVII. FILL RISER SUMP TESTING INFORMATION Manufacturer Iden' Tank lD from section 111 for each Manufacturer A❑ B❑ GO D❑ A❑ SO CO D❑ Teat Method Used: ❑ Manufacturer Guidelines: (Specify) ❑ Industry Code or Engineering Standard: (Specify) ❑ Engineered Method: (Specify) Afbch Me heading proeedures andall documenfedon required he determine the resuft is of Attached Pages Fill Riser Sump Tenting Training and Certifications (List applicable certifications) Expiration Date XVIII. COMMENTS Provide any additional comments trero. Direct Bury buckets XIX. VENT / TRANSITION PIPING SUMP TESTING INFORMATION Manufacturer Identify Venti Transition Sump ID from section III for each Manufacturer a b❑ 1=0❑ d❑ a❑ b❑ c❑ d❑ Teat Method Used: ❑ Manufacturer Guidelines: (Specify) ❑ Industry Code or Engineering Standard: (Specify) ❑ Engineered Method (Speefy) Attach Me fesdngprocedures and all documenfefion required to determine the results. A of Attached Pages Vent/Transgion Piping Sump Testing Training and Cerdlicallore(UsfappimbM certifications) Expiration Date XX. COMMENTS Provide any additional comments hers. 10 = Identeleatlon UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page a of e) XXI. UNDER -DISPENSER CONTAINMENT TESTING INFORMATION Manufaciurer(s): Identify UDC ID from section III for each Manufacturer 1® 2❑ 3❑ 4 ❑ 6 ❑ 6 ❑ 7❑ 8❑ 9❑ 10❑ 11❑ 120 1❑ 120 130 14 ❑ 15 ❑ 6 ❑ 70 180 190 110❑ 1 11❑ 12❑ Test Method Used: 15 min test with incon ® Manufacturer Guidelines: (Specify) ❑ Industry Code or Engineering Standard: (Specify) ❑ Engineered Method: (Specify) Aftsch the testing procedure and all documentation required no constrains the msube. g of Attached Pages UDC Testing Training and Certifications (List applicable certdicetions.) Expiration Date XXII. COMMENTS Provide any additional comments hare, gas facility has more components than this form acoommodete, additional copies of Mesa pages may be egached. UDC = UnderELspemer omrminmerq ID= IdeMifioation '1 '�) UPS SLO 3601 SACRAMENTO ST SLO 03/24/2020 1;0? PM SUMP LEAK TEST REPORT SIP TEST STARTED 12:51 PM TEST STARTED 03/24/2020 BEGIN LEVEL 3.9852-IN END TIME 1:06 PM END DATE 03/24/2020 END LEVEL 3.9B67 IN LEAN TIRESHOLO 0.002 IN TEST RESULT PASSED DIN TEST STARTED 12:51 PM 'TEST STARTED 03/24/2020 BEGIN LEVEL 4.4321 IN ENO TIRE 1:05 PM: END DATE 03/24/2020 END LEVEL 4.4318 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED SB TEST STARTED 12:51 PM TEST STARTED 03/24/2020 BEGIN LEVEL 3.9716 IN END TIME 1:06 PM END DATE 03/24/2020 ENO LEVEL 3.8715 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED. UNDERGROUND STORAGE TANK MONIT(" WG SYSTEM CERTIFICATION FORIr ' e 7 of e) This fom,muct bn usslm tlocumentteatin alpMelrq of underground storage mnk(llST) e. ..Poring equipment Acopy of lhh farts mpt be Provided to the UST owner. oropemtor. The owner or operator must submita copy of thisIons Wife /owl agency mgutanng the USTs within N days of the date of Me monitoring aratsm cerifflcation. 1. FACILITY INFORMATION CERS ID 10416094 Dale of Monaaing Sysem CertifcaWn 09-23-2019 _ Business Name (Same u7FME�drDB4-Doing BushressAs.) suitdkg sUPSBusiness she Awd ess City 3601 Sacramento San Luis Obis ZIP Code 93401 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of Company Performing the Certiflceaon R.L Stevens Co. phony a (510) 435 - 6249 Ext, Mating AWMss - P.O Box 361 San Leandro, Ca. 94577 Name of UST Servke Technician Pr!darming Ma CadAdation (Pdm as allows on bYe ICC CermtcetionJ David Pereira Contsetonrramt neater Lioeme • ICC Cenificaion a 415807 5240739-UT Ifx: Cartificafion E�irmion Dale 05-18.2079 IWO ..... Muchnnomi Veeder Root I EXPestiop Date 02/20 Service Tech 05I20 Va orless UD Tester 0�21 III. RESULTS OF TESTINGISERVICING IotlWafenMaeeeltthelogoWinfloqu yff tlmmorshavingequlpmeotbeapam orgMsnpngetmx. ® Monitoring System Set-up ® Alaon History Report Y N NA Wes any monitoring equipment rep aced? (ItWea.'den* Me spac9k devices raplsetl and list Me menu/ac(urereno model tor all rip/acemantparta in section w baMw.) ❑ ® ❑ Was damage,debm, or loud found Inside any secondary containment systems? fit "Yes,' descnbe what was found in section IV beiav) El ® ❑ Is all monitoring equipment Dperatbnal per manufacture's specncatbns7 (if 'AW," doscri why in secion IV below) ® ❑ ❑ N. COMMENTS lftlHaoNd to on Ws section, describe him and when the issues were or we re erected V. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the equipment Identifed in this document was inspecleNprvked In aeeordanca with California Code of Regulations, title 23. division 3, chapter 16, section 2638 and all information contained herein is true and accurate. Attached to this certification is information (e.g., manufacturers' checklists, monitoring system setup, alarm history report, etc.) necessary to vert that this information and the Showin the la ut of UST s is cos late and accurate. UsT Service Technician Signature CERs=Ca6onea EmArananenW ISTymng stoma. ID2 kWO LOm ICC. MiNnmkrW Code Council, Y aVeA N= tie NA � Nettpplralsk UNDERGROUND STORAGE TANK MONITOR I SYSTEM CERTIFICATION FORM U 2or Sl VI. INVENTORY OF EQUIPMENT CERTIFIED A separate Nonitwmg System CWW "ffw Form must 0eprsp~ rol9aM nromNmlg syamm eombW,a.. Make of Monitoring System coMml Panel moot of Monitoring Syclom Comeol Panel Soltwen' Vanion Installetl Veeder Root TLS 350 325A2 chock ores mprlare 6oxwto lmGcaPo apeeme equipment lmapecrad/aarvlcaJ. Monitorin Dwfm tbatl DwIce Moral a Nomfodn ,swim Usetl Devine Model Y Tank w; T-1 Diesel B lank number. akued act, elc O In -tank Gaaging (swranq Tank ID: B lank numban stored w alc ❑ in -tam Gauging (sw rarer) ® Annular Space or Vauk Senor 303 ❑ Annular Spam or Veuk Sensor ❑ VPH Sensor 0 VPH Sew Product Pl in Roduct -Rping ® Mechan"I LLD FX1 DV ❑ Mechanical LLD ❑ Electronic LLD ❑ Elemonc LLD ❑ VPH Sensor (Piping) ❑ VPH Sensor (Pining) ® Sump Sensor 208 ❑ Sump Sensor ❑ VPH Sam" (Sump) ❑ VPH Sensor (Sump) Flaropirwo FIN piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Pomp) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vera PIPIng VectPiping ❑ VPH Semor(Plping) ❑ VPH Semor(Pipirg) ❑ Sump Sensor ❑ Sump Semcr ❑ VPH Sensor (Sure) ❑ VPH Senor (Sump) Vapor Recowry Piping Vapor Rocovery Piping 0 VPH Sensor (Piping) ❑ VPH Semorlpipkg) ❑ Sum Senor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Senor (Sump) I MoniWdng DenimU cl Devlm Model McnWWri Dov"Used I Devica Moral• Tank O: B tank number, stored t4 etc. Tank ID: (By fank number slomd mduct efr, ❑ In -tank Gauging (SW Tank) ❑ In-enk Gauging (SW Tank) ❑ Annular Spam or Vault Sensor ❑ Annular Spam or Vault Sensor ❑ VPH Sensor ❑ VPH Sensor Mon product Pl ❑ MwlMnlcal LLD ❑ Mechanical LLD ❑ Electronic LLD ❑ EWmnic 11D ❑ VPH Senaw (%ping) ❑ VPH Senor (Piping) ❑ Sump Semw ❑ Sump Swwr ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) FIII PI n Fill Piping ❑ VPH Sena" (Piping) ❑ VPH Sensor (Piping) ❑ Sump Senor 0 Sump Sanaor ❑ VPH ni Seor (Sump, ❑ VPH Sweor (Sump) Van PI veampirg ❑ VPH Sensor (Piping) ❑ VPH Semor (Piping) ❑ Sump Sam( ❑ Sump Samor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vapor Reownwy r1pno Vapar Remvery Plping ❑ VPH Sensor (Piping) ❑ VPH Senor (Plpinp) ❑ Sump Sensor ❑ SumP Seruror ❑ VPH Sensor (Sump) ❑ VPH Sens" (Sump) ID-kk lJfiw on,SW=Sirglawelled,VPH=Varuunlo(msksakrytirostadc LLD=Ure Ieakclob t Monitoring owim Used UNDERGROUND STORAGE TANK MONITr"ING SYSTEM CERTIFICATION FOR aga7ofd. vice Models Monitoring Device L4,-.- Devlm Model OnV mmiban Sump to: ❑ Sump Sensor Vardammidon Sump 10: I ❑ Sump Sensor ❑ VPH Sensor 1 ❑ VPH Sensor UDC ID: UDC ID: ❑ Electronic Sensor ❑ Electronic Sensor ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Senior ❑ VPH Serum UDC ID: # 1.2 Diesel DDC 10: 0 Electronic Sensor 001 ❑ Electronic Senscr ❑ Mechanical Device ❑ Mechanical Davies ❑ VPH Sensor ❑ VPH Senior UDC ID: UDC ID: ❑ Electronic Sensor ❑ Electronic senem ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor UDC ID: UDC ID: ❑ Electronic Sensor ❑ Electronic Sensor ❑ Mechanical Device ❑ Mechanics] Device ❑ VPH Sensor ❑ VPH Senor Other Monitored Compomrd ID: Odlm Monilored Can ID: ❑ Othm (Spec/lyin aectrm VI/.l spent ❑ Other (SpecifyM secfbn Vll.) Otber Monitored Component ID: Othm Monit0rsd Cmn snt1D: ❑ O[har lSpeGH rn aaoean we) ❑ Other(Spocdy In miser Vn.) Other Monitored Compomnt ID: Other Monitorsd Component ID: ❑ Other (SpecdyN section Vll.) I❑ Other (Specify in section VD) Include M/ormadoniorerery undsoground storage qnk compmmtmmlboedby nib momMdn a system control pant mordtm more canspanefis flren We lions aecommodaNa, addntgyl pg� esaconlrol peael. gme mardOwlrg cop! papea nsaYba adxnad YII. COMMENTS llse mk sectlm to provids enyaddidarel comments about dre inreNary o/fn eaulpmmf certHled ID.mdnudm. VPH =VauncrifibressuralilelrogstIt,== lntler./pM,W,ppyhrrrea UNCIEWHOUND STORAGE TANK MONITOy"9G SYSTEM CERTIFICATION FORM (par --'ot ill. AUNITORING SYSTEM AND PROGRAM all sectlon mumhe eonklleledlya nronholfrg gnarls aswdmperfomrleek dataedan monhonny. e visual entl autlbb ahanna operatonal? ell aemore usually Inspected br NNs and breaks In me Gabbs aMfor residual buildup to ensure Mri Mats mow freelyonall kstetl. and confimretl o armkngy! ell sensors irrelaAad at kwrebt point asecondary coNarmem entl pouldonW so Mat mM1er puipmmt will not iMaddh thir rP ration? Y N NA ® ❑ ❑ ® ❑ ❑ E71i onaadngaritem sat-uv revlewod eerho Proper eetdnga?he moniorng panel's backup battery visualN Inspected, knnaly Issued, and confinned operational? the flow dfuel atop m dw dispenser as leak s tlaedad in the untlm4spensmcomemmenl7nne D�thewrbi a aulomadcody shut down Mlle piping secondary amainmenl monitoringsystefalls tooperatsorsekpriWly the Whine automagcally shut down tithe piping secondary conhassnam mentoring $yetem deters a leak? sensorsinftleimposifiseshutdown? (Check ag that apply) ®SUMP ❑Under-dispermescpbnmem are relayed to a remohe rawhomig slation, ball communications puipmem (e g. modem) opershorraM answer of "N•abo Ueswittes Msacdon lXhow aml when Mme dellaaneles waaorwlgb correctad. U(. COMMENTS ®l ® ❑ ❑ x. IN -TANK GAUGING TESTING Check this box d tank gsugmg is used only for invplory cm'"". (Do Mtcamp.4te MN section) ❑ Check this box dNO hank gauging equipment is usualkd.(Do noicempkfe this session.) Thrz section muvtM tWNtmrenk ra gsedm Asek tlat6etlen maNmrin. Input wiring bean inapephad br kinks fund breaks in the cap" ands For proper entry and elimination, Including tasting for ground eutts71 WBre all n hank peuglnIt probes visually inspedW far tlamage and rosktue II Ill to I!" con Ibeb move Realy, tunpionally kfshatl, ens eonrt,med operational? Y ❑ ❑ N ❑ ❑ NA ❑ ❑ Wmaccuracyolsriham'spmd=level readingstasted? Wac accuracy dayatem's water kwl rwtlirga teatetl7 Wmealpmbeaia Mlbdpmpedy? Wero all gems an thaeguipmem menukdurasa mainbnsnw aMcklst completed? Forts mower o!"N"9" d bs M ascdonxl how and when Mesa defthencbs was w ilgas cpnaehad. xl. coMMENrs ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ y=Yes, N=No, NA=Not Applicale , UNDERGROUNDSTORAGETANK MONITr'IJNG SYSTEM CERTIFICATION FOR r""Top 5 off) XII. LINE LEAK DETECTOR TESTIN. Chack this bon if line leak dlectors(LLD)aro NOT humped(Do nit corephts Vus section) This "COW mustbe p hdHLLDS an; Installed. Y N NA Was a leak simulated to vent' LLD Peritoneum? Chxkagtheta . Simulated leak raNwdfied: 3GPH 0AGPH L 02GPH ® ❑ ❑ Was the testing apparatus properly maunder ® ❑ ❑ For mordancy generator mink systana does this LLD aeNe an audible and visual alarm when a leak is detected? ❑ ❑ For mechankal LLDS, does the LLD mind the fiow through the pipe when a leak is deterred? ® ❑ ❑ For eledronb LLDS, does the turbine auhmsficafy shut off wan a leak ls detected? ❑ ❑ 13 For elearonk LLDS, does the Widure autocratically shut oh F any pardon of the monisming system is disabled or d'woonneded? ❑ ❑ Far electronic LLDS, does the tutbine aulomaacaly shut off d my portion of the mondodrg system maeunctlons or falls a test? ❑ ❑ For electronic LLD$, have all accessible wiring connections been visually inspected for kinks and breaks? ❑ ❑ Wme all dame on the equipment manufacturefs mainterence ohecklist completed? ® ❑ ❑ Were ail LLDs wrifimed operational within regulatory equimments? ® ❑ ❑ For en answer of 9t"81100w (Aeamlbe in secdom XD how orrd when lheae WUNIS wan or wig be coneafad. )UII. COMMENTS XIV. VACUUM I PRESSURE/ HYDROSTATIC MONITORING EQUIPMENT TESTING ® Chock this box if WH monitoring is NOT used. (Do not compbto Um secllon.) This aecdon muslbe cemplaMd N VPH momNoring is used bpeAorm hair daepb'en mordrmkni. System Type (Mark as thw applyd ❑ Vacuum ❑ Pressure ❑ Hydrostatic Sensor ID Cnmpoienl(s) Mendmetl by this Sensor Sensor Functionality Teat Interstitial Cammunkegon Test ❑ Pass ❑ Fell ❑ Pass ❑ Fall ❑ Pon ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fell ❑ Pass ❑ Fall ❑ Pan ❑ Fail ❑ Pass ❑ Fail []PUS ❑ Fail ❑ Pass ❑ Fall ❑ Pass ❑ Pass ❑ Fail ❑ Fail ❑ Pass ❑ Fall ❑ Pass ❑ Fail ❑ Pass ❑ Fail 1 ❑ Pass ❑ Fail ❑ Paas ❑ Fall ❑ Pus ❑ Fail ❑Pass ❑Fail ❑Pass [I Fail ❑ Pare ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pam ❑ Fail How was hlerafitlY eanmunfpaeom verified? ❑ Sknulated look at far ends of the lydamU al space. U Visual Inspection ❑Other cube fhe aelhod In socsoor XV below.) ❑Gauge Was the vacuum or proswm restaed b operating levels in all irdeeatlal spam? ❑ Yes ❑ No (Desrnbe fhe main in section XVbebw.) For an y omswrof•FAl NsalbsM NpgplXV mar and whom MEss iteuas wale would be EOpedBd. XV. COMMENTS GPN=GYbrwpwhaa,Va Vee,N=N%M=NatapAubh,VPH=VaMAMM%BMS"dM@W D=klNMfiwI Dffie UNUtMUKOUND STORAGE TANK The C im4dlnsNfed, Qmenftft m v&0,, 4) Devices mmifowhg UNDERGROUND STORAGE TANK SPILL^NTAINER TESTING REPORT FORAY petorf) wee TVps of Action ❑ Imtallahon Test ❑ Repair Test ® 12 Month Test ICERS 1. FACILITY INFORMATION 104110 10416094 Dale of -20 ColdNnar Teat 09-23-2019 Business Name (Same ss FWMy Name or OBA-Dovg Business As.) UPS Business Site Address 3601 Sacramento Dr City San Luis Obispo ZIP Code 93401 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Techrtitlan QIIIII meTest owas shown on me icc corGYrauon.) David Pereira Phonal (510) 889 - 0908 Ext. Contractor TaMc Tasbr l-icama l R. L Stevens Co/ 415807 Icc Cedifintlon N 5240739-UT Icc carllr¢eUon Expiration Dne 05/18/2020 Spill Container Tssting irsinng and Cen'dicetlms (Lffi applkMb cedi3caGans) Service Tech Ill. SPILL CONTAINER TESTING INFORMATION Test Metl of Used: ® ManufacwrerGuidelines: (Specify) DPW ® Industry Cade or Engineering Star card: (Specify) PEI/RP 1200 ❑ Engineered Method: (Spea'ryj Attach Metasdngproce msadaBdocrnn tan requlredto determine McIeaulfE. lof ad Pages Tank ID: (BY tank number, sacredmoduct ens.) T-1 Diesel Spll Container Manufacturer: OPW Method of Cathodic Protection I& NonWetallic ❑ Isolation ❑ Other SpsdNn secem V) ❑ Non-Mdallic ❑ Isolation 0 Cover r3 fy h section Yl ❑ NomMatallic D Isolation ❑ Other (Specion aicoon V) ❑ Non-Metalec ❑ Isolation ❑ Other (SMrM b section V.) Inside Diameter of Spill Container. (Riches) 1219 Depth of Spill Container: (mobes) 13 114 " Does the Nis consumer have a 5 gallon capacity? ®yes ❑ No ❑ Yes ❑ NO ❑ yes ❑ No ❑ Vas ❑ No Method to Keep Spin Container Empty ® Drain Valve ❑ Onsite Pump ❑ Other (Sparely m season V.) ❑ Oran Vahne ❑ Crude Pump ❑ Omer (Spouty M seahbn V) ❑ Dmin Valve ❑ Onsita Pump ❑ Other (SpidN m secrbn V) ❑Main Vale ❑ Onsita Pump ❑ Other (SpeoN In main V) IV. SUMMARY OF TESTING RESULTS Spill Container Test Results ®Pau ❑Fell ❑ Psss ❑Fail ❑ Pssa ❑Fail ❑ Paas ❑Fail V. COMMENTS All dams merked'Fatl"abort mustbe expkinetl n mis fecr/ar Any eddllonal commoners mayaiso bepmvlded hem. Liquid tested for 1 hr with no loss V1. CERTffICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify thI spill containers wemtested in accordance wino California Code of Regulations, title 73, division 3, strapper 16, section 2037.1 and all the information contaiMd titre curate. I Service Technician Signature l ahefaclllry Ras mom ooarponeoks Oran s nradatn, addtlansl agpfar olBdapapa araY pe arlaabed. cl3sv.lSlllanaa errhonrreraalRgprtkg Syabm, O=MerdkWoM1UST• IkmrAwalabrgee.ar,ltx-mrrmmrrcomatal SAV] tlIS OBISPO RS-232 END OF MESSAGE 805SAN LUIS 1BISPO .BEP 23. 2019 9:53 �iSABLED 805 544 7184 ..jTO DIAL ALARM SETUP SEP 23. 2019 9:53 -- -- -- - ---_ _ SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL I NVEMTORY REPORT T ]:DIESEL VOLUME 7708 GALS ULLAGE - 3819 GALS 90% ULLAGE- 2666 GALS TC VOLUME - 7621 GALS HEIGHT - 56.36 INCHES WATER RVOL n 0.00 INCHES TEMP = 76.0 DEG F x x x x x END x x x x x COMMUNICATIONS SETUP PORT SETTINGS COMM BOARD : 3 <FXMOD) BAUD RATE : 2400 PARITY : ODD STOP BIT : I STOP DATA LENGTH: 7 DATA RS-232 SECURITY CODE : DISABLED DIAL TYPE : TONE ANSWER ON : 1 RING MODEM SETUP STRING DIAL TONE INTERVAL: 32 RECEIVER SETUP: D 8:VEEDER ROOT (FMS) 1-866-743-0379 RCVR TYPE: COMPUTER PORT NO: 3 RETRY NO: 5 RETRY DELAY: 5 CONFIRMATION REPORT: OFF AUTO DIAL TIME SETUP: D B:VEEDER ROOT (FMS) DIAL WEEKLY SAT DIAL TIME 3:43 PM RECEIVER REPORTS: SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYYY HH:MM:88 255967 UPS 3601 SACRAMENTO SAN LUIS OBISPO 805 544 7184 SHIFT TIME 1 : 1:00 AM SHIFT TIME 2 : DISABLED SHIFT TIME 3 : DISABLED SHIFT TIME 4 : DISABLED TANK PER TST NEEDED WRN ENABLED TANK PER TST NEEDED WRN DAYS - 30 TANK PER TST NEEDED ALM DAYS = 30 TANK ANN TST NEEDED WRN DISABLED LINE RE -ENABLE METHOD PASS LINE TEST LINE PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F ): SO.0 STICK HEIGHT OFFSET DISABLED H-PROTOCOL DATA FORMAT HEIGHT DAYLIGHT SAVING TIME ENABLED START DATE MAR WEEK 2 SUN START TIME 2:00 AM END DATE NOV WEEK I SUN END TIME 2:00 AM RE -DIRECT LOCAL PRINTOUT DISABLED EURO PROTOCOL PREFIX S LEAK TEST METHOD TEST WEEKLY TANK I SUN START TIME : 12:00 AM TEST RATE :0.10 GAL./HR DURATION : 6 HOURS TST EARLY STOP:DISAELED LEAK TEST REPORT FORMAT NORMAL D B:VEEDER ROOT (PMS) LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM ALL:WATER ALARM ALL:WATER OUT ALARM ALL:HIGH LIQUID ALARM ALL:LOW LIQUID ALARM ALL:LIQUID WARNING RECEIVER ALARMS SERVICE REPORT WARN ALARM CLEAR WARNING LIQUID SEN80R GETUP- - - L [:ANNULAR SPACE DUAL POINT HYDROSTATIC CATEGORY : ANNULAR SPACE L 2:TURBINE SUMP TRI-STATE (SINGLE FLOAT) CATEGORY t STP SUMP OUTPUT RELAY SETUP R ]:TURBINE SHUTDOWN TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L 1:FUEL ALARM L 2:FUEL ALARM L I;SENSOR OUT ALARM OUT ALARM L ]:SHS[GGHl LIQUID ALARM L 2:HIGH LIQUID ALARM 2:LOOWW LIQUID L LIQUID ALARM SYSTEM ALARM ----- _____ SENSOR ALARM ----- T I:DIESELRPER OUT L (:ANNULAR SPACE PRODUCT CODE I AUG 1, 2019 10:59 ANNULAR SPACE THERMAL COEFF :.000700 PRINTER ERROR LOW LIQUID ALARM TANK DIAMETER : 92,00 AUG 1. 2019 10:59 SEP 23, 2019 10:11 TANK PROFILE 4 PTS BATTERY IS OFF FILL VOL : 11527 AUG 9. 2005 0:00 69.0 INCH VOL : 9604 " 46.0 INCH VOL : 6023 ----- SENSOR ALARM ----- 23.0 INCH VOL : 2361 L I:ANNULAR SPACE ANNULAR SPACEHIGH ALARM HISTORY REPORT LIQUID ALARM FLOAT SIZE: 4.0 IN. SEP 23, 2019 10:11 ____ IN -TANK ALARM ----- WATER WARNING 1-1:0 HIGH WATER LIMIT: 2.0 7 (:DIESEL MAX OR LABEL VOL: 11527 LEAK ALARM ----- SENSOR ALARM ----- OVERFILL LIMIT 95% DEC 21, 2014 6:00 L I:ANNULAR SPACE 10950 ANNULAR SPACE HIGH PRODUCT 90N OVERFILL ALARM LOW LIQUID ALARM SEP 23, 2019 10:11 10274 SEP 14, 2019 10:27 DELIVERY LIMIT : 1 1152 LOW PRODUCT ALARM --- -- SEP 14, 2018 10:25 -- LOW PRODUCT 1000 LEAK ALARM LIMIT: 5 HIGH PRODUCT ALARM ----- SENSOR ALARM ----- L SUDDEN LOSS LIMIT: LOG SEP 14. 2018 10:27 (:ANNULAR SPACE ANNULAR SPACE TANG TILT 0.00 JAN 30. 2015 14:56 LOW LIQUID ALARM PROBE OFFSET 0.00 DEC 19. 2011 13:53 SEP 23. 2019 10:14 INVALID FUEL LEVEL SIPHON MANIFOLDED TANKS SEP 14, 2018 10:29 --- TA: NONE LINE MANIFOLDED TANKS PROBE OUT ----- SENSOR ALARM ----- TO: NONE SEP 14. 201B 10:28 L I:ANNULAR SPACE SEP 14. 2018 10:25 ANNULAR SPACE OCT 11, 2013 11:12 HIGH LIQUID ALARM LEAK MIN PERIODIC: 0% SEP 23, 21119 10:16 0 DELIVERY NEEDED LEAK MIN ANNUAL ON SEP 14. 2018 10:25 0 ----- SENSOR ALARM PERIODIC TES[ TYPE L I:ANNULAR GRACE ANNULAR SPACE QUICK ALARM HISTORY REPORT LOW LIQUID ALARM SEP 23, 2019 10:17 ANNUAL TEST FAIL -- SENSOR ALARM ----- ALARM DISABLED L I:ANNULAR SPACE PERIODIC TEST FAIL ANNULAR SPACE ALARM DISABLED LOW LIQUID ALARM JUL 9, 2019 10:39 ORO6`S TEST FAIL ALARM DISABLED LOW LIQUID ALARM __ -- ME OR ALARM ----- L 2:TURBINE SUMP JUL 9, 2019 10:37 ST.P SUMP ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF HIG HIGH LIQUID ALARM FUEL ALARM SEP 23. 2019 10:19 S. 2019 10:36 JULTANK TEST NOTIFY: OFF INK TST SIPHON BREAK:OFF DELIVERY DELAY : 5 MIN ----- SENSOR ALARM ----- - PUMP THRESHOLD : 10.00% L 2:TURBINE SUMP ALARM HISTORY REPORT STP SUMP SENSOR OUT ALARM ----- SENSOR ALARM ----- BEP 23, 2019 10:22 SOFTWARE REVISION LEVEL LS,�2:TBURRSINE SUMP VERSION 325.02 SOFTWARE# 346325-100-C FUEL ALARM CREATED - 05.06.09.12.51 JUL 9, 2019 11:42 NO SOFTWARE MODULE SENSOR OUT ALARM SENSOR ALARM ---- __-_ SENSO SYSTEM FEATURES: JUL 9. 2019 11:38 L I: SPACE PERIODIC IN -TANK TESTS ANNULAR SPACE ANNUAL IN -TANK TESTS SENSOR CUT ALARM JUL 9,NSOR 2019 11�:38 SEP 23, 2019 L0:22 R.L. Stevens Co. 22254 Meekland Avenue Hayward, CA 94541 (510) 889-0908 LEAK DETECTOR TEST REPORT SITE NAME: U TEST DATE: Q - 2 3— tQ Technician name: David Pereira Environmental Health Agency: C ,Ay o� Sc,-t Lws Db�'s o rJre Site address: .3toot 5QCfCi/1V1ern 0 0(. Clty: Sa v. (. i S i S ? Present I1 Not Present n Phone: + 2 fro 217 Technician signature: Inspector Name: 1{e, f Operator Name: Ede, e LEAK DETECTOR KEY A LD2000 D FE Petro STP-MLD-D G Red Jacket FXIVD B 99LD2000 C FE Petro STP-MLD E FE Petro STP-MLD-E F Red Jacket FXIV H Other ! LEAK DETECTOR TEST INFORMATION Tank # Product LD Key Serial # Resiliency (ML) CpeamgTlme jSecondsi Test Leak Rate (ML/ruin.) FUnCtionalElement Holding PSI Metering PSI PASS/FAIL T-1 D�es�i �� es� lfo4� 2 '� 1 8 2� P/F OF P/F P/F P/F P/F P/F UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 1 of 6) This form must be used to document testing and servicing of underground storage tank (UST) monitoring equipment. A copy of this farm must b s provided W the UST owner or operator. The owner or operator must submit a copy of this form W the local agency regulating the USTs within 30 days of the date of the monitoring system certificadon. I. FACILITY INFORMATION CERS ID 7.9.2019 Business Name (Same as Facrl#y, Name or DBA — Doinp Business As.) UPS Buildingit Business Site Address 3601 SACRAMENTO City SAN LUIS OBISPO LP Cade II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of Company Perkmling the Certifka0on B&T SERVICE STATION CONTRACTORS Phone # IS05) 929 - 8944 Eat. 1012 Mailing Address 630 S FRONTAGE RD NIPOMO, CA 93444 Name of UST Service Technician Performing the Certification (Priat as shown on the ACC Certification.) NICK ADAMITZ Contractod-rank Tester Ucenae# 902034 ICC Certification# 8158837 ICCCertification Expiration Date OBI0312021 Monitnrinto Sstem Training and Cenaications Usf all applicable certtlbations. piration Date VEEDER ROOT #A20030 04/16/2020 III. RESULTS OF TESTINGISERVICING IrM/eate andattech Me follawfing reports if the monitoring equipment is capable of generating either. ❑ Monimring System Set-up El Alan History Report Y N NA Was any monitoring equipment replaced? (if" es,"idenfiry the Weciflc devices replaced and llst the manufacturerand model Mrall replscementpers in section Wbebw) 11 Was damage, debris, or liquitl found inside any secondary containment systems? (if "Yes,"describe what was found in section IV bebw) 113 Is all monitoring eeuipment operational per manufacturer's speclflcationa? (if "No,"describe why in section IV below) ICOMMENTS If devoted to use this section describe how and when the issues were or coil be corrected DURING IN HOUSE AUDIT, FOUND APPROX 110 GALLONS OF WATER IN STP SUMP. SENSOR FAILED TO INDICATE ALARM CONDITION. WATER WAS REMOVED FROM SUMP AND PLACED IN 55 GALLON D.O.T. DRUMS ON SITE. SENSOR WAS REMOVED AND REPLACED BY CERTIFIED TECHNICIAN, NICK ADAMITZ, AND RETESTED FOR FUNCTIONALITY. ALL TESTED GOOD. V. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the equipment identified in this document was inspected/serviced in accordance with California Code of Regulations, title 23, division 3, chapter IS, section 2638 and all information contained herein is true and accurate. Attached to this certification is information (e.g., manufacturers' checklists, rritoring system set-up, alarm history report, etc.) necessary to verifythat this information and the site Ian showin the but of UST system is complete and accurate. UST Service Technician Signature CERS=Calforni EmNgmenfal Passing System, 10Cninharriffioral Code Courni,Y=Yes, N=No, NA=NotypilceNe UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (P ezotb) VI. INVENTORY OF EQUIPMENT CERTIFIED A separate Monitoring System Certification Form must be prepared for each monitoring system control panel. Make of Monitoring System Control Panel VEEDER ROOT I Model of Monitoring System Control Panel TLS-350 Software Version Installed 325.02 Check the appropriate boles fo iMicete in equipment ins ected/servlced. Monitorin Device UaetlI Device Model b Monitoring Device Used I Device Model a Tank ID:1 DSL (Bv tank number stored oroduct a Tank ID: (By tank number, stored ek. ❑ In -tank Gauging (SW Tank) ❑ In -tank Gauging (SW Tank) ❑ Annular Spam or Vault Sensor ❑ Annular Space or Vault Sensor ❑ VPH Sensor ❑ VPH Sensor ProductPipina Product Pl In ❑ Mechanical LLD ❑ Mechanical LLD ❑ Electronic LLD ❑ Electronic LLD ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ® Sump Sensor 208 ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) FIII Piping FIII Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vent Pipina VOM Piping ❑ VPH Sensor (Piping) ❑ VPH Senor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vapor Recovery Piping Vapor Recovery Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Samar (Sump) Monitoring Device Used I Device Model ♦ Monitoring Device Used I Device Model a TanklD: (By tank number, snored product a TsnklD: (By tank number. sionxtproduct. etc ❑ lirtank Gauging (SW Tank) ❑ In -tank Gauging (SW Tank) ❑ Annular Spam or Vault Sensor ❑ Annular Spare or Vault Sensor ❑ VPH Sensor ❑ VPH Sensor Product Piptna Product Mono ❑ Mechanical LLD ❑ Mechanical LLD ❑ Electronic LLD ❑ Electronic LLD ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Fill Piping Fill Pi n ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensir(Sump) ❑ VPH Sensor (Sump) varnpiping Vent Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) Vapor Racavriurt Piping Vapor Recove Piping ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) D=Idaneftcagan, SW=9nglawriM d.VPH=VacwmRmssural Iyrhmtal LLD=Ureleakde�mor UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM d ot5 Monitoring Devlee Used Device Model a Monitoring Devlce Used Device Model e VentlTransition Sum ID: VentiTrenaltlon Sum ID: ❑ Sump Sensor ❑ Sump Sensor ❑ VPH Sensor ❑ VPH Sensor UDC ID: UDC ID: ❑ Electronic Sensor ❑ Electronic Sensor ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor UDC ID: UDC ID: ❑ Electmnc Sensor ❑ Electronic Sensor ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor UDC ID: UDC ID: ❑ Electronic Sensor ❑ Electronic Sensor ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor UDC ID: UDC ID: ❑ Electronic Sensor ❑ Electronic Sensor ❑ Mechanical Device ❑ Mechanical Device ❑ VPH Sensor ❑ VPH Sensor Other Monitored Counonent ID: Other Monitored Com onent ID: ❑ Other (Specify in section VII.) ❑ Other (Specifyin secfmn VII.) Other Monitored Component ID: Other Monitored Com onentlD: ❑ Other (Specifyin section VII.) ❑ Other (Specify in section VIL) Other Monitored Corponent ID: Other Monitored Component ID: ❑ Other (Specify in section VII.) 1 ❑ Other (Specify in seciien VIL) Include Information forevery underground storage tank compmrent manik"d by this monitoring system control panel. If the monitoring system confmlpenef monitors more components than this form accommodates, additional copies of these pages may be attached. NI. COMMENTS Use Nu section to provide any additional comments about Me inventory of the equipment certified. NA ID= ldentlflcadon,VPH=VausavvProssurefilydroplafic, UDC=urMx+YaparoercarrdlnmaR NDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Prigns a of s Vlll. MONITORING SYSTEM AND PROGRAMMING Mis section must be coneomfedifamonhodngpanel is used to perform leak defectionmonirofing. Y N NA Are the visual and audible alarms operational? ❑ ❑ ❑ Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move treaty, functionally tested and confirmed operational? ❑ ❑ ❑ Were all sensors installed at lowest point of secondary containment and positicned so that other equipment will not interfere with their prittleroperation? ❑ ❑ ❑ Was monitoring system set-up reviewed to ensure proper sedings? ❑ ❑ ❑ Was the monitoring panel's backup battery visually impacted, functionally tested and confirmed operational? ❑ ❑ ❑ Does the flow of fuel stop at the dispenser if a leak is detected in the under -dispenser containment? ❑ ❑ ❑ Does the turbine automatically shut down if the piping secondary containment monitoring system fails to costal or is electrically disconnected? ❑ ❑ ❑ Does the turbine automatically shut down N the piping secondary containment monitoring system detects a leak? Which sensors knies positive shut down? (Check as that apply.) ❑Sump ❑Under -dispenser containment ❑ El❑ If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? I DI ❑ 1 ❑ Fitrally answer of"Alm above, describe in lesson Winner and when these deficienciee were or will be wrrecrod. IX. COMMENTS NA X. IN -TANK GAUGING TESTING Check this box if tank gauging as used only for inventory control (Oo not complete this section.) ❑ Check this box if NO tatic gauging equipment is installed.(Do not complete this section) This section must be completed Ifin-tank gainaling is imillW perfourn leek distinction manufforting. Y N NA Has all input wiring been inspected far kinks and bmeke in the cables and for proper entry and termination, including testing tor ground faults? ❑ ❑ ❑ Were all in -tank gauging probes visually inspected for damage and mill buildup to ensure that floats move freely, functionally tested, and confirmed operational? ❑ ❑ ❑ Was accuracy of system's produd level readings sell ❑ ❑ ❑ Was accuracy of system's water level readings tested? ❑ ❑ ❑ Were all probes reinstalled properly? ❑ ❑ ❑ Were all items on the equipment manufacturers maintenance dWeckli&completed? ❑ ❑ ❑ Fairiany answer of 'N' above describe in seodw Xl how and when these deficiencies wale or will be connected.. XI. COMMENTS NA Y w Yes, N • No, NA = Nd Appllcatble UNDERGROUND STORAGE TAN. MONITORING SYSTEM CERTIFICATION FORM Pig -sots XII. LINE LEAK DETECTOR TESTING ❑ Check this box If line leak detectors (LLD) are NOT installed (Do not complete this section) This section must be cornpleftelf If LLDs are Installed. Y N NA Was a leak simulated to verify LLD Performance? Check all that Simulated leak rote verified; El 3 GPH El 0.1 GPH 0.2 GPH ❑ ❑ ❑ Was the testing apparatus property calibrated? ❑ ❑ ❑ For emergency generatortank systems, does the LLD create an audible and visual alarm when a leak is detected? ❑ ❑ ❑ For mechanical LLDs, does the LLD restrict the Flow through the pipe when a leek is detected? ❑ ❑ ❑ For electronic LLDs, does the turbine automatically shut off when a leak is detected? ❑ ❑ ❑ For electronic LLDs, does the turbine automatically shut off if any portion of Me monitoring system is disabled or disconnected? ❑ ❑ ❑ For electronic LLDs, does the turbine automatically shut off if any portion of Me monitoring system malfunctions or fails a test? ❑ ❑ ❑ For electronic LLDs, have all accessible wining connections been visually inspected for kinks and breaks? ❑ ❑ ❑ Were all Items on the equipmentmanufacturer's maintenance checidist completed? ❑ ❑ ❑ Were all LLDs confirmed operational within regulatory requirements? ❑ ❑ ❑ Forany answer of"N"above describe In secNixe Me how errd when Mesa issues were or will be corrected. XIII. COMMENTS NA XIV. VACUUM I PRESSURE/ HYDROSTATIC MONITORING EQUIPMENT TESTING ❑ Check this box if VPH monWring is NOT used.(Do not complete this section.) This section must he completed if WN moniforing Is used fo perform leak debedon monitoring. System Type (Mark all that apply.) ❑ Vacuum ❑ Pressure ❑ Hydrostatic SensorlD Component(s) Monitored by this Sensor Sensor Functionality Test Interstitial Communication Test ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fall ❑ Pass ❑ Fall ❑ Pass ❑ Fail ❑ Pass ❑ Fall ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail How was interstitial cornmunication vented? ❑ Simulated leak at far ends of Me interstitial space. Visual inspection ❑ Other (Describe the methodin section" bebw) [I Gouge Was the vacuum or pressure restored to operating levels in all interstitial spaces? ❑ Yes ❑ No (Describe the reason to section "below) For answerof "FAA"above describe in section XV howand when Mese issues were or will be correcfed. XV. COMMENTS NA GPH aGallons pw hour, Y=Yes, N = No, NA= Not applicable, VPH = VacuumiPressureRlydniall, I0= IderNfiCatlpn NDERGROUNDSTORAGETANK MONITORING SYSTEM CERTIFICATION FORM ippmeeof el XVI. MONITORING SITE PLAN Data site map was prepared! If you already have a site plan Mat shows all required information, you may include it, rather than this page, with yourh ilonhg System Garb/ hah Form. The sate plan must show Me general layout oftanks and piping and clearly identify bcations of Me following equipment, ifinstaded: 1) monitoring system control panels; 2) in -tank liquid level prebes (d used for leak detection); 3) devices monitoring tank annularspaces or vault, 4) devices monitoring product piping: 5) devices monitonng fill piping; e) devices monitoring vent piping; T) devices monitoring vapor recovery piping; e) devices monitoring ventebansrTion sumps; 9) devices monitoring urder-0ispenasrcontamment; 10) line leak defectors; and 11) devices monitoring any othersecondary containment areas LEGEND B & T 5ervick-'3tation Contractors WORK ORDER n. T , fy30 Smith Frontage Bond Nipomo, CA 93444 (805) 929-8944 FAX (805) 929-8948 License # 90=34 To: t� JGBCOMPLETE My NO EPACHARGEOJANRTY O n �� NIA 1I.. IIIIIIII III III �__ IIIIIIIIII'lllllllllllllllllllllllll. _ IIIIIIIIIIIIIIIIIIIIIIIIIIIIItllllllllllllllllllllt ._IIIIIIIIIIIIIIII1 IIIIIIIIIIIIIIIIIIIIIIIIIIIII1IIIIIIIIIIIIIIIIIII1 NAME ARWVAL DEPART MILES LABOR TRAVEL TOTAL HOURLY C TIME TIME HOURS HOURS HOURS RATE AMOUNT a l \ W C W g F Me eeMma of an dllorreyya mNMmtlb mbraenypdHdMa CFrye Feea:SOr f0f egnmed. arbredctttiddawIHPmlldcmaaltram Ndmi MgneU meroa MATERIAL $ eror br, a la egmetl Mellha tlebMrwlN pryrwmpaNle rmM dmleplbn MaMng e nwe reamlMNd egomeya lwa. LABOR COST j TERMS: A SERWCE CHARGE OF 11Q1 PER MONTH (ANNUAL RATE OF iS%) WILL BE EQUIPMENT $ m CHARGED ON PAST DUE SAIANCESOVE 0 MILEAGE CHARGE $ W THIS IS TO CERTIFYTHAT WORK WAS SATISFACTORILY COMPLETED ININDIGATED TI OUTSIDE SERVICE] $ TAK j SIG RE LER. J R OR CO IGNE IUTAL WORKORDER $ UNDERGROUND STORAGE TANK OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT FORM (Paso +or It Type ofAction ❑ Installation Inspection ❑ Repair Inepeollon p 36 Monty astrachan 1. FACILITY INFORMATION CERS ID 10416094 Dole of Overal Prevendon Equfpmenl Inspeokon 10 3018 spininess Name (Sams as Facility Name o/ RA-Vok2 Business e) United Parcel Service - San Luis Obispo Business Shte Address - �" y 3601 Sacramento Dr. San Luis QbI$PQ 93401 n -.. 11, UNRE GROUND:ATOKAQRTANKERRVlCE7ff;REGtiMIO AN:INEQRINA?ISMI dmeo US Service is n en Pennomang the inspection(rmlas wa comol Cerp eatlpn. Ab Chris Haft 909 949-9141 cantaclorl Tank Tooter m $ - 767902 CC Cgni Callum 6246730 ICC Com motion Etlplralon Pate $111/2019 vadllfPrevandan EqulpmoM lmpodion Tminlna and ar6asadona (6!&appl eb ewdinaatbnaJ OPW.Ph. 1 UST Enhanced Vapor Recovery 4100314 - III, OVERFIL4:.PREYENTION FGiUiPMENT INSPECTION INFORMATION - n6ps4an maNp used; Q sonu aourer r oddelinas Maoglfy): Q knoustry Code or Enoln"i standard (Spealy): - . ❑ Engineered Metllod (Spas) Attach the /nspes don pmesdraes a ndaildopummfedon rsqulred to doWWne fine maNrs. A 0 Attached Pops TANK 10;(6yoteins roper, woradprodi etc.) Tl-DIe el I What is the tank was diamata? (Incnas) - 9D.8 to the at piping "Roma y contains"? - L] Vas M No ❑ Yea ❑ No Q Yea [jNn [I Yas ❑ No Is the vent piling saeen lalay contained? Q Yes ONO CI Yen Cl No ❑ Yes ❑ Nd 0 Yes Q Np overall Proportion Equipment Monurealumr 3) - OPW What Is the spe ds proportion equipment respense when anthis il't (CM1aaNell fM1ar appyl ❑ shuts Of Flow W Resolds Flow ❑ AN aanl ❑ Snub Oa Flow ❑ Renblats Flow © iVs Alam1 ❑ shuw On Flow 1] Reslnc[8 Flaw C7 Ael Alarm M ahuw PKPIow [J Rosalce Flaw [I M Ale rn Are flow resmCters replied on varnishing? M Yes CINo IDYN& ONO 1 Q Yee Q No [I Yes ❑ No Af whet lavpl In the tanks the overfill proportion ON to aaU rifii rigs from bosom ofWk..) 81 n Mat is the percent Capacity of to lank at which me overall provantlon wipmenl netnews? 95% a the owrnq prevention In proper operating con iflon to respond when the substance machos the ropdato levd7 ®yes Q Yea Q Yes ❑ Yes ❑ No(Sisoffy In V,) IV. -SUMMARY OF. INSPECTION RESULTS Overfill Pievenean Insip ckm Results i] Pass ❑ Fall ❑ Pass ❑ Fail ❑ Paso ❑ Fail ❑ Paaa Q Fail V. - COMMENTS..... -. Anyimi mai "Fad" must he explained in this section. Any additional commen(s may also ixt provided here. .' Vi. CERTIFICATION OY'US'(sERVIGE-9'ECNNICfAN�C19PlDUCTIN6THI3INSPECTION - 1 heredity certify tha the overNll pmvention egolpmegtwas Inspected in accordance with California Code of Regulations, Title 2a, Olvlsion holier 10, Section 2637.2 and all the Information contained hamin Is accurate. T Te i SiosWre tla}p'feopibhajlharo connections man tion form accommods"additional colt" of them pass may he shaped. CEPS a CaKaMe F,nWmvnerM Reporks Spwm, Da kenylmton.U3T= Urdwpahml SlcnNaTark[CC =Inemalioal Coda Goons, ANsAWNh am VW 1.111161119 wwe.umdoos.org 'IM. Rev, 06111 S_VSTBM SETUP OCT 3, 2018 11:25 AM 255967 UPS 3601 SACRAMENTO SAN LUIS OBISPO 805 544 7184 OCT 3, 2018. 11:25 AM SYETSr-STATUS REPORT ALL FUNCTIAS NORMAL'.' - INVENTORY REPORT `•T ]:DIESEL .'VOLUME - 9285 GALS ULLAGE 3242 GALS 90% ULLAGE� 2089 GALS TC VOLUME = 8190 GALS HEIGHT - 60.03 INCHES WATER VOL - 0 GALS WATER = 0.00 INCHES TEMP 76.2 DEC F x x x x x END x x x x x SYSTEM UNITS A" U.S. SYSTEM LANGUAGE - ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYYY HH:MM:SS xM 255967 UPS 3601 SACRAMENTO SAN LUIS OBISPO 805 544 7184 SHIFT TIME I : 1:00 AM SHIFT TIME 2 : DISABLED SHIFT TIME 3 : DISABLED SHIFT TIME 4 : DISABLED j TANK PER TST NEEDED WRN ENABLED TANK PER TST NEEDED WRPI DAYS - 30 TANK PER TST NEEDED ALM DAYS = 30 TANK ANN TST NEEDED WRN DISABLED PASSRE LI ENTE9 METHOD LINE PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET DISABLED H-PROTOCOL DATA FORMAT HEIGHT DAYLIGHT SAVING TIME ENABLED START DATE 1 MAR WEE K 2 .--SUN .._- START 2'00 AM END DATE NOV WEEK 1 SUN END TIME 2:00 AM RE-DDIBLID LOCAL PRINTOUT DISA SURD PROTOCOL PREFIX CUSTOM ALARM LABELS DISABLED j COMMUNICATIONS SETUP PORT SETTINGS 0" BOARD : 3 (FXMOD) BAUD RATE : 2400 PARITY : ODD STOP BIT : I STOP RS-TA DATA CODE : DISABLED DIAL TYPE : TONE MODEM ER SETUP STRING NG DIAL TONE INTERVAL: 32 RECEIVER SETUP: D B:VEEDER ROOT (FMS) 1-966-743-6379 RCVR TYPE: COMPUTER PORT NO: 3 RETRY NO: 5 'RETRY DELAY: 5 CONFIRMATION REPORT: ON AUTO DIAL TIME SETUP: D B:VEEDER ROOT (FMS) DIAL WEEKLY' TUE DIAL EPM RECEIVER REPORTS: -IN-TANK SETLP- RS-232 END OF'MESSAGE DISABLED AUTO DIAL ALARM SETUP D B!UEEDER; _ROOT_wr,3)._„_. IN -TANK ALARMS ALL:LEAK ALARM ALL:HIGH WATER ALARM ALL:OVERFILL ALARM ALL:SUDDEN LOSS ALARM ALL:HIGH PRODUCT ALARM ' a T. T HU&T m n in i Pkm LIQUID SENSOR ALMS ALLIFUEL ALARM ALL:BENSOR OUT ALARM ALL:SHORT ALARM ALL:WATER ALARM ALL:WATER OUT ALARM ALL:HIGH LIQUID ALARM ALL:LOW LIQUID ALARM ALL:LIQUID WARNING RECEIVER ALARMS SERVICE REPORT WARN - ALARM CLEAR WARNING -T I:DIESEL PRODUCT CODE I THERMAL CORD :.000700 TANK DIAMETTEER 92.00 TANK PROFILE 4 PTS FULL VOL 11527 69.0 INCH VOL 9604 46.0 INCH VOL .6023 23.0 INCH VOL 2361 FLOAT SIZE: 4.0 IN WATER WARNING 1.0 HIGH WATER LIMIT: 2.0 MAX OR LABEL VOL: 11527 OVERFILL LIMIT 95% 10950 HIGH PRODUCT - 90% 10374 DELIVERY LIMIT 10% • 1152 LOW PRODUCT 1000 LEAK ALARM LIMIT: 5 SUDDEN LOSS LIMIT: 100 TANK TILT 0.00 PROBE OFFSET 0.00 SIPHON`MANI FOLDED TANKS T#: NONE LINE MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 0% 0 LEAK MIN ANNUAL D% 0 PERIODIC TEST TYPE QUICK 'ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED RNN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON SRFAK:OFF DELIVERY DELAY : 5 MIN PUMP THRESHOLD : 10.00% LEAK TEST METHOD TEST WEEKLY : TANK 1 SUN E STAR2:00 AM 110 Cf1UHR TEESTTTRATE DURATION :0 : 6 HOURS TST EARLY STOP:DISABLED LEAK TEST REPORT NFOORMAT LIQUID SENSOR SETUP- - - L 1:ANNULAR SPACE DUAL POINT HYDROSTATIC CATEGORY : ANNULAR SPACE L 2:TLRBINE SUMP TRI-STATE STPr SFLOAT) SUMP OUTUT RELAY SETUP R I:TU)BINE SHUTDOWN TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L I:FUEL ALARM L 2:FUEL ALARM L L:SENSOR OUT ALARM L 2:SENBOR OUT ALARM L I:HIGH LIQUID ALARM L 2:HIGH LIQUID ALARM L I:LOW LIQUID ALARM L 2:LOW LIQUID ALARM Os UP5 6 ,r) LU(S vYJlbxv- Aonendic8 71 SO Overfill Valve in Tank Shut off level Worksheet Im ortanL° This is meant to be supplemental worksheet and not a substitute tofollowing the installation manual instructions. All length measurements are in inches. Please contact the Authority Having Jurisdic- tion (AHJ) and review local, state, and national codes to determine the regulatory requirements governing shut-off capacity In your region, as well as take into account other considerations such as extreme tank tilt. Take the following measurements with the vaIva In- stal led 1n the tank: Distance from the 71 SO Inlet tube flange to the cast lug In the 7150 body (see figures), upper tube length. Note: the Upper Tube Length must be at least 16"to in- clude the protective bend in the tube. (D)= 6r6.5 rr Distance from the 71 SO inlet tube flange to the top and bottom of lower tube, valve length. (Wl_ /r (U) _ Distance from the 71SO inlet tube flange to the bottom of the tank Note: If a tank bottom protector is present it may be necessary to add this thickness to dimension (OPW 6111 & 61TP models add GAI (B)= / �q, S Ir From the tank calibration chart provided by tank manu- facturer find the dipstick number (f) which corresponds to the 100%volume. (Y)= 224 = 1. Todetermineshut-otFpercentage: Subtract upper tube length (D) from distance to tank bottom (a) 00=(13)-(D) r= Using the tank calibration chart provided by the tank manufacturer determine the tank capacity at the cal- culated DO dimension and the 100%volume (Y) tank capacity. ()0 tank capacity in gallons= /O 4Q7 (ntank capacity Ingallons= % SO%= (X) capacity / (Y) capacity x100 = (D) Upper Tube (B) TOTank (U)Valve Length, top of cut ew)valve Length, bottom of cut m Tank Chart 100% Volume Dipstick Note: The overfill valve must be installed per AHJ require- ments and ail applicable local, state, and national codes. If the overfill valve is set above the allowable shut-off percent- agetheoverfill valve must beremovedand replaced. For reference40 CFR part 280 Subpart B Section 28020 overfill valves should be set to a maximum of 95%. 7XE!MESe Ja✓1 L-vls 7901 XERXES AVENUE SOUIH www.xwx"corp.com MINNEAPOLIS, MN 55431-1200 952-997"1590 Dipstick Calibration Chart for 12,000 Gallon - 8' Diameter DINT-Ii Tank DIPSTICK HEAPING OIPSTICK BEADING RIPBTICK HEADING DIPSTICK HEADING 01P8TICK BEADING RU+3TI0K HEARINB _ 2 -114" 36-1i/2' 7 518' 14-7/6" 22.1/8" 29-3m" - 36-5/8 - 0.1/2" 7 314' .a... "* 15" 22.114" . $. 29.7/2" _ 36.3/4" _ 0.6/8" 7-718" ,. - :.. 75.1/8" '- 22-318 9. A" - 3B-7/8'- ..: .. 03/41l ..... 6" •dry .^,S' 1.-1/4" -22.11Z' ::..._ - 29-3/4" u':.: .. 37" .'.. 0-718, - 8.118° *" - 15.3/8' '4.•� 22-6181, 29,7181. 's - 37-116" ^ 1", 6-114" - „;.a .,_ 15-1/ „ 22- 14„ :. 30:, 37-1/4" 8-318" ,r 18.6/8" 22.7181, __ ' • 30.1/8" 37.3/8" M1/A" - X8-112" - 1&314, 23" . a 30.1140 37-1/2" 8-518 ';.p:.. 15418" 23.118" " - 30-318" 37-5/8" 8.314" ifi" 23.1/4" _ 30-IITI 37-3/4' 1.518" $. 18' 16•118, 23.3 8" 30-518"' 37.7/8' 1-314" .s; 8" - 16-1/4" 23-112" 30.3/41, 36' 1-08" V8' .. '. ,.._ a iv � 1013/81, - - ni 23.6/8" .,.. 30-7/8" ✓• 38.1/8 • .... 2" '. - 9-114" ,'` 16-1 ;:• 23all.3/4" .. 31 38-1/4" 2-1/81, - " 93/8" _ -,y� t6-6/8" 3 23-7/8" 31-118" - 38-3/0, 2-1Y4" 9-112" 16.3/4" 24" - 31.114" 38-1/2" 2-3/8" - , a 9.5/8° - 16-T/ " 24,118" 31°3/8" _ 38.5/8" 2-1/2" 9.314" 17" 24.14" 31.112M 8-W4" - ;1 2-6/8" : 9.70 17A 8" 24-3/8" - _ - 31318 3 7/8" 4- 2-3/44 10" 17.1/4" 24.1 -' 31+3/4° WMINIM 39n 2-7/8" - 10.118" 174AV 24-5/8" __ 31.7 39-f W _ 3' 10-114' ". 17-1 ' 43/4" 32" 3&V4 ' • ' ' 3-7/8" '-. 7031e" 173/8 24,718" 32-118" 39-318" " 3.1 4"S8? 10-1/2" 17.3/ " 25" - �t 32• !4" 9 i" 33/8" _ 1013/90 17- 16" - 25.1/8" a- 39-5/8' SAW 70.31W - 18" 26.1/4" -32-7/2° 39.3/4" 3.8/8" eb: E' 10- / " e 1 8" 25, 3 18 39-7/ " 11 ', '18.17a" ' 5.1 ' -SW k 40" 3- At" -1/8" 18.3 26. 8" " 32.7/8" '4 40-1 it 4" -..'n 11-1/4' 18-172' ': 25.314" 33111 400.1 4 - 4.1/8" .. - 11-3/8" 18-518' � 25.7/8" 33.1/8" ' - 40.3/6" 4.1/4" .'-11.1/2" :, 18.3/4" - 28" . � 3.1/4" _ 40-7/2" .° _ 43/8" : , 11.5/8" :, =.a . 18-7/8" r ,- v 26-1/8" 33.1 43 40- ;t .? 41/2• ".... 'a 11314" - .. 18" .. � ;:' 28-1/4"_. 33•i(2n ... - 40.W3/W •_ 4- 8" fs 11 7/8 - 79.1 W 264f " 33- /8" 407?8 4314" g 1'2" 18-1/4" 26,112" - - 33-3/4" 41 ' 4-718" - 12-1/8" _ `. 18.3/y, a..' '. 264/a" -' 33-7/5" -..<. ;": - 41-v8" 6" --.-. .-,.: 12-v4^ 1Nl it 19-1/21' - 26.314".. :.. 34" 41•114" :- 5-1/8" 12-3/W 19.91W - 26-718" - - 34-IW 41.3l8 5- W '. 12,112" 19-3/4" 27" -34 /4" 4 -1 . 12.518" , 3 � 19-7/8" 27-118' •- 343/8" 41-5/8" 5.1 2" - .. :" 12.3/4" - 20" -.. - 27-114. ;4. 34-1/2" 41.3/4' - 5-Wl) _ 12- /8" 20-1/8" 27 8" = 34 41•7/8" S.3/4" r... 13" 2 -1/4" 27.112" w 343/ p 42" " Can sell t.- ,-. .,. 0-38" , 27-518. .. _, 4 42-1 1 - . . 6" 3 1 - /4' ,;; p 20-1/2" 27-314" ,- 35" 42-1/4' .. 6.1/8" .,,:.a^ 13-3/8, 20-5/8" 27.710 35.7/8• 42.3 " Vitt" 13-1/2" 20.3/4" - " 2a' !:". '. - 3$.1/4n ., -4 -1/2" 6-3/8" - 13-5/8, 20-7/8" 28 1/6" 2-884 e-/2 1314" 21" - M 2-4 -1/2" 4 a :y 6-5/8" 13-7/8" V 21-1f8° 28.318" - 5.5 it 8.3/4" 14" 21,1/4" '. _ 28%112" e _ 36 4" 43" 213/8" 2851e" -3.7v 43-118" '^ '7" 14.1/a" - 21-1/2" 2 4 36 43 114' 7.1l8" 143J8' °'. 21-5/8" .,.., 28 718 . _ 36.1/ s " '. �. 43 318 .-F ' a; -38- 14"�'s -43.1 2" 1Y3"' t Win he not can the CdAM1ratioA idartprithout"awlBg XerMaBl lnetallatlan Manual and Operating Guidelines, and xcrxase applicable t Thad Warta1NN oaples of which are Al the 1Kentoni pAoxet dolluereld in to site, or available at 1VNW xerxeslPxpAam, 1 UPS Sr .L-yu<, QklCoA � Q Tap of- r e Sew' -b loo-l+wn 13N,o o 5" 5 s„ Set over rawry � 0 -77,5" = Io G495zO IY r.y11 V'^ 7/ co -.fit IXlrl-i- Qa) F3a= IllfGl _ 11.�27nn� 9(oia = U (?jai £SU9-OZ6-606 :xed T4t6-6b6.606:auo4d •oul 'saolnJaS id ZZV,IAvW 21940w 'All%padsay -soul sn 301 aseeld'swaouoo jo suogsanb Aue ane4 noA dl 4odslg0 sinl ueS'v0 ojuawelaeS T09E 3e pamoyad „uopoadsul IIUJa O„ a47 sl P843eAb 'alAog joaoodsul odslg0 slnl ueS •JO oyuewejmS 509E - uogoadsul II!!�a^O :ssa(gns ;a0 ,;G�ap'a16o8, :01 Wd 85Z BSOZ'SO+egwanoN Xepuoyl :Juas 03!mes :wojd zeupson Gletpew B& T Service Station Contractors woRK ORDER 75587 630 South Frontage Road Nipomo, CA 98M (805) M9.8944 FAX (80H) 989.8946 Idcense # 902084 Ttx UPS SI 9 . Date: 3601 $wa ra.mM l0 8'r P.O. No. 5w, Luis 04;spo sarw.o. 3GBsN nun. rnre a�nwr l oro-oo 77-S -Mai' •i � toga IIIIII��I�IS B&T MONITORING SYSTEM CERTIFICATION � 6BMce6 CpmracLMa Far Use ByAlfkdsdk[iwv VVI IM Same of Collision] AUMorhy Cried: Chapter Gl Heokh and Sandr,Code, Channerl6, ON61ans,, 11tk33, Colifomlo Code of Femll This form most be used to document testing and shordid g Wmonitormulmospmem. mesa ormuffermand or in= MIS Ed prepared Me 00 ranged "a � addrighol Noe I by the tecalan who PMwms the wk. A copy of this (mm heart be molded to the sank system wret/olu`alor. The owner/operator moat submit o ropy of this Man to she Lod agency recording LIST system within 30 days of test thee. A. Geamal InformatiaO FadlitVName: LISP San Wls Bldg: Site Address: 3601 Sacramento City. San Lulls Obispo lip: Fadlity Contact Person: Contact Phone No.: Make/Model of Monitoring System: TLS 350 Date of Testing/SeMrJng: 9/14/Ig B. lave qof EgldPs TCOBWCOUBcd Call 4.sul-...-.----------. ... ID: OSL -Tan k Gauging Probe Model: Mag Probe Annular Space or Vault Sensor Motlel: 302 Plpl his Sump/Trench Sensors) Model: 205 Fill Sump Sensorlsl Model: Mechanical Line Leak Detector Model: FXIDV Electronic Lin a Leak Detector Model: Tank Overfill /High -Level Sensor Motlel: tither( specify equipment type and model In section E on page 2) seek 10: In -Tank Gauging Probe Model: Annular Space or Vault Sensor Model: Piping Sump Trench Senam(s) Model: NII Sump Sensorls) Model: Mechanical line Leak Detector Model: Electronic Line leak Detector Model Tank Overfill/High-Level Sensor Model: Other( speedy equipment type and model in section E on page 27 Tank X In X X X Tars In.Tank Gauging Probe Motlel: annular Space or Vault Seiddr Model: Piping Sump/Trench Sere l Model: Fill Sump Senora Model: Mechanical Line Leak Detector Model: Electronic Line Leak Detector Model: aON Overfill/NIgRLevel Sensor Model: ONer(spetlfy equipmenttype and model In se[ and Eonpa e2j o TarMID: In -Tan k Gauging Probe Model: Annular Spam or vault Sensor Model: Piping Sump/Trench$ensi Model: Fill Sump Sensors) Model: Mechanical Line Leak Democrat Model: EleQronls Line Leak Detector Model: Tank Overfill/HIgMLrvel Senzor Model: Otaer(spedN equipment type and model In sedlgnEon page 2) Dispenser 10: 12 Dispenser Costal human Serso lsj Model', 323 Shear Valvelsl Dispenser Containment Floatlsl and Chalnls) Olspenser 10: Dispenser Containment Sera ls) Modal: Shear Valve(s) Dispenser Containment epatlel and Chainlsl X X Dlsperrssi Dispenser Conceinmem Senspr(s) Model: o hear Valvelsl Dispenser Containment Floatlsl and Chain(s) Dispenser lD: Dispenser Containment Sensgrls) Model. Shear Valvelsl Dispenser Containment Floatls)and Chainls) Dispenser ID: Dispenser Containment Sensdr(s) Model Shear Valvels) Dispenser Containment Floatlsl andChalnls) DiFeenserlD: Oupense r Containment Sensorlsl Model: Shear Valvelsl Dispenser Containment Float(sl and[hain(af *IF *ahgh, conoim more Links or dispensers. trips the harm. incudeimormanon ra every ulna also curl e. al C. Unlicatlln. I artily that the equipment identlfled In this document was lnspened/secs in accordance with Me manufaaturen' guidelines. Attached W this commitment K information j e.g. manWacturere checklists I necessary to verify that this Inormation is mrren and a Plot Plan showing the layout of monitoring equipment. For any equipmam well of generating such repone.I have also ananhed a copy of mae span; fchmk oil Mat apply): lsystan set-up X❑Alarm hlato repot Technician Name (print): Rickey ginger Signature: certification No.: 8452629 Bourse No.: Testing Company Name: B&T service Annual transformation Phone Ifil Testing Company Address: 630 Frontage rd supreme Dale of Testing/Servicing: 9/14/18 D. Results of Testing/Servicmg Software version Installed: 325.02 Complete the following checklist: X Yes Noe Is the audible alarm operational? X Yes NO* Is the visual alarm operational? X Yes NO* Were all sensors visually inspected, functionally tested, mat confirmed operational? X Yes Li No* were all sensors installed at the lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes IF alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) N/A operational? XNoe X Yes Noe For pressurized piping systems, does the turbine automatically shut down if the piping secondary N/A containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If Yes: which sensors initiate positive shut -down?( check all that apply) sump/Trench Sensors; X Dispenser Containment Sensors Did you confirm positive shut -down due to leaks grad sensor failure/disconnection? X Yes No X Yes Noe For tank systems that utilize the monitaring system as the prlmary, tank overfill warning device li.e.no N/A mechanical overfill prevention valve is Installed), is the ovefill warning alarm visible and audible at the tank fill points and operating properly? If so, at what %of tank capacity does the alarm trigger? 90% Yes* X NO Was any monitoring equipment replaced?If yes,Identify specific sensors, probes, or other equipment replaced N/A and list the manufacturer name and model for all replacement parts In Section E, below. X Yes* X No Was liquid found Inside any secondary containment systems designed as dry systems? (crack alf that apply) Product; Mwater. If yes, describe causes in Section E, below. X Ye5 Noe Was monitoring system set-up reviewed [a ensure proper scroll Attach set-up reports if applicable. X Yes No* Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. R Compositions: page 2 of 3 Monitoring System Certification F. In -Tank Gauging/SIR Equipment: ❑X Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is Installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Yes No" Has all input wiring been Inspected for proper entry and termination, including testing for ground faults? 'Yes No"Werealltank au Ring probes visually inspected for damage and residue buildup? Yes No" Was accuracy of system product level readings tested? Yes No" Was accuracy of system water level readings tested? Yes No: Were all probes reinstalled properly? Yes No" Were all hems on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe haw and when these deficiencies were or will be corrected. G. Line Leek Detectors I= ): ❑Check this box if LLD's are not installed. Complete the following checklist: X Yes No" For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? N/A (Check all that apply ) Siulated leak rate: X 3 gph; F10.1 gph; nO.2 gph X Yes No" Were all LLD's confirmed operational and accurate within regulatory requirements? Was the testing apparatus properly calibrated? X Yes No" For mechanical LLD's, does the LLD restrict product flow if It detects a leak? N/A :]Yes R%N/A No" For electronic LLD's, does the turbine automatically shut off ifthe LLD detects a leak? Yes P% No" For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is N/A disabled or disconnected? Yes No" For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? % HN/A Yes No" Far electronic LLD's, have all accessible wiring connections been visually inspected? N/A X % Yes No" Were all items on the equipment manufacturer's maintenance checklist completed? " In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: page 3 of 3 j�' e CCLEAK DETECTOR �: ( FXT EVALUATION CHART vioe Station Coonntractor9 DATE: 9/14/2018 SITE NAME: UPS SLO SERVICE CO.: 9&T SERVICE STATIONCONTRACMRS SITE ADDRESS: 3601 Sacramento St SERVICE CO. ADDRESS: 630 S FRONTAGE RD SITE CITY: San Luis Obispo SERVICE CO. CITY: NIPOMO TECHNICIAN: RICKEY BINGER CERTIFICATION NO. 8452629 TYPES OF LEAK DETECTORS TESTED XLD(116-036-5) OLD (116-017-5) BFLD (XL MODEL 116-039-5) BFLD (116-012-5) XLP(116-035-5) PLO (116-030-5) FX1(116-047-5) Lj �FX2(116-046-5) FX1D(116-054-5) FX2D (116-048-5) FX1DV(116-055-5) FX2DV (116-053-5) VMI LD2000 VR PLLD 8484 MEN FX2BFLD FX1V(116-056-5) FX2V (116-057-5) FX1DV(116-058-5) FX2DV (116-059-5) FX1V(116-051-5) FX2V (116-052-5) X MEN TEST INFORMATION PRODUCT APPROX LEAK RATE mI/min BPN METERING PRESSURE PSI OPENING TIME PUMP PRESSURE P51 FUNCTIONAL ELEMENT HOLDING PSI PASS/FAIL DSL 189 ml/min 10 PSI 3 Sec 32 psi 15 psi PASS 189 ml/min 189 ml/min 189 mI/min 189 ml/min Spill Bucket Testing Report Form SWRCB, January 2006 tB& Service Stagon CONractora Thisfibirmsntene oruse by contracfamperforming annual testing of USTspill cantainment structures. The completedfarm and printaurs from tests (if applicable), shouldbe provided to thefri owner/operatorfor submittal to the local regulatoryagency ql MM N'1 l,e. Yi Facilty Name: Santa Maria Public Works Date of Testing: 9/14/2018 Facilty Address: 910 W. Church Facility Contact: Phone: Date Local Agency Was Notified: Name of Local Agency Inspector: BERRY BOYLE 9. TF.4ITNG CONTRACTOR INFORMATION Company Name: B&T SERVICE STATION CONTRACTORS I Technician Conducting Test: Rickey Binger Credentials: OCSLB Contractor ® ICC Service Tech. OSWRCB Tank Tester OOther(specify) License Number(s): 902034 A,B,C-61/D40 HAZMAT CERTIFICATION Test Method Used: ONydrnaatic ❑vacuum ❑Other Test Equipment Used: INCON TS-STS Equipment Resolution: Identify Spill Bucket (By Tank Number, Stored Product etc.) 1 DSL 2 3 4 Bucket Installation Type: O Direct Bury OCuntalned In Sump ❑Direct Bury El Carboni in sump ❑Dims Bury ❑tbntalnel H sump ❑Diret Bury ❑ Contained In sump Bucket Diameter: 1111 Bucket Depth: 1211 Walt time between applying vacuum/water and start of test: Test Start Tlme (Tl): 10:391 Initial Reading (1 2.4219 Test End Time (TF): 10:54am Final Reading(RF): 2.4227 Test Duration (TF-TI): 15 mmin Change in Reading (RF-R0: 0.002 Pass/Fail Threshold or Criteria: Pass RESULT: Pass Oommmn. (roc/udc u�muRonon rcpvrs+nadc• pnoTro tesrtisG, zid recommcudcd tDJ/orwup 18r Lvkv/ hsh/ CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby aiii that all the Information caatamsai in there art Is goes accurate, and in full mmpibnm with legal requirements. Technicians Slgnaure: Date: 9/14/2018 stare laws and resuli do not currentNregmretm note' a vedormea In a aualmm Contractor. Bomer, load remaernenn mar x more modern. f-) '1 UPS 3601 SACRAMENTO ST SAM LUIS OBISPO - 09/14/2080 10:37 AM SUMP LEAK TEST REPORT DSL FIL TEST STARTED 10:22 AM TEST STARTED 09/14/2080 BEGIN LEVEL 2.4263 IN ENO TIME 10:37 AM END DATE 09/14/2090 ENO LEVEL 2.4237 IN LEAN THRESHOLD 0.002 IN TEST RESULT FAILED UPS 3601 SACRAMENTO ST SAN WIS OBISPO 09/14/2000 10:54 AM SUMP LEAK TEST REPORT OSL FIL TEST STARTED 10:39 AM TEST STARTED 09/14/2000 BEGIN LEVEL 2.4219 IN ENO TIME 10:54 AM ENO DATE 09/14/2080 ENO LEVEL 2.4227 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED ALARM HISTORY REPORT ALARM HISTORY REPORT ____ IN -TANK ALARM _____ _____ SENSOR ALARM ---- L 1:ANNULAR SPACE T I:DIESEL ANNULAR SPACE LOW LIQUID ALARM LEAK ALARM SEP 14. 2018 10:23 AM DEC 21, 2014 6:90 AM HIGH LIQUID ALARM OVERFILL ALARM SEP 14, 2018 10:23 AM SEP 14, 2018 IU:27 AM HIGH LIQUID ALARM LOW PRODUCT ALARM SEP 14, 2018 10:22 AM SEP 14, 201B 10:25 All HIGH PRODUCT ALARM SEP 14, 201B 10:27 AM JAN 30, 2015 2:56 PM DEC 19, 2011 1:53 PM INVALID FUEL LEVEL SEP 14, 2018 10:29 AM PROBE OUT END xxxRx SEP 14. 2018 10:29 AM SEP 14, 2010 10:25 AM OCT ll. 2013 11:12 AM i DELIVERY NEEDED SEP 14. 2018 10:25 AM ALARM HISTORY REPORT ----- SENSOR ALARM ---- L 2:TURBINE SUMP STP SUMP FUEL ALARM SEP 14. 2018 10:20 AM R RR R x END RRR x FUEL ALARM .IUN G. 2CI8 2:17 AM FUEL ALARM FAR 21. 2018 9:34 PM x x x x x END x x x x R SYSTEM SETUP SEP 14, 201B 11:37 AM SYSTEM UNITE U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYYY HH:MM:SS xM 255967 UPS 3601 SACRAMENTO SAN LUIS OBISPO 805 544 7184 SHIFT TIME 1 : 1:00 AM SHIFT TIME 2 : DISABLED SHIFT TIME 3 : DISABLED SHIFT TIME 4 : DISABLED TANK PER TST NEEDED WRN ENABLED TANK PER TST NEEDED WRN DAYS w 30 TANK PER TST NEEDED ALM DAYS � 30 TANK ANN TED NEEDED WRN D IBASLED LINE RE -ENABLE METHOD PASS LINE TEST LINE PER TST NEEDED WRN DISABLED LIVE ANN TST NEEDED WRN DISABLED PRINT TO VOLUMES EIIA9= TEMP COMPENSATION VALUH (DEC F ): 60,0 STICK HEIGHT OFFSET DISABLED H-PROTOCOL DATA FORMAT HEIGHT DA'iLIGHT SAVING TIME ENABLED START DATE MAR WEED 2 SUN START TIME 2:00 AM END DATE NOV WEE{ I SUN END TIME 2:BD AM REDIRECT LOCAL PRINTOUT ' DISABLED EURO PROTOCOL PREFIX S I CUSTOM ALARM LABELS i DISABLED .. COMMUNICATIONS SETUP PORT SETTINGS COMM BOARD : 3 (FXMOD) BAUD RATE : 2400 'PARITY ODD STOP BIT : I STOP DATA LENGTH: 7 DATA RS-222 SECURITY CODE : DISABLED DIAL TYPE : TONE ANSWER ON : I RING MODEM SETUP STRING : DIAL TONE INTERVAL: 32 RECEIVER SETUP: D B:VEEDER ROOT (FMS) I-GGG-743-8379 RCVR TYPE: COMPUTER PORT NO: 3 RETRY NO: 5 RETRY DELAY: 5 CONFIRMATION REPORT: ON AUTO DIAL TIME SETUP: D O:VEEDER ROOT (EMS) DIAL WEEKLY THR DIAL TIME 4:08 PM RECEIVER REPORTS: i I i RS-232 END OF MESSAGE DISABLED AUTO DIAL ALARM SETUP D 8:VFMEIR ROOT (FMS) LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM ALL:WATRR ALARM ALL:WATER OUT ALARM ALL:HIGH LIQUID ALARM ALL:LOW LIQUID ALARM ALL:LIQUID WARNING RECEIVER ALARMS SERVICE REPORT WARN ALARM CLEAR WARNING IN TANK SETUP_ _ - _ _ " LEAK TEST METHOD i I:DIESEL TT WEEKLY TANK l PRODUCT CODE 1 THERMAL :.0 START TIME : 12:00 AM TANK DIAMMETERETER 92.00 2.00 TEST RATE :0.10 GAL/HR TANK PROFILE q DURATION 6 HOURS FULL VOL : .0 INCH VOL t 11527527 9604 TST EARLY STOP:DISABLED 46.0 INCH VOL : 23 23.0 INCH VOL 6023 6023 2361 LEAK TEST REPORT FORMAT NORMAL FLOAT SIZE: 4.0 IN. WATER WARNING 1.0 HIGH WATER LIMIT: 2.0 MAX OR LABEL VOL: 11527 OVERFILL LIMIT 95% 0950 HIGH PRODUCT 90% DELIVERY LIMIT L0074 10% LIQUID SENSOR SETUP 152 Lq.l PRODUCT 1000 L (:ANNULAR SPACE LEAK ALARM LIMIT: 5 DUAL POINT HYDROSTATIC SLLOEN LOSS LIMIT: 100 CATEGORY : ANNULAR SPACE TANK '!'ILT 0.00 FR02E OFFSET O.DO L 2:TURBINE SUMP SIPHON MANIFOLDED TANKS TRI-STATE (SINGLE FLOAT) Tit: NONE CATEGORY : STE SUMP LINE MANIFOLDED TANK Tk: NONE LEAK MIN PERIODIC: 0% 0 LEAK MIN ANNUAL ON 0 PERIODIC TEST TYPE Qu[cx I EA OUTPUT RELAY SETUP _ _ _ ANNUAL TEST FAIL ALARM DISABLED R (:TURBINE SHUTDOWN TYPE: PERIODIC TEST FAIL STANDARD ALARM DISABLED NORMALLY CLOSED GROSS TEST FAIL ALARM DISABLED LIQUID SENSOR ALMS L I:TUEL ALARM ANN TEST AVERAGING: OFF L 2:FUEL ALARM PER TEST AVERAGING: OFF CUT ALARM L 2:SENSOR CUT ALARM TANK TEST NOTIFY: OFF L 2:HIGH LIGU-D ALARM TNK TST SIPHON BREAK:OFF L (:LOW L:OLIID ALARM L 2:LOW LIGL'IG PLARM - DELIVERY DELAY 5 MIN PUMP THRESHOLD : 10.00% Second_.y Containment Testing Report Form This form Mended Cmum by omuactM pe fomtiog p¢iadk leatiug of UST axooderr canuua cot Wyv Ilse the W r*Fru tc pages of this farm to report results forall oompooeab temed. The completed form, written tm Pmcedmes, and Printouts from msm (iCapplirshk), should be provided tothe facility o /operator for suhnutW to the baal regnletory agency. a e^ v+r rvn aeili Name: UPS Smt Luis pate ofT - V18/20t7 aeili Apdress: 3601 Sacmmenb St. $ao Luis Gb' G 93401 Mai (.Wt6Q: fUVin 30h8 Local tto Wm Notified afTe Phone: SI0 633-3%0 time ofLocal Aggr;y laspecmr (ifpreserrr dtvtng resting): a da a usse wn l KAUI UK INVORMATJON om Name: Ba,T Service Subon Lmtr tors e MCMPerf Test: L:es llendevon redentixla: + CSLB Licmwd Cwrtmum .cmx A, B, G61 Q40 Fiexivlet USVMCB Lwer and Took Teem I.iama Numhec 902031 M. Maoufecaaer r m. Tr 1L cam s TSSTS Dater ° CERTIFICATION OF TECBNICIAN RLWONSIBLE FOR CONDUCITNG TIRS TESITNG TodYeiaa9fAV �"��6e.14Jarb�v�m/l�M r/u'r axvnewr �e wtttmYe w/(e firtf mar///uvr rPol fella! relabew Txhoieieo's Signature: y"AN pate. 4IM2017 LEAK TEST METHOD TEST WEEKLY TANK 1 SUN START TIME : 12:00 AM TEST RATE :0.10 GAL/HR DURATION : 6 HOURS 'i1Faowl415atylLlg1ffi'L•111-35 LEAK TEST REPORT FORMAT NORMAL j LIQUID SENSOR SETUP L (:ANNULAR SPACE DUAL POINT HYDROSTATIC CATEGORY : ANNULAR SPACE j L 2:TURBINE BUMP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP OUTPUT RELAY SETUP R I:TURSINE SHUTDOWN TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L I:FUEL ALARM L 2:FUEL ALARM L ]:SENSOR OUT ALARM L 2:SENSOR OUT ALARM L I:HIGH LIQUID ALARM L 2;HIGH LIQUID ALARM L ]:LOW LIQUID ALARM L 21LOW LIQUID ALARM SECONDARY PIPE TFSTING cat Method DevcloPed By: 0+ P'Pi%Mawfaamer ❑+ 6&d ySbdrtd ❑ Pmfasnow Fj*i Qher ci ) ert Method Used: + Pre®um vaouum Hydmsbh ❑ ONer i est H mt Used: 4.5' Li aid filled mum E Rmlu4oa. 0-I5 b3i in 1 10 inn. DSL Psudad Mannal: Fiberglass MaoefacWrer: AAD Smith Wing Di®ootor: 5.2• of Paling Rm: lot t Sned: Diesel OW Ic tim of piping isolabwa: STP tsolatim Boot an time hetween applying eewoeWacosaaAwaw and �iag ted: 15 Min eat Sb T®e: 12: eA Fnd Time: 12:45p iml Readng(Rs): SA est Durafim: 75 Me in Rcading(Rt %): 0 a0 Threshold or ten: 0.002 L41is efR Ragdtef: Ass #'at0 Paafi. Prna :... IIMY YStes Eip+: Comments —ebwludeb o,anrlou oa j ieyrf „".:,,_Jl.�:�' 'drili;'Ti�. !v \,„,4,,.i�:. 7_M�Q1 (b 1. y7fy )a�.i^; 1'T }i�'(►f '._ T ;T. � .. •1 _ .. : PM - 1 17 - ? �' *'`fit � , �°�• ' . �y � . s Jlu FREAK TEST REPORT `DSL sr � r • • � . TEST - ,.. • ..�. STARTED 12:02 PM ,� •. i TEST .STARTED 04/38/2017 BEGIN LEVEL -4.7519 IN . END TIME ��H t 12:I7 Pfi I END DATE 04/18/Z017 END LEVEL,,. 4.7517 IN LEAK THRESHOLD 0.002 IN f Y r TEST RESULT PASSED UPS W SPA TO OR. SAKI LUIS OBISPO CA 04/lEV201.7 .12:34 PM SIB �.EAK TEST REPORT -bl-STP L 1 i TEST S-TARTff 12:19 FBI TEST STARTED, 04/18/2017 N; BEGiI t.VEL ''a, 7516 IN 12: 34 PM iM. END DATE 041I8/2017 END:, LEVEL 4y3515 IN , A 1/ TiiE3C`t`lJtlf h 11 (tP1rl T kt B & T 5ervicF )tation Contractoro 630 South Frontage Road Nipomo, CA 93444 (t To: QPIS. awn 1 SebcRr nao rp D et 'I L✓ls 08Uf0 a,,a.. 1929-8944 FAX ( 929.8948 License # 9020S4 P.O. No. M &ER O104 Bar W,01 MWI a,y ir a:l p NAME ARRNAL TIME DEPART TIME MILES LABOR HOURS TRAVEL HOURS TOTAL HOURS HOURLY RATE AMOUNT aj [r0 AM1010y'B Feae:SOWIE M990NCfiUO/Bn BOOmaY O@MOWrotlroenMnx aT/paOOIMe fIBUIIwINIINIII. biIX IIN OJCDJII pf9 dHI11GYp111 pCryUlll NUT T1U UMIOr Nj11Bi CVMQT. OfMyYMMX, kg NoM Mel Yre tlBMorwill pay Ie00ensbb rmu INcdkglp01Aa1Mllq 0 IaMOnebH alOblmys lane. MATERIAL i LABORCOST S m TERMS: A SERVILE CHARGE OF 112% PER MONTN(ANNUAL RATE OF 10%)WILL BE CHARGED ON PAST DUE BALANCES OVER W DAYS EQUIPMENT S p MILEAGE CHARGE S THAT THISISTAS SATI F A=I MURKIM INOICTEILV IN CQNPL2TLD IN INDICATED TMF.� OUTSIDE 9EflVILFA S l ` TAK N WAR E. � E4LER. A)BOER OR GONSIGHEE TOTAL kT N IA WORK ORDER 3