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This f<rrnr must bc used to docunent testing and servicing of monitoring equiprnent. A separate certjfication or report must be prepared for each
monitoring system control oanel by thc tcchnician rvho performs thc rvork. A copy ofthis form must be providcd to thc tank systcm ownerioperetor,
The orvnerlrrperator must submit a copy of this form to the looal agenoy regulating US'l' $ystems within 3 0 days of test date.
A. General Information
Facility Name: UPS Bldg, No
Site Address: 360't Sacramento City:San Luis Obispo zip: 93454
Facility Contact Person: ALVIN SOLIS ContactPhone No,: (559) 978-3592
Make/Model of Monitoring Systcm:TLS 350 Date of TestinglServicing: 9l I 512017
B. Inventory of Equipment Tested/Certified
to indicate
*If the faciliry contains morc fanks or dispensers, copy this form, Include information for every tank and dispenser at the facility.
C, Ceftification - t certify that the equipment identified in this documont was inspectedlserviced in accordance with the manufocturers'
guidelines. Attached to this Certilication is information (e.g. manufacturers! checklists) necessary to verify that this information ls
\\
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MONI T ORING SYSTEM CERTIFTLATION
For Use By :1ll Jurisrlictioru llithin the Slate of California
Authorily Cilecl: Chapter 6,7, Hedlth and Safety Code; Chapter 16, Dtvision 3, Title 23, California Code of Regulations
correct and a Plot PIan showing tho layout of monitoring equipment. For anv equipment capable of
attached a copy of the reportl fuheek atl thal apply): [] System set-up X Alar* history
generaiing such reports, I havo also
Technician Name (print):Rickey Binger
Certification No.: 8452629
Sigrature:
License, No.: 902034
Testing Company Name: B&T Service Station Gontraclors
630 S. Frontase Road Nipomo . cA.93444
Phone No.: (805) 929-8944
:911512417
Tank ID: Diesel
[l In"Tank Gauging Probe.
[l ,Annulnr Space or Vault Sensor,
[l eiping Sunrp /'l'rencb Sensor(s). Modol; 208
I Fitt Sump Sonsor(s). Modeli
D Mechanical Line LeakDeteotor. Modol:
f] Electronic Linc Lcak Doteotor. Model;
E] 'fant Overfill I High'Lsvcl Sensor. Model:
E Other (speciS equipment typc and nrodel in Scotion E on Page 2).
)vlodel: Maq 1
Model: 302
Tank ID
! In-rarrt< (iauging Probe.
Q Annular Space or Vault Sensor,
! niping Sunrp / Trcnoh Scnsor(s).
! Fill Sump Scnsor(s).
fl Mechanical I.ine l.esk Dcrcctor.
E Electronic Line l-cak Dctcctor,
E fank overfilt / High-Lcvcl Scnsor
tvlodet:
tv{odell
Model:
Modolr
Modetr
Model:
Model:
E Oth"r (specifu equipment type and mo<lcl in Scction E on Page 2),
Tank IDr
I tn-Tank Cauging Probe. Modcl:
I Annntar Spaoe or Vauh Sensor, Modol:
! niping Sump I't'rench Sensor(s). Modcl:
E Fill Sump Sensor(s). Model:
EMechaniollLineL€ekl)etector, tv{odel:
F Electronic Line Leak Detector, Mode{:
E fank Ovcrfill / Itigh-Level Sensor. Model:
[ {lttcr (speci& equipment typc and modcl in Scction U on Page 2)
Tank ID;
D ln-tank Gauging Probe. Model:
fl A.nnular Space or Vault Serrsor. lvlodol:
D piping Sump l Trenoh Scnsor(s). Modsl:
El t,ill Sump Sonso(sJ. )vlodel:
fl Mechanical Line l.eak Detector. Model:
fl Eleotronic Line I,eak Detector. Modol:
E'fank Overtill i High-Levcl Scnsor. Modelt
E Other fspcoify- cquipment tvpe afld model in Section E on Page 2).
Dispenser lD: 1-2
ffl Dispenser Containnrent Scnsor(s),Model: 302
fil Shear Vatvo(s).
fl Dispenscr Clontainmont Float(s) nnd Chain(s),
Dispenser ID:
! Dispensor Containmont S€nsol(s). N{odcl:
! Shear Valve(s).
fl Dispenser Containmcnt Float(s) and Chain(s).
I Dispcnsu Containment Sensor(s). lvhdel:
D Shear Valve(s),
Dispenser ID;
! Dispenser Containmcnt Float(s) and Chain{s),
Ilispcnser ID
! Disponscr Conteinment Sensor(s). L{odel
fJ Shear Valvc(s).
I Disponser Containment Float(s) and Chain(s).
fl Dispenscr Containment Sensor(s). Model:
fl Shear Valve(s),
I Dispcnser Containnrent Float(s) and Chain(s),
Dispenser ID:
fl Dispcnser Containment Sensor(s). Model:
E Sttsar Valve{s).
! Disponser Conainmcnt Float(s) and Chajn(s).
Dispenser IDr
Testing Company Address:
Page 1 of 3
Date of TestingiServicing
Rev (?t08)
Monitoring System Certification
D, Results of Testing/Servicing
Software Version Installed: 325,02
the fol checklist;
* fn Section E below, describe how and when these deficiencics were or will be corrected,
E. Comments:
I Yes D No*Is the audible alarm operabional?
I Yes D No*Is the visual alarm operational?
El Yes D No*Were all scnsors visually inspected, funstionally tested, and confirmed operalional?
fft Ycs I No*Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere rvith thcir proper operation?
E Yes E No*
I N"A
If alarms are rolayed to a remote monitoring station, is all communications equipment (e.g,, modem)
operational?
EI Yes E No*
tr N/A
For pressurized plping systems, does the turbine automatically shut down if the piping secondary containment
monitoring system detects a leak, fails to operatc, or is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check all that apply) 8 SumplTrench Sensors; S Dispenser Containment Sensors,
Did you confim positive shut-down due to leaks 4g! sensor failureidisconnection? EI Yes; E No,
E Yes D No*
8 N/A
For tank systems that utilize the monitoring system as the primary tank overfill warning device (i,e., no
mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the hnk
filI point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? %
fl Yes*El No Was any monitoring equipment replaced? If yes, identiff specific sensors, probes, or other equipment replaced
and list lhe manufacturcr name and model for all replacement pads in Section E, below
fl Yes*EINo Was tiquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
! Product; E Water, If yes, describe causes in Section E, below
E No*Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicableE Yes
fi Yes D No*Is all monitoring equipment operational per manufacturer's specit'rcations?
Page 2 of 3
Monitoring Systcm Certlfication
F, In-Tank Gnuging / SIR Equipment: I Check this box if tank gauging is used only for inventory oontrol,
E Check this box if no tank gauging or SIR equipment is installed,
This section must be completed if in+ank gauging equipment is used !o perform leak detection monitoring.
Complete the following checklist:
* [n the Section II, below, describe how and whcn these deficiencies were or will be eorrected,
G. Line Leak f)etectors (LLD): fl Check this box if LLDs are not installed.
lete the fo checklist:
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
E Yes E No*Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
E Yes D T'{o*Were all tank gauging probes visually inspected for damage and residue buildup?
I Yes E No*Was accuracy of system product level readings tested?
E Yes D No*Was accuracy of system water level readings tested?
I Yes D Nor Were all probes reinstalled properly?
E Yes E Nor Werc alI items on the equipment manufacturer's maintenance chccklist completed?
El Yes E No*
I] N/A
For equiprnent staxt-up or annual cguipment certification, rvas a leak simulated to verifo LI.D performance?
(Cheek all that apply) Simulated leak rate: I 3 g.p,h.; tr 0,1 g.p.h; E3 0,2 g.p,h.
Were all LLDs confirmed operational and accurate within regulatory requirements?S Yes E No*
El Yes E No#Was thc testing apparatus properly calibrated?
X Yes E No*
tr NIA
For mechanical LLDs, does the I.,LD restrict product flow if it detects a leak?
For elechonic LLDs, does the turbine automatically shut offif the LLD detects a leak?fl Yes E No*
tr N/A
E Yes E No*
tr NiA
For electronic LLDs, does the turbine autcmafically shut off if any portion qf the monitoring system is disabled
or disconnected?
I Yes I No*
I NIA
For electronic LLDs, does the turbine automatically shut off if any portion of the moniloring system malfunctions
or fails a test?
For electronic [,LDs, have all accessible wiring connections been visually inspected?! Ycs E No*
E NIA
El Yes D No*Were all iterns on the equipment nranufacturer's maintenance checklist completed?
H, Comments:
Page 3 of 3
ll-,eak. Deteator
]F-XT' ]EVA]LUA']TTCN C][-][AR.T"
Site Location: UPS
3601 Sacramento San Luis Obispo
Service Company: B&T Sen'ice Station
Contractors
Date: 9/1512017
Technician: Rickey Bineer Tech Number: #8457629
TYPES OF'LEAK DETECTORS TESTED
TEST INT'ORMATION
tr xLD (116-036-s)I FXID (l i6-054-s N FX2BFLD
il DLD (116-017-5 ! FXz fl 16-046-5 n FXrV (116-056-5)
tr BFLD (XLModel I16-039-5 t] FX2D (116-048-5)Lt FXzV (116-057-5)
tr BFLD il16-012-s)x FXIDV (116-0ss-s)tr FXI DV (116-058-5)
r1 xLP (116-035-5 U FXzDV (116-0s3-s)t] FX2DV (116-059-5
t] PLD (1 16-030-5 N FXIBFLD rJ FX1V (116-05i-s
n FXI (116-047-s n tr FXzV (116-0s2-s)
Product Serial
Number
Opening
Time
Metering
PSI/kPa
Functlonrl
Elcmcnt
Ilolding
PSkfa
Approximr(c
Tesl Lerk
Rrte
MtJMln
GPH
Prss/Frll
TcstLeak
Retc
RII/Min
GPH
Pump
PSUkPT
Fressure
Diescl 3 sec t0 l2 3 GPH Pass 30
S$FThlAFtl FEI/lSIfit'l LE'\JEI
\JEESIiII{ $T.E. L1E
H$FTktAFEf 346gS5-1 rl[*r]
CFESTEIT * nE.B"q,L-]T. I E.51
I'lS |]$FT'J*EE l.lLlFULE
STFTEI"I FE*TLIRES:
FEHI*DIC I N-TAN}{ TEST*q
AI'INUf,L IN-TANK TEL1TF
ALFIEI"I HIST(}RY EEF.iIFT
..-- IN-TANK f\LAFJt'{
T 1 :DIEFEL
LEAH ALARPInE* Sl, g[1.1.
HIGH F'ROIUCTJitN S[., pLll5
DEC1 I :t, !n I I
F'R,-\FE 11l_.lT
E:0[ At.l
+rtT 11. S[13 11 :1I Ar.1
t{HNi{xEI,lli{r{*HR
ALAEI"I HISTI]E? REPT]RT
SEI'ISL]H ALAFFIL I :AI,IFIULAtrI FFAf.IE
AI,INI-ILAR SFB$EL$t{ LI{IUID ALARI'IsEP 15" lul? lQ:n9 Atl
HIL]H LIIiUIN ALART,IsEF t5. tfltT ltl:r]9 AH
Lflt'J LIAUID ALFIRI'I
sEF 15.. ll-t1T l0tU? Atvt
3{3(xxfiEt'iDs*xkt€
FILARI,I HTSTIJKV REPI1FT
L g:TUFFINE FUI-IF
HTF. EUI..IF?
FLIEL ALSFI.I
HEF 1F" glllT trlr[F Af',l
FUEL ALAFI'I
l"lAE 1rl. ![1T t1:tt'J At"l
FUEL ALAEI"I
Nr1\J 1U. 'Ilt I 6 E: AT Pfl
X.*X!d-Eltl!3:{HXX
sT$TEI"I I]ETLIP
rSEF 1F, s01T I I :15 *l'l
EYBTEI"] UNITEu.s.
FYISTEI"I LATIIGI]AdE
ENGLIFH
FY,*TE["1 DATE...TiI"IE F{IRHAT
l4SN nD YYYY HH:ttf,l;En* xI'1
!E596? UPli}]FII SACFAI'IENTO
EAN LUIS tlFIHP$BB5 54q ?1 84
SHIFTTTI'IE 1 : I:I]flAI*I
,BHIFT TII.IE E : III,BAFLEN
SHIFT T]I-IE 3 : DISAELENSHIFT TII.,IE 4 : NI|A-AELEN
TANI{ FEF TST NEENET I,,JEI.I
ENAELEN
TAI'IH FEF TFT l,JEEIjEn htENIAVS = 110
TANK PEE TFT FIEEUED Frltl
DAYS - !D
JANK ANN TST NEEDEI1 t4lFiH
N IFAFLETI
LiNE RE*ENAFLE METHLT.IFg,:S LINE TEET
L]I'IE TEE TFT FIEETED I,rIFN
NISAELED
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FRIFIT Tft U(ILUI'IEi=]
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TEt-tF *sf,lFEflSAT I L1l'l
I.ALUE {fIE$ F }: 6[.r"IBTII]I{ HEISHT $FFHET
NISABLEN
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START DATEf.lAR KIEEI{. g HUI,I
START TIP1E!: rt[ AM
ENU NATENL1U I,IEEH I SUN
END TII.{E
P: ll0 At'{
t:Or"lFluH I cfcT I *N*q i.iHTUFi
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f\LL : HI GH IiIATER I,IIAFFII NI:
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ALL:ANI'IUSL TEST FAIL
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ELl.U INCH \iOL
FL*AT ,5IAE:IN.
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LIfiUIN FENSOR fil.t.{S
ALL:FUEL ALAFI"I
ALL:SENSOH +UT f;LARI'l
ALL:SHL-IRT ALf;FI..I
ALL iL'IATER ALARI'I
ALL:tilATER fi,UT ALAFl"l
ALL : HIIiH LI&UID ALAFI1
*LL :LQI'J LI(IUID F\L*Rt'l
ALL :L IAU I 0 hl$RNI t'ttl
REL-EIVER ALART"IS
SERVII:E REP$RT |''IARTI
AL*Rl"l L1LEAR tilARl,l I I,i(;
ti*TEF tilAFlllllG
HIGH I'JATER LIl"lIT
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OVEFFILL LII"IIT
HIGH PF{]rJU{:T
DELIUEFf LII'IIT
Lftlai FRCtttUtlT
LEAN ALARI.I
ELIDNEN LOSS
TiiNK TILT
FRL1EE $FFFET
s I F'HOf{ t't{lN IF,tlLDEr:r TAl.l1{5TH: N$I{E
LI NE I.IANIFI1LBEf,] TAI.IKFTS: NT1NE
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ftt\II.IUAL TEET FAIL
ALARI"I FI|IAELED
PERIONILl TE*T FAIL
ALART.I DISAELEN
[:RtTSh* TEST FAIL
ALARI"I tIISf,ELET'
ANN TEFT AUERAGING: OFF
FER TEST A\IEHAGING: $FF
TAl,lH TE$T I'I,]TIF!': 0FF
TNH TET -qIF,H+N FREAiI:$FF
DELIUER\'
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TEBT IAJEEKLY i TANK I
SUN
START TII"IE : iE:U[ AI,I
TEST RATE : !:I, lU GAL./HH
NURffTION : E HOURS
TST ESRLY STI]F:DISAELETI
LEAI{ TEFT REFSRT FTIRI-IST
f,lr_1Bp,161
LItl|-11P SENEOR FJETUF.
L 1 :ANI\IULAR SFAUE
DLIAL PC1INT HYT]FSFTATI*
CIITH*+R\T : ANNULAR SF.Itrt]E
L T:TUFBINE 5UI.1F
TR I *5TATE ,I S I ITIGLE FLI]AT }
CATEGORY I FTF SI.JI"IP
SUTFUT RELSY EETUF,
R 1 :TUREINE AHUTNAKIN
TYF.E:
STANNARD
N{.\RI.IALLY CLCISEN
LI'iUi N .FENF{IF AL],{H
:FUEL ALFrFl"l
:FUEL ALARF1
:EENS$R tlUT ALARI.I
:SENSOH ftUT ALARI'I
;HIGH LIBUIN ALfIFI'I
:HIGH LIQUIN ALARI"I
:Lili-J LI&UIft *LSRf"t
:LO[] LIDUIN ALARI'I
L1LIL1L3II
LgLIL!
SACRAMENTO AVE
/-l
UST Monitoring Site Plan
Site Address: 3901 Sacramento. San Luis Obisoo
DISP
t/2
Annular
TI-M
Future
Vapor
Spill
Bucket
Iveeder Root
ESO
Building
Breakers
ESO -|O
- -'t
Secondr.. ! Containment
,- \
Testing Rciort Form
This form is furfided fu use by cmhsctcs perftrmiry e€riodic kstitrg of UST nsndary cmtairncd Erd€rns. tJse the{pp!€priats prgct of rhi+ fcrm tor€pqt rpsrlts forall oompmcnts tertod. Thc cmpletal fonn, writteD ts$l procoducc, endpriutaus from t€Ss (if agpticable), should be pmvrded tothe facfigouaarloperator for submittal to
FACILTTY INFORMATION
TESTING COI{TRACTOR INTIORIIATTON
SUMMARY OF TEST N,ESULTS
DatG
SmLui$Cs 93.m1
Solis
Was sf
testhg
L:cs
Numben
Mr.lufr ctlrer Treinine
IEm L"Tll' IIEIIUD&
Prsr Frfl
Not
Tcrhd
Rcprirc
Mrdc Coqponcrt hss Fril
Not
Teded MrdcProdrcttat.i U U U JIJUUUIULIUtlIILIJUUULILIJtltJ1tt-l .]U L]LI U _lUU.TT +-#-T*r #-UTr#-rr LI-tT--rrLJT.IT LIT1--n-t-J-tT'
TT Jt-L-l LI U #UttUttUIUUIIUJttULIIILIIUTTULIUttIItlttttttUU-tT-LJ-m IIHTT IL.J-17
II tl lt lt LI
lrlrtl
If was describc urtat uas done with wa&rafter tests:to tEst be urd
CERTIF'TCATION OT IT,CEFIICIAN ITESFONSIBIJ FOR OOITDUCTING TTIIS TE$TINGTo tLc k a{ny l'o',lc+., tLc/e s*d h dr& &',tt,,*rt ce to,,'frc ad hfiu e.-,plt.o*w ,fr lccrt m',o,aro,,,,*
Tcchicion's Signah[E:hte: 4lt8l20t7
Method Dewloped By:E
SECONDARY PIPE TESTING
fv{rnrfacnrcr E tnAusFy Sfandrrd D Professied
Other
Commcnts - (inckde infonution on tzpain mde prior to tcslitg, atd
Vasuurn
Othcr
DSLh,odmt
Piping bfaterid:Fibergless
Piping lvlanufacuuer:A/CI Smith
Piping Diannter 3"ft"
trrrythof Piping Run:l0'
Product Stcre.<I:Dics€l
Method and location of pipng
nrn isolition:STP Isolation Boot
Writ tirm between applying
pernneAracuumAmtcrand
lrrting test:I5 Min
fe$ Stsrt'fime:12.W
6rft;x1 ftesding (R1)5.4
fcst End Tims:l2;45p
Finrl Readirg (R{}5.4
Iest Duration:75 Min
:bmge ioPssl;ns(RrRi 0
Pess/Fail Threshold or
)iteria:0.002
j:
forfaited tests)
retertod productline est failure.to
B & T Senrice itation Contractors woRK ORDBR 6109 2
630 South Frontage Road
Nipomo, CA 93444 (805) ese-8e44 nU( (8O5) 9e9-8948 License # 90g084
To: U.PS.
3?61 Sac.gep+lq.ltl Da96r Lr.rrr Olrfeo gnt_
Date:r*,-Ltst1
P.O. No.A
B&T W.Ct.
JJ
(J
No
ETtlt-E,oILE,lrto--Eo
=
JOB COMPTETE vesfr- xo il EFACHARGE QUANNTY
(t
ut
3r,3
g
EutL
=
PRICE AII'OUNT
NAT'E ARRIVAL
TIME
DEPART
ntrE MILES I.ABOR
t{ouRs HOURS
TOTAL
HOURS
HOURI.Y
RATE AIIOUNT
,1,0
I o 0
oEo(J
utg,
ut.
Allomey3 F8€si shourd the seilicss of an attomey be nquid to onfor. any p€rt of th'ctmtt agr€Gment, or for the coilecnrn or a derinquint ecdunifro'n to ""a.i'rii"Jt"Jtrr_€f 0r guaranbr, ir is agr'cd thet th€ d€bror wi[ p€y reaaombrc coau or coil€do; rncrrdr,rg it€asmsbla atbmaF8 tb6s.
TERMS: A sERVtcE CHARGE .ql^l_112-l l_ER MONTH (ANNUAL RATE OF 18%) IMLLC}{ARGEB ON PAST DUE BALANCES OVER SO DAVS "ooi,ulc THIS IS TO CERNFY THAT
V\MRK VIAS SATISFACTORILY
COMPLETED IN INDIGATEO TIM?
MATERlAL
LABORCOST
EOUIPMENT
MILEAGE CHARGE
OUTSIDE SERVICES
Tru(
$
$
i
3
6
3
TOTAL
I/I'ORKORDER
I "\ 1
Seconda. f Containment Testing Rep6rt Form
This form is intended for use by contractors performing pedodic tesing of UST secondary containmcnt systcms- Use the
apprupriate pages of rhis fsrm to r€pon results for all components test€d, The completed form, written test procedures, and
printouts from tests (if applicable), should be provided to the facility owner/operator to
X'ACILITY
TESTING CONTRACTOR INFORMATION
SUMMARY OF TEST RESULTS
UPS San Date
3601 Sacramento St. San Luis Ca 93401
Solis Phone:633-3960
rtas Notified
Name:B&T Service Station Contractors
Test:James
Manufacturcr
c-6t D-40 HazMat
Licensed
M4nufecturcr Treininq
l,icense Number: 902034
Tank Tester
lncon TS.STS
Component Pass Fail
Not
Testcd
Rcpairs
Made Comnonent Pess Feil
Not
Tested
Repairs
Ilfrdc
DSL Annular LI Lrl L_j {l tt I J
DSL Product L_l U LJ U U I U
DSLSTP u LI tl U U I I
UDC I/2 H tt II U U I IUUUtlttIlttUIIIIUIttttLJUTlIttttJIttLIttltltJttUltllttlItLIltttttJLlLILJUUUIUttLJUIIIIUttUUllI-lttttLItttfJttttJttllttttt_tUttltULII IIIIIttltilltttI
If describe what wru done with the water after of tcsts:
to tcst trailer to be used agatn.
CERTIFICATION OT TECHNICIAN RESPiONSIBLE FOR CONDUCTING TIIIS TESTING
To the H af my buwledge, thcfac* sloled ta this dacununt arc acautale and lnfull compliuce *ith lqat requiremente
'I'echnician's Signature:Date:3il0t2017
fJtndustry Standard fl Rrofessional
Method Developed By:I fU,Manufacturcr
Other
Used Pressurr Vacuum
Other
DSL
E ves fJxo D v"" ENo il ves [No Yes No
Iank Material:
Iank Manufacturer:
Product Stored:
\ryait time between applytng
pressure/vacuum/water and starting test:
fest Start Time:
tnitial Reading (R1):
Iest End Time:
Final Reading (R5):
lest Duration:
Change in Reading (Rp-R1):
PasVFail Threshold or Criteria:
TcstRcgtlh D rrsl [] rrir Drrsg f]rt*flnrsr ,I Feil [Erss [Fril
Was sensor removed for testing?[YesDvo Dv,c fJvesflvo gn [ves[]No f]*ra flves f].{o fJ'lA
verifi ed firnctional after testing?
Was smsor properly replaced and
[]yes DNo fNe flYesfhro f].ta Eyes D*ro flle [res ff.lo l-],lA
Is Tank Exempt From Testing?
Comments - (inclu& information on repairs mnde
Wet exempt from
TANK AIYNUL\R
prior to testing, and recomme nded follow-up lor failed tests)
[1] Secondary containment $ystems where the continuous monitoring automatically monitors both the primary and secondarycontainment, sr'rch as s_ystems that are hydrostatically inonitored or under constant vacuum, are exempt fiom periodic
containment testing. {califomia code of Regulations, Tide 23, section 2632(a)(6)}
TESTING
Method Developed By:B niping Mrnufacturer E Industry Standard U professional
Other
Comnents - (ittlude itformation onrepairs made prior to testing, snd recommendedfoltow-upforfailed Us*)
Mefiod Vacurmr
Other
Icst Equipment Used: 4.5" Lir
DSL Product
/10 incr
Piping Material:Fiberglass
Piping Manufacturer:A/O Smith
Piping Diameter:3"/2
Length of Piping Run:l0'
Product Stored:Diesel
Method and location of piping
run isolation:STP Isolation Boot
Wait time between applying
Dressure/vacuum/water gnd
itarting test:l5 Min
Iest Start Time:l0:00a
Initial Reading (R.,):5.0 psi
Test End Time:lI:00a
Final Rcading (Rp):0.0
fest Duration:lHr
Change in Reading (RrRJ:5.0 psi
Pass/Fail Threshold or
Criteria;Fail
fl.Prlr,' l"lfet : [l Prg f]rit'tl nrrl l-lf;air [l Prru l-]Fril
DSL product line failure due to test boot in STP sump- Will relurn to replace and retest boot"
Q tnausrysrandad I professionalM€thod Devcloped By:E So*p Manufrturer
Other
Pressure Vapuum
Other
Sump Diamctcr:424
Sump Depth:47"
Sump Mafcrial:Fiberglass
Height fr,om Tank Top to Top of
!igh.=t Piping Penetrarion :lg"
Height from Tank Top to t owesl
Electric€l Penctration:26"
Condition of sump prior to testing:Dirfy
20"Portion of Sump Tested[ll
Does turbine shut dorm when sump
sensor detects liquid (both product
and water)?'EJYcs flruo flqa flves [wo ga lyes []ruo l*Ne es
shurdown tlme l0 Sec
system
Elyo flr.ro [Nn flves lNo !N.,t fJves lNo [r,i*flYes flro l F,rAWas fail-safe verificd to be-
rperational?'Bves [No l*fte lves flNo [na [ves lNo [rrre ffies [rlo f[.rAwait time between applying
pressun/varuum/waler and starting
hst:15 Min
Iest Start'fime:I l:28a
(&):lnitial 2-2674
Iest End Timc:I l:43a
final Reading (Rn):2.2673
Test Duration:l5 Min
Qt*gg in Reading (R*-R1):.000t
PasslFail Threshold or Criteria:Pass
fest Rcrnh: ., ElP.cr flrrir [] nll f]Frrr nP"* flrdt flFrs flFril
Was sensor removed for testing?ElYes fNo N.A flVes Dqo [lNa flYes ffvo QH.rr ffves [vo ff.t,r
Was sensor properly replaced aod
yerilied functional after lssting?Bves f-lNo l-fin fjres nxo [Jnn l-lves l-lxo lJlr,n Dres l-trtlo l-hll
Comments - (include infonnation on repirs made prior to testing, and rccommended follcw-up far fatted tests)
[l] lf the entite depth of the sump is not test€d, sp€ciry how much was tested. If tha answ€r ro any of the questions
indicated with an m'terisk (r) is "No" or "NA", the entire sump must be tested. (see swRcB LG-160)
Method Dweloped By:! UPC MrnufactuEr E nausry standard f] prnfessiond
Odt€r
Comments - (include information on repairs nade prior to lestlag, and r e co mmende d fo I I ow - up fo r fu i I e d tests)
[l ] If the entire depth of the U DC is not tested, specify how much was tesrd. If the answer ro eny of ttre questions indicatedwith an aserisk (') is 'No" or *NA-. tie enrire tJDc must b€ tested. (s€e swRcB LG-|60)
Uscd:Pressurc Vacuum
Otlrcr
lncon
UDC#I/2
Grwn
Plastic
Higf iest Piping Penetration:
UDC Bottom toT<rp
0'
Electrical Penctrotion:
to
0'
to bsting:of
Irirty
Yes Uves [t'to f]n lr"* fF.ro fhre es
turbine shut down when
detects liquid (both producr
waterp*
l
Is system programffi'
shutdown?'E]yes flrrro flNn [ycs Er.io flnn _[-JYes []hro fJNa [Yes ['to f]r{AWas fail-safe verified io be
operational?'Eyes nuo LNa Eyes flbro fNe [yes lNo D{a [Yes [.Io [.gn
and starting
time
15 Min
Start
I I :?8a
tnitial Reading (Rj:2.9344
Iest End Tirne:
I l:43a
Reading 2.9344
fest Duration:l5 Min
in Reading 0
orPass/l-ail Threshold
Pass
Elrirr flrrl Frilnrrrn fllrrr Er.u Dr.ry fiFrilWas scnssr rcmoved for testing?E}Yes f].Io NA flYes flqo []Nn flY"s ffvo [Na [Yes ffvo [tlAWas sensorproperly replaced and
vsrificd firnctional after testing?Evos [lNo l-h.ta IYes l-lNo Tt'rn Eves Dno llrla [Yes fJtlo ffrlA
Facility Name:UPS San Luis Obispo Date of 3ltot20t7
Facility Address: 3601 Sacramento Dr., San Luis Ca 93401
Facility Contact:Alvin Solis
Date l.ocal Was Notified of Testing :
Name of l,ocal Agency lnspector (if present during Kerry Boyle
SWRCB, Janury2006
Spill Bucket Testing Report Form
This form is intendedfor use by contractors performing annual testing of UST spitl containment sttuctures, The compleledform und
printoutsfrom lests (if ryplicable), shoutd be provided to thefacility ownerloperatorfor submittal to the local regu[otory ogency.
l.IIYFORMATION
2. TESTING CONTRACTOR INFORMATION
3. SPIL BUCKD,T TESTING IUTONUITION
Comments - (include information on repairs made prior to testing, and recommended follow-w for failed tests)
CERTTTICATION OF TECHNICIAN RESFONSIBLE FOR CONDUCTING THIS TESTING
I hereby cerdly thsr all ihe infontolton contuiaed in thls report it fiae, accurotq and i,afull comptiance plth legal requfuement.
Technician's Signaturc:Date:03/r t7
t State laws and regulations do not currently require testing to be perfouned by a qualified connactor. However, local requirements
may be more sFingent.
Company Name: B&T Service Station Contractor
Teclmician Test: Janes Welsch
Credentials X CSLB Contactor X ICC Service Tech" I SWRCB Tank Tester u Other (Spectfu)
License Numbe(s): 902A34
Test Method Used:X Hydrostatic Vacuum Other
Test Used:Equipment Resolution:
ldentifo Spill Bucket (ByTaak I DSL 2 DSL J 4
Stored
B ucket lnstallation Type:X Direct Bury
! Contained in Sump
tl Direct Bury
I Conained in Sump
lllDircct Bury
U Contained in Sump
il Direct Bury
tr Contained in Sump
Bucket Diameter:12"12"
Bucket Depth l4-14"
Wait time between applying
vacuum/water and stan of test:l5 Min 15 Min
Test Staft Time (T1):l2:l8p l2:34p
Initial Reading (Rr):3.0416 3.0419
Test End Time (Tp):l2:33p 12:49p
Final Reading (Rr):3.0409 3.04t'l
Test Duration (Tn * Tr)15 Min 15 Min
Change in Reading (R+- &):0 0
Passffail Threshold or
Criteria:Pass Pass
Test Resultl X Ps$s D Fail X Pess CI Feil il Pass O Fril I Pass tr Fail
-t
UPS#,"-\
3601 SACRAI4ENTO DR
SAN LUIS OBISPO
03/10/2017 L?:J3 pt1
SUI'IP LEAK TESI REPORT
UPS
3601 SACRAI'ITNTO DR
SAI{ LUIS OSISPO
03/10/2017 12:49 pil
SUI4P LEAK IESI RIPORT
uoc 1-2
TEST SIARTEO tZ:34 pU
IEST SIARTE[] A3/TO/1OIT
BEGIN LEVEL ?.9350 II{
EHD llllt 12:49 plt
Er{0 0ATE 03/t0/2017
Et{0 LEVEL 2.9351 Iil
LEA( THRTSHOLD O.OO2 II{
TEST RESULT PASSEO
t)SL STP
TEST STARIE0 12:34 Ptl
IESI STARIED O3/iO/2017
BECIN LEVEL 2.2621 III
E}lI) TII'IE 12:49 PH
END OATE A3/LO/2017
til0 LevEL 2.2617 Ir{
LEAK IHRESHOLO O.OO2 IN
IEST RESULI PASSED
TEST 1?:34 Pl'l
TESI SIARIEI) A3/LO?AN
BEGIN LEVEL 3.0419 III
ENI} TII'IE 12:49 Pfl
Eri0 0AIE A3/10/2017
ENO LEVEL 3.0417 III
LEAK IHRESHOLD O.OO2 II{
IESI RESUTT PASSED
TEST STARTED 12:18 Pil
TEST STARTED O3/IO/20I7
BEGIN LEVEL 2.9341 II{
END TIl,lE 12:33 Pl,l
END DATE O3/IO/20I7
END LEVEL 2.9349 IN
LEAK THRESHOLD O-OO2 IN
TEST RESULT PASSEO
uDc 1-2
DSL STP
TEST STAftTED 12:18 Pt'l
TEST STARIED 03./IO/20I7
BEGIN LEVEL 2.2652 Il{
ENO TII{E 12:33 Pl'l
ENO 0ATE 03/t0/2017
E|lt) LEVEL 2.2649 IN
LEAK IHRESHOLD O.OO2 Il{
TEST RESULT PASSEU
IL
TEST ST 1Z:18 Pt'l
TEST STARTED WlLA/lAfi
BEGIN LEVEL 3'0416 IN
ENt) TIl'lE 12:33 Pt'l
EilO DATE A3/LO/2017
Et'lD LEVEL 3.0409 II{
LEAK THRESHOLD O.OO2 I}I
irst Rrsult PASSED
UPS"#
3601 SACRAilENTO DR
SAI{ LUIS OBISPO
03/10/201i ll:27 At'l
I
I
I
I
I
I
i
i
!
i
I
I
i
i
SUIlP RTPORTE
Iit
II
;
I
I
:
!
iuoc r-2
IEST ST ll:I? Al1
IEST SIARTED 03/10/2017
BEGII{ LEVEL 2.9343 II{
Et{D TII'IE 1t:27 Atl
EN0 oATE A3/rD/20t7
tilo LEVEL 2.9327 IN
LEAK IHRESHOLO O.OO? III
TEST RESULT PASSED
DSL STP
IEST STARTED ll:12 Al'l
TEST STARTTD O31IO/2017
BEGII{ LEVEL 2.2i56 I}I
Et{D III'IE 11:27 ffl
ENO oAIE 03/10/2011
Eilt) LEVEL 2.2673 lt{
LEAK THRESHOLD O.OO? II'I
TEST RESIJLT FAITED
FIL BKT
UPS
360I SACRAI'IENIO OR
SAN LUIS OBISPO
03/10/?017 [:43 Atl
SUI'IP LEAK TIST
TEST SIAR :28 Atl
IEST STARIEO O3/10/ZOI7
BEGIN LEVEL ?.9344 II{
END TII'18 11:43 Al,l
EN0 DAIE 03/10/2017
Er{0 LEVEL 2.9344 nr
LEAK THRESHOLO O.OO2 tII
IEST RE$I.I PISEI)
'+-/\
6sr srp I\t
IEST SIANEO ./ tl:ZB nn
TEST STTRIEU/o}/LONQN
BTGIti LEVEL ?.2674 IN
Et{t) III'IE ll:40 Al{
Er{D {}ATE 03/102017
Elro LEVEL 2.2673 lll
LEAK IHRESIIOLI] O.OO2 III
TEST RESII.T PASSEII
FIL BKI
TIST SIARIED I1:?8 All
TEST STARTEO ISILO/2917
BEGIII LEVTL ?.3103 II{
EllD TIIIE ll:43 Frll
EilO oArE a3/r0/2011
El{0 LEVEL 3.1029 lll
tE'tK TtfrEstft0 0'002 lN
TEST RESTT-T IIICREASED
ups
3601 SACRAIIENTO OR
SAI{ LUJS OEISPO
03/10/?017 il:59 fft
SU}IP LEAK TESi REPORT
t[c 1-2
TEST SIARIED 1l:43 At'l
TESI SIARTEO OSIIO/aAN
BEGIII LEVEL 2.S39 It{
Ell0 III'IE 11:59 Al't
Er{0 oRrE m/10/m17
Eli(} LEVEL ?.9354 It{
|_.EAK iHRE$fl0 0.002 Iil
TEST RESIJ.T PASSEI)
.,,*Jd,,-,.
IEST SIARTE0 03/10/mI7
BE0I|{ LEVEL 2,2659 lt{
EN0 TIlf, 1I:59 Al'l
EnO D^iE 03/l0i20lT
EilO LEVEL 2.2675 Il{
LEAI( IHRESHOLD O.OO2 1I{
IEST fiESULT PTSSE(I
FIL flfi
TESI STARTEO 11:12 AI{
TEST STARTEB O3/LO/ZAI7
BEGIN LEVEL 2.8323 II{
Et{D Tll'lE 1l:?7 All
tlr0 DATE nnalllLl
EIID LEVEL 2.0477 Iil
LEAK IIEESTIOLD O.OO2 III
TEST RESIX-T FAILED
IEST SIARIED li:43 All
IEST STAftIEIt O3/IOI?OII
BEGIII LEVEL ?.6350 It{
FllD IIlf ll:59 ifl
nrn nrrg a3/Wnfi
iln r-rvrt I.9989 Iil
iix rHnesroto o.ooa Il{
irit nrsnr FrItEo
I
,/.'.\I naoNl -)RING sysrEM CERTIF. -i,A.TtoN
For Use By All Jurisdictions Within the State of Califarnia
Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 2 j, CaliJbrnia Code of Regulations
'l'his form must bc used to document testing and servicing of monitoring equipment. A $eparatc certification or-repq4.must bg.prsparcd for cach
monitoring system control panel by the technician who performs the work. A copy o1'this form must be provided to the tank systcm owner/opcrator,
The owner/operator must submit a copy ol this lbrm to the local agency rcgulating UST systcms within 30 days of tcst datc.
A. General Information
Faciliry Name: UPS Bldg. No.:_
Site Address: 3601 Sacramento City:San Luis Obi sDo zip:93454
Facitity Contact Person:Contacr Phone No.: (559) 978-3592
Make/Modc I of Monitoring System : TLS 350 Date of Testing/Servicing:9/1 6t201 6
B. Inventory of Equipment TestediCertified
Tank ID:
I ln;l'ank Cauging Probe. Modcl:
fl Annular Spacc or Vault Scnsor. Model:
! Piping Sump /'l'rench Scnsor(s). Model:
D Fill Su.up Sensor(s). Morlel:
fl Mechanical Line Leak Dctcctor. Model:
I Electronic Line Lcak Dctector. Modcl:
fl Tank Overfitl / High{,evel Sensor. Model:
I Other (speciiy cquipmcnt type and modcl in Section E on Pagc 2).
El In-fan* Gauging Probe.
fil Annular Spacc or Vault Scnsor.
El triping Sump / Trench Senso(s).
D nill Sunrp Sensor(s).
I Mechanicd Line Leak Detcctor.
ff Electronic l-ine Lcak Dctcctor.
E Tank Overfill i lligh-Lcvel Sensor
I Othcr (speci& equipmcnt type and model in Section E on Pagc 2).
Modct: 794390-205
Model: Mas 1
Modcl: 794380-302
FXDVl
Tank lD: Diesel
Modcl;
Modol:
Model:
Model:
! In-Tank Gauging Probe. Model:
! Annular Spacc or Vault Sensor. Model:
! Piping Sump /'[rench Sensor(s). Model:
fl Fitt Sunp Sonsor(s). Modsl:
E Mechanical Line Leak Detector. Model;
fl Elcctronic Line Lsak Detector. Modcl:
f] 'l'ank Overfill / Lligh-Level Sensor. Model:
E Othcr (speci& equipmenl type and model in Scction E on Page 2).
Tank II)
I ln-Tank Gauging Probc. Model:
I Annular Space or Vautt Scnsor. Model:
I eiping Sump /'l-rcnch Senso(s). Modell
I nitt sump Scnsor(s). Model:
fl Mcchanical Line Lesk Detector. Modcl:
E Electroniq Line Leak Detector. Model:
I't'ank Overfill / Fligh-Level Sensor. Model:
I Oth., (specify equipment type and modcl in Scotion lj on Page 2).
Tank [D:
! Dispenser Containment Sensor(s). Model:
D Shear Valve(s).
fl Dispenser Containment Float(s) and Chain(s),
Dispenser ID
E Shear Valve(s).
p Dispenscr Containmenl Float(s) and Chain(s).
Dispenser tD: 112
I Dispense. Containment Sensor(s)Modcl; 847990-00{
I Dispenser Containment Scnso(s). Modolr
E St ear Valve(s).
fl Dispsnser Containment Float(s) and Chain(s).
Dispenser lD:Dispenser ID:
! Dispcnscr Containment Sen.sor(s). Model:
E Shcar valvc(s).
I Dispenser Containmcnt Float(s) and Chain(s).
fl Dispenser Containment Scnso(s), lvlodel
D Sh"ur Valve(s).
fl Dispenser Containment Float(s) and Chain(s).
Dispcnser II)Dispenser ID,
I Dispenser containmcnt Sensor(s), Model
E Shear Valve(s).
! Dispcnser Containment Float(s) and Chain(s).
thr
*ll'the facility contains morc tanks or dispensers, copy this form. lncluds information lbr every tank and dispcnser at the facility.
C. CCftifiCAtiOn - I certify that the equipment identilied in this document wns inspected/serviced in accordance with the manufacturers'
gu idelines. Attached to this Ccrtification is information (c.g. manufacturcrs' checklists) necesstry to verify that this information is
correct and a Plot Plan showing the layout of monitoring
attached a copy ofthe report; (check all lhal apply)t
cqutr
Technician Name (print)JAMES WELSCH
ipment. For any
System set-up
Signature:
equipment capable of
[Jrttarm history
ganerating such reports, I have nlso
Certification No.: 8201843 UT
Testing Company Name:B&T Service Station Co
630 S. Frontaqe Road Nipomo, CA. 93444
Phone No.: (805) 929-8944
9/1612016
License. No.:902034
Testing Company Address:
Page 1 of 3
Date of Testing/Servicing:
Rev (2/08)
Morr itorirrg Sy-stem Ccrtilication
D. Results of TestinlServicing
Software Version Installed 325.02
Com the
E Yes
Yes
* ln Section E below, describe how and when these deficiencics were or will be corrected.
E. COMMENTS: PRODUCT WAS FOUND IN UDC AND REMOVED
Is the audible alarm operational?El Yes D Not
El Yes E No*ls tlre visual alarm operational?
E No*I Yes
E No*
functionally tested, and confirmed operational?
Were all scnsors installed at lowest point of secondary containment and positioned so that other equipment will
Were all sensors visual
operation?not interfere with their
fi Yes
fl Yes D No*
tr N/A
If alarms are relayed to a remote monitoring station, is all cotnmunications equipment (e,g,,rnodem)
operational?
itive shut-down due to lcaks and sensor failureldisconnection? I Yes; E No.
rt inmentcontadowntheshutthedoesneturbisecondaryautomaticalorFprprnSlysystems,pipingpressurized
sensorswhich ateinitiIf"ldisconnected yes:tofails or tsadetects electricallyleak,operate,systemmonitoring
Scnsors.nmentDContaisSensors;shut-down?ve all that ispenserapplv)ump/Trench(Checkpositi
Did confirm pos
I Ycs D No*
n N/A
I No*
n N/A
device e nooverfitank(i.as thethattheutilize wamingprimarytankForsystemmonitoringsystems
aud atible tankthevisibalarmandleinstathelsoverfillvalnlswarnlngveicalmechanlled),overfill preventio
90%alannthedoesoftankfIatwhat$orandllfi
I Yes
lacedotherorrepIfequipmentprobes,sensors,specificidentifrWasyes'replaced?any equipmentmonitoring
bel owlnonSectiEandmodeallforthenamemanufacturerlistand
I Yes*8No
fl No Was liquid fbund inside any secondary containment systems designed as dry systems ? (Check dll that dpplY)
I Product; ! Watcr. lf Yes,describe causes in Section E, below
i1'licablereviewcd to ensure settings? Attach setWas mon
manufacturer'sls all equipment
EI Yes*
E No*
D No*
Page 2 oI 3
Monitoring System Certification
F. In-Tank Gauging / SIR Equipmcnt: I Cheok this box if tank gaugilg is used only for inventorl control
.r E Chcck this box if no tank gauging or SIR equipment is inslalled.
This section must be cornpleted if in-tank gauging equipment is used to perform leak detection monitoring.
Complcte the following chccklirt:
fJ Yes fl No*Has all input wiring bccn inspected for proper enty arrd termination, including testing for ground laults?
il Yes E No*Were all tunk gauging probcs visuall-v inspected for damage and residue buildup?
! Yes E Nox Was accuracy of systenr product level readings tested'l
I Ycs ll No+Was accuracy of system water levcl rcadings tested?
I Yes f] No*Were all probes reinstalled pr<rperly?
fl Yes I No*Were all items on the equipment rnanufacturer's maintenance checklist completed?
* ln the Section H, belrtw, tlcscril* how anrl when thcse dcficiencies were or will bc corrcctcd.
G. Line Lenk l)etectors (LLD): I Check this trox ifl-Ll)s 0rr nol insralted.
the follow checldirtr
Yes
* In thc Scction H, bclow, describc how anrl when these rleficicncics wcrc or rvill hc corrcclod.
H. Comments:
E Yes [f No*
Dpn
For equipment start-up or annual equipment certification, rvas a leak simulated to verifv {,[,]) perfornrance'/
(Check all that apply) Sirnulated leak rate: tr 3 g.p.h.; tr 0. I g.p.h I [ 0.2 g.p.h.
El Yes [] No*Were ail I-LDs confirmed oprerational and accuratc within rregnlatory l'equiletnents?
El Yes I No*Was [re testing apparanrs propelly calibrated'/
E No*
r] N/A
For mechanical LLDs, does the LLD restrict proiluct Ilou'il'it detects a leak'l
E Yes I No*
tr N/A
For clectronic LLDs, does the turbine automatically shut off if thc l.LD detects a lenk'l
D Yes n No*
B NIA
electrcrnic LLD* docs thc turbine autoutaljcallv n-hu[ olf il'tn1' prxtion qrl'ilre monitoring s\.stcnl is rlisahled
or disconnected I
[jor
! Ycs I No*
tr llle
Lultrine automatictrlly shut olT if any porlion of the mcnitorirrg systcm nrallunctions
or l'ails a test'l
For electronic LLDs. does thc
il Yes fj No*
B N/A
l-or electt'onic LI-l)s. have all accessitrle wiring connections been visually inspectedlr
El Yss I Nn*Werre all items on the erluipment rnanul'acturer's maintenance clrccklist contpleled'l
Page 3 of 3
SWRCB. Ianuary 2O06
Spill Bucket Testing Report Form
'l'his.form is intendecl.for use by contraclors performing annual lesting of tlST spilt containmenl stt:1tctures. 'fhe complelecl fotlr anc!
printttuts.fi'om tesls (if applicable), shoulct be provided to the facilily otvner./operotor.for submittal ta rhe local rcgulatt ru iguurS,.
I. FACILITY INTORMA
2-TESTING CONTRACTOR II\TFORMATION
Facility Name;UPS Datc of lf 9-r6-
Facilify Address:3601 Sacramento
Facility Contact:
Datc Local Agerrcy Was Notified of Testing
Nanre of Local Agcncy Inspector (if presant clufing testing)Kerry Boyle
Nanre: B&T Service Station Contractor
Technician 'fest: JarnesWelsch
Credentials X CSLB Contractor X ICC Service Tech. il SWRCB 'l'ank '['esrer I Olher (Specify.)
I-icense Number(s): 9A2034
Test Method Used:X l{ydrostatrc OtherVacuum
I DSL a
Storcd
Test Equipment {Jsc'd: INCON
ldentify Spill Buokct (lly'l'anb
Rcsolution:
3 4
x Direct Buly
ll Contained in Suntp
E Direct Buly
ll Llontained in Sump
I Direct l3ur1,
! Contained in Sump
I l*
i lCurtained i,t_-!ugil
lJ Dircct Burl
12"
Wait time lletween applying
rracutrnr/water and star-t of test:
Test Start Time (T):Sce
InitialRcading (R1)Incon
Test End'Iinre ('l'p):Test
Final Rcadine (&):Results
Test Duration (1'F *'llr)
in Reading (Rr.-Rr):Cha
or'Pass4:ail Thresho
Criteria:
TestResutf:x'Pass Ll'tr'ail U P*ssr lJDall'l-l Pa*c tl Fail Ll Prss U Fait
3. SPILL BUCKET G IMORMATION
IJuckel Instollation Type
)uckct Dianreler:
Bucket Depth:
COrnments - (inclnde infornution on repair's nadc prior lo te.rling,and tvcomnenrlecl .frr.f'ailed test,r)
CERTTF'ICATION OF TECHMCIAN RESPONSIBLE FOR COI\DUCTING TrIIS TESTING
I herehy certifir that all the in-formation contained in thir report is true, aceurate, and in full comp&ance witlt legal requiremenls.
Technician's Si gnature Date: 9- t6-16
I slrte laq's and regulaLions do not currtlntll, rcquire testing to hc perlbnned b;, s qualified contractor [-lorr.evel-. local rct1u]enrcnts
may bc more stringeul.
I )
et@ctorea
Site Location: UPS
3601 Sacramento San Luis Obispo
Service Company: B&T Service Station
Contractors
Date:9-16-16
Technician: James Welsch Tech Number; #8201843 UT
TYPES OF LEAK DETECTORS TESTED
TEST INFORMATION
n xLD (1t6-036-5)tr FXID (n6-054-s tI FX2BFLD
u DLD (lr6-017-s L FX2 (l16-046-5 u FXlv (l 16-056-5)
tr BFLD (XL Model I l6-039-5 tr FX2D (116-048-5)fi FX2V ( u6-057-5)
E BFLD (116-012-s)D FxIDV il 16-055-5i r FXIDV (l t6-058-5)
Lr xLP 016-03s-5 Lt FX2DV (l l6-053-5)IJ FX2DV I l6-059-5
ri FXrV (l 16-05r-5I r PLD (ll6-030-s D FXIBFLD
r:l FXI (l16-047-_5 tl U FX2V (l l6-0s2-5)
Prnoduct Serial
Number
Opcning
Time
Metering
PSUkPe
Funcliond
Elemcnt
Holdlng
PSrtkPa
Approrlmic
Test Lcak
Rrte
ML/Min
GPH
Frss/Fall
l'est LeckRrtc
MUi\{ln GPI{
tomp
PSlftPn
Prcsgurtr
Diesel J 9 ?<3gph lS9MLiIvIin 30psi
UST Monitoring Site Plan
ite Address:1
DISP
rl2
SACRAMENTO DRIVE
s'lP
TLM
Fuhrre
Spill
Iveeder Root
Building
ESO
Breakers
ESO +O
$1r, )rpnn{c sysrEM cERi -ftcATrorr{
l''ur {ise By ill! .Jtritc{ictions lf ithir /re,l}trtc' tt[{.'ulifuaru
This i'orrn rlusl bu uscd lu docunrcnl tcsling lnd scrvioing ol'rnonitoring cquipnrcnt- 4 .sltttlfSlg, c_cl_tilicstion or rs$orl, nlrs
'['hc orvncr,/rrpcr:rl(1r ]nu$l +rrbnrit a c<rpv ol'this lirrn trr thr; Iocal agcrrclr rcgultling LJ!i'l- ry'.rlcrns rvrlhin 3(] dirys cf tci*t datc.
A. Genernl lnformation
Fnciliry Nu.me: UPS Bldg No
Site Arldress: 3601 Sacramento Cit.v San Luis Obispo 7'ip 93454
l;'a,.li Iity Corrtust llersur r (ionracr I'honc No (559) 978-3592
Mnli,"'ih,lodel ol' Monitcrilr.g Sl,stcnt:TLS 350 I );r tc oll'csaing/Servicing 9/16/2016
B. Inventory of Equipment Tested/Certilied
I In-'Innl* Cauging frubu.
[ ,tnnrr]ar Spur.: (tr Vault S'insor.
I I'ipit'g SunrJr /'licnch Scnsrr(+-].
[ ]'lll Surrp Solsor(s].
I lvfuuhurit:nJ Line l*ak l)uk:ctrrr.
n Dt,rctrtnic Linc Lt;r[. f]rtrular.
[ 'frrrk t]verllll .t High-L,uvul Scnsur,
\lorjcl:
Modcl:
l\ltttL-l:
.\'lodcl:
Modcl:
Modu:l:
It{odu:l:
f] Otlrer (sp*ily ct;r.ripnrenl lyJrc nad mtrrlcl in licclion I'l on Mgc:i.
Trrrrk ID:
ffi ,'lrurulu'Spauc ur Vrull Srnsor. ftfudul: 3D2
E Itiping Sump,''l'rcrrch Surstr(s).
D t'ill Sunrp Scnsad.r.),
E il.Ixhanical Line lllak Dctrctor.
fl Hcctmlic Linr: l*irk D*itctor. lvftrdul:
-J 'tarft Overlill / llig,h-l*vel Scnsor. h,Iodcl:
fl Orher (spccit-v" cquipmcnt lype and nrodel in Seclion F, on Faqc 2]-
Trnk lD: Diesel
lvlodcl: 205
lv{ridul:
lu{mlel: FXDU'I
ffi LrTrurk Onuging Probc.lr,{orirl: Mag I
fl hr- !'ank riauging Frobe. M,rdcl:
n Arurulur Spaac or Vaull Seitof. M<rdth
Fiping $urnp i 'licnch Scnror(s).
r*i I I $urrrp Scrr,ror{ sJ.
r\lccho:ticnl I.i:rc I -:ak l)etetlur.
Ekclr,.rrri* Urrc I.ruk Dulcctor.
'l'iurk Orrcrfill i FI ieJr-[evcl Srnsor'.
Ofrcr{spccify equilurffil t1Tu rurl rnodcl in Sm'ticn l.] orr Pagc ?}.
Trnk ID:
I,lodel:
fu{rxicl:
\Iulel:
.\'lodcl;
li{rrlel:
fl Hu'thnk GnugirrgPrnbr:. Motlcl:
fl ,fulurlnr,{pacs or' lhult l+crrsor-- Mrrtlul:
fJ fipi"$ Surnp,t -;inu"lt Senrru{,s). Mrrdul:
n Fill Sunrp Scruor'(s). Mrtle l:
n -ltc,:irantcrl Lin+ I,dak l)eruclor. lvlodclr
E [hctronic Lirre l-r-nk Delector. lvludrl;
n Tank Ovcmtl i lligh-Icvel Smsor. \lo,lel:
Othcr (spci [y tqu ipnrcnt typc arr rl rnrxlel in Suction F. on lagc 2).tr
'frnk lD:
ffi DispcrrserCorrtlinmcnt Scnsn4s). \4rxlel: 323
E Sh..... Valve(s).
I Disp,rnser Conlidnmcnl F'loflt(i) ilrd Chdn{s},
Dispe.nscl ID: 1-2
! l)irpurser Cfirrtrinmsrrl llerrsur[s)- !luduf:
E Shcrr l'alve(s)-
! Dispunser Cmtnirrmcrrt florti$) nn(i Chain(s).
Dispensel lD:
Dispcnscr ll),-.-
I Dl+lens+r' Canhinrniml Scnsorl.sJ. lvtodol:
I Sh"ut lialv"{s}.
fl Dispens*r ConlainnlL*nl Fkrat(r) urrd Chail(s).I Fllrpunser ContilLu]renl Fluarlsi lnd ehuin(.s).
I Eispr:uscr Couhinnrcnt Scruor(s]. lvlr:dcl
I Sh,ot Vrlve(*).
Dfuprrxcr II)
D llispcruer Conlain$rcnt Scnsor(s]. tvlodel:
I Shcar Valrre{s;,
I Di.ponor' C<rrrtnirrmrnt Flonl(s) rurd Chnln(s).
Dispcnscr lD:Disprnv:r ID:
n l)ispcnscr Containmcnt Sensnr(s.|. Modcl:
E Shcar Valvcis),
! Di*p*n,*, Corrt.ninnrent lrloal{s} and Ltrain(*i.
Chcdi lhe
+Ilt.hc lhcility conluins morc hnks or dispcnrtcr.t, copy this l'orm. hr$ludr,' infolrnatiorr for evsry lank lnd di.spcnsel lt tlre facrlitr.
C- CgrtifiCati0n - I certifS' lhnt tltrr cquipnrcnt itlentilied in this dotomurt wrs inrlxr.tetliser-viccd in nc'rrrr'drrncr: with the manufircturer.+'
guidclines. .{trtchcrl tn this Ccrtifir:ntion is inl+r'nrrrtiotr (c-g. mrnufuotufcrr'ctrccklists} ncr.'r:sstrrl? t<r vcrif_v that this inlbrrnntiurr is
col'r'ect rtrd a Plot Plun ;horving the lnyout o[ monilrrring equilnrent l-or urlv
nttnchr:rl r c<rp-r <r[ the r€Frrt; (checF alt lhat apply]: ffi Systcm sct-up
'l'cchnician Nnrrre {pr int): JAMESWELSCH SignatuE
Certilication No,: 8201843 UT
'l'esting Cornparlv Name: B&T Seruice $trtion Contractors
Alldrcsx: 530 S- Frontage Road Nipomo, CA, 93444
t crpable ofg+nrrrrting such rtlxrrts. I huv+ llso
Alarm hirt<lry rclxrrl
l.iccnsc. No.: 902034 _ _
I'hone No,; [805) 929-S944
l'c.^ting (lonrp:rn!
Page 1 of 3
Datc ol'l'c.sLin gy'Scrvicino
t(cv \zI \td )
Monitoring Systcm Ccrtitication
D. Results of Testing/Servicing
Saft*'are Version Installcd: 325,A2
Com lete the fsl checklistr
* ln Section E hclorv. descrihe how and when these deficiencies werc or u ill be ctrrr-ectcd.
E. ComnTcnts; PRODUCT WAS FOUND IN UDC AND REMOVED
I Yes E No*Is the audible alann operational?
E Yes I No+ls the visual alarm operational','
E Yes D No+Were all sensors visuatly' inspected, firnctionall,"- tested, and crrnfirmcd opcral.ional?
E Yc.s D No+Were all sensors installed at lowest point of secondary containment antl prr.sitioncd so thnt othcr equipurent rvill
rroL intcrl'ere with their proper operation?
itrYes I No*
EX Ni^
If alurrns are relayed to a fen)orc rnonitoring station, is rrll communicalion.+ cquipmcnt (c.9,, rnodem)
operatiunal?
B Yes E No+
f] N/A
For pressurized piping systeru$, dqes the ilrbine automatically shut down if thc pipingsecondary contalnment
rnonitoring systcnl detects a leak, fails to operate, or is electrically disconnectcd? Il'ycs: which sensors initiate
positivc shut-<Iqrvn? (Chech ul{ thut ilppty) 8 SumpiTrench Scnsors; ffi Dispenser Crrntirinmcnl Scnsors-
ljvc shuL-down drrr: to leaks and senscr thilureidisconnection'i B Yes; D NoDid you confirm posi
! No*
I NiA
For tank systems that rrrilizc thc mrinitoring systern as the primary tank overfill warning device (i.c-, no
mechanical overfill prevention valvc is insLallcd), is the overfill wantitrg alarm visible and audible at the tank
fitl point(s) and operaring properly? If so, at what pcrccnt oltank capacilv does the alarm trigger'! 90uh
El Yes
Was arry nronitoring equipment roplaced? Iflycs, idcnti$ specific serlsor'$, probcs, or other equipment replaced
and list the nrunullrcturer naftle and model for all replaci:rncni parts in Section E, lrelorv.
! Ycs*E I'lo
E Yes'D Nit Wa.r liquid found inside au,u- secondary containment systems dcsigncd as dr,n- systertrs? /Chect ill thal appll;)
B Product: I Water. If ycs, dcscribe causes in Section E, belorv.
E Yes E No*Was monitoring system set-up rcvicwcd to ensure proper settings? Attach set up reports, if applicable
E No*ls all monitoring equiprnent operatiunal pcr matuhcturer's specifications?E Yts
Page 2 of 3
", ltlonitoring Slstem Ccrtifhntior'l
F. In-Tank Gauging / SIR Equipment: B Oheok this box if tzurk gnuging is uscdonly for invehtory control
tr Check this box if no tank gaugirrg or ,SIR eqnipmcnr is installed.
This section must be u,ompleted if in-tank gauging cquiprnent is used to perform leak detection monitoring.
Complete thc fulkming checklist:
E Yes E No*I las lll input wiring been inspected for proper crrlry and terminirfion. including testing for grouud faulEi?
ll Yes E No+Were *ll lxnk gauging prolres visually rnspeclcd lirr danroge arrd rcsiduc brriltlup?
E Yes I No*Was accuracv of systcrn producL lcvel readrng$ tested?
E Ycs il Nn*Wns ircoruacy ol'systeln rvalcr lcvclrca<lings testod?
lf Yes n No+Wcrc ull pr ohes rcinstalle<I properlv?
fl Ycs il No+Were all itr:m-t on thc equipment mantfacturer's ntainteunnce oheeklist compleledl
* fn the Scctirott H, lrclow, dc*rilrc hon' lnd whcn thcse deficicncies wcrc (I! will lrc crrrrcctcrl.
G. Linc Leak .Detedor* (LLD)I n Check this hox if l.,LDs ntr not instltle,J.
Co the
+ In th+ S+cfion [I, bclcnv, dencrihe how and whcn lhere rleficiencier wcre or will lrr crrrn:ctcrl.
H- Comments:
ffi Ycs fl No+
r] N/A
l;or ccluiprtrellt sturt-up or annual eqtril:rment ccrtilicotiorr. was rr lcuk simulalcd r.r yefify Ll.D perigrgrance'l
(Check ull that ilpFl-y) Sinruhtcd leakrate: fif 3 g.p.h,, E0 l gp.h : fl 0.? ir p.h.
B Ycs fl No*Wurc all I.,l,Ds confirmed opcrational anrJ accLralc *ithin regulnlory requrrcnrcnrs?
E Ycs E Ncr*Was the testi ng appuraLus prop erll' c irli [:ralcd?
E Yc-s n Ntr*
I N//\
li'or mechanical LLDs, dccs thc l.l D restricl pnx-lncr tla*' if ir detertr u leak?
I Ycs l-l No+
El N/A
For eleclnrnjc LLDs, does ths turbine f,utomfitioally shul olf if tlre LLD deteclr a lea]fl
D Yes E No*
EI N/A
Frrr eleclronic l,l,l)s, docs lhc turbine
or disconnccted?
automntically' shut (iff il rny porlion of the uoniloring system is disabled
I Yes I Nu*
EI NiA
For eleclronic LL.l)s, does tlrc rurhine arrtomalically shut uflif
or I'nils a tr:-st'r
any portion of ttre monitrrring system malfunclions
t--t v,."I No*
EI N/N
or electroric Ll"Ds, htvc all acc,essiblc u.rring corurrclions heen visr-rallv inspected?F
E Ycs [f No+e qu ipment manufa{.}lr.rr$r's maintcnuce ch ecklist c omp I cled?Were sli ilcms on Lhe
Page 3 of 3
spilr Bucket Testing Report Form
swRc*' Jrnuarv 2006t
This fornt ic ittletfrcd.fbr rrsc #y eonlractarz performing annual tcstingo,f l'l,ST spill eontoinm{nl slt'ttcture.y. |'he compltte{ ft*, oorl
printouts troilt tesls (if applicahle), should be prcvidtd to tfu facitiy- owneriopercttorfor subnilal ta the local regrlitory d&eilc!.
I. FACILITY INFORMATTON
2. TESTING CONTRACTOR INF'ORMATION
3. SPIL BUCKET TESTING INFORMATION
Comments -nde un repain nwdt prior I0 lc:t I i ag, a nt! re ct nt ne ndc d teils)
Dste of 'l'9- r6-r|lr
Kerrry Boyls
I.'uciiit .Addrcss:
UPS
3601 Sacmmcnto
Was Notified of
Tnspecl.or (tf ptus"rrt during lesting)
Nanrc:r
Facility Contacl.;
Nurne of Looul
Dute Local
Technician Cnnducting'l'cst: JanresWelsr;h
Naure: B&T Serv'icc Slation Contractrrr
I r)ther {,\pecifu)X lC:C Service'l'eoh. I SWRCB'fank Tcstcrft'e dentietsl X CSI.B Conh'actor
Licemr,' Numbcr(s): 9{)2034
Use<l: INCON
X I-[1,46*66.VlcntrmTest Meftod Used:Other
Equ ipment l{esolution:Test
Idcnufl'' Spill tiuckct (RyTank
N rm ba r, S?ored P rcducl, e I c. )
I DSL 2 3 +
U F*il il F.rsx
Incon
Ur Pinr ll Fait U Psss U F.rril
Buckci Inslalll{ ian'l'vpe
Initial Rcading (R1);
[2"
II"
J'est
Rcsrtlls
.IJuuket Diarnetcr.
lest Start'fimc {'fJ:
llluskcl Dcpth:
Test Erd Tinrc ("1's):
Finnl Rcading (Rn):
Twt Durution (Tr - Til:
Changc in Reading (tt1, - R1):
or
li Din:ct l-lrrrj
[] Conlrrincd in
t... Drcot lJurr
fi Curtuincd in S
J Dilect lSur;,
ll Contnined in
x Direct J.iury
l.lContained in
Wait tiurc hetwccn applying
vacuum/water and start of lcst:
Ilasr/Fail
Critcrin:
CERTIF'ICATION OI.'TICHNICL{I{ RESPONSIBLE
I hcrchlt c*lif.1t 1ft$I ail rte information cttntilinsd in t*is report i,r lFre.
FOR CONDUCTING THIS TESTING
accuralu, and in.fitll compliance with lzgal. rcquircmtn$.
'f echnician's Si gnatu'e l)atc:9-1fi-l{i
I Stote laws antl regulations dq ncrt ountntlY rr-qrrirc testing to lie perforured by a qualihed crrnlractor, [-lor.vever., 6cal requirements
may be morc stringerrt.
SACRAMENTO DRIVE
UST Monitoring Site Plan
Site Address: 3601 Sacramento Drive. San Luis Obispo
DISP
lt2
STP
Annular
TLM
Fufure
Vapor
Spill
ESO
Building
Breakers
Root
ESO {
!
)
ea,lk lDeteat @]r
Site Location: UPS
3601 Sacrarnento San l-uis
fechnician: Iames Welsch
Servicc Company: B&T Seruice Station
Contractors
Tech Number: #8201843 UT
I- FXzBFLD
FXIV I r6-0s
r-l FX2V r l6-057-s
x FXID\r l1 5
N FXIV 1 t6-05 l -s
U FX2V I I 6-052-
llSI/kRr
o
'T'YPES OF'LEAK DETECTORS TES'TBD
|_ xLD I16436-5 r FXID I l6-0.54-)
:: DLI)1 l6-0 t7-.5 f FXz I l6{46-5
U BFLD Itilo<ju"l I i6-{)39-5 .l FxzD I 16-
U BFLD fl I6-.0t N FXIDV il
N XLP r6-035--5 Lt FXzDV (r r6-053
n Pt-D I t6-030+IJ FXIBTILD
D FXl I l6-047-5 {".1
TEST II\FORMATION
.:l
g -r'r.r8ure
Date: 9-16-ttt
tJ FX2DV r I 5-059-5
Prudrct Serinl
Number
Opcning
Tlmc
llteterirg
F$lJkFn
Fqnctionsl
Ehnrlt
lloldlng
PSitPr
?5
Appnrrlrutc
T+rt l.calc
Rate
lllLlMin
GPTI
Prss/lrrll
Tttt Lrrk Rrtc
llfl^/Mirr GPII
Dicsel J I 3gph l89N{l,Min 30psi
MONI-'-}ITING SYS'I'EM CERT'IFT \ATIOI\
Iiur U.re ill' A1, t,,r,t,rtc:lirns II'ithin the f;tftl.t of'Cnliy'ititt
.l]risl.orrrrrntrsl.lrrtsq'ltotlocrultenttcstilrgarrtlscrvicingofnrorriklringcqrriprrlerrt.@s}4!lI'!-bg.Ple{4_|oI-sitslt
'l}c otrrcr/opoator rnust subrnit u ct4lv ol'tlris lomr to thc local lgenvY rcgulating LISI' systcnts u'ilhin 30 daf s of test date.
A. General Ittforlrtatiort
F'acilitl Nanrc: Ups SLO Bldg. No:_
Sitc Acldrcss: 3601 Sacramento Dr Citr'San Luis Obispo zip.93401
F'aciIity Contact Persou:ConlnctPhorrc No.: (559) 978'3592
Make/Model of i\4onitori ng S1'stent ;TL$-350 Date of Tcslirtg/Sen,icing:10t112015
B. Inventory of Equillntent Tested/Certified
Tnnk lD: Diesel
I r-uho lspccill'oquiprrrcnl l1pc arrd nrrrdel in Settion I] rrrr Prgc 2),
[l In"'l rnk (iaugfurg Ittrbe .
[t i\nnulnr Spaoc or Vattlt Srnsor.
B Pipirrg Srrnrp,''lienclr Scnsor{s),
I Fill $unrp Scrnsor(s),
ffi Irtochanical l,ine l*ak l)ttechn',
I l.]lirc.nrtilic I jne lreak Dst,lct{r.
fl falk Qv.'rlill r lligh-l-cvr-l Scnsor
Irlodell Mag 1
Nlodel: 302
\lodcl: 205
\lorlel:
\'lodpl:
\.lorlel:
\lodcl:
FXlDV
Tnuk lD:
I ln;l'ark (iaugingProbc. \ftttlcl:
[ ;\nnular Space or Vauh Sen$or. \{odsl:
D Pipirrg {iutrp r liurch Sensoris}. Iodr'l:
I Fill Sump Senso(s). IlD.lcl:
! N{echunirnl Line l.cak l}lectcr. Nodel;
I Elc.ctrorric l.irrc Loak Dcleclor. trlodcl:
[ 'ta:rk Owl'ill J llighJ*r'cl Sensor. ]\[txlel:
! Other 1spr.cily equipntcrtt t11*:utrl nrodel in Sectir:n E rn Pagc ?t
Tank ID;
U hr-'lhnk Garrgtrg l)r'obe. hlulcl:
E .,\lrnular Spacc trr \:null Sensor. \'hxlol:
I Pipine Surnp /'lierrch Senror{s). \lodel:
I Fill srunp Scrrsor(s). Iltrdnl:
I ir'lechanical l.inc. l.ak l)clcr;tor, \lodr:l:
f] F.lcrctrrrric l.ine l*aft Dctdctor. \lodcl:
f] 'fnnk Ovcllill i I ligh-l'cvel Scnsor. \'lndcl:
I tlthir (specili'rxluilnrr]ll l)?d end nrttcl irt Scctiorr Ii on Page 3).
I'ank lD:
! h-'t'arrk Cauging l\otr*.
f] .dlrulnr Spacc or \'atrll Scusor.
I Rplng Sunp r Trurch Scnsorls).
fl Fill sunrp Scn"co(r).
tl i\lcchurical ljne Lcak Dur.clor.
I Electrolic l-,irre hak l)dldDkx.
fl 'l'zurk Ovsfill r llighJ-ei'el SLtror
[ lh.hcr (spr-cill'cquipnrcnt t)Tr; alld ntt.rdel in Secliorr l'i orr I'ag* 2].
lrlod.'l:
\lodel:
\{odel:
llodel:
Iloilel:
I\{odel:
l\lodel:
Dispcnscr ID: 1-?
fi Dispcrrsu' Corrtsinnldrl Svrsor(s).\.lodel: 323
E Sh..ar \ralvc{s).
I Dispcnsw Cnntainnretrl Flcxrl(s) and Chain(.s).
Disocnscr lI):
fl Dispetrser Cotllaillnleill.Sottsot'(s). \lddel:
I Sh*.r \.hlve(s).
fl l)ispcrrscr Conlalunorl lloat(s) ond Chain(s).
Dispnscr LD
f] Disp:nsct Clonlainnrenl Sens$1's). \{odcl:
il She{r Valrc{s}.
! l)is1*-nser Cunlainrttcul Flort(s) arrd Chain(s).
Disncnscr ID:
fl Dispnrscr Cr:nlainuclrt Sonsor{s). lrltrdel:
I Sh.xr \''nlvc(sl.
I Dis}crrsr-t' Corlairrnrorl 1:loal(s] and Chainit].
I)ispcnser ID
f] l)i spcus'r Crurtainntonl S!-ns(, (s). \lodcl:
I Shcar \hlrt{s),
I Disprrser Conhinrt'fl| Flrrtl(s) and Chail(s).
Dispcnscr lD:
I l]irporsr:r' (lurlahrn,rrrl Scrrsor{s), iikdel;
fl sh*ar Vollc(s),
I l)ispurso" Conlatuuqrl I,]oat(s) zurd Chnjl(s).
thc borcs to inrlicate r'cdl
'tlf thc lhcilitr cernlains urorc tanks or rliqtensers. copy this lonn, lncltrtle inl'oruurlion lo:'cvctv tank nnil disp,:nscr at thc ircilitY
C. CertifiCation - I ccrtifl. that thc cquipnrcnt irlentilicd in lhir docunrent rrns insl*cted/scn'iccd ln accord&nce lYith tltc Irtanttfaclurt'r's'
gut rJeliucs, Alllchetl kl this Certilicalion is infornration {e,g. manufacturers' checklists) necersary to vcri$ that lhis inforuration is
col.re(t anrl a Plot Plnn sborving the layout of tttoniloring
lltrrchr-'tl ir copl' r)f lhe rcporti ftlrcck allthat appll'):
equ
X
ipnrcnt. l.'or an1'
Syslcnr set-ul)
nt capablc ofgcnenrling sttch rclxirls, I hnve nlso
AlRrnr historl rellort
'fcchniciart Nanrc (pil nt): James Welsch Sig,nature:
Cerlification No.: 8201843 UT License 902034
Testing Contpaly Natnc B&T Seruice Stalion Contractors Phone No.: (805)929-8944
Road o, CA. 93444 Datc of Tcstittg/Scn'icirlg 1011t2015l'csling Corlt;rant Addrcss: 630 S. Fronta
Page 1 of 3
Ro'(2i0tt)
Monitori4 g S.vstcnt Ccrlilication
D. Results of Testing/Servicing
Softrvare Vcrsionlnstallcd: 325.02
letc lhc ul
* In Scction E, bclorv, dcscribc hon' rrntl whcn the.'*c dcficicucics n'crc ot'rvill ltc corrclctcd.
[. (lomnrenls:
El Yes D No*ls the audible alanrr opcrational?
U No*Is the visual alann operational?ffi Ycs
E Ycs E No*Wcre all seusors functi tested and confirmed rational?
ff No*Wnre all seRsors insterlled at lo\r'esl point of sccondaq' contairutrcnl and positioncd so thal otiler equi;urent u'ill
not interfere rvith lheir pmper operatiort?
ffi Yes
f] Ycs ! No*
EI N/A
lf alarnu are relal'ed lo f lcnlotc nroniloring station, is all conununications cquipment (e.g.. modern)
operational?
For prcssuriz*d piping systcn$. docs ilrc tufuirm autonraticallv shut dorvn if tlrc piping secondary containnrent
rnonitoring systern detects a leak, fails to opcr.atc, or is clectdcally discorurccted'l Il'yes: rvhich sensors initiate
positir,e shuldorvn? (Check att that nppl.t) ffi Sunp/Trcnch Sensors; E Dispenser Colttainmcnt Senson.
Did confirnr shut-dotrrr duc lo leaks 3nd seruorfailurc/discorurcction? E Ycs: D No.
E Ycs fl No*
N N/A
For L.urk s],steilN that utitiz.e the monitoring s.vsten as thc prinnry tank overfill rvanting do'ice (i.c., no
nrcchanical ovcrfill prevcntion valvc is installed), is the overlill rvarning alarnt visiblc ald nudiblc al thc tank
fill point(s) and opcrating proprl]'? [f so, at *,hat percent of tarrk capacitl'docs tlrc alanri trigger? %
fl Yes D No*
I N/A
fl Ycs*ENo Was any uronitoring equipnrcnl replaced? lf yes, identify specilic scllsors, probes. or other equipnrcnt replaced
and list the rnauufachlrer name and nrcdel for all replacenrcnt pnns in Section E, belorv
Was liquid found inside aly scrcondary containrneut systems dcsigncd ns dry st'stcltu'l (Chetk alt lhat a1ry1.1'1
I Prcduct; ! lVater. lf yes, describc causcs in Scction E, belorv
I Ycs*EI No
E Yes ! No*set.up revieu'ed to cnsure proper sctlings? Atlach set llp rcports.
ls all nrouitoring e qulprnent opcrational per nmrtufacturer's specifications?
Was nroniloring systenl if applicablc
ffi Ycs D No*
Prrgc 2 ol' 3
Ntonitoriug S1'sfcnr Ccrtificttion .1 . .)
F. In-TnnhGnuging/SIREquipment: I Chcckthisboxiftankgaugingisusedonlyforinlentoryconlrol
n check this box if no tank gauging or slR equipmcnt is installed.
This section tnust be cornpleted ilin-tank gauging equipnrent is useclto perlorrn leak dctection monitoring.
Cornplctc the follorvin g checldisl:
fl Yes fl No*Has all inpgt s'irinp, bccn inspccted for proper entry arrd tcmrination, including testing for ground faults?
E Yes E No*Wcrc all tank gauging probcs vinrally inspectecl for danrage and residue huildup?
fl Ycs fl No*Was accuracy of systcm product level readings tes{ed?
fl Yes fl No*Was accuracy of s1'slem n'ater lct'cl rcadings tested?
I Yes fJ No*Were all probes reinsrallcd propcrb'?
I Yes I No*Werc all itenu on thc cquipnrcnt nranuLlctrrrcr's nuirtlcrurnce chccklist contpletcd?
* In thc Scction H, ltclorv, tlcscrilrc hon' and rvlten tbcsc deficicncies n'erc or rvill bc corrcctcd.
G. Line Leak Detectors (LLD): I Check thisbos if LLDs are not installed
Co lctc thc lbllorvin chccklist:
* ln lhc Scclion H, bclorr, tlcscribc horr and n'hcn lhesc dcficicncies ryere or ryill bc corrcclcd.
B Yes I No*
tr N/A
For uluipnrcr{ $tan-rp or annufll cquipnrent certiftcation, rvas a leak sirlulatcd to verifl' LL,D pcrfonrtance'?
(L'heck atl that apply/ Sinrrrlated ieak ratc: E 3 g.p,h.; D 0.1 g.p.h: E 0'2 g'p.h.
El Yes D No*Were all [.LDs corfirnrc<l operational and accurale rvithin rcgulntory rcquirenrents?
El Yes I No*Was tlre testing apparatus properll' cal ibratcd?
El Yes D No*
tr N/A
For nrechanical l.LDs, does tlrc LLD rcstrict product flo*' i[ it detects a lcak?
fl Yes ;1 l.lo*
X N/A
For electronic l,LDs, daes the turbinc aulonlaticallt' shut off if tltc LLD dctccts a leak?
I Ycs E No*
X N/A
For elcclrolic LLDs, docs the lurbine autonuticnlh' shut off if any portion of 0tc tttottito riug svstent is disablcd
or disconnectcd'l
! Yes fl No*
M N/A
For elcctronic Lt,Ds. does the turbittc atrtottmtically shut off if arll' portion of the monitoring sl'stenl tnalliurctiotrs
or fails a tcst?
fl Ycs I No*
B N/A
For clechonic LLDs. Imvc all accessiblc rviring cotuectigtts becn visualll'inspccled'l
E Ycs fl No*Were all itens on thc cquipnrcnl rnanufacturcr's nuilnlenatlcc chccklisl cornpleted?
I{. Cornntertts:
Prtgc 3 ol' 3
UST Monitoring Sitc lllan
Sitc Atlrlrqss; 3901 Sacrarnento" San Luis Obispo
DISP
I t2
SI'P
Annular
'il-\,1
I;uturc
\tapor
Spill
tiso
Building
-,Veeder Root
Bleakers
ESO ->O
SAC'IiAMENTO AVTi
I
t
l
SWRCB. Januan 2006
Spill Bucket Testing Report Form
I. FACILITYINFORMATION
2, TESI'ING CONTRACTOR INFORMATION
Licen-sc Nunrber(s) : 90203 4
3. SPILL BUCKE'I' TESTING TNFORMATION
Contmcnts - (inclwle infornmt iort on rc:pairs nade prior lo l(tstitql,, ttntl reconurcnded ftllou-tu p .fit r fn i I e d t e,st s )
CERTIITICATION ON TE(:IINICIAN RESPONSIBLE FOII CONDUCTING'I'ITISTBSTING
I herchl, ur1ifl' thd atl the inforntutiorr contqiilud in this repofl is hne, accilrole, and in lnll contpliance wilh legal tequirements.
Teclutician's Siglnturc Date: l0-l -l-i
I Slatc lan-s alci regulirtions do not currentll' rqrrirc tcstiug to bc perlontred b1' a qualiticd contractor. lJorlcvcr. local reqtrircrncrrls
ma1' be n$rc strillgcllt.
Facility Name:uPs sl-o DateofTesting: l0-l-15
Facilitv Addrcss 3601 Sacmnrcnto Dr
Facilit.v Contact:Maurice Barksdale
Date Local Agcncl' Was Notified of Testing
Nanre of Local Agencv lrslrcctor (i.[ present &uing lesling): Kcrr1, Botlc
Conrpanv Namc: B&T Scnice Station Conlractor
X CSLIS Coutraclor X ICC Servicc Tcch. n SWRCB TankTeslcr -l Otlrcr (SpactJi,)
Technician Co
Credentials
Test: James Wclsclr
Test Method Used:ti Flldrostatic Ll Vacuunr X Other
Test Used Ilcsolution:
Spill Brrcket (111,'1'nrf I Iliesel I'ill 2 3 d
Nunber Slorad llroducl,
Buckct hutallation T1'pe:
s Dircct Bury
: Contained in Sunp
:,: Direct Bury
Lr Contained in Surnp
ll Dircct Burv
l Contained in Suntp
,l Direct Bun'
I Containcd in SurnD
Bucket Diameter:I l"
BLrcket Deplh 12"
Wait tirue betl'cen applving
t,acuilrn/n'alcr and slart of test l5 min
Test Start Tirnc (T1)Sce
Initial Readirtg (Rr)
Test End Tinre (Tr)lncon
Final Rcadirtg {Rr')
Tesl Druatiort (Tr -'li)Rcsults
Changc in Reading (ltr - Rt
x Pnss U ['ail tJ Pas U I'ail LJ Pass U Fail U Pnss ll ['nil
ea.lk Det,ect@tr
TYPI|S OF LEAK DIITECTORS TESTBD
TEST INPORMATION
Service CompattY:
B&T Service Station Contractors
Site l,ocation: UPS SLO
3601 Sacrarnento Dr
San Luis Obispo CA 93401
Date: l0lll20l5
Tech Number: 8201843 UTTechnician : James Wel sch
!_IlD_ (r l6-036-s)
i: DLD (l l6-017-5
_n lx_lp{llr ltl-s _ _ _
r-l FX2 (r 16-046-5
.I FX2BFLD
i FXIV (l l6-056-s)
I BFLD ()ftModel l16{39-5 {'-t FX2D (ll6-048-5);j FX2V 0l6-057-5)
it BFLD (il6-0l2-5)x FXIDV (l 16-055-5)!aL'l IDV I l6-058-5
: xl,P (l l6-03s-5 ;j FX2DV (l l6-053-5)N FX2DV I l6-059-5
i PLD (l 16-030-5 ,:l FXIBFLD iI FXIV I r 6-051-.5
-t FXI (ll6-047-5 LD 2000 FE Petro
Producl Scrial
Numbcr
Opering
Time
Mttcring
PSI/ltPn
Flrnrllonal
Iilcrncnt
Iloldlng
PtVkl'a
Approilnnte
Ttel Lenk
llnle
rll,/iIln
CPII
PasVl'nll
Tcst l.cnk
Itate
1\{t,/i\Ijn
GPII
Puntp
FSI/kPr
lrressurc
Diesel
3 sec t0 t2 3gph Pass 30
.Ji.S
itru I :,ii{lhillt[:i ilj
SAI1 LIJiS IBISFO
lr-r/irlllrili l1;Lrl i\l'l
;c-lir . FilI, T[i; ] FrEf irH I
trst F iLr
Ti:Sl sirrl'lrl, lil:iili dl'l
IEST Sl AFrli; l{-)/f l/2il'i5
BE[ilft L[uij- {, Ei tZ lil
INU IIHE 11IOO AH
EHD tArE l0/01i2015
Elji, _[\rLL li, [i] I I Ili
I EAi lhiEsll{lltr f,002 Ilj
TIST iiEStItI PASSEU
-, i-,
)ili
, ; 1_, rl'1
:jUill ii.11 1'
1l.ii t il. I
t-:rr ''rliii,;l:.'
-r'''1'ti111'.11.'
:i:t,lll LFilt
Liil I llaF
, i ''..
IFjl ri;rt;L
i,:l;i r
: ,1"1
F l')
Secondary Containment Testing Report Form
This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the
appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and
printouts f'rom tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
F'ACILITY INFORMATION
TESTING CONTRACTOR INF'ORMATION
SUMMARY OF TEST RESULTS
If hydrostatic teqtilg was performed, describe what was done with the water after completion of tests:
UPS San Luis Date of 1
Facilitv Address: 3601 Sacramento St. San Luis Obisno. CA
Facilitv Contact: Jason Schoon Phone: 818-947-4831
Date Local Agency Was Notified of Testins,: 316/2014
Name of Local Agency lnspector (if present during testing Kerry Boyle
Test:J
Licensed Tank Tester
License TyDe:A. B. C-61. D-40 Hazlvlat l.icense Number; 902034
Manufacturer
Manufrcturcr Training
Comoonent(s)Datc Trainins Expires
Incon TS-STS
Comoonent Pass F'eil
Not
Tested
R€pairs
Made Comoonent Pess Fail
Not
Tested
Repeirs
Made
Diesel Annular (Wet)tt I lvl tt I U U LI
Diesel Produot Pipins lll U U U LI LJ U U
Diesel STP Sumo lrl I lt tt tt tt tt
UDC I-2 lvl L LJ L_.1 tt tt L-l
LI L U LJ tt tt lt
LI L LJ tt tt lt tttlItltltttttlttItttlLIL_l L]
LI L LI LI I tt ll tllttllltIttttttltIttttULIUU
U L U LJ U LJ LI LJltIUttLJLILJ
I tt tt U LI L]
I U U LI LI L]
U L U L]LJ L l U
LI L t_J LI LJ L]U
LJ L LJ LI U L]L]
LJ L LI tt LI L]ttttIItttt
Wa!q! Ur UIQ lpllllcSlgl1qdrfD0T drum on site. Water in STP sump was returned 989 trailer tank.
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best of my hnowledge, lhe facls stated in this documcnt are accurate and in full compliance with legat requiremenls
Technician's Signature:Date:3/2U20t4
TANK ANNULAR TESTING
ls Tank Exempt From Testing?
Comments - (include informalion on repairs made prior to testing, and recommendedfollow-upforfailed tests)
E tank Manufacturer I Industry Standard I ProfessionalMethod Developed By:
Other
Method Used:Pressure Vacuum
Other
Dicsel
l-lv"r lllNoE Y.r nNo fl Y"r n No Ev"r Ewo
tank Material
Iank Manufacturer:
Produst Stored:
Wait time between applying
pressure/vacuum/water and starting test:
Test Start Time:
Initial Reading (R1):
Iest End Time:
Final Reading (Ro)
Test Duration:
Shange in Reading (R5-R):
Pass/Fail Threshold or Criteria:
ii;in f ffi :i i!il;iii$lr i!: r:itotrtrRr$rriiii:i:iii:i:iiirri;iir.ririiii r:iii:iiii, i::,::::r,:;
Was sensor removed for testing?flvesnNo Dlelves nNo Eun flvesnuo nNn lYes [{o f].lA
Was sensor properly replaced and
rerified functional after testing?l-lves l-lNo [-Nn l-lves l-lNo l-]qn l-lvesl-lNo l-Nn [-lYes l-No f-].ll
Wet annular
[1J Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary
containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic
containment testing. iCalifornia Code of Regulations, Title 23, Section 2637(a)(6)i
) sncoNDARY PIPE TEsrrNG ' )
Method Developed By;p niping Manufacturer E] lndustry Standard n Professional
Other
Comments - (include information on repairs made prior lo lesling, and recommendedfollow-upfor failed tests)
Method Used:Pressure Vacuum
Other
filled in l/10 incr
vapor91Diesel Product ent
Piping Material;Fiberglass
Piping Manufaoturer:A/O Smith
Piping Diameter:3"/2"
Length of PipingRun:l0'
Diesel ProductProduct Stored;
lsolation boot in STP
Sump
Method and location of piping
run isolation:
l5 min
Wait time between applying
pressure/vacuum/water and
starting test:
Iest Start Time 12:47p
Initial Reading (Rr):5.51 psi
l:47pTest End Time
FinalReading (Rp):5.5 lpsi
Iest Duration I hour
0.03hange in Reading (Rp-R):
ilfi;'----".iiiF$,ffi--TF$,jjiffi.Hfi
Threshold or
jjjijffi:iiii.j--]Fr: jl.-ffi
r:i l?li:'P6Gsii iii ri:irniFiil:ii
0
El Surp Manul'anturer E] lndustry Standard I ProfessionalMethod Developcd By
Othqr
U Pressure Vacuum
Otlrcr
Ipst EauiDment User
Sump Diameter:42"
Sump Depth:47"
Sump Material Fiberglass
Height from Tank Top to Top of
Hiehest Piping Penetration:18"
Height from Tank Top to Lowest
Eleotrical Penetration :26"
Condition of sump prior to testing:Dirty
20"
l*jYes l-No l-].rAIves l-Itto [-rN,q Eves nNo fhrA flYes lxo DqR
Turbine shutdown response time l0 second
ls system programmed for fail-safe
shutdown?'I-lves lNo FIua llves []lNo [-]rqa nves nNo Eu [Yes $o $.lA
l-lves l-lNo l-ln^l
Was fail-safe verified to be
operational?"l-lYes l-ltto lrlx,c Eves [-lwo []nR [res f].{o [lA
Wait time between applying
pressure/vacuum/water and starting
tsst:l5 minutes
Test Start Time:SEE
tnitial Reading (\):INCON
Iest End Time:'I'EST
Final Reading (Rr):RESULTS
fest Duration:
Shange in Reading (Rp-R):
Threshold or Criteria:
as sensor removed for f-lYes l-T.lo IINR [-[res f]o ffiA
ffi-ffi,Eiil;iiii i lglPt!!i i:! iiiLJ:Seilii
lrlYes l--L.to NA [ves ltto [N.t
l--lve.s l-lNo l-lNA l-lYes l-lNo l?lNl l-lYes Flqo l-Nn
Was sensor properly rcplaced and
verified functional after testing?Flves [lNo l-TNn
PIPINC SUMP
Portion of Sump Tested[1]
turbine shut down when sump
detects tiquid (both product
water)?'
Comments - (include information on repairs made prior to testing and recommended follow-up {or failed tests)
[ ] lf the entire depth of the sump is not tested, speci$ how much was tested. If the answer to any of the questions
indicated with an asterisk 1'*) is "NO" or "NA", the entire sump must be tested. ($ee SWRCB LG-160)
I )
AINTUENT 't'lNG
Does turbine shut down when UDC
sensor detects liquid (both pmduct
and water)?r
Comments - (include informatlon on repairc made prior to testing, and recommendedfollow-upfar failed tests)
[l] If the entire depth of the UDC is not tested, specify how much was tested. [f the answer to any of the questions indicated
with an asterisk q*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG'160)
U
El UoC Manulacturer EJ tnaustry Standard I PnrfessionalMethod Developed By:
Other
Method Used:Pressure
Other
UDC Manufacturer:Environ
UDC Material:Plastic
9ilUDCDepth:
Height from UDC Bottom to ToP
of Highest Piping Penetration:
0r
Height from UDC Bottom to
Lowest Electical Penetration:
0'
Condition of UDC prior to testing;Dirty
.1"
l-lves [-lNo l-].tR nves f}.to Dlnlrlves l-lNo l-lNa Eyes f]tto D{,t
ilY"s nNo ENa [Yes $Io [.r.AEves flNo flue nyes nNo nNn
ls system programrned for fail-safe
lhutdown?'
llves [.]No Dttl flYes f[.lo $lA
Was fail.safe verified to be
rwrational?'Eves nNo [Nn lves ENo INA
t#oit time between applying
cres$ure/vacuum/water and starting
iest
l5 minutes
Iest Start Time:SEE
INCONtnitial Reading (&):
Iest End Time TEST
Final Reading (Rp):RESULTS
fest Duration:l5min x 2
Change in Reading (Rp-R1):0
flves Dlo f]tt,c
.002
ffi
:i i!l i lJilEf.{i:: iii i U ffili i
FlYes [-[.to NA flYes l blo D{A
i : i ii i ir-i iilisi i ii :ri f iii i
!.lj.'.;j:j.;.l.@
Threshold or Criteria:
removed for testing?as s€nsor nyes []tto ENe
l-lves l-lNo |JNA [-Ves l-Trlo l-TrlaFlves [lNo l-lNe l-lves [No Dna
Was sensor properly replaced and
verified functional after testing?
SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intendedfor use by contactors performing annual testing of UST spill containment structurcs The completedform and
printouts from tests (if applicable), should be provided to thefacility owner/operator.for submittal to the tocal regutatory agency.
1.INFORMATION
2. TESTING CONTRACTOR IITFORMATION
Company Narne: B&T Service Station Conffactor
Technician Conducting Tesu James Welsch
Credentialsr: X CSLB Contractor X ICC Service Tech. ! SWRCB Tank Tester O Other (Specify)
License Number(s): 8201 843
3. SPILL BUCKET TESTING INFORMATION
Comments - (include information on repairs made prior to testine. and recommended follow-up for failed tests)
CERTIF'ICATION OF' TECHNICIAN RESPONSI BLE F'OR CONDUCTING THIS TEST I NG
I hereby ceilW lhal ull the informatlon contuined in this report is lilte, accutale, and in full compliance with legal rcquirements.
I State laws and regulations do not cunently require testing to be performed by a qualified contractor. However, Iocal requirements
may be rnore stringent.
Facility Name:UPS SLO Date of Testing: 3-Zl-14
Facility Address:3601 Sacramento
Facility Contact:Jason Schoon
Date Local Agency Was Notified of Testing : 3-6-14
Name of Local Agency Inspector (if present during testing)i Kerry Boyle
Test Method Used:x Hydrostatic tr Vacuum Other
Test Equipment Used:
Identify Spill Bucket (By Tank t Diesel Fill t
Stored
Resolution:
3 4
Bucket Installation Type:x Direct Bury
I Contained in Sump
D Direct Bury
D Contained in Sumo
I Direct Bury
E Contained in Surnp
E Direct Bury
D Contained in Sump
Bucket Diameter:12"
Bucket Depth:13"
Wait time between applying
vacuum,/water and start of test:l0min
Test Start Time (T1):SEE
Initial Reading (R1):INCON
Test End Time (Tr)TEST
Final Reading (Rp)RESULTS
Test Duration (Tp -T1):IsMINX2
Change in Reading (Rp- R1):0
PasslFail Threshold or
Criteria;.002
Test Reflult:X Pass E Fail tr Pass tr F'ail E P.sss ElFail O Psss EFail
UPS -San Luis Obispo
S8989
03t2ut4
SLO IJPST
3601 SACRAI|INTO
SAN LUIS OBISPD
03/21/201A 11:50 Al'l
SUI.IP LEAK TEST REPORT
DSt FBK
IEST STARTED 1 1 :34 AI'I
TEST STARTED O3/21/2OUI
BEGiN LEVEI- 5.0979 iN
END T IHE .I
1 I4g At'I
END BATE 03/21/2014
ENO LEVEL 5.09?6 IN
LEAK THRESHOLO O, OO2 IN
TEST RESULT PASSEO
uDc
SLO UPS
3601
'SACRAI{NTil
SAiI LUIS OBISPO
03/21/201A i2:08 Pl'l
SUIIP LEAK TEST REPORT
OSL F8K
TEST SIARTEI] .Ii:52
A}I
TEST STARTEII 03/21/2014
BEGIN LEVEL 5,09]8 IN
END TIi4E '12:08 Pl]l
END DATE 03/21/2010
END LEVEL 5. Og?4 IN
LEAK THRESHOLD O. OO2 IN
TEST RESULI PASSED
UOC
TE$T SIARTED 11:52 AI4
TESI STARTED o3l2i/20]4
EEGIN LEVEL 1.6739 iN
ENU TIl,lE 12:08 Pt'l
ENo 0ATE 03lnl2a$
END LEVEL 1.6751 IN
LEAK THRESHOLO O. OO2 IN
TEST RESULT PASSEO
TEST STARTED 11:34 All
TEST STARTED O3/21/?UA
BEEIN LEVEL 1.6?20 IN
END TIIIE 1]:dg A1'l
END oATE 03/?1/201[
END LEVEL 1.6?36 iN
LEAI{ THRESH[]L[] O. OO2 IN
TEST RESULT PASSEO
SLO UPS
3601 SACRAIlNTO
SAN LU]S OBISPO
031211201[ 1:10 Pl'l
SUIIP LEAK TE$T RHPI)RT
OSL STP
TEST STARTED 1:OO PII
TEST STARTED 03/21/2014
BEGIN LEVEL . 5.415i IN
ENo TIfiE j:'tD pt'l
ENo DATE 03/21/2010
END LEVEL '5.4]81 IN
LEAK THRESHOLD O, OO2 IN
TEST RESULT PASSED
SLt] UPS
3601 SACRAI,INTO
SAN LUIS OEISPO
03/21/2014 l;33 Pl'l
SUI'IP LEAK TEST REPORT
DSL STP
TEST STARTED 1:16 PI'I
iEsT STARTED 03121/201a
EEOIN LEVEL 5,4163 IN
END TII.IE 'I:33 PI'I
ENo DATE 03/21/2014
END LEVEL 5,4164 IN
LEAK THRESHOLI) O, OO2 IN
TEST RESULT PASSEO