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Home My WebLink About*Other - BOCCR U: M & F 0 R TE R -------- -- . 11 Renewal Quotation For Crum & Forster Storage Tank Pollution Liability Coverage June 19, 2019 INSURED: PRODUCER: Angela Marsman Grant County Environmental Risk Managers PO Box 37 PO Box 210 F Ephrata, WA 98823 Moline, MI 49335 (509) 754-2011 (269) 792-1070 Fax (616) 877-5098 We are pleased to offer this renewal quotation along with an application. Please review the application for accuracy and completeness, answer the questions, sign and return. Please advise in writing of any changes. FACILITY ADDRESS AND NUMBER OF TANKS TO BE INSURED: 7 facilities per the attached Storage Tank Application 10 Storage Tanks Limits of Insurance Deductible Per Pollution Incident Total All Pollution Incidents Defense Costs Per Incident $1,000,000 $15000,000 $1,0005000 $59000 Company: Crum & Forster Specialty Insurance Company Policy Form: Claims Made Retroactive Date: Varies With Terrorism Coverage Excluded 1 Year Premium $4,186.00 Added Premium Filing Fee Policy Fee $100.00 Tax $90.01 TOTAL $4,376.01 With Terrorism Coverage Provided: Premium, Filing Fee and Policy Fee as above Terrorism Prem $335.00 Tax $97.04 TOTAL $43718.04 Premium is subject to 25% Minimum Earned. Required Items in Order to Bind Coverage: Completed & signed Storage Tank Application acceptable to the underwriter Signed Notice of Terrorism Rejection / Selection Form Premium payment required within 7 -days of policy inception This quotation is "'Subiect to" the following items: Last 2 months of Automatic Tank Gauge[ATG] printout for USTs Evidence of Current Satisfactory Cathodic Protection Testing Results Confirm Insured's name and contact phone number Crum & Forster Storage Tank Application Page 1 of 8 U T 7 ------------------- ----------------- SURPLUS LINES TAX FILING ACKNOWLEDGMENT The producing broker is responsible for complying with surplus lines regulations in the applicable state and arranging for payment of the required state tax and /or stamping fee on this Policy. Please .-.omplete and return this form. Thank you. INSURED INFORMATION: Insured: Grant County Policy#: Effective Date:#: Policy Premium#: Producer#: Producer Mailing Address#: Independently Procured Coverage(IPC)? El Yes L-1 No SURPLUS LINES BROKER INFORMATION (The following licensed surplus line broker is handling all of the required filings and will pay the required taxes and fees, as indicated below.) Surplus Lines Broker's Name(Person or Entity): Surplus Lines Broker's Mailing Address: Surplus Lines State: Surplus Lines License #: Surplus Lines Association #(SLA #): (NJ domiciled risks only): Surplus Lines Tax: Surplus Lines Stamping Fee(if applicable): Other Taxes or Fees: Crum & Forster Storage Tank Application Page 2 of 8 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE You are hereby notified that under the Terrorism Risk Insurance Act, as amended, you have a right to purchase insurance coverage for losses resulting from acts of terrorism, as defined in Section 102(1) of the Act: The term "act of terrorism" means any act or acts that are certified by the Secretary of the Treasury—in consultation with the Secretary of Homeland Security, and the Attorney General of the United States—to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS, WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES [85% through 2015; 84% beginning on January 1, 2016; 83% beginning on January 1, 2017; 82% beginning on January 1, 2018; 81% beginning on January 1, 2019 and 80% beginning on January 1, 2020] OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $100 BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS' LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BE REDUCED. Acceptance or Rejection of Terrorism Insurance Coverage E: hereby elect to purchase terrorism One Year coverage for a prospective premium of � $335.00 hereby decline to purchase terrorism coverage for certified acts of terrorism. I understand that will have no coverage for losses resulting from certified acts of terrorism. Grant Coun N med lnsujeq IZA- � older/Applicant's i'c Signature Cindy Carter, Vice -Chair Richard Stevens, Member Print Name 4 Date Crum & Forster Specialty Insurance Company Insurance Company Policy Number NOTE: Excepting Hawaii domiciled insureds, if you do not complete and return this form or advise us otherwise in writing of your terrorism election then, a rejection of terrorism coverage will be deemed have been made. If you are domiciled in Hawaii, your failure to complete and return this form is deE an acceptance of our terrorism offer. EN0006-0215 Crum & Forster Storage Tank Application Page 3 of 8 ----------------------- CRUM&FORSTEW Storage Tank Application Insurance Co Crum & Forster Specialty Insurance Company Occurrence: $1,000,000 Aggregate: $1,000,000 Deductible: $5,000 FACILITY INFORMATION Ephrata Central Shop 124 Enterprise St. SE Ephrata, WA 98823 Tan TANK INFORMATION 1 Retroactive date 7/07/2006 In Use Cap. Gal. Contents Install Date Y 10,000 Gasoline 1999 Tank Position Other Contents Lined Date Under Tank Construction Tight Test Date Steel, Dbl Wall TANK PROTECTION Corrosion Protection Y Concrete Dike N Painted/Coated N Earthen Dike N Tank# TANK INFORMATION 2 Retroactive date 7/07/2006 In Use Cap. Gal. Contents Install Date Y 10,000 Diesel 1999 Tank Position Other Contents Lined Date Under Tank Construction Tight Test Date Steel, Dbl Wall TANK PROTECTION Corrosion Protection Y Concrete Dike N Painted/Coated N Earthen Dike N PIPING INFORMATION Install Date 1999 Piping System FG/FLX, Dbl Wall Dispenser Type Pressure % Aboveground 0 PIPING PROTECTION Corrosion Protection N Other Y PIPING INFORMATION Install Date 1999 Piping System FG/FLX, Dbl Wall Dispenser Type Pressure % Aboveground 0 PIPING PROTECTION Corrosion Protection N Other Y TANK MONITORING INFORMATION June 19, 2019 Grant County Phone No (509) 754-2011 PO Box 37 FAX No Ephrata, WA 98823 Contact N Email Producer Phone No (269) 792-1070 Environmental Risk Managers FAX No (616) 877-5098 P• Box 21 OF Spill/Overflow Moline, MI 49335 Angela Marsman Email angela@ermi.us Insurance Co Crum & Forster Specialty Insurance Company Occurrence: $1,000,000 Aggregate: $1,000,000 Deductible: $5,000 FACILITY INFORMATION Ephrata Central Shop 124 Enterprise St. SE Ephrata, WA 98823 Tan TANK INFORMATION 1 Retroactive date 7/07/2006 In Use Cap. Gal. Contents Install Date Y 10,000 Gasoline 1999 Tank Position Other Contents Lined Date Under Tank Construction Tight Test Date Steel, Dbl Wall TANK PROTECTION Corrosion Protection Y Concrete Dike N Painted/Coated N Earthen Dike N Tank# TANK INFORMATION 2 Retroactive date 7/07/2006 In Use Cap. Gal. Contents Install Date Y 10,000 Diesel 1999 Tank Position Other Contents Lined Date Under Tank Construction Tight Test Date Steel, Dbl Wall TANK PROTECTION Corrosion Protection Y Concrete Dike N Painted/Coated N Earthen Dike N PIPING INFORMATION Install Date 1999 Piping System FG/FLX, Dbl Wall Dispenser Type Pressure % Aboveground 0 PIPING PROTECTION Corrosion Protection N Other Y PIPING INFORMATION Install Date 1999 Piping System FG/FLX, Dbl Wall Dispenser Type Pressure % Aboveground 0 PIPING PROTECTION Corrosion Protection N Other Y TANK MONITORING INFORMATION Auto Tank Gauge Y Statistical Inventory N Dipstick N Interstitial N Visual N Ground Water Mon N Oil/Water Sep N Spill/Overflow Y Vapor monitoring N PIPE MONITORING Electronic Y Other N Interstitial N TANK MONITORING INFORMATION Auto Tank Gauge Y Statistical Inventory N Dipstick N Interstitial N Visual N Ground Water Mon N Oil/Water Sep N Spill/Overflow Y Vapor monitoring N PIPE MONITORING Electronic Y Other N Interstitial N Crura & Forster Storage Tank Application Page 4 of 8 FACILITY INFORMATION Ephrata Landfill 3803 Neva Lake Road Ephrata, WA 98823 Tank# TANK INFORMATION 1 Retroactive date 7/07/2016 In Use Cap. Gal. Contents Install Date Y 4,000 Split Tank 2012 Tank Position Other Contents Lined Date Above Gas,WO Tank Construction Tight Test Date Steel, Dbl Wall TANK PROTECTION Corrosion Protection N Concrete Dike N Painted/Coated Y Earthen Dike N Tank# TANK INFORMATION 2 Retroactive date 7/07/2016 In Use Cap. Gal. Contents Install Date Y 4,000 Diesel 2012 Tank Position Other Contents Lined Date Above Tank Construction Tight Test Date Steel, Dbl Wall TANK PROTECTION Corrosion Protection N Concrete Dike N Painted/Coated Y Earthen Dike N PIPING INFORMATION Install Date 2012 Piping System Steel, Sngl Wall Dispenser Type Pressure % Aboveground 100 PIPING PROTECTION Corrosion Protection N Other N PIPING INFORMATION Install Date 2012 Piping System Steel, Sngl Wall Dispenser Type Pressure % Aboveground 100 PIPING PROTECTION Corrosion Protection N Other N TANK MONITORING INFORMATION Auto Tank Gauge N Statistical Inventory N Dipstick Y Interstitial N Visual Y Ground Water Mon N Oil/Water Sep N Spill/Overflow Y Vapor monitoring N PIPE MONITORING Electronic N Other N Interstitial N TANK MONITORING INFORMATION Auto Tank Gauge N Statistical Inventory N Dipstick Y Interstitial N Visual Y Ground Water Mon N Oil/Water Sep N Spill/Overflow Y Vapor monitoring N PIPE MONITORING Electronic N Other N Interstitial N FACILITY INFORMATION Hartline 232 Chelan St. Hartline, WA 99135 Tank# TANK INFORMATION PIPING INFORMATION TANK MONITORING INFORMATION 1 Install Date Auto Tank Gauge N Retroactive date 7/07/2016 Statistical Inventory N In Use Cap. Gal. Contents Install Date 1999 Dipstick Y Y 12,000 Split Tank 1999 Piping System Interstitial N Tank Position Other Contents Lined Date Steel, Sngl Wall Visual Y Above Gas, Diesel Dispenser Type Ground Water Mon N Pressure Oil/Water Sep N Tank Construction Tight Test Date % Aboveground ound Spill/Overflow Y 0 Vapor monitoring N Steel, Dbl Wall TANK PROTECTION PIPING PROTECTION PIPE MONITORING Corrosion Protection N Concrete Dike N Corrosion Protection N Electronic N Painted/Coated Y Earthen Dike N Other N Other N Interstitial N Crum & Forster Storage Tank Application Page 5 of 8 FACILITY INFORMATION M attawa 24378 Broadway St. Mattawa, WA 99344 Tank# TANK INFORMATION PIPING INFORMATION TANK MONITORING INFORMATION 1 Install Date Auto Tank Gauge N Retroactive date 7/07/2016 Interstitial Statistical Inventory N In Use Cap. Gal. Contents Install Date 1999 Dipstick Y Y 61000 Split Tank 1999 Piping System Interstitial N Tank Position Other Contents Lined Date Steel, Sngl Wall Visual Y Above Dispenser Type Ground Water Mon N Pressure Oil/Water Sep N Tank Construction Tight Test Date % Aboveground Spill/Overflow N 80 Vapor monitoring N Steel, Dbl Wall TANK PROTECTION PIPING PROTECTION PIPE MONITORING Corrosion Protection N Concrete Dike N Corrosion Protection N Electronic Y Painted/Coated Y Earthen Dike N Other N Other N Interstitial N FACILITY INFORMATION Moses Lake 12171 Wheeler Rd. Moses Lake, WA 98837 Tank# TANK INFORMATION 1 Retroactive date 7/07/2016 In Use Cap. Gal. Contents Install Date Y 10,000 Gasoline 2009 Tank Position Other Contents Lined Date Above Tank Construction Tight Test Date Steel, Dbl Wall TANK PROTECTION Corrosion Protection N Concrete Dike N Painted/Coated Y Earthen Dike N Tank# TANK INFORMATION 2 Retroactive date 7/07/2016 In Use Cap. Gal. Contents Install Date Y 10,000 Diesel 2009 Tank Position Other Contents Lined Date Above Tank Construction Tight Test Date Steel, Dbl Wall TANK PROTECTION Corrosion Protection N Concrete Dike N Painted/Coated Y Earthen Dike N PIPING INFORMATION Install Date 2009 Piping System Steel, Sngl Wall Dispenser Type Pressure % Aboveground 15 PIPING PROTECTION Corrosion Protection N Other N PIPING INFORMATION Install Date 2009 Piping System Steel, Sngl Wall Dispenser Type Pressure % Aboveground 15 PIPING PROTECTION Corrosion Protection N Other N TANK MONITORING INFORMATION Auto Tank Gauge N Statistical Inventory N Dipstick Y Interstitial N Visual Y Ground Water Mon N Oil/Water Sep N Spill/Overflow N Vapor monitoring N PIPE MONITORING Electronic N Other N Interstitial N TANK MONITORING INFORMATION Auto Tank Gauge N Statistical Inventory N Dipstick Y Interstitial N Visual Y Ground Water Mon N Oil/Water Sep N Spill/Overflow N Vapor monitoring N PIPE MONITORING Electronic N Other N Interstitial N Crura & Forster Storage Tank Application Page 6 of 8 FACILITY INFORMATION New Royal City 13766 Road E SW Royal City, WA 99357 Tank# TANK INFORMATION PIPING INFORMATION TANK MONITORING INFORMATION 1 Install Date Auto Tank Gauge N Retroactive date 7/07/2016 Statistical Inventory N In Use Cap. Gal. Contents Install Date 2003 Dipstick Y Y 12,000 Split Tank 2003 Piping System Interstitial N Tank Position Other Contents Lined Date Steel, Sngl Wall Visual Y Above 12000 Dispenser Type Ground Water Mon N Pressure Oil/Water Sep N Tank Construction Tight Test Date % Aboveground Spill/Overflow N Steel, Dbl Wall 0 Vapor monitoring N TANK PROTECTION PIPING PROTECTION PIPE MONITORING Corrosion Protection N Concrete Dike N Corrosion Protection N Electronic Y Painted/Coated Y Earthen Dike N Other N Other N Interstitial N FACILITY INFORMATION Quincy 4718 Rd P -NW Quincy, WA 98848 Tank# TANK INFORMATION PIPING INFORMATION TANK MONITORING INFORMATION 1 Install Date Auto Tank Gauge N Retroactive date 7/07/2016 Statistical Inventory N In Use Cap. Gal. Contents Install Date 2005 Dipstick Y Y 12,000 Split Tank 2005 Piping System Interstitial N Tank Position Other Contents Lined Date Steel, Sngl Wall Visual Y Above Dispenser Type Ground Water Mon N Pressure Oil/Water Sep N Tank Construction Tight Test Date % Aboveground Spill/Overflow N Steel, Dbl Wall 25 Vapor monitoring N TANK PROTECTION PIPING PROTECTION PIPE MONITORING Corrosion Protection N Concrete Dike N Corrosion Protection N Electronic Y Painted/Coated N Earthen Dike N Other N Other N Interstitial N - I'M c aII Lal NI ) 111 UUI I 1plldr KA: vvlLn current r -r- A aria State regulations Xyes No If No, please provide details. (Attach separately) G - VV YUU UVVI I U IC Ld r Z> ! XYes F-] No If No, please provide the name & address of the tank owner. (Attach separately) 3 - Is the Applicant aware of any incident, fact, circumstance, or situation including any act, error or omission that may result in a claim being made against it or any other person or entity for which coverage is sought? [] Yes K No 4 - Have any claims ever been made against the applicant or have any claims ever been reported under any Storage Tank policy? [:] Yes KNo If Yes, please provide details. (Attach separately) 5 - Has the Applicant ever had any reportable releases or spills of regulated substances, hazardous waste or any other pollutants, as defined by the applicable environmental statutes and regulations? Yes �No If Yes, please provide details. (Attach separately) 6 - Has there ever been any contamination at any owned facility prior to or during your tenancy, operation and/or ownership? Yes No If Yes, please provide details. (Attach separately) 7 - Are there any plans to close, remove or upgrade any tanks at any facility in the next 18 months? F-] Yes K No If Yes, please indicate anticipated closure/removal/upgrade date and plans. (Attach separately) 8 - Are there any additional insureds? F� Yes No If Yes, please provide the name(s) and address(es). (Attach separately) Crum & Forster Storage Tank Application Page 7 of 8 REPRESENTATIONS AND WARRANTIES NOTICE TO APPLICANT - PLEASE READ CAREFULLY The undersigned authorized officer of the applicant declares that the statements set forth herein are true to the best of my know- ledge and that no material fact has been omitted or misstated. The undersigned authorized officer agrees that if the information supplied on the application changes between the date of the application and the effective date of the insurance, he/she (undersigned) will immediately notify the insurer of such change, and the insurer may withdraw or modify any outstanding quotations and/or auth- orization or agreement to bind the insurance. Signing of this application does not bind the applicant to purchase or the insurer to provide the insurance. Acceptance of the applicant by the company is required prior to quotation or binding of coverage or the issuance of a policy. It is agreed that this application and the reliance upon its contents shall be the basis of the issuance of a policy and shall be attached and made part of said policy. FRAUD WARNING: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD OR DECEIVE ANY INSURANCE COMPANY, SUBMITS AN APPLICATION OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE, INCOMPLETE, OR MISLEADING INFORMATION MAY BE SUBJECT TO CIVIL OR CRIMINAL PENALTIES. I HAVE READ AND FULLY UNDERSTAND THE QUESTIONS AND MY ANSWERS ON THIS APPLICATION. I UNDERSTAND THAT ANY OMISSION OR MISSTATEMENT OF Af JY OF THE RESPONSES THAT ARE MATERIAL TO THE RISK ASSUMED (AS WELL AS ATTACHED TO THIS APPLICATION), MA��JSE IS CYTO BECOME NULL ��OID � /Qi2 MAY GIVE RISE TO A RESCISSION OF THE POLICY. � � i dA ., 1/ Applicant/Insured Signa�'Nlfflffj! M�11& 1, JJMFA #a' V Print Name and Title: Cind�Carter, Vice -Chair Richard Stevens, Member Producer Signature: Print Name and Title: Date: Crum & Forster Storage Tank Application Page 8 of 8 a Monitoring Syste Equip ent Ceftalflucation This form must be used to document testing and servicing of monitoring equipment A parate certificatIM pu=-r must -be. Dared f-Qr each..oxibring.ay-stem- - woe! by the technician who performs the work. A copy of this form must be provided to the tank system owner/oper-ator, A. General Information Facility Name: Grant County Public Works Bldg. No.: Site Address: 124 Enterprise St. SE City: Ephrata ZIP: 98823 Facility Contact Persom Lonnie Contact Phone Number. 509-760-8706 In Make/Model of Monitoring System; Incon TS-550EVO n.%+ r%; T.M /C , 4 9 *If the facility contains more tanks or dispensers, copy this form. Include Information for every tank and dispenser at the facility. Page of "V CIV '"'j. 1Ufed1?_U1?J R. Inventory of Equipment Tested/Certified Check the appropriate boxes to Indicate specific equipment Inspected/serviced, Tank ID: Unleaded Tank ID: in - Tank Gauging Probe Model: Incon TSP-LL2 101 In - Tank Gauging Probe Model: Incon TSP.LL2 101 Annular Space or Vault Sensor Model: Incon TSP -FIS Annular Space or Vault Sensor Model-, Incon TSP -EIS Piping Sump/Trench Sensor Model: Incon TSP-ULS ............. Piping Sump/Trench Sensor Model: Incon TSP-ULS D Fill Sump Sensor(s) Model:'" Fill Sump Sensor($) Model: Mechanical Line Leak Detector Model: VMI 99LD2000 Mechanical Line Leak Detector Model: VMI 99LO2000 Electronic Line Leak Detector Model: V Electronic Line Leak Detector Model-, TankOverfill/High Level Sensor Model: Incon TS-RA1 MX Tank Overfill/High Level Sensor Modell Incon TS,AA1 Other (Specify equipment type and model In Section G on Page 3) El Other (Specify equipmenttype and model in Section G on Page 3) Tank ID: N/A Tank ID: NIA C] in - Tank Gauging Probe Model.- In - Tank Gauging Probe Model,-, Annular Space or Vault Sensor Model., Annular Space or Vault Sensor Mo . .... .. dek" Piping Sump/Trench Sensor Model.- . ..... Piping Sump/Trench Sensor Model: 0 Fill Sump Sensor(s) Model: Fill Sump Sensor(s) Model: Mechanical Line Leak Detector Model-, Mechanical Line Leak Detector Model; E] Electronic Line Leak Detector Model: . [� Electronic Line Leak Detector Model: ,E] Tank Overfill/HIgh Level Sensor Model: TankOverfill/High Level Sensor Model: ... ... . ...... Other (Specify equipment type and model in Section G on Page 3) Other (Specify equipment type and model in Section G on Page 3) Tank ID: NIA Tank 10: N/A NNE rl in - Tank Gauging Probe Model: In -Tank Gauging Probe Model: Annular Space or Vault Sensor Model: Annular Space or Vault Sensor Model: Piping SumpfTrench Sensor Model: Piping Sump/Trench Sensor Model: D Fill Sump Sensor(s) (Model; Fill Sump Sensor(s) Madel; n Mechanical Line Leak Detector Model-, Mechanical Line Leak Detector Model: Electronic Line Leak Detector Model: Electronic Line Leak Detector Model: E] Tank Overfill/High Level Sensor Model: TankOverfill/High Level Sensor Model: Other (Specify equipment type and model In Section G on Page 3) Other (Specify equipment type and model In Section G on Page 3) *If the facility contains more tanks or dispensers, copy this form. Include Information for every tank and dispenser at the facility. Page of Date of Testing/Servicing-, 10/23/201 8 Site Address: 124 Enter rise St. SE Dispenser 1D#* 112 Dispenser ID: 3/4 Dispenser Containment Sensor(s) Model, rc„Dispenser Shear Va lve(s) Containment Sensor(s) Model: Shear Valve(s) Dispenser Containment Float(s) and Cha'.n(s) Dispenser Containment Float(s) and Chain(s) Dispenser ID: N/A Dispenser 1D; N/A Dispenser Containment Sensor(s) Model: Shear Valve(s) Dispenser Containment Sensor(s) Modek Shear Valve(s) Dispenser Containment Float(s) and Chain(s) Dispenser Containment Floats) and Chain(s) Dispenser ID: NIA Dispenser 04- N/A Dispenser Containment Sensor(s) Model- Shear Valve(s) Dispenser Containment Sensor(s) Model: Shear Valve(s) Dispenser Containment Float(s) and Chaln(s) Dispenser Containment Float(s) and Chaln(s) Dispenser ID: N/A Dispenser ID: N/A Dispenser Containment Sensor(s) Model` El Dispenser Containment Sensor(s) Model; Shear Valve(s) E: Shear Valve(s) Dispenser containment Float(s) and Chain(s) Dispenser Containment Float(s) and Chain(s) C. Results of Testing/Servicing Software Version Installed: 2.10.0.8346 ............. .. . .............. .......................... . . . . . . . ............ .......... ..........i.... ;i............ Complete the following checklist* Yes ❑ No* Is the audible alarm operational? Yes ❑ No* Is the visual alarm operational? ❑x Yes No* Were all the sensors visually inspected, functionally tested, and confirmed operational? Were all sensors 'Installed at lowest point of secondary containment and positioned so that other 0 Yes C] No* equipment will not interfere with their proper operation? ❑ Yes®No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? ❑ N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary Yes ❑ No* containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shutdown? N/A (Check all that apply) 0 Sumpfrrench Sensors E] Dispenser Containment Sensors Did you confirm positive shutdown due to leaks and sensor fail ure/discon nection? E] Yes ❑ No For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. r] Yes ®No no mechanical overfill protection valve is installed), Is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent does the alarm trigger? ❑ N/A 90 % [j Yes* Z No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment below. replaced and list the manufacturer name and model for all replacement parts In section G, ❑ Yes* ❑ No Was liquid found Inside any secondary containment systems designed as dry systems? (Check all that apply) [3 Product [] Water Ifyes, describe causes in Section G,, below. ❑ Yes ❑ No* Was monitoring system set-up reviewed to ensure proper settings? (Attach set-up reports, if applicable) ❑ Yes R No* Is all monitoring equipment operational per manufacturer's specifications? * In section G below, describe how and when these deficiencies were or will be corrected. Monitoring System Certification - Page of Site Address.- 124 Enterprise St. EDate of Testi ng/Servicing: 10/23/2018 .. . ............. D. In - Tank Gauging/ SIR Equipment E] 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 detectfion monitoring, IE Yes E] No* Has all input wiring been inspected for proper entry and termination, Including testing for ground faults? ED Yes E] No* Were all tank gauging probes visually Inspected for damage and residue build-up? 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 property? Yes No* Vere all items on the equipment manufacturer's maintenance checklist completed? ............. *11n section G below, describe how and when these deficiencies were or will be corrected. E. Line Leak Detectors UM Complete the following checklist: Check this box If LLD's are not installed Yes No* For equipment start-up or annual equipment certification was a leak simulated to. verify LLD performance? (Check all thatapply) Simulated leak rate: 3 .poi M; [10. 1 g.p.h. (2.); 0.2 gopsho (2J6 [� N/A Notes*- 1. Required for equipment start-up certification and, annual certification. . . ............. _ 2 -.-Ynl1ess mandated by local agency, certification required only for electronic LLD Startup. Yes No* Were all LLD's confirmed operational and accurate within regulatory requirements? Yes No* Was the testing apparatus properly calibrated? Yes No* For mechanical LLD's, does the LLD restrict product flow is it detects a leak? N/A Yes No* For electronic LLD's, does the turbine automatically shut off If the LLD detects a leak? N/A 1:1 Yes F] No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is N/A disabled or disconnected? E]Yes E] No* For electronic LLD's, does the turbine automatically shut off if any portion -tithe monitoring system is N/A malfunctions or fails a test? Ej Yes E] No* For electronic LLD's, have all accessible wiring connections been visually inspected? 0 N/A Z Yes No* Were all Items on the equipment manufacturers maintenance checklist completed? *In section G below, describe how and when these deficiencies were or will be corrected. F. Certification -I certify that the equipment identified in this document was Inspected/serviced in accordance with the manufacturer's guidelines. Attached to this Certification Is Information (e.g. manufacturers' checklist) necessary to verify that this Information is correct. For any equipment capable of generating such reports, I have also attached a copy of the; (Check all that apply) G. Comments 5ystern set-up Alarm History Report Monitoring System Certification - Page of SME SOLUTIONS, LLC UPSS Test Report October 24, 2018 Grant County Public Works 124 E Enterprise Ephrata, WA 98823 Test Date: October 23, 2018 Reason for Test.- Due Diligence Service Distributor: SME Solutions, LLC www.smg:glufl ,s ions,40M Telephone: 253-572-3822 Executive Summary The Regular and Diesel fines passed the tests. There are no recommendations. LEIGH"N O'BRIEN E-mail: J9ffjMtCM061eJ9bA'9MbdeD&&M' Website: www.le*tohtonobrien.com Ephrata Grant County WA SM10754 Diagnostic Report to 23-Oct-18.doc Page 1 of 3_ Aim To investigate the integrity of the UPSSs as a due diligence exercise. Method Individual tests were performed on the product lines. Summary of Line Results as Tested Line Test Round I Descripflan ]Date lResult Regular I 23-Oct-181PASS Diesel I 23-Oct-181PASS Lines testea to a u. i gpn ieuk rate using Leighton O'Brien PGI2 test equipment & procedure's *Temporarily manifolded for test Comments/Discussions The Regular and Diesel lines passed the tests. Recommendations There are no recommendations. -".I .... Ephrata Grant County WA SM 10754 Diagnostic Report to 23 -Oct- I 8.doc: Page 2 of 3 Date of Test: October 234 2019 Certified Tester., Anthony Gauna (ICC # 8884705) Report Prepared by,,,, Jeff Stevenson Report ID: Ephrata Grant County WA SM10754 Diagnostic Report to 23-Oct- 18,doc Glossary of Acronyms used ATG Automatic Tank Gauge UPSS Underground Petroleum Storage System USEPA United States Environmental Protection Agency The underground pipe and tank configurations contained in this rcport arc deduced from information. gathered at the site by Leighton O'Brien and by information given to Uighton O'Brien by the client. Details of Line Test . .......... .. Line PASS Timm psl gaYhr Vahe NA 110:58: 37.28 -0.00t ed We Start 10:30:001 Date 23-00-181 fl Unit SN Cart No. 970M ... .... ... Une PASS Ilme gw/hr Vww NA 11:29.52 37.43 -0,001 te'S' ted Wet Start 111:41,451 Date 23-octm-181- Unit SN Cort No.. 97085 Ephrata Grant County WA SM10754 Diagnostic Report to 23 -Oct- I 8.doc Page 3 of 3 U:Ai TESTINGHE KLI T FOR UNDERGROUND STORAGE TANKS DEPARTMENT OF This checklist certifies testing activities were conducted in acco r ince ECOLOGY with Chapter 173-360 WAC. Instructions are found on pages 4 and 5. State of Washington Name: Same as above Mailing Add rens: UST ID #: 409127 County: Grant APMAD Phone: Email: City: State,, Zip: . . ....... nkll) ...s. 1. Tank ID # (tank name registered with Ecology) ....... 1 2 2. Date installed (if known) 12-01-1996 12-01-1996 3. Tank capacity (gallons) 9730 9730 -------------. 4. Tank material (selectNV if not visually verif led): ........ Steel (ST); Steel Clad w{ Corrosion Resist (CLAD); FRP FRP Fiberglass Reinforced Plastic (FRP) - STlp3-, Not Vis! ble (NV) S. Tank construction (select NV if notvisual ly ve (died): S*1 ngle Wal I (SW); Double Wal I (DW); Compartment (COMP); riot DW DW Visible(NV) E. Piping material (select NV if not visually verified): Steel (ST); Fiberglass reinforced Plastic (FRP); FLEX FLEX Flexible P I asti c (FLEX); N ot V i si b le (NV); Ot h e r (s pecil fy): 7. Piping construction {select NV if notylsuallyverified). Single Wall (SW); Double Wall (DW); Not Visible (NV) DW DW S. Pumpingsystem: Pressurized (PR); Safe Suction (SS); Non -Safe Suction (NS); Siphon (S) PR PR ECY 070-69 (Rev.3/2016) t law 10 an k N/A N/A 40 Describe: dispenser It used for testing lines and ALLD PASS FAIL tested and other Information required to duplicate test results, ALLD Test. 2 Unleaded tested from DI /2 Diesel lasted from 133/4 Method Used* LDT-890 Mfr. Ce rt, exp. date: 09-P20gQ Manufacturer and nodel numbers must be providedfor each tn ALLD on the tatton, Lj,.#9cumen ............. ............. ............. .... ..... ....... . ........... ............ . . .... Cj Line "rightness Test [Z] 0 2 Unleaded tested from D1/2 Diesel tested from D3/4 Method used: LOB Mfr. Cert. exp. date: 20 RW R Al . ..... . ..... El Line interstitial (or Sump Sensor) Test 2 Incon TS,,P-*ULS ......................... . .. ......... . .. ............................................. .... ................ Tank Tightness Test (i.e. 3rd -party ❑ certified test up to overfill prevention ❑ ❑ .,.,®. I evel) Method used. Mfr. Cert. exp. date: .. .................... . . Tank Interstitial (or Tank Sensor), Test Incon TSP -EIS ❑ Monitor Equipment Check ❑ Incon TS-550EVO ...... . ...... O Au to s h uto ff d nevi ce 2 Overfill droptubes Overfill ar ❑Equipment' 0 0 - ❑ all fioatva.lve. E Check (check. all • thaltapply) � ove rfi 11 Alarm lnC0.n TS -RAI Cr ............ . ....... ................. ............... ......... ....... ..... ........................ . .. ...._....:.W ._.w .. ............... 1mm Ln 0 Spil I Bucket Test D 0 M ........... . . .... L�1 I TankSampTost, 0, 0 .... ..... ...... . .. .......... . ...... ........................ 0 Other (describe briefly) ❑ ❑ ,,�, MI The following items shall be initialed by the Certified Service Provider. YES NO N/A 1. Have all checked items been tested per recommended practices, code and/or manufacturer's requirements and in accordance with federal and/orstate ACS regulations? 2. Has the owner/operator been provided with wriluen documentation of the ADI G test! ng results? 3, Has the owner/operator been made aware of any faulty equipment or El ADG necessary repairs?* ECY 070-69 (Rev. 3/2016) ( CT -- ,.4W PERSPNS S'UBMITFING FALSE INFORMATION ARE SU BJECTTO, FORMALENFORCE E M NT ANO/PR' PENALTIESUNDER'CHAPTER 173M360 WAC. AW AM f WJ, Date Signature of CerlifM &,WK?-20HM Date Signature of Tank Owner or Authorized Representative ECY 070-69 (Rev. 3/2016) Print or Type Name P rl rpt or Type Na me LEAK TESTING CHECKLIST INSTRUCTIONS The tank owner/opator - er isr nslble for: 1. reporting failed tests to the appropriate Ecology regional office within 24 hours, if the test results in a suspected or confirmed release. 2. signing and submitting a copy of the completed checklist to Ecology at the address listed below. Mail Checklist to-, Department of Ecology Underground Storage Tank Section PO Box 47655 Olympia, WA 98504-7600 The attached Underground Storage Tank (UST) checklist is required fore activities described above. Completing this checklist documents and certifies testing activities are performed and conducted in accordance with Chapter 173-360 WA. 6 This checklist must be filled out completely by an International Code Council (ICQ certified provider for Tank Tightness Testing (which. covers tanks, fines and leak detectors) within 30 days following the completion of testing activities, 0 To be considered complete, the service provider must attach supporting data and/or documentation of testing or inspections completed by the service provider. Proof of testing equipment certification must also be attached. A copy of the completed checklist with supporting documentation must be provided to the tank system owner/operator. 1. UST Facility: Complete this section about the UST facility and use the facility compliance tag # (license plate) and/or UST ID 4 if known) to help identify the locatiom 11. Testing Service Provider. Complete this section about the ICC certified service provider and company. III. UST Owner/Opemtor: Complete this section about the owner or operator of the UST facility. IV. UST System Information: Identify tank and piping material and construction only if k is visually verified during the site visit. Do not use Ecology records to complete this section., V. Services Performed: Check all that apply and specifically describe which equipment was tested. If several components are tested but only one is found to be faff'mg, check 'fair' and provide a description of the observations (Le. which equipment passed or failed). Note: the UST regulations do not require all of the equipment listed be iested. An example of Section V is found on page 6. a. ALLD: The ALLD manufacturer, test method used and manufacturer's test method certification expiration date must be provided. If the piping has main/satellite dispensers, the test must demonstrate the ALLD functions if there is a leak in the entire piping run, including the fine that runs to a satellite dispenser. On the checklist, indicate the dispenser number where the testing egubment was connected. Follow testing procedures described by the manufacturer and be sure to verify the leak detector is third -party certified for the UST system and type of product stored. ECY 070-69 (Rev. 3/2016) b. Line Tightness Test: The test method and manufacturer's test method certification expiration date must be listed. If the piping has main/satellite dispensers, be sure the entire piping run is tested (Le. all the way to the satellite dispensers). Follow testing procedures described by the manufacturer and verify the test method is third -party certifwd for the UST system and type of product stored, The service vider is I must provide proof he Ls certified to operate the egiLipment used for testing. c. Line Inters titial (or Sump Sensor) Test: Sensors must be tested per manufacturer specifications or list the Recommended Practice used. Verify the sensors are third -party certified for the product stored., d. Tank Tightness Test: i. Third -party certified test: The test method and manufacturer"s test method certification expiration date must be fisted. Follow testing procedures described by the third -party certified test method. Be sure the test method is approved for the UST system and product stored. The service pLovider must V. provide proof of certification to operate the _eguipme nt-. used for test.. IL Pre-test: This test is conducted on the tank ullage and may be used to test tanks prior to receiving fuel. It does not substitute for a third -party certified tank tightness test. e. Tank Interstitial (or Annular Sensor) Test,* Interstitial monkoring equipment must be tested as per manufacturer specification or list the Recommended Practice used. Verify the equipment is third - party certified for the product stored. E Monitor Equipment Test: Include the make and model of automatic tankgauging equianent installed. Describe which components were checked/tested (i.e. probes, sensors, programming, etc.) or list the Recommended Practice used. Be sure to verify the equipment is third -party certified for the UST system and that components are compatible with the product stored. . g. Dispenser Sump Test: Describe how the test was conducted or list the Recommended Practice used. h. Ove rill.1 Equipme nt Tes t: Overfill alarms must be set at 90% tank capac ity and verified to be audible to the delivery driver. Describe how the test was conducted or list the Recommended Practice used. If ball float valves or automatic shutoffs are *Mstalled, describe if they are visually verified an /or removed and inspected for functionality. 1 0 Spill B acke t Te s t: Describe how the test was conducted or list the Recomme nded Practice used. j. Tank Sump Test: Describe bow the test was conducted or list the Recommended Practice used. VI. Comments: Descn*be reason for test' and, for failed test results, how and when the problem will be Ing corrected, VII. Checklist: Initial in the appropriate box to answer the questions. V111. Site Diagram: The she diagram should include location, number and description of tanks and dispensers. Be sure descriptions in Section V are consistent with labels on the site diagram. IX Required Signatures*, The ICC certified service provider must sign and date the completed checklist. The owner/operator must sign and submit the completed checklist to Ecology. SUPPORTING DATA AND/OR DOCUMENTATION MUST BE ATTACHED FOR THIS CHECKLIST TO BE CQMPLETE ECY 070-69 (Rev. 3/2016) SME SOLUTIONS, LLC 10707 S. Tacoma Way 2900 N.W. 31st Ave Sufte, A-2 Portland, OR 97210 Lakewood, WA. 98499 (603j%64= M3) 5T2.3822 Mechanical Leak Detector Test Data Sheet Site Name Grant County Public Works Date 10/23/2018 Address 124 Enterprise St SE .... ................. . . .............. Ephrata WA,, 98823 . ...... . ......... - ......................... Test Information Comments ................ This letter certifies that the annual leak detector tests were performed at the above referenced facility according to the equipment manufacturers procedures and limitations and the results as listed are to my knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor, SME Solutions, LLC. TechnicianAnthony Gauna Lic# ICC 8884705 Signature 2 3 4 5 Product Unleaded Diesel N/A N/A N/A Manufacturer VMI VMI Model 99L02000 99LD2000 Full Operating Pressure (PSI) 25 30 Line Bleed Back (ml) 50 50 Trip Time (sec) 2 6 Metering Pressure (PSI) 15 15 F/E Holding Pressure (PSI) 24 28 Test Leak Rate (mi/min)(gph} 3.0 GPH 3.0 GPH PASS or FAIL PASS� j PASS Comments ................ This letter certifies that the annual leak detector tests were performed at the above referenced facility according to the equipment manufacturers procedures and limitations and the results as listed are to my knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor, SME Solutions, LLC. TechnicianAnthony Gauna Lic# ICC 8884705 Signature Details Grant County Rublic Work 85/05/2019 06:00:10 s Net 6,519*3 124 Enterprise Temperature 56,21 Ephrata, WR 98823 Level 58.35 509-754-6082 05/05/2019 05:00-P86 05/06/2019 06:00:102 Net 6 ► 519.3 • Temperature 56-21 TRNK TEST REPORT Level 58-35 Last Rvailable 05/05/2019 04;00:86 'FA Net 6x519.3 units. -gal. in, *F Temperature 56.21 Level 58.35 T 05/05/2019 03:00:06 Net 6*519*3 Unleaded Temperature 56.21 Unleaded Level 58.35 Capacity 9,728.0 05/05/2019 02:00:02 Net 61,519.2 Begin End Temperature 56.22 05/05/2019 05/B5/2019 Level 58.35 00:59:57 06:04:06 Diesel Product 2 6,50..6 6,502.0 Capacity 9,728.0 ------ Water Level®------ ® .00 Begin End ------ Water Volume-_-- - 05/05/2019 05/05/2019 0.0 0.0 00-059:59 09:00bo08 ----------- � Y� - .� � Gross 6o519.0 6P519.3 5PS77.5 5w577,6 58.35 58.35 0.00 0.00 ---Temperature --- --- -Water Volume ------ 56o22 56021 0*0 0.0 Last Delivery 5,591.1 50591.1 04/24/2019 08-005:09 -�'' - -:-M W-.- L e ve I - - TP. � " - � Test Type Monthly(..0.2) 51.35 51,35 Threshold 0.10 Temperature Leak Rate 0.05 54o63 54.66 Result Pass Cap acity( %) 66.84 Last Delivery 04/24/2019 07:52:02 Test Type Monthly(0.2) Threshold 0.10 Leak Rate -0.02 Result Pass CapacityM 57,34 ■ w. 4t AR, • pd, F r 'FA MMUW-71211. .1-4. 5P ■ Grant County Public. Work s 124 Enterprise Ephrata, WA 98823 509-754-6082 05/13/2019 0604 units:gal, in, *F inleaded inleaded Capacity 9,728.0 Beg in End 05/12/2019 05/11.2-e-'2019 005958 01:00:02 a -s 6o665.0 6P665.0 ------ Water Level: ------- 0100 0.00 _'FwNO-Ow --Water Uolume 010 000 ----------- 6,666.3 6o666.4 Level 59.61 59.61 ------ Temperature ------- 57.50 ■ Last Delivery 05/07/2019 16-005:16 Test Type Monthly(O.2) Threshold 0010 Leak Rate 0*00 Result Aborted CapacityM 68.51 fiesel Product 2 Capacity 9,728.0 ;egin End 05/12/2019 05/12/2019 01:00:00 06:04:01 05/12/201916 61191.7 6o192.1 ------ Water Level ------- 0.00 0.00 _'FwNO-Ow --Water Volume ------ 0.0 Net 6119900 Temperature 6J99.1 Level 55.98 55.98 ------ Temperature ------- 57.50 57,50 Last Delivery 05/07/2019 15:57:17 Test Type Monthly('0.2 Threshold1 001 Leak Rate 0.0 Result Pas, Capacity(%) 63.6 Details 15/12/2019 06:00:1'!1 Met Temperature Level 55.98 05/12/201916 Met 6,199.1 Temperature 57.50 Level 55,098 05/12/2019 04:00:12 Net 6119900 Temperature 57.50 Level 55*98 05/12/2019 03:00:08 Net 6,199tO Temperature 57450 Level 55*98 05/12/2019 02:0040 04 Net 60198.9 Temperature 57o5O Level 55.98 Grant County Public Work S 124 Enterprise Ephrata, WR 98823 509-754-6082 05/20/2019 06:00-001 x units -,gal, in, 'F Unleaded Unleaded Capacity 9,728.0 Begin End 05/19/2019 05/19,P,2019 00:59:58 06:04:06 05/19/2019 5*188.4 5,188.5 ------ Water Level ------- 0.00 0.00 ------ Water Volume ------ 060 000 ---------- N e t - -::- — 5t188.5 5PI88.7 --------- Leyel----.------ 48.45 48*45 a 59.95 59.94 Details 13-5/19/2019 06:00:01 'iet 5 t 188. 8 Temperature 59-94 Level 48*46 05/19/2019 05:00:05 Net 5v188,8 Temperature 59.94 Level 48.45 05:/19/2019 04400*04 Net 5tISS.? Temperature 59.94 Level 48.45 05/19/2019 03:100*04 Net 5p188.7 Temperature 59.94 Level 48.45 05/19/2019 02:00:03 Net 51118M Temperature ■59,95 Level 48.45 D:Iesel Product 2 Capacity 9,728.0 ;egin End 0 05/19/219 05/19/2019 01:00:00 06-204-213 o 5o489,8 ■5t490.0 Water 1 *i6 Level - 0100 0.00 ter Volume-.*�.WWMS� 010 0*0 mia _ - � . A."'.� Aet �"W"Ww 5v49348 5t494.1 50.70 50-70 58.37 56.39 Last Delivery 05/0?/2019 15:57:17 Test Type Monthly (0 Threshold 0 1 &ap Leak Rate 0.01 Result Pass Capacity(%) 56.44 ■ Grant Countu public Work S 124 Enterprise Last Delivery Ephrata t wR 98823 05/20/2019 15* -27:17 0115 509-754-60oa hi 05/27/2019 06:00-4 02 Test Type Monthly(0,2) Threshold 0.10 TRNK TEST REPORT Leak Rate 0.00 Result Aborted Last Available Capacity 56o58 units-6gal. in, *F Diesel Product 2 TANKS Capacity 9,728.0 Unleaded Unleaded Capacity 9,728.0 Begin En i 05/26/2019 05/26,/2019 00:59:57 01:00:02 5P504.2 5,504.2 ------ Water Level ------- 0.00 0000 ------Water Volume- 0.0 0.0 ---------- 5P499.3 5,499.3 50.80 50'81 ------ Temperature—-- - 61-28 61.28 Beg in End 05/26",2019 051/26/2019 000-59do5g 01-920*040 6,072.0 00,00 0.00 mWater VoIumem_w"w"4AwwIw"I 0110 0.0 6o0?2.4 6v072.2 55oOT 55.07 ------ Temperature—-- - 59.85 59.85 Last Delivery 05/20/2019 15 40 19 -6 50 Test Type Monthly(O.2) Threshold 0.10 Leak Rate 0.00 Result Aborted CapacityM 620 Grant COUnty Public 1141ork Begin End S Grant County Public �brk 124 Enterprise S Ephrata, WR 98823 124 Enterprise 509-754-6082 Ephrata, WR 96823 060�1'06/2019 16:36:55 50/ 9-72019 54 -6082 160-04:ig 16:21*51 06/10 06:00:01 DEL I VERY REPORT - Water ('.'t-lume Last Rvailable THHK TEST REFQR,' -M e t MIMAM Last Rvailable units:gal, in, OF, Ullaunits:gal , in, *F ge:95 % TANKS TRMKS Unleaded Unleaded Unleaded Unleaded Capacity 9r728.0 Capacity 9,728.0 To t a I s *- - ft. - -w- - - - - Begin End Gross lo495.2 06/09.-.#2019 06/09/2019 Net 11488.7 00:59:56 01:00:02 06/09/2019 Gross ---------- Begin End 6 6 i95.1 06/06/2019 06/06/2019 _k 4 x1a e.L 160-04:ig 16:21*51 O.Ou 0.00 yre - Gross- - Water ('.'t-lume 5 o46.5 26*741.7 0.0 -M e t MIMAM 62.96 5o225.4 6JI4.16*370.3 6,378.22' - -' - �- -0 --, -L eve I- -` Q"O'Mr - Leve I -- -- 48.89 60,21 57453 57.53 Water Level— ------Te:mperature---- - oleo 0.00 65,53 65,53 -Temperature-w 4 02:00:01 65-72 65 .82 Last Delivery =iiw.----Water 06/061/2019 16:36:51 010 0.0 Test Type Monthly(O.2) ""-U1lage--,_ Threshold 0.18 3,t995z,,1 2j499.9 Leak Rate 0.00 Result Aborted Capacity 65.74 Diesel Product 2 Capacity 9328.0 Begin End 06/09/2019 0649/2019 06:04:03 51329.6 5P329e9 .,ter Level ------- 0.00 • .ter Vo.1 j';,ne- 0.0 0.0 5,322.4 5t322.7 49. 49.51 Vfnperature ------- 62.9t 62.96 Ldst De I ivery 05/3Le2019 15:21-009 Test Type Monthly(O.2) Threshold 0.10 Leak Rate 0.07 Result Pas�A Capacity(%) 54,71, Deta i ls 16/09/2019 0600: 11. I pe t 5932267 Temperature 62.96 4 Level 49.51 06/09/2019 05:00: 10 'let 5,322.6 Temperature 62*96 -evel 49451 06/09/2019 04:00,08 Net 5v322*6 Temperature 62.96 Level 49.51 06/09/2019 03::06:04 Net 5p322.5 Temperature 62.96 Level 49.50 06/09/2019 02:00:01 Net 5.1,3222.4 Temperature 62-96 L 1 49.50 Grant County Public Work s 124 Enterprise Ephrata, WA 98823 509-754-6062 06/17/2019 06:00:01 TRHK TEST REPORT La-st Available , 'L I �n-its-gal, in, *F Unleaded Unleaded Capacity 9.728.0 Begin End 06/16/2019 06/16/2019 01:00:00 02:24:49 --------- Gross ---------- 4t?39.6 4,738.1 -_-_--Aster Level ------- 0.00 0000 -----ala r Volume ------ 1 Oao ---------- Met ----------- 4t720.7 4v719.3 ---------Level-i-------- 4 .1 45,11 ------ Temperature --_--_- ®7 65-66 Deta i ls 16/16/2019 02:00:8A Beg in End 06/16/2019 06/16/2019 00:59:58 06:03:51 06/16/2019 4r259.0 4o259.4 ------ Water Temperature 01000 0100 ------ Water Vo1ume,.--,w:----- 0*0 0.0 4P232.4 4o252.2 C252.5 Leve 1 --- o- - - - - 41o55 41*55 ------ Temperature - 63.54 63.56 LastDelivery 05/31,/2019 15*P21:09 Test Type Nonthly(0.2) Threshold 0.10 Leak Rate 0.07 Result Pass Capacity(%) 43.78 Details 16/16/2019 06:00:011, Net 4r252o5 Temperature 63.56 Level 41-55 06/16/2019 05:00:05 Net 4t252.4 Temperature 63.56 Level 41.55 06/:16/2019 04:00:03 Net 4P232.4 Temperature 63.55 Level 41.55 06/16/2019 03:00:02 Net 4o252.3 Temperature 65.55 Level 41455 06/1&/2019 02-000:00 Net 4,252.2 Temperature 63.55 Level 41-55 Grant County Public Uork s 124 Enterprise Ephrata, IJR 96823 509-754-6082 06/24/2019 06:00-901 TRHK TEST REPORT Last Rvailable units.: al, in, OF k fl"aw Unleaded Unleaded Capacity 9,728.0 Begin End 06/23/2019 06/23/2019 00*059*,58 05:01,037 -----Gross R w: 3wI85.2 ------ Water Leve 0.00 0100 ------ Water Volume*��O_ 0.0 040 ---------- 3o171-9 31171.2 -------- Level ---------- 33.44 33,43 ------ Temperature ------- .66.26 66-26 Last Delivery 06/06,/2019 16:04: 19 Test Type Nonthly(0 '64 Threshold 0.12 Leak Rate 0.00 Result Rbarted Capacity(.%) 32-74 Details 06/23/2019 05-200:07 Net 3,171.9 Temperature 66.26 Level 33,44 06/23/2019 04:00:03 Met 3P17149 Temperature 66.26 Level 33.44 06/23/2019 05: 00 *0 00 Net 3*171.9 Temperature 66.26 Level 33.44 06/23o,,,2019 02: 00: 00 Net 3,172.0 Temperature 66.21 Level 33,44 Diesel Product 2 Capacity 9,728.0 Beg in End 06/23/2019 06/23/2019 01:00-000 05:531-157 0.10 3vI53.7 3, 154.0 ------ Water Level-- 4 .144. 04,00 0000 33.1 Volume --- 0.0 0.0 3,146o 3tI45.9 3ol4642 ... ----... --Leve1 ----------- 33.19 33.19 02:00:02 Net 3,145o Last Delivery 05/31/2019 14:55:54 Test Type Monthly (0. 2) Threshold 0.10 Leak Rate 0.06 Result Pass Capacity(%) 32.42 Details 16/23/2019 05-000001-19 Net 3,146. Temperature 65A Level 33oA 06/23/2019 04:00:06 Met 3,146. Temperature 65.4 Level 33.1 062019 03:00*02 Net 3,146o Temperature 65.4 Level 33,1 06/23/2019 02:00:02 Net 3,145o Temperature 65.o4 Level 33.1 Grant County Public Work Grant County Public Work 124 Enterprise Ephrata, WR 98823 S 124 Enterprise 509-754-6082 Ephrata, WR 98823 Last Delivery 07/01/2019 06 -0 30:03 509-754-6082 05/31/2019 14 :55:54 07/01/20 1 9 06 *000:02 Test Type Monthly(8.2) TRHK TEST REPORT Threshold 0.10 Last Rvallable TRHK TEST REPORT Leak Rate 0.08 Last Rvailable Result Pass Qnits:gal, in, r Capacity(%) 25.07 units:gal, in, *F TOCK S Details U nleaded9 TANKS 06/30/20105:00:07 Net 2o431.8 Unleaded Unleaded Temperature 66*30 Capacity 9,728.0 Unleaded Level 2T.54 Beg End Capacity 9,728.0 06/30/2019 04:00:06 -in 06/30/2019 06/30/2019 Begin End Met 31,7 2o4 Temperature 66.30 00:59:56 01:00:01 06/30/2019 06/-30/2019 Level 27*54 �.' - 11-:1: ��yea ---Gross- 00:59:56 01*600:01 06/30/2019 03:00:06 lr630.0 lo630.1 I --Gros Net 2F431.6 Water Level ------- 11630.0 It630.1 Temperature 66.30 0.00 00.00 to go ---- Water Leve Level 2T.54 at Qolume ------ 00,00 0o 00 06/30/2019 02:00:03 0.0 010 ------tJater Volume- -,+,+,w,,* Net 2P431.5 H et ----------- 0.0 010 Temperature 66.30 1r622.9 1,622.9 e t ----------- Level 2 7, 54 ;� � - - - L eve I - - - -- - - - ® - lv622.9 1,622t9 0 A 0 0 lb 0 20.71 20.71 -- - - -. -- - L e ve 1 - R.P. - - --- - - - - -- - m� - Te roper r at ure- - I,.& ___� .20.71 20.T1 66-26 66.26 --Tempera t ure ------- Grant County Publ6brk ic 66.26 66.26 $ Last Delivery 124 Enterpr i se 06/06/2019 16-04:19 Last Delivery Ephrata, WR 96023 Test Type Monthly(O.2) 06/06/2019 16:04;19 509-754-6082 Threshold 0110 Test Type Month ly(B.2) 07/01/2019 06:001-103 Leak Rate 0.00 Threshold 0.10 Result Aborted Leak Rate 0*00 REGULRTOR' REPORT CapacityM 16.76 Result Aborted (Passed Tests) Capacity M 16.T6 July 2019 Diesel Product 2 Diesel units Capacity 9,728.0 Product 2 Capacity 9,728.0 Begin End No Records Found 06/30/2019 06/30/2019 Begin End 00:59:58 05: 38 so 36 06/30/2019 06/30/2019 --------- 00-059:58 05-438:36 2o438.4 21438.8 Gross --------- ---------- -Water Level ------- 2o438.4 2,438,8 oleo 0.00 ------ Water Level ------- --___-dater Volume --- 0100 0,000 ------ Water 0®0 0.0 Volume - 2,,,431.5 2t431.8 ---------- Net ----------- 2*43165 2w431*8 27.54 27.54 --------- ------ Temperature— 27.54 27,54 66.30 66.30 ------ Temperature ------- 66.30 66.30 MMMMMF---� Detaiis 06/30/2019 05:00:07 Met 2,431-3 Temperature 66-30 Level 27-54 06/30/2019 04: 00 06 Met 2 4 3 1 4 7 Temperature 66-30 Level 27-54 06/30/2019 031-100$06 Net V. 31-6 Mr.. Tmperature 66-30 Level 27 54 06/30/2019 02:00:03' Net 2o43145 Temperature 664,30 Level 27,5q Grant County Public Wora S 124 Enterprise Ephrata, WA 98823 509-754-608 2 06/01/2019 06-0000-05 REGULATORY REPORT (Passed Tests) June 2019 Mm=j Grant County Public Work S 124 Enterprise Ephrata, WA 98823 509-754-6082 06/01/2019 06:30:04 TRNK TEST REPORIT Last Rvailable units:gal® in, *F Unleaded Unleaded Capacity 9,728.1 Begin End 05/26/2019 05.26/2019 00:59 -157 01*1%00*-02 Gross 5v504.2 5o5O4.2 ------ Water LevelM.VII_""rmww 0000 0.00 ------[Jater Uolume . 8.0 0.0 -Met 5o499.3 5t499.3 ------- Level--.----,--.--: 50,80 50.81 ------ Tempe 61,28 61-28 Last Delivery 05/20/2019 15:27:17 Test Type Mon.thly(O.2) Threshold 0.10 Leak Rate 0.00 Result Aborted Capacity(%) 56,58 Diesel Product 2 Capacity 9,328*0 Beg in End 05/26/2019 05/26/2019 00-0 59:59 01:20:40 G r o s s ■ : 6t071-6 ------ Water Level ------- 0.00 0.00 ------ Water Uolume ------ 010 000 6,072.4 6tO72.2 �-----~---Level ---------- 55*07 55.07 9 ,-�- 59.65 5.85 Grant County Public Work S 124 Enterprise Ephrata, WR 98821 509-754-6082 06/03/2019 061:00:03 units gal, in, OF Unleaded Unleaded Capacity 9,728.1 Begin End 06/02/2019 06/02/2019 00:59:57 03 -f 26 -* 46 6P477.3 6 y 475 . 9 ------ Water Level-- 0100 0.00 ------[Jater Uolume . 0.0 6t446*7 6eq45.5 L evz ---------- 58,16 58.15 -Temperature- ___M* aw- 66-72 66.66 Details 16/02/2019 03:00:04 Met 6v446,7 Temperature 66.67 Level 58-16 06/02/2019 02:00:03 Net 6,446.7 Temperature 66,63 Level 58.1i Diesel Volume ----- Product 2 0.0 Capacity 9,728.0 5v905.9 Beg in 4 End 06/02/2019 06/02/2019 01:00:00 06:03:58 sa- 59912.7 5,913.0 ------ Water Level -------- 0.00 0.00 er Volume ----- 0.0 0.0 ---------- 5v905.9 5t906.2 53.87 53,67 �-----Temperature---- 62.55 62.53 Last Delivery 05,o -o3112019 15:21:09 lest Type Monthly(O. Threshold 09 Leak Rate 0.0 Result Pas, CapacityM 60.71 Deta i Is 116/02/2019 06:00-11 Met 5o906*3 Temperature 62*53 Level 53.87 06/02/2019 05:00:09 Net 5V906*1 Temperature 62,53 Level 53.87 06/02/2019 04:00:06 Net 5F906.1 Temperature 62*54 Level 53.87 06/02/2019 03:00:02 Net 51906,0 Temperature 62o54 Level 53*87 06/02/2019 02:00:01 Net 59905.9 Temperature 62.55 Level 53.87