HomeMy WebLinkAboutFMC RESULTS 2013MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Wit/tin tlte State of Cal(fornia
Authority Cited: Chapter 6. 7, Health and S{!f'ety Code; Chapter /6, Division 3, Title 23, Cal(f'ornia Code of Regulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each
monitoring system control panel by the technician who pcrfonns the work. A copy of this form must be provided to the tank system
owner/operator. The owner/operator must submit a copy of this fonn to the local agency regulating L ST systems within 30 days of test date.
A. General Information
Facility Name: #2233 D & G Liquors Bldg. No.: ____ _
Site Address: 2732 Brundage Lane City: Bakersfield, CA Zip: -=-93-=--3:....:0:....:4 __ _
Facility Contact Person: Omero Garcia Contact Phone No.: {661) 393-7000
Make/Model of Monitoring System: Veeder-Root TLS 350 Date ofTesting/Servicing: 8/16/2013
B. Inventory of Equipment Tested/Certified
VII'-''-'"' Ill'-n I l VII lUI.,_. VV-''-'i~ IU IU\.·I~UI'-' <Jf'r\.111._ "''1U1pun .. IH llliJ 1"'"-''-'-H.-:P'-1 11"1 ... '-U•
Tank 10: 12,000 gal. Regular Tank 10: 12,000 gal. Su~er
~ In-Tank Gauging Probe. 'vlodcl: 847390-107 ~ In-lank Gauging Probe. Model: 847390-107
0 Annular Sp.1cc or Vault Sen.'iOr 'vlodcl: 0 Annular Space or Vault S\.'1\-.<lr. Model:
0 Piping Sump I r\.'tlch Sen.-.<lr{s). Model: 0 1'1pmg Sump,-, rcnch Sclt'iOr{s). Model:
0 Fill Sump St:nwr{s). Model: 0 Fill Sump Sensor{s). Model:
0 Mechanical Line Leak Detector. Model: 0 Mechanical Line Leak Octector. Model:
181 Electronic I inc Leak Detector. Model: WPLLD 181 Electronic Line Leak Detector. Model: WPLLD
181 Tank Ovcrfillllfigh-Levcl Scn.'iOr. Model: 847390-107 181 I :mk Overfill/1-ligh-1 eve! Scm.or. Model: 847390-107
0 Olhcr(specify equipment type and model in Section F. on Page 2). 0 Other (specifY equipment type and model in Section I on Page 2).
Tank 10: 12,000 gal. Diesel Tank 10:
~ In-I ani.. Gauging Probe. Model: 847390-107 0 In-I ank Gauging Probe. Model:
0 Annular Space or Vault Sensor. Model: 0 Annular Space or Vault Sen..,or. Model:
0 Piping Sump I I rench Scnsor{s). Model: 0 Piping Sump I Trench Scnsm(s). Model:
0 Fill Sump Scnsor{s). Model: 0 Fill Sump Scn.'iOr(s). Model:
0 Mechanical l inc Leak Detector. Model: 0 Mechanical Line Leak Detector. Model:
181 Electronic l inc Leak Detector. Model: WPLLD 0 Hectronic Line Leak Oet\.'Ctor Model:
181 Tan!.. 0\\.Tiill lfigh-Lcvcl Sensor Model: 847390-107 0 I ;mk Overfill I ligh-1 C\'cl S\.'Tt.'iOr. Model:
0 Other (spec1fy equipment type and model in Section Eon Page 2 ). 0 Oth\.'T (~pecify equipment type and model in Section I on Page 2).
Dispenser 10: 1&2 Dispenser 10:
181 Dispenser Containment Sensor(s). Model: 794380-208 0 Dbpenser Containment Scnso•~s). Model:
181 Shear Valv4..'(~). 0 Shear Valvc(s).
0 Dispenser Containment Float(s) and ( 'hain(s). 0 Di~pcnscr Containment Flom(s) and Chain(s).
Dispenser 10: Dispenser 10:
0 Dispens4..-r Containment Sen.'iOr{s). Model: 0 Dl>p4..'11SCT Containment Sclt-.<lr{s). Model:
0 Shear Valv~'(s). 0 Shear Valvc(s).
0 Dispenser Containment Float(s) and C'hain(s). 0 Dispen,o;er Containment Float(s) and Chain(s).
Dispenser 10: Dispenser 10:
0 Dispert.<;cr Containment Scnsor{s). Model: 0 Disp4..'11S\.'T Containment ScnMir{s). Model:
0 Shear Valvc(s) 0 Shear Valvc(s).
0 Di~lJl.'t\~'T Containment Floal(s) and ( 'ha111(s). 0 Dl.,p4..'t\-.cr Containment lloat(s) and Chain(s).
•If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility.
c. Certification -I certify that the equipment identified in this document was inspected/serviced in accordance with the
manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this
information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such
reports, I have also attached a copy of the report; (check all that appM: [g) System set-up [g) Alarm h.istory report
Technician Name Kristopher Karns
Certification No.: B34106
Testing Company Name: Confidence UST Services
Site Address: 2732 Brundage Lane, Bakersfield, CA 93304
Page 1
Signature: ~ fs~
License. No.: 804904
Phone No.: (800) 339-9930
____ Date ofTesting/Servicing: 8/16/2013
of 3
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed: 327.04 ~~~---------------------------
c -------he foil --------. --heckr ---_ ........
1:81 Yes 0 No* Is the audible alarm operational?
1:81 Yes 0 No* Is the visual alarm operational?
1:81 Yes 0 No* Were all sensors visually inspected, functionally tested, and confirmed operational?
1:81 Yes 0 No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment
will not interfere with their proper operation?
0 Yes 0 No* If alarms arc relayed to a remote monitoring station, is all communications equipment (e.g., modem)
1:81 N/A operational?
1:81 Yes 0 No* For pressurized piping systems, docs the turbine automatically shut down ifthc piping secondary containment
0 N/A monitoring system detects a leak, fails to operate. or is electrically disconnected? If yes: which sensors initiate
positive shut-dov.'rl? (Check all that apply) 0 Sumprfrench Sensors; 1:81 Dispenser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? 1:81 Yes; 0 No.
1:81 Yes 0 No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no
0 N/A mechanical overfill prevention 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 of tank capacity does the alarm trigger? 90%
181 Yes* 0 No Was any monitoring equipment replaced? If yes, identifY specific sensors, probes, or other equipment
replaced and list the manufacturer name and model for all replacement parts in Section E, below.
0 Yes* 1:81 No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that app~1~
0 Product; 0 Water. If yes. describe causes in Section E. below.
1:81 Yes 0 No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports. if applicable
1:81 Yes 0 No* Is all monitoring equipment operational per n1~~ufacturer's specifications?
* In Section E below, describe how and when these deficiencies were or will be corrected.
E. Comments: I replaced Veeder Root Battery, the 3.5 Gal. Phil Tite Spill Bucket on Diesel and Phil Tite Fill Adaptor
due to failing test. and thE:) ~.0 Gal. Phil Tite Spill Bucket on the Super due to a failing test. After all the repairs WE:)r:!L__
r_nade everything was re-tested and confirmed operational_ .. ____________________ _
Page 2 of 3
Monitoring System Certification
F. In-Tank Gauging I SIR Equipment: 18] Check this box if tank gauging is used only for inventory control.
0 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 perfonn leak detection monitoring.
Complete the following checklist:
l8l Yes 0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
181 Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup?
1:8:1 Yes 0 No* Was accuracy of system product level readings tested?
1:8:1 Yes 0 No* Was accuracy of system water level readings tested?
1:8:1 Yes 0 No* Were all probes reinstalled properly?
1:8:1 Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): 0 Check this box ifLLDs are not installed.
---'1""---···------.. --•!'; ----------..
1:8:1 Yes 0 No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
0 N/A (Check all that apply) Simulated leak rate: 181 3 g.p.h.; 0 0.1 g.p.h ; 0 0.2 g.p.h.
181 Yes 0 No* Were all LLDs confirmed operational and accurate within regulatory requirements?
1:8:1 Yes 0 No* Was the testing apparatus properly calibrated?
0 Yes 0 No* For mechanical LLDs. does the LLD restrict product flow if it detects a leak?
181 N/A
181 Yes 0 No* For electronic LLDs. does the turbine automatically shut off if the LLD detects a leak?
0 N/A
1:8:1 Yes 0 No* For electronic LLDs. does the turbine automatically shut off if any portion of the monitoring system is disabled
0 N/A or disconnected?
1:8:1 Yes 0 No* For electronic LLDs, docs the turbine automatically shut off if any portion of the monitoring system
0 N/A malfunctions or fails a test?
181 Yes 0 No* For electronic LLDs. have all accessible wiring connections been visually inspected?
0 N/A
1:8:1 Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section II, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 3
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SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors pe1.{orming annual testing of UST spill containment structures. The completed form and
prinloutsfrom tests (if applicable), should be provided to the facility owner/operator.for submittal to the local regulat01y agency.
1. FACILITY INFORMATION
Facility Name: #2233 D & G Liquors I Date ofTesting: 8/15/2013
Facility Address: 640 I White Lane, Bakersfield, CA 93309
Facility Contact: Omero Garcia I Phone: 661-393-7000
Date Local Agency Was Notified ofTesting: Ernie Medina
Name of Local Agency Inspector (if present during testing): 7/24/2013
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials': X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester n Other (Specify)
License Number(s): CSLB #804904 ICC #5264406-UT SWRCB #09-1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic 0 Vacuum n Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (By Tank 1 ReguJar 2 Super 3 Diesel 4
Numbe1~ Stored Product, etc.)
Bucket Installation Type: 0 Direct Bury 0 Direct Bury 0 Direct Bury 0 Direct Bury
181 Contained in Sump 181 Contained in Sump 181Contained in Sump n Contained in Sump
Bucket Diameter: 14.00" 14.00" 14.00"
Bucket Depth: 12.00" 12.00" 12.00"
Wait time between applying 5 min. 5 min. 5min. vacuum/water and start of test:
Test Start Time (T1): !0:30AM !0:30AM 10:30 AM
Initial Reading (R1): 10.75" 10.75" 10.75"
Test End Time (TF): I 1:30AM I 1:30AM I 1:30AM
Final Reading(~): 10.75" 10.75" 10.75"
Test Duration (TF-T1): 1 hour 1 hour I hour
Change in Reading (Rr-R1): 0.00" 0.00" 8.00"
Pass/Fail TI1reshold or 0.0625" 0.0625" 0.0625" Criteria:
Test Result: 181 Pass 0 Fail 181 Pass OFail 181 Pass OFail 0 Pass OFail
Comments -(include information on repairs made prior to testing, and recommencled.follow-up forfailed test.\)
The passing results above reflect the reoairs that were made to the Super and
Diesel to get passing results. I replaced the Diesel3.5 Gal. Phil Tite Spill Bucket
and the Phil Tite Fill Adaptor on the Diesel. I also had to replace the 5.0 Gal.
Phil Tite Spill Bucket on the Super. After the repairs everything was re-tested
and confirmed operational.
CERTIFICATION OF TECHNICIAN RESPONSffiLE FOR CONDUCTING THIS TESTING
I hereby certifY that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician's Signature: L, .f; ~ Date: 8/16/2013
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
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I LEGEND
L1 UDC 1 ·2
H HEALYCAS e ANODE
P PRODUCT SPILL BUCKET
V VAPOR SPILL BUCKET
ATG AUTOMATIC TANK GAUGE
ESO EMERGENCY SHUT .OFF I W·S WATER SHUT .OFF® STREET
W-B WATER SHUT .OFF~ BLDG
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SITE PLOT PLAN for:
#233 D & G MARKET I
2732 Brundage Lane
Bakersfield, CA 93304 I
(861)326-1083 _j
na.-..-..
SCALE: 1• =20FT
PllOJECT 0'00(11! JACO-MU
SITC PU< rAStlll~-z-w
CW.'EHEMct: $11)0£ fOil: rASTRIP OIL COMPANY, L.P.
IAJIUSIOJ), CAUrO~
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CJo ~ ~USlci ~,ces.'~
Job Order /Invoice#: S ( { / ~
Time
"BUILD WITH CONFIDENCE" "COMPLIANCE WITH CONFIDENCE"
Lic.970703 Lic.804904 1 ;). ·co
Toll Free #: 1-800-339-9930
Name: Confidence UST Site Name: ::If '22 s~ D ~ /.-L!QGI~d
Street: 16250 Meacham Road Street: "2 ':t 3:2 RtJuAJ ;\Af...li / .LU. r
City: Bakersfield CA 93314 City: t::),.y-_ ~ r-,r L/) State: {_ .1]. Zip: 9.S.J'o~
Terms: /Y)(jJ...AI/;.~UN.-<;u<;-a:;_.A 1'7.-n ...,._, """'· J Store No:
Description of work oerformed:
'7i.1.b I"Yl/"/ / r5" "'-.rc:-ul?.LL£ 41tr1"!-~ ~.:.::>r£? (" l>/.F'Vv: (
IA/tV/1 f <:-:Jtll €~re..r 1-:i~ .H:J.J~ o. T 16 -?UI ~A r ~. ~"" t-A-1
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TRAVEL and LABOR (0.5 Hour Minimum Labor Charge) OVERTIME (5:00 PM -7:00AM)
Date Technician(s) Name Start End Total OT Start OTEnd OTTotal
~//t/151 ~ S' .t:;;;;;; A f <\ Travel
I I Labor fSJ,r
Travel
Date Technician(s) Name Start End Total OT Start OTEnd OTTotal
Travel
Labor
Travel
Date Technician(s) Name Start End Total OT Start OTEnd OTTotal
Travel
Labor
Travel
SUPPLIES -MATERIALS-RENTALS Check One
Qty. UST Parts Site Parts
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COMMENTS
Store Employee Print Name:
SITE -(.,'"' •• \li ,