HomeMy WebLinkAboutFMC 2013MONITORING SYSTEM CERTIFICATION
For Use l~v A/1./uri.s·dictions Within the State of California
Authority Cited: Chapter 6. 7, 1/ea/th and Sc!fety Code; Chapter /6, Division 3, Title 23, Cal((omia Code qf'Regu/(1/ions
TI1is fonn 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 perfonns the work. A copy of this fonn must be provided
to the tank system ov•ner/operator. The owner/operator must submit a copy of this fonn to the local agency regulating UST systems
within 30 days of this date.
A. General Information
Facility Name: Shell Bldg. No.: ___ _
Site Address: 4700 Coffee Road City: Bakersfield Zip:....:.9....:..3....:.30_8 __ _
Facility Contact Person: Matt Jeffries Contact Phone No.: 661-496-7006 ~~~~~----------
Make/Model of Monitoring System: Gilbarco EMC Date of Testing/Servicing: 8/13/2013
~;},?.~~~,?.~t,~~o~d~a~i.f.!~!..~~~m!~~.~~~!,S~!.!ified
Tank 10: 10000 gal. Regular {North} Tank 10: 10000 gal. R~ular {South)
[x] In-Tank Gauging Probe. Model: 847390-107 [i) In-Tank Gauging Probe. Model: 847390-107
[x] Annular Space or Vault Probe. Model: 794390-420 [i) Amular Space or Vault Sensor. Model: 794390-420
[i) Piping Sump I Trench Sensor(s). Model: 794380-208 [i) Piping Sump I Trench Sensor(s). Model: 794380-208
[x] Fill Sump Sensor(s) Model: 794380-208 [i) Fill Sump Sensor(s). Model: 794380-208
[xI Mechanical Line Leak Detector. Model: FX1V 1iJ Mechanical Line Leak Detector. Model: FX1V
0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
[x] Tank Overfill I High Level Sensor. Model: OPW-61-SO W Tank Overfill I Iligh Leva! Sensor. Model: OPW-61-SO
0 Other (specify equip. type and model in Sec. Eon Pg. 2) 0 Other (specify equip. type and model in Sec. Eon Pg. 2)
Tank 10: 10000 gal. Sueer Tank ID: 10000 gal. Diesel
[x] In-Tank Gauging Probe. Modc1:_847390-107_ ~ In-Tank Gauging Probe. Model: 847390-107
W Alllular Space or Vault Sensor. Model: 794390-420 [x] Annular Space or Vault Sensor. Model: 794390-420
[x] Piping Sump I Trench Sensor(s). Model: 794380-208 ~ Piping Sump I Trench Sensor(s). Model: 794380-208
[!] Fill Sump Sensors(s). Model: 794308-208 ~ Fill Sump Sensor(s). Model: 794380-208
lx1 Mechanical Line Leak Decector. Modei:FX1V [i) Mechanical Line Leak Detector. Model: _FX1 DV --0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
[!] Tank Overfill I High Level Sensor. Model: OPW-61-SO [!] Tank Overfill/ High Level Sensor. Model: OPW-61-SO
0 Other (specify equip. type and model in Sec. Eon Pg. 2) 0 Other (specify equip. typs and model in Sec. Eon Pg. 2)
Dispenser 10: 1 & 2 Dispenser ID:_ 3 & 4
[X] Dispenser Containment Sensor(s). Model: 794390-420 [i) Dispenser Containment Sensor(s). Model: 794390-420
[X] Shear Valve(s). W Shear Valve(s).
0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s)
Dispenser ID: 5&6 Dispenser 10: 7 & 8
[!] Dispenser Containment Sensor(s). Model: 794390-420 W Dispenser Containment Sensor(s). Model: 794390-420
~ Shear Valve(s). [i) Shear Valve(s).
0 Dispenser Containment Float(s) and Chains(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser 10: Dispenser ID:
0 Dispenser Containment Sensor(s). Model: 0 Dispenser Containment Sensor(s). Model:
0 Shear Valve(s). 0 Shear Valve(s).
0 Dispenser Containment Float(s) and Chain(s) 0 Dispenser Containment Float(s) and Chain(s).
*If the facility contains more tanks or dispensers, copy this fonn. Include infonnation for every tank and dispenser at the facihty.
C. Certification -I certify that the equipment identified in this document was inspected/services in accordance with the
manufacturers' guidlines. Attached to this Certification is information (e.g. manufacturers' checklist) necessary to varify that
this information is correct and a plot plan showing the layout of monitoring equipment. For equipment capable of generating
s~c.h reports, I ~ave attached a copy of the report; (check all that appl~) 0 System Set-up_ ~x Alarm history report
Techmc1an Name (pnnt): Kristopher Karns Signature: !:-... _ _ ~ ~ """ Certification No: 834106 License No:..:8:.:.04::::.:9::.::0:.::4 _______________ _
Testing Company Name: Confidence UST Services, Inc. Phone No: ....::8:.:0..:..0·..:3:.:.39::..·..:.9::..93:.:0:__ ______ _
Site Address: 4700 Coffee Road, Bakersfield, CA 93308 Date of Testing/Servicing: ..::.8:...:/1..:.3/..:.2..:.01....::3:__ __ _
D. Results of Testing/Servicing
Software Version Installed: 329.00 ----------------------------
Complete the following checklist:
[i] Yes 0 No* Is the audible alarm operational?
X Yes r l No* Is the Visual alarm operational?
X Yes r 1 No* Were all sensors visually inspected, functionally tested, and confirmed operational?
X Yes D No* Were all sensors installed at the lowest point of secondary containment and positioned so that other
'---equipment will not interfere with their proper operation?
. DYes @No* If alanns are relayed to a remote monitoring station, is all communications equipment (e.g. modem)
N/A operational?
~Yes 0No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary
ON/A containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes:
which sensors initate positive shut-down? ~ Sumprrrench Sensors [x] Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? [i] Yes; D No;
DYes 0No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no
~N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visual and audible at
the tank fill point(s) and operating properly? If so, at what percent of tank capasity does the alarm
trigger? l 61-SO _] %
~Yes* 0No Was any monitoring equipment replaced? If Yes, identify specific sensors, probes, or other eqmpment
replaced and list the manufacturer name and model for all replacement parts in Section E, below.
[i] Yes* 0No Was liquid fom1d inside any secondary contaimnent systems designed as dry systems? D Product; [i] Water. If yes, describe causes in Section E, below.
Tx v~" r l No* Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable.
X Yes [ ] No* Is all monitoring equipment operational per manufacturer's specifications?
*In Section E below, describe how and when these deficiencies were or will be corrected.
E. Comments: I had to replace both the Regular North and Regular South FXl V Line Leak Detectors as both
originals failed to detect a leak of3 GPH@ 10 PSI. After the repairs were made they were both re-tested and
confirmed operational. I also removed 1.5 Gal. of water from the Diesel STP Sump.
F. In-Tank Guaging I SIR Equipment: [x] Check this box if tank guaging is used only for inventory control.
D Check this box if tank guaging or SIR equipment is installed.
This section must be completed if in-tank guaging equipment is used to perform leak detection monitoring.
Complete the following checklist·
~Yes D No* Has all input wiring been inspected for proper enter and termination,including testing for ground faults?
-x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
X Yes No* Was accuracy of system product level readings tested?
X Yes No* Was accuracy of system water level readings tested?
X Yes No* Were all probes reinstalled properly? -~Yes D 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): D Check this box ifLLD's are not installed.
c he foil heckr ---·
[x] Yes DNo* For equip. start-up or annual equipment certification, was a leak simulated to varify LLD performance?
(Check all that apply) Simulated leak rate: ~3 g.p.h.: Do.I g.p.h.; D0.2 g.p.h.;
-.... ~Yes D No* Were all LLD's confinned operational and accurate within regulatory requinnents?
ixJ Yes No* Was lhe testing apparatus properly calibrated?
~Yes No* For machamcal LLD's, docs lhe LLD restrict product flow if it detects a leak? ~ N/A
DYes No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? !:-: [x] N/A
DYes L.....J No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is
[x] N/A disabled or discormected?
DYes '=--=JNo* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system
~N/A malfunction or fails a test?
DYes DNo* For electronic LLD's, have all accessible wiring connections been visually inspected?
llxJ Yes
~NIA
No Were all items on the equipment manufacturer's maintenance checklist completed?
*In the section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments: I replaced both the Regualr 87 North and Regular 87 South FXIV Leak Detectors as original
Leak Detectors were unable to detect a leak of3 GPH@ 10 PSI. After they were replaced they were re-tested and
confirmed operational.
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SWRCB. January 2006
Spill Bucket Testing Report Form
This fonn is intendedforuse by contractors pe1jonning annual testing of UST spill containment structures. The completedfonn and
printows.from tests (if applicable), should be provided to the facility ownerloperatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: Shell T Date of Testing: 8/13/2013
Facility Address: 4700 Coffee Road, Bakersfield. CA 93308
Facility Contact: Matt Jeffries I Phone: 661-496-7006
Date Local Agency Was Notified of Testing: 7/29/2013
Name of Local Agency Inspector (if present during tesling): Ester Duran
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services. Inc.
Technician Conducting Test: Kristopher Karns
Credentials1: 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 Vacuum r1 Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
IdentifY Spill Bucket (By Tank 1 Regular (North) 2 Regular (South) 3 Super 4 Diesel
Number, Stored Product. elc.}
Bucket Installation Type: r Direct Bury I I Direct Bury Direct Bury =: Direct Bury
X Contained in Sump X Contained in Sump X Contained in Sump X Contained in Sum__g_
Bucket Diameter: 12.00" 12.00" 12.00" 12.00"
Bucket Depth: 12.50" 13.00" 13.50" 13.00"
Wait time between applying 5 min. 5 min. 5 min. 5 min. vacuum/water and start of test:
Test Start Time (T1): 12:00 PM !2:00PM 12:00 PM 12:00 PM
Initial Reading(~): 11.00" 11.50" 10.75" 11.75"
Test End Time (TF): 1:00PM 1:00PM 1:00PM 1:00PM
Final Reading(~): 11.00" 11.50" 10.75" 11.75"
Test Duration (T F-T1): I hour I hour I hour I hour
Change in Reading (~-R1): 0.00" 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" 0.0625" Criteria:
Test Result: X Pass 0 Fail X Pass OFail X Pass 0 Fail X Pass OFail
Comments -(include il!{omwtion on repairs made prior to testing, and recommendedfollow-up forfailed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
1 hereby certify that all the information contained in this report is true, accurate, all{/ in full compliance with legal requirements.
Technician's Signature: hAs~ Date: 8/13/2013
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
1= Veeder Root TLS 350
2= Emergency Shut Off Switch
3= Veeder Root ATG Probe
4= Veeder Root 208 Sump Sensor
5= Veeder Root 420 Annular Sensor
6= Veeder Root 420 D1spenser Sen.
7= Red Jacket FX1V LLD
8= Red Jacket FX 1 DV L LD
9= 10000 Gallon Regular North STP
10= 10000 Gallon Reg South
STP11 = 10000 Gar! on Super STP
12= 10000 Gallon Diesel STP
13= Regular North Fill Sump
14= Regular South FUI Sump
15= Super Fill Sump
16= Diesel Fill Sump
2
@ (})
4
@
SheJ
4700 Coffee Road
Bakersfield,CA 93308
l3J
6
~
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8
Name:
Street
City:
Terms:
~fiDE'+. CJo c:-~ ~~Sl~
)-lfuc'f\0
'"8UILD Willi CONHOt·~·
Lic.970703
~fiDE'+.
CJo ~ ~UST(J. "'t,CES•~
~ WITHCONAOENCC'
lie. 804904
Toll Free#: 1-800-339-9930
Confidence UST
16250 Meacham Road
Bakersfield CA 93314
fnf"A.JI7MIN? "'M. I
Descriotion of work oerformed:
-/ .f)rJl) /b IL ~'lf,;.-r ~?=I-f
Job Order /Invoice #: 3 ( I .58
OatoC<llled lime
8/t3/13 ;) . ~3D p,v....
Site Name: ~t-IE tL -\£1 ·A.'t".
Street uico c~;::rn:; w
City: '&Af~~~ <C.~ II'-, State: C ,£) . Ztp:
Store No:
~ t=l?::tl~ rxt</ 1~.;~
l'v ~~) /C£.c I"' bl n!' .~~v~•t.. < ./Ad. }) 7c ~ ~ 1C ~ /.c.,.;c <!' k-rc~ e._a4M7C
'Ti-ll JU/f:.td ·~=~IV' 1 ~ 1A Crtc t-F 7i:d~/') f. Cc~ -.r:~,.___ r /\ t:.J:Jr /?A._ .;."A/~ / .
"'/ A I <:;-u" Q ._,..__,. JC >-> lj :') h-A ( ( nil. ) c.-·;::' ''-.A-'1Z ./2_ 1';::7,-{.. "'-"' iJ/J;'.V I
.::::'7 0 ~ -' tA.A:7 .
( I I' I F y:::::· Ll. ~ -
'/ C"Tt='tc-t:rl6~f-??~--CJJ'?tj
TRAVEL and LABOR (0.5 Hour Mtnimum Labor Chargo) OVERTIME (5:00 PM ·7:00AM)
Date I Technician(s) Name Start End Total OTStart OTEnd OTTotal
IG/;~/t?l -t:. t;' .r:: ,.,.. .<" Travel
Labor (K,._"i,A ,.
Travel (
Date I Technlcian(s) Name Start End Total OT Start OTEnd Ol'Total
I Travel
Labor
Travel
Date I Technlcian(s) Name Start End Total OT Start OTEnd OTTotal
I Travel
Labor
Travel
SUPPLIES -MATERIALS -RENTALS Check One
oty. I UST Parts Site Parts
COMMENTS
Oalo
SITE -CANARY