HomeMy WebLinkAbout2013 RESULTSMONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Wilhin the Stale ofCal{fornia
Authority Cited: Chap1er 6. 7, Healtlr and Safety Code; Chapter 16, Division 3, Title 23, Cal{fornia Code of Regulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or rcpot1 must be prepared for each
monitoring system control panel by the technician who performs 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 form to the local agency regulating UST systems within 30 days of test date.
A. General Information
Facility Name: #3360 Farrell's Fastrip Bldg. No.: ____ _
Site Address: 6401 White Lane City: Bakersfield, CA Zip: .::...93.::...3:....:0c...::.9 __ _
Facility Contact Person: Omero Garcia Contact Phone No.: (661) 393-7000
Make/Model ofMonitoring System: Veeder-Root TLS 350 Date ofTesting/Servicing: 8/14/2013
B. Inventory of Equipment Tested/Certified
c b ·r. -~-·· -------~-------------~-----------~ -·-dlscrviccd
Tank 10: 12,000 gal. Regular Tank 10: 12,000 gal. Su~er
~ In-Tank Gauging Probe. Model: 847390-107 ~ In-Tank Gauging Probe. Model: 847390-107
~ Annular Space or Vault Sensor. Model: 794380-303 ~ Annular Space or Vault Sensor. Model: 794380-303
~ Piping Sump I Trench Sensor1s). Model: 794380-208 ~Piping Sump/Trench Scnsor(s). Model: 794380-208
~ Fill Sump Scnsor1s). Model: 794380-208 ~ Fill Sump Sensor1s). Model: 794380-208
~ Mechanical Line Leak Detector. Model: FX-1V ~ Mechanical Line Leak Detector. Model: FX-1V
0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
1:81 Tank Overfill/ H igh-Lcvel Sensor. Model: 847390-107 1:81 Tank Overfill/ H igh-Lcvel Sensor. Model: 847390-107
D Other (specifY equipment type and model in Section Eon Page 2). 0 Other (specifY equipment type and model in Section Eon Page 2).
Tank 10: 12,000 gal. Diesel Tank 10:
~ In-Tank Gauging Probe. Model: 847390-107 0 In-Tank Gauging Probe. Model:
~ Annular Space or Vault Sensor. Model: 794380-303 0 Annular Space or Vault Sensor. Model:
~ Piping Sump I Trench Sensor1s). Model: 794380-208 0 Piping Sump I Trench Scnsor1s). Model:
~ Fill Sump Sensor1s). Model: 794380-208 0 Fill Sump Sensor1s). Model:
l8l Mechanical Line Leak Detector. Model: FX-1DV 0 Mechanical Line Leak Detector. Model:
0 Electronic Line Leak Detector. Model: D Electronic Line Leak Detector. Model:
~ Tank Overfill/ High-Level Sensor. Model: 847390-107 0 Tank Overfill I High-Level Sensor. Model:
D Other (specifY equipment type and model in Section Eon Page 2). D Other (specifY equipment type and model in Section Eon Page 2).
Dispenser 10: 1&2 Dispenser 10: 3 & 4
~ Dispenser Containment Sensor1s). Model: 794380-208 ~ Dispenser Containment Scnsor1s). Model: 794380-208
~ Shear Valve(s). ~ Shear Valvc(s).
D Disp<..'llser Containment Float(s) and Chain(s). 0 Disperlwr Containment Float(s) and Chain(s).
Dispenser 10: 5 & 6 Dispenser 10: 7 & 8
~ Dispenser Containment Sensor(s). Model: 794380-208 ~ Dispenser Containment Sensor1s). Model: 794380-208
~ Shear Valvc(s). ~ Shear Valve(s).
0 Dispenser Containment Float(s) and Chain(s). D Dispenser Containment Float(s) and Chain(s).
Dispenser 10: Dispenser 10:
D Dispenser Containment Sensor(s). Model: D Dispenser Containment Scnsor1s). Model:
D Shear Valve(s). D Shear Valvc(s).
D Dispenser Containment Float(s) and Chain(s). D Dispenser Containment Float(s) and Chain(s).
*lfthc 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 apply): I:8J System set-up I:8J Alarm history report
Technician Name Kristogher Karns Signature: ~ t~
Certification No.: =B:..:3:....:4~1..::0..::6 ____________ _ License. No.: 804904 ------------------------------Testing Company Name: Confidence UST Services Phone No.: (800) 339-9930
Site Address: 6401 White Lane, Bakersfield, CA 93309 Date ofTesting/Servicing: 8/14/2013
Page 1 of 3
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed: _.::::3.::3..:.1:.:.0:...:1 _____________ _
c he foll kr .........
181 Yes D No* Is the audible alarm operational?
1:81 y cs D No* Is the visual alarm operational?
181 Yes 0 No* Were all sensors visually inspected, functionally tested, and confirmed operational?
181 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?
DYes 0 No* If alarms arc relayed to a remote monitoring station, is all communications equipment (e.g., modem)
181 N/A operational?
181 Yes D No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
D N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check all that apply) 181 Sumpffrench Sensors; 181 Dispenser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? 181 Yes; D No.
181 Yes D No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no
D 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.
181 Yes* D No Was liquid found inside any secondary containment systems designed as dry systems? (Check all thai apply)
D Product; 181 Water. If yes, describe causes in Section E, below.
181 Yes D No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable
181 Yes D 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 removed 1/4 Gallon of water from the Regular Fill Sump, and also removed small amounts of water
from all three STP Sump.
Page 2 of 3
Monitoring System Certification
F. In-Tank Gauging I SIR Equipment: 1.81 Check this box if tank gauging is used only for inventory control.
D Check this box if no tank gauging or SIR equipment is installed.
This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring.
Complete the following checklist:
--
1.81 Yes D No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
1.81 Yes D No* Were all tank gauging probes visually inspected for damage and residue buildup?
1.81 Yes 0 No* Was accuracy of system product level readings tested?
1.81 Yes D No* Was accuracy of system water level readings tested?
1.81 Yes D No* Were all probes reinstalled properly?
1.81 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 ifLLDs are not installed.
c he foil heckf
1.81 Yes D No* For equipment start-up or annual equipment certification, was a leak simulated to verifY LLD performance?
D N/A (Check all that apply) Simulated leak rate: 1.81 3 g.p.h.; D 0.1 g.p.h ; D 0.2 g.p.h.
1:81 Yes D No* Were all LLDs confirmed operational and accurate within regulatory requirements?
1.81 Yes D No* Was the testing apparatus properly calibrated?
1.81 Yes 0 No* For mechanical LLDs, docs the LLD restrict product flow if it detects a leak?
0 N/A
0 Yes D No* For electronic LLDs, does the turbine automatically shut offifthc LLD detects a leak?
1.81 N/A
DYes D No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
1:81 N/A or disconnected?
DYes D No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system
1.81 N/A malfunctions or fuils a test?
DYes D No* For electronic LLDs, have all accessible wiring connections been visually inspected?
1.81 N/A
1.81 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.
H. Comments:
Page 3 of 3
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SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intendedfor use by contractors pe!forming annual testing of UST spill containment structures. The completed finm and
printouts from tests ({f applicable), should be provided 10 the facility ownerloperator.for submillallo I he local regulat01y agency.
1. FACILITY INFORMATION
Facility Name: #3360 Farrell's Fa strip I Date of Testing: 8/14/2013
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 ({{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 0 Olher (Specify)
License Number(s): CSLB #804904 ICC #5264406-UT SWRCB# 09-1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic 0 Vacuum 0 Olher
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (By Tank l Regular 2 Super 3 Diesel 4
Number, Stored Product, etc.)
Bucket Installation Type: 0 Direct Bury 0 Direct Bury 0 Direct Bury 0 Direct Bury
129 Contained in Sump 129 Contained in Sump 129Contained in Sump 0 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. 5 min. vacuum/water and start of test:
Test Start Time (T1): 1:15PM 1:15PM 1:15PM
Initial Reading (R1): 10.75" 1 0.50" 10.75"
Test End Time (TF): 2:15PM 2:15PM 2:15PM
Final Reading (~:): 10.75" 10.50" 10.75"
Test Duration (T F-T1): I hour I hour I hour
Change in Reading (RF-R1): 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" Criteria:
Test Result: 181 Pass OFail 181 Pass OFail 181 Pass OFail 0 Pass OFail
Comments -(include information on repairs made prior to tesling, and recommended.follow-up .forfailed tests)
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.
Teclmician 's Signature: {1 ~ -k ~ Date: 8/15/2013
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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L1 87 STP
L2 87 ANNULAR
L3 87 FILL
L4 91 STP
L5 91 ANNULAR
L6 91 FILL
L7 DSLSTP
L8 DSLFILL
L10 UDC 1·2
L11 UDC 3 ·4
L12 UDC5·6
L13 UDC7·8
L 16 DSL ANNULAR
W.S WATER SHUT-OFF @I STREET
W·B WATER SHUT-OFF @I BLDG
F FILL
V VAPOR
PN PRESSURENACUUM VENTS
H HEALY CAS
TLS VEEDER·ROOT MONITOR
ESO EMERGENCY SHUT .OFF
•
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GAS SHUT.OFFIMElER BANK ..,..
FIRE
SITE PLOT PLAN for:
#360 FARREll'S FASTRIP
6401 White lane
Bakersfield, CA 93309
(661) 397..0271