HomeMy WebLinkAboutFMC 2013MONITORING SYSTEM CERTIFICATION
For Uve By All Jurisdictions Within the State of California
Awhority Cited: Chapter 6. 7, I lealth and Stifety Code: Chapter 16. Dil'ision 3. Titie 23. Califomia 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 perlonns the work. A copy of this form must be provided to the tank system
owner/operator. The owner/operator must ~ubmit a copy of this form to the local agency regulating UST systems within 30 days of test date.
A. General Information
Facility Name: Plaza_T_o_w_e_rs _________________ ~--....,.,--....,--,-----,---Bldg. No.: ____ _
Site Address: 3015 Wilson Road City: Bakersfield, CA Zip: 93309 -----Facility Contact Person: Michael Ruiz Contact Phone No.: (661) 631-101 5
Make/Model of Monitoring System: TLS_2_0_0 _______ ~------Dare of Testing/Servicing: 8/13/2013
B. Inventory of Equipment Tested/Certified
Cl k I 'fj ICC I te appropnatc bo'c' to tndtcatc spec• 1c equipment inspcctcd/\Cr\'iccd:
Tank 10: 300 Gallon Diesel Tank 10:
0 ln-Tnnk Gnuging Prohc. Model: 0 In-Tank (iauging Probe. Model:
~ Annular Space or Vault SctL'>(lr. Model: 794390-420 0 Annular Space or Vaull Sen~or. Model:
~ l'iping Sump IT rcnch SctL-.<lr(s). Model: 794389-208 0 Piping Sump I ln:nch Scnsor(s). Model:
0 I ill Sump Scnsor(s). Model: 0 Fill Sump ~cn.wr(~). Model
0 Mechanical I inc I caJ.. Det~-ctor. Model: 0 Mechanical! inc L~'ak Detector. Model
0 I lcctmnie Line I eaJ.. Dct~-ctor. Model: 0 Electronic I inc I cak Detector. Model:
~ rank Overfill /It igh·l cvel Sensor. Model: Ftaeeer Valve 0 Tank Ovcrfill /11 igh-Lcvet Sensor. Model:
0 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: Tank 10:
0 In-lank Gauging Prnhc Model: 0 In-Tank Gauging Probe. Model:
0 Annular Space or Vault S~1L-.<lr. Model: 0 Arumlar Space or Vault Sen.-.or. Model
0 Piping Sump Tfl.'llCh s~'ll.-.or(s). Model: 0 Piping Sump I I rcnch Sensor(s). Model
0 Fill Sump Scnsor(s). Model: 0 Fill Sump Sensor(s). Model:
0 Mechanical I inc I en!.. Det\.'Ctor. Model: 0 Mechanic.1t I inc U.'ak Detector. Model:
0 Electronic Line l.cak Dct<.:ctor. Model: 0 Electronic Line I eak Detector. Model:
0 rank Ovcrfill /lligh-1 cvcl Sensor. Model: 0 Tank Overfill /II igh-Lcvcl Sensor. Model:
0 Other (specifY t.'quipmcnttype and model in Section I· on Page 2). 0 Othcr(spccify equipment type and model in Section Eon Pagc2).
Dispenser 10: Transition Sump Dispenser ID:
~ Di~pcnscr Containment S~'llSOr(s). Model: 794389-208 0 Dispenser C"ontain111t.11t Sen~r(s). Model:
0 Shear Valvc(s). 0 Shear Vatvc(s).
0 Dispenser Containment Flmll(s) and Chain(s). 0 Dispenser ( 'outnimncnl Float(s) and Chniu(s).
Dispenser 10: Dispenser 10:
0 Dt~penser Containment Sensor(~). Model: 0 Dispen . ..cr Containment Sensor(s). Model:
0 Shear Valvc(s). 0 Shear Valv<.'(!oo)
0 Dtspcnscr Containment I loot(s) and Chain(s). 0 Disperu.<.-r ( 'ont<tinmcnt float(s) and Chainh).
Dispenser 10: Dispenser 10:
0 Dispenser C"ont;1inmcnt Sensor(s). Model: 0 Dispenser Containment Scnsor(s). Model:
0 Shear Valvc(s). 0 Shear Valvl.'(s).
0 Di~perL~ Containment Hoat(s) and C"hain(s). 0 Dispenser Containment Float(s) and ( 'hain(J.).
. . . . •If the factltty con tams more tanks or dtspcnsers, copy thts form. Include mformatton for every tank and dtspcnscr at the factluy .
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, 1 have also attached a copy of the report; (check all that apply): 0 System set-up 0 Alarm history report
Technician Name Kristopher Karns Signature: ~ :h, d .. ,
Certification No.: B34106 License. No.: 804904 ------
Testing Company Name: Confidence U~S=-T:.........:S~e.:.rv.:.i:...:c~e~s_l.:.n:...:c:..._. --------Phone No.: (800) 339-9930
Site Address: 3015 Wilson Road, Bakersfield, CA 93309 Date ofTesting/Servicing: 8/13/201_3 __
Page 1 of 3
Jnitoring System Certification
D. Results of Testing/Servicing
Software Version Installed: ----------------------------------
c omplete the ollowing checklist:
[8J Yes D No* Is the audible alarm operational?
[8J Yes D No* Is the visual alarm operational?
[8J Yes D No* Were all sensors visual ly inspected, functionally tested, and confmned operational?
[8J Yes D 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 D No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem)
[8J N/A operational?
DYes D No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
[8J N/A monitoring system detects a leak, fails to operate, or is electrically discormected? If yes: which sensors initiate
positive shut-down? (Check all that apply) D Sump/Trench Sensors; D Dispenser Containment Sensors.
Did you confmn positive shut-down due to leaks and sensor failure/disconnection? DYes; D No.
DYes D No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no
[8J 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? -61%
DYes* [8J No Was any monitoring equipment replaced? If yes, identifY specific sensors, probes, or o·ther equipment replaced
and list the manufacturer name and model for all replacement parts in Section E, below.
DYes* [8J No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
D Product; D Water. If yes, describe causes in Section E, below.
[8J Yes D No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable
[8J 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: This site doesn't have positive shut down, because the tank is for a generator that has a suction system.
Page 2 of 3
Monitoring System Certification
F. In-Tank Gauging I SIR Equipment: 0 Check this box if tank gauging is used only for inventory control.
181 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:
0 Yes 0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
0 Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup?
0 Yes 0 No* Was accuracy of system product level readings tested?
0 Yes 0 No* Was accuracy of system water level readings tested?
0 Yes 0 No* Were all probes reinstalled properly?
0 Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed?
,. In the Section H, below, descnbe how and when these defic1enctes were or will be corrected.
G. Line Leak Detectors (LLD): 181 Check th is box if LLDs are not installed.
c h fi II h kf omp1ete t e o owm2 c ec · 1st:
0 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: 0 3 g.p.h.; 0 0.1 g.p.h : 0 0.2 g.p.h.
0 Yes 0 No* Were all LLDs confim1ed operational and accurate within regulatory requirements?
0 Yes 0 No* Was the testing apparatus properly calibrated?
0 Yes 0 No* For mechanical LLDs, does the LLD restrict product now if it detects a leak?
0 N/A
0 Yes 0 No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
0 N/A
0 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?
0 Yes 0 No* For electronic LLDs, does the n1rbine automatically shut off if any portion of the monitoring system malfunctions
0 N/A or fails a test?
0 Yes 0 No* For electronic LLDs, have all accessible wiring connections been visually inspected?
0 N/A
0 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: .::J:Aere~re no leak-4etect~alled-as-tAere-is-Ao turbine pump, cmly-a-suctiQA-SYSte:j.i.m------
Page 3 of 3
SWRCB, January 2006
Spill Bucket Testing Report Form
Thisfonn is intended for use by contractors pelforming annual testing ofUSTspill containment structures. 1'l1e completed form and
printoutsfrom tests (if applicable), should be provided to thefacility ownedoperatorfor submittal to the local regulat01y agency.
1 FACILITY INFORMATION
Facility Name: Plaza Towers I Date ofTesting: 8113/2013
Facility Address: 3015 Wilson Road, Bakersfield, CA 93309
Facility Contact: Michael Ruiz I Phone: 661-631-101 5
Date Local Agency Was Notified of Testing : 6/25/2013
Name of Local Agency Inspector (if present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials1: 181 CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester 0 Other (Spec{fy)
License Numbcr(s): CSLB# 804904 ICC# 5264406-UT SWRCB# 09-1743
3. SPILL BUCKET T ESTING INFORMATION
Test Method Used: 181 Hydrostatic fl Vacuum n Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identi f)r Spill Bucket (By Tank 1 Diesel 2 3 4
Number, Stored Product, etc.)
Bucket Installation Type: X Direct Bury U Direct Bury 0 Direct Bury 0 Direct Bury
0 Contained in Sump 0 Contained in Sump n Contained in Sump n Contained in Sump
Bucket Diameter: 12.00"
Bucket Depth: 10.25"
Wait time between applying 5 Min vacuum/water and start of test:
Test Start Time (T1): 9:1 5AM
Initial Reading (R1): 9.75"
Test End Time (TF): I 0:15AM
Final Reading (RF): 6.75"
Test Duration (TF TJ): I Hour
Change in Reading (RF-R1): 3.00"
Pass/Fail Threshold or 0.0625" Criteria:
Test Result: 0 Pass X Fail 0 Pass 0 Fail 0 Pass OFail 0 Pass 0 Fail
Comments-(include information on repairs made prior to testing, and recommendedfollow-upforfailed test!.}
The Direct Burial Emco Weaton Spill Bucket Failed and needs to be replaced with a Phil Tite Spill Bucket.
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained i11 this report is true, accurate, anti in.fi1ll complia11ce with legal requirements.
Technician's Signature: _______ J=Jic,.A.LA.4.6-a_.t::.~F::s.===-=:...:.._-----Date: 8/13/20 13
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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