HomeMy WebLinkAbout#721 FMC RESULTS 7-9-13MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of California
Authority Cited: Chapter 6. 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations
This 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 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 USTsystcms within 30 days of test date.
A. General Information
Facility Name: #7721 Fastrip #22 (North) Bldg. No.: ____ _
Site Address: 4013 South H Street City: Bakersfield Zip: _9_33_0_4 __ _
Facility Contact Person: Omero Garcia Contact Phone No.: (661) 393-7000
Make/Model ofMonitoring System: Veeder-Root TLS-350 Date ofTesting/Servicing: 7/9/2013
B. Inventory of Equipment Tested/Certified
-.. ~~·· •··~ <IIJI" UJJ. ••••~ --"~" "" """""~-·~" ·~~···-~'1-• .... -... """" .__, __ ,,_, ·----·
Tank 10: 12000 gal. Regular Tank 10: 12000 gal. Super
1:8:J In-Tank Gauging Probe. Model: 847390-107 1:8:J In-Tank Gauging Probe. Model: 847390-107
1:8:J Annular Space or Vault Sensor. Model: 794390-420 1:8:J Annular Space or Vault Sensor. Model: 794390-420
1:8:J Piping Sump I Trench Scnsor(s). Model: 794380-208 1:8:J Piping Sump I Trench Sensor(s). Model: 794380-208
0 Fill Sump Sensor(s). Model: 0 Fill Sump Scnsor(s). Model
1:8:J Mechanical Line Leak Detector. Model: FX1V 1:8:J Mechanical Line Leak Detector. Model: VMI L TO 2000
0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
1:8:J Tank Overfill/ High-Level Sensor. Model: 847390-107 1:8:J Tank Overfill/ High-Level Sensor. Model: 847390-107
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 ID: 12000 gal. Diesel Tank ID:
1:8:J In-Tank Gauging Probe. Model: 847390-107 0 In-Tank Gauging Probe. Model:
1:8:J Annular Space or Vault Sensor. Model: 794390-420 0 Annular Space or Vault Sensor. Model:
1:8:J Piping Sump I Trench Sensor(s). Model: 794380-208 0 Piping Sump I Trench Scnsor(s). Model:
0 Fill Sump Scnsor(s). Model: 0 Fill Sump Sensor(s). Model:
1:8:J Mechanical Line Leak Detector. Model: FX1 DV 0 Mechanical Line Leak Detector. Model:
0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
1:8:J Tank Overfill I High-Level Sensor. Model: 847390-107 0 Tank Overfill/ High-Level 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).
Dispenser ID: 9 & 10 Dispenser ID: 11 & 12
1:8:J Dispenser Containment Scnsor(s). Model: 794380-208 1:8:J Dispenser Containment Sensor(s). Model: 794380-208
1:8:J Shear Valve(s). 1:8:J Shear Valve(s). 0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 13 & 14 Dispenser ID: 15 & 16
l:8:l Dispenser Containment Sensor(s). Model: 794380-208 1:8:J Dispenser Containment Sensor(s). Model: 794380-208
1:8:J Shear Valve(s). 1:8:J Shear Valve(s).
0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 17 & 18 Dispenser ID: 19 & 20
1:8:J Dispenser Containment Scnsor(s). Model: 794380-208 1:8:J Dispenser Containment Sensor(s). Model: 794380-208
1:8:J Shear Valve(s). 1:8:J 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 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 alit/tat apply): ~ System set-up ~ Aprm history report
Teclmician Name (print): -=B:..:.ryLa=.:n:..:....:..A.:....S.;;;:.-=.el:..:..f _______ _
Certification No.: B34106 --~--------------
Signature: r (/ f • I /F v• '
License. No.: ....:8::..:0:.:4:..:::9'L.Pf:::::....... ____ v _______ _
Testing Company Name: Confidence UST Services, Inc. Phone No.: (800) 339-9930
Site Address: 4013 South H Street, Bakersfield, CA 93304 Date ofTesting/Servicing: 7/17/2013
Page 1 of 3
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed: 327.04 ~~~---------------------------
c fl ------------UIIV ~y Ill" '-'11'-''-'RII~&..
f8l Yes 0 No* Is the audible alarm operational?
f8l Yes 0 No* Is the visual alarm operational?
f8l Yes 0 No* Were all sensors visually inspected, functionally tested. and confirmed operational?
f8l 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 alanns are relayed to a remote monitoring station, is all communications equipment (e.g., modem)
f8l N/A operational?
f8l Yes 0 No* For pressurized piping systems, does the turbine automatically shut down if the 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-down? (Check all that apply) f8l Sump/Trench Sensors; [8) Dispenser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? f8l Yes; 0 No.
f8l 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 oftank capacity does the alarm trigger? 90%
f8l 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* f8l No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
0 Product; 0 Water. If yes, describe causes in Section E, below.
f8l Yes 0 No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable
f8l Yes 0 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 replaced the LLD (FX1V) on the 91 grade.
Page 2 of 3
Monitoring System Certification
F. In-Tank Gauging I SIR Equipment: 181 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 perform leak detection monitoring.
Complete the following checklist:
181 Yes 0 No* Has all input wiring been inspected for proper entry and tennination, including testing for ground faults?
181 Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup?
181 Yes 0 No* Was accuracy of system product level readings tested?
181 Yes 0 No* Was accuracy of system water level readings tested?
181 Yes 0 No* Were all probes reinstalled properly?
181 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 if LLDs are not installed.
c he foil heckf
181 Yes 0 No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD perfonnance?
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.
0 Yes 181 No* Were all LLDs confirmed operational and accurate within regulatory requirements?
181 Yes 0 No* Was the testing apparatus properly calibrated?
181 Yes 0 No* For mechanical LLDs, does the LLD restrict product flow 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?
181 N/A
0 Yes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion of the m.:mitoring system is disabled
181 N/A or disconnected?
0 Yes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions
181 N/A or fails a test?
0 Yes 0 No* For electronic LLDs, have all accessible wiring connections been visually inspected?
181 N/A
181 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: eak of 3 GPH at 10 PSI The red jacket FX1VLLO was replaced aoo
confirmed operational
Page 3 of 3
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SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by comractors pe1jorming annual testing of UST spill containment structures. The completed form and
printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to lite local regulatOJy agency.
1. FACILITY INFORMATION
Facility Name: #7721 Fastrip #22 I Date of Testing: 7/17/2013
Facility Address: 40 13 South H Street, Bakersfield, CA 93304
Facility Contact: Omcro Garcia I Phone: 661-393-7000
Date Local Agency Was Notified of Testing: 6117/2013
Name of Local Agency Inspector (if present during testing): Ernie Medania
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bryan A Self
Credentials': IEl CSLB Contractor IE] ICC Service Tech. IE] SWRCB Tank Tester w Other (Specifj~
License Number(s): CSLB #804904 ICC #8022804-UT Tank.Tester# 11-1756
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: IE] 11ydrostatic [)Vacuum 0 Other
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 Direct Bury
IEl Contained in Sumo IE] Contained in Sump !EJContained in Sump Contained in Sump
Bucket Diameter: 12.00" 12.00" 12.00''
Bucket Depth: 14.25'' 14.00" 14.50"
Wait time between applying 5 min. 5 min. 5 min. vacuum/water and start of test:
Test Start Time (T1): 9:00am 9:00am 9:00am
Initial Reading (R1): 13.25" 13.00" 13.25"
Test End Time (Tr): 10:00 am 10:00 am 10:00 am
Final Reading (Rr): 13.25" 13.00" 13.25"
Test Duration (T r-T1): I Hour I Hour I Hour
Change in Reading (Rr-R1): 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" Criteria: 0.0625" 0.0625"
Test Result: IEl Pass 0 Fail IE] Pass OFail IEl Pass OFail 0 Pass 0 Fail
Comments-(include if?formation on repairs made prior to testing, and recommendedfollow-up.for.failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true, accurate, lnd in full compliance with legal requirements.
Technician's Signature:-~
1 State laws and regulations do not curren
may be more stringent.
Date: 7117/2013
qualified contractor. However, local requirements
I
SITE PLOT PLAN for:
015-021-03022
#721/#781 FASTRIP #22
4013 SO. "H" STREET
BAKERSFIELD, CA 93304
03/01/2012
3 • 12,000 GALLON
USTs J
0 '-
1 z,
#721
1 7
·t5 l 0 II tr_J
0 "\IRCUIT
BREAKER
OF\~---,
WHilE LANI!
·lD
USTs
--
ESO
LEGEND
ESO EMERGENCY SHUT-oFF
OFA OVERFILL ALARM e PRODUCT SPILL CONTAINER
• VAPOR SPILL CONTAINER
® ANNULAR fD: FIRE EXnNGUISHER 0 GAS METER SHUT-QFF
• WATER METER SHUT-oFF
@ HEALYCAS * EVACUAnON MEEnNG POINT
#721"l" SENSOR SETUP:
l1 87 STP
l2 87 ANNULAR
l3 91 STP
l4 91 ANNULAR
LS DSLSTP
l6 DSL ANNULAR
l9 UDC9/10
llO UDC 11/12
lll UDC 13/14
l12 UDC 15/16
L13 UDC 17/18
l14 UDC 19/20
#781 "l" SENSOR SETUP:
L1 87·1 STP
FIRE l2 87·1 ANNULAR
HYDRANT l3 DSL STP
z
~
l4 DSL ANNULAR
l5 87·2 STP
l6 87·2 ANNULAR
l7 91STP
l8 91 ANNULAR
l9 UDC 1/2
l10 UDC7/8
l11 UDCS/6
l12 UDC3/4
U3 NO. TRANS
l14 SO. TRANS
FASTRIP -7-nl 1 .,_
JAIJIESON HILL COMPANY A·O CONVEh1ENCE \!ARKIT FOR~. SII:IT No.
t013 S. ; SlREEl
eAK£RSfi£LD. CAlltORh•A Of ~
Name:
Street:
City:
Terms:
~fiDE"+, CJo (\t" \UST;
IS' ~-~'>9uc'f\0
~fiDE""+,
CJo ~ ~UST(J. ~ ~ "IcES•
"BUILD WITH CONFIDENCE" ~~E Willi CONAOENCE"
Lie. 970703 0ic. 804904
Toll Free #: 1-800-339-9930
Confidence UST
16250 Meacham Road
Bakersfield CA 93314
Description of work performed:
L-._,/ .,In ,§ r-()/ Ct / r:-c:/.
/'/),.,) Jl"l M'*' u' ;/ :4' 'w6:
/:;-t/~--
<:;..-
/l.L//
WI' A/f, l'u//..,4
01.-(A O-f =-n~ , p):::;._
>4 Tre--e-a.~ . G.~t* . ..J ~f~'""'
TRAVEL and LABOR
Date Technician(s) Name r?
1~1?/1? !,<; 1 vo.n A--c)..( I-/' Travel
I/ (;fn ') 55?-00 1-s-Labor
Travel
1'--Date Technician(s) Name
Travel
Labor
Travel
Date Technician(s) Name
Travel
Labor
Travel
Job Order /Invoice #: 5tsq{p,S""
Date Called 11me To Whom
Site Name: -:::r1ZI FtV?t"' ·17
Street: LU;_f3__ ~~ ~~~
City: l~c-t 1/_..-?.~J:.~;cl State: rJA-Zip: qg~,V
~ Store No: ·::;:·::;-z_ j_
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s4Y1/JCAftA/ 0/,;-; ..rl. ":::f::J.& / 5: C/_,-.I
~ e+ STP £~
(0.5 Hour Minimum Labor Charge) OVERTIME (5:00 PM -7:00AM)
Start End Total OT Start OTEnd OTTotal
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Start End Total OTStart OTEnd OTTotal
Start End Total OTStart OTEnd OTTotal
SUPPLIES -MATERIALS-RENTALS Check One
Qty. UST Parts Site Parts
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COMMENTS
Store Employee Print Name:
Store Employee Signature: Date
INVOICE • WHITE