HomeMy WebLinkAbout#781 FMC RESULTS 7-17-13MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of California
Authority Cited: Chapter 6. 7, Health and Safety Code; Chapter 16, D;vision 3, Tille 23, California 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 S\Stem control panel by the technician \\hO performs the work. A copy of this form must be provided to the tank system owner/operator.
The owner/operator must submit a cop) of this form to the local agency regulating UST systems within 30 days of test date.
A. General Information
Facility Name: #7781 Fastrip #22 (South) Bldg. No.: ___ _
Site Address: 4013 South H Street City: Bakersfield 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: 7/9/2013
B. Inventory of Equipment Tested/Certified
'-.,11\:f.;t\ Ill\: l1. I II U II lUI\: UV-'\:.;) IV IIIUI\..iU\:., J\:\..1111.. Cl.IUI 1111\.:.lll Ill.;) n.A.l'"-U.f.:U..I l'1'-1o.U•
Tank 10: 12000 gal. Regular 1 Tank 10: 12000 gal. Regular 2
18]In-Tank Gaugmg Probe. Model: 847390-107 (8Jin-Tank Gauging Probe. Model: 847390-107
18] Annular Space or Vault Sensor. Model: 794390-420 18] Annular Space or Vault Sensor Model: 794390-420
18] Piping Sump I Trench Sensor(s). Model: 794380-208 18] Piping Sump I Trench Sensor(s). Model: 794380-208
0 Fill Sump Scnsor(s). Model: D Fill Sump Sensor(s). Model:
18] Mechanical Line Leak Detector. Model: FX1V D Mechanical Line Leak Detector. Model: N/A
D Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
l8l Tank Overfill/lligh-Levcl Sensor. Model: 847390-107 l8l Tank Overfill/ High-Level Sensor. Model: 847390-107
D Other (specify equipment type and model in Section Eon Page 2). D Other (specify equipment type and model in Section F on Page 2).
Tank 10: 12000 gal. Su~er Tank 10: 12000 gal. Diesel
18]In-Tank Gauging Probe. Model: 847390-107 (8Jin-Tank Gauging Probe. Model: 847390-107
18] Annular Space or Vault Sensor. Model: 794390-420 l8l Annular Space or Vault Sensor. Model: 794390-420
l8l Piping Sump I Trench Sensor(s). Model: 794380-208 l8l Piping Sump I Trench Scnsor(s). Model: 794380-208
0 Fill Sump Scnsor(s). Model: 0 Fill Sump Sensor(s). Model:
18] Mechanical Line Leak Detector. Model: FX1V 18] Mechanical Line Leak Detector. Model: FX1 DV
0 Elcctromc Lme Leak Detector. Model: 0 Hectronic Line Leak Detector Model:
l8l Tank Overfill I lligh-Le\'el Sensor. Model: 847390-107 l8l Tank Overfill/ High-Le\'el Sensor. Model: 847390-107
D Other (spec1fy equipmemtype and model in Section Eon Page 2). 0 Other (spccif)• equipment t)pc and model in Section l on Page 2).
Dispenser 10: 1&2 Dispenser 10: 3&4
18] Dispenser Containment Sensor(s). Model: 794380-208 l8l Dispenser Containment Scnsor(s). Model: 794380-208
18] Shear Valvc(s). l8l Shear Valve(s).
0 Dispenser Containmem Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser 10: 5 & 6 Dispenser ID: 7&8
18] Dispenser Containment Sensor(s). Model: 794380-208 18] Dispenser Comainmem Scnsor(s). Model: 794380-208
l8l Shear Valve(s). 18] Shear Valve(s).
D Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser 10: Dispenser 10:
0 Dispenser Containment Sensor(s). Model: D Dispenser Containment Sensor(s). Model:
0 Shear Valve(s). D Shear Valvc(s).
D Dispenser Containmem Float(s) and Chain(s). 0 01spenscr Comainment 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 -1 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): [g) System set-up [g) Alarm history report
Technician Name (print): -=:B..:..ryLa::.:n..:...:..:A:..:S::..:e:.:.lf-=---------
Certiftcation No.: B34106 ~~.::._.::._ ____________ _
Testing Company Name: Confidence UST Services, Inc.
Site Address: 4013 South H Street, Bakersfield, CA 93304
Page 1
Signatuce: ~ zr 1¥=
License. No.:So44 V
Phone No.: (800) 339-9930
Date ofTesting/Servicing: 7/17/2013
of 3
'
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed: .....::.;33::.:3:.:·.::.:02=--------------
c tete the foil heck list
181 Yes 0 No* Is the audible alann operational?
181 Yes 0 No* Is the visual alann 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 c;o 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)
181 N/A operational?
181 Yes 0 No* For pressurized piping systems, docs 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
I positive shut-down? (Check all that apply) 181 Sump/Trench Sensors; 181 Dispenser Containment Sensors.
Did you conftrm positive shut-down due to leaks and sensor failure/disconnection? 181 Yes: 0 No.
181 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%
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 pans in Section E, below.
0 Yes* 181 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.
181 Yes 0 No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports. if applicable
181 Yes 0 No* Is all monitoring equipment operational per_111anufacturer's specifications?
* In Section E below, describe how and when these deficiencies were or will be corrected.
E. Comments:
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 termination, 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 D No* Was accuracy of system water level readings tested?
181 Yes D 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, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): 0 Check this box ifLLDs are not installed.
c ---he foil -heckl' ~ -~ --·-........
181 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?
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
DYes D No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
181 N/A or disconnected?
0 Yes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion ofthe monitoring system malfunctions
181 N/A or fails a test?
0 Yes D 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:
Page 3 of 3
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SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors 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 submillallo tf:e local regulatory agency.
1. FACILITY INFORMATION
Facility Name: #7781 Fastrip #22 (South) I Date of Testing: 7/17/2013
Facility Address: 40I3 South H Street, Bakersfield, CA 93304
Facility Contact: Omero Garcia I Phone: 661-393-7000
Date Local Agency Was Notified of Testing: 6/17/2013
Name of Local Agency Inspector (if present during 1es1ing): Ernie Mednia
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Jnc.
Technician Conducting Test: Bryan A Self
Credentials 1: 129 CSLB Contractor 129 ICC Service Tech. 129 SWRCB Tank Tester 0 Other (Specijj)
License Number(s): CSLB #804904 ICC #802280-UT Tank Tester# 11-1756
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: 129 Hydrostatic 0 Vacuum 0 Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (By Tank 1 Regular I 2 Regular 2 3 Super 4 Diesel
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 129Contained in Sump
Bucket Diameter: I2.00" I2.00" 12.00" 12.00"
Bucket Depth: 14.00" 13.75" I4.00" 14.50"
Wait time between applying 5 min. 5 min. 5 min. 5 min. vacuum/water and start of test:
Test Start Time (T1): 11:00 am II:OO am 11:00 am II:OO am
initial Reading (RI): 13.00" 12.25" 13.00" I3.25"
Test End Time (TF): 12:00 pm I2:00 am 12:00 am 12:00 am
Final Reading (RF): 13.00" 12.25" 13.00" I3.25"
Test Duration (T F-T1): l hour I hour I hour 1 hour
Change in Reading (RF-R1): 0.00" 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" 0.0625" Criteria:
Test Result: 129 Pass OFail 129 Pass OFail 129 Pass Fail 129 Pass OFail
Comments-(include information on repairs made prior to testing, and recommended follow-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, and in full compliance with legal requirements.
Technician's Signature: '#;c:;LL~ I./ ;z-r-: ,=-\ t4/l Date: 7117/20 13
1 State laws and regulations do not curr6ntly require testing tooe performed by a qualified contractor. However, local requirements
may be more stringent.
'
SITE PLOT PLAN for:
015·021·03022
#721/#781 FASTRIP #22
4013 SO. "H" STREET
BAKERSFIELD, CA 93304
03/01/2012
•Ui j 1r 1
0 L~lr--~ #721 I "<SO
""
l4 @ll5 9; ---.1r~ lnl II lu7
.t&
0
\ ~
'!= It-J
~RCUIT
BREAK£R
---
-
.............
.
#781
WHITB &.ANI
46
~ ll LS l7 l3
I II II II I I I I~ 87·11187~21191 II D~l ! 1~11~11~11~1 ~:~-u '-'\'-'7~ CH 4·12, GAL ~IN _
,-I
LEGEND
ESO EMERGENCY SHUT-OFF
OFA OVERFILL ALARM
8 PRODUCT SPILL CONTAINER
• VAPOR SPILL CONTAINER ® ANNULAR fO: FIRE EXTINGUISHER
G GAS METER SHUT-OFF
• WATER METER SHUT-OFF
@ HEALYCAS * EVACUATION MEETING 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 DSLSTP
z
i •
L4 DSL ANNULAR
L5 87-2 STP
L6 87-2 ANNULAR
L7 91STP
L8 91 ANNULAR
L9 UDC 1/2
LlO UDC7/8
L11 UDCS/6
L12 UDC3/4
L13 NO. TRANS
L14 SO. TRANS
1/111 A r "V=-JY A.e.r.i ~o~-~~-~~-oo-~ I DATE II£VISICIIS
-. "--· ~ ~' '" ... ---
1Ditlft
CONVE.-.JENCE lo!AR~IT F'OA: SHEET NO.
JAMIESON HILL COMPANY A·O ~013 S. 'i SlREEl
BAK[RSfi(LO, CALIF'ORNIA OF' 1