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Home My WebLink AboutFMC 2012F2 ss MONITORING SYSTEM CERTIFICATION For Use By Ail Jurisdictions Wdhin the State of CaAlomia Authority Cited: Chapter 6.7, Health and Safety Code, Chapter 96, DiirJsion 3, Title 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 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: Pan pacific Bldg. No.: Site Address: _1860 Coffee Road City: _Bakersfield Zip: _93308 Facility Contact Person: _Ken Wiley Contact Phone No.: (_881 _)_,889 -2300 Maka/Model of Monitoring System: _Veeder Root TLS -380 Date of Tes6ng/Servicing: _08_/_11 / 2012 Inventory of Equipment Tested/Certifled Check the appropriate boxes to indicate specific equipment Inspectediserviced: Tank ID: _ Diesel Tank ID: X In -Tank Gauging Probe. Model: _846890 -110 ❑ In -Tank Gauging Probe. Model: X Annular Space or Vault Samar. Model: _794380 -303 ❑ Annular Space or Vault Sensor. Model: X Piping Sump / Trench Sensor(s). Model: ,_794380-208 ❑ Piping Sump i Trench Sensor(s). Model: X Fill Sump Sensor(s). Model: -208 ❑ Fill Sump Sensor(s), Model: X Mechanical Line Leak Detector. Model: _794380 _RJFXIDV ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Una Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: X Tank Overfill /High -Leval Sensor. Model: _Flapper D Tank Overfill I High -Level Sensor. Model: ❑ Other (8pLw& e u ment type and model In Section E on Pa 2). ❑ Others u ment type and model In Section E on Pa e2, Tank ID: Tank ID: ❑ in -Tank Gauging Probe. Model: ❑ In -Tank Gauging Probe. Model: ❑ Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model: ❑ Piping Sump / Trench Sensor(s). Model: ❑ Piping Sump / Trench Semor(s). Model: ❑ FIII Sump Sensor(s). Model: ❑ FIII Sump Sensor(s). Model: ❑ Mechanical Line Leak Detector. Model: ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other (sUcify equipment and model in Section E on Peas 2). ❑ Other ul nt type and model In Section E on Dispenser ID: _Diesel 1 -2 Dispenser ID: X Dispenser Containment Sensor(s). Modet: -208 ❑ Dispenser Containment Sensor(s). Model: X Shear Valve(s). _794380 ❑ Shear Valve(s). ❑ Dispenser Containment Float a and Chain s . ❑ Dispenser Containment Floats and Chain s . Dispenser ID: Dispensw ID: ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s). ❑ Shear Valve(s). 0 Dispenser Containment Float (s) and Chain(s). o Dispenser Containment Floats and Chain a . Dispenser ID: Dispenser ID: ❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Semor(a). Model: ❑ Shear Valve(s). ❑ Shear Valve(s). ❑ Dispenser Containment Floats and Chains ❑ Dle nser Containment Floats and Chains . '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 inspectsdieerviced 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): X System set -up X Alarm history report Technician Name (print): Jerry Ranael Signature: Certification No.: ICC: 5309488. Veeder Root: 835480 License. ,' 1733 A. Haz Testing Company Name: Cal Valley Eaulament Phone No.:( GG (1 32i f-514 i Testing Company Address: 3500 Gilmore Avenue, Bakersfield, CA. 93308 Date of Tesfing/Servicing: (Q I /t / / Z— Monitoring System Certification Page 1 of 4 12107 2/21/07 D. Results of Testing/Servlcing Software Version Installed: 329.00 Comolete the following checklist: X Yes ❑ No' Is the audible alarm operational? X Yes a No' Is the visual alarm operational? X Yes ❑ No' Were all sensors visually Inspected, functionally tested, and confirmed operational? X Yes o No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not Interfere with their proper operation? ❑ Yes ❑ No' If alarms are relayed to a remote monitoring station, Is all communications equipment (e.g. modem) operational? X WA X Yes ❑ No* For pressurized piping systems, does the turbine automaticalty shut down If the piping secondary containment monitoring system ❑ N/A detects a leak, falls to operate, or Is electrically disconnected? If yes: which sensors Initiate positive shut -down? (Check all that apply) X Sump/Trench Sensors; X Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks MW sensor fallure/disconnectlon? X Yes; ❑ No. ❑ Yes ❑ No' For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no mechanical overfill prevention X WA valve is Installed), Is the overfill warning alarm visible and audible at the tank fill point(s) and operating property? If so, at what percent of tank capacity does the alarm trigger? % ❑ Yes' X 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' X No Was liquid found Inside any secondary containment systems designed as dry systems? (Check all that apply) ❑ Product; Cl Water. If ea describe causes In Section E below. X Yes ❑ No* Was monitoring system set -up reviewed to ensure proper aetttrrga? 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: Monitoring System Certtftcatlon Page 2 of 4 12107 2/21/07 F. In -Tank Gauging/ SIR Equipment: X Check this box if tank gauging Is used only for inventory control. ❑ 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: ❑ Yes ❑ No` Has all Input wiring been Inspected for proper entry end termination, including testing for ground tub? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No' Was accuracy of system water level readings tested? ❑ Yes ❑ No" Were all probes reinstalled properly? ❑ Yes ❑ No' I Were all items on the equipment manufacturer's maintenance checklist completed? ' In the Section H, below, describe how and when these deflclencles were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Complete the following checklist: X Yes ❑ No` For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all ❑ N/A that apply) Simulated leak rate: X 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. X Yes D No' Were all LLDs confirmed operational and accurate within regulatory requirements? X Yes ❑ No' Was the testing apparatus properly calibrated? X Yes ❑ No" For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ NIA ❑ Yes ❑ No' For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? X NIA ❑ Yes ❑ No' For electronic LLDs, does the turbine automatcally shut off if any portion of the monitoring system Is disabled or X N/A disconnected? ❑ Yes ❑ No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or X NIA falls a test? ❑ Yes ❑ No' For electronic LLDs, have all accessible wiring connections been visually Inspected? X N/A X Yes ❑ 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: Monitoring System Certification Page 3 of 4 12/07 2/21/07 Monitoring System Certification UST Monitoring Site Plan Site Address: {f G-b Coi✓frEE f2OA-o ?�acce��,�.'�� ,-A- ................................................. ..................... ........................... .... . . . . . .'-�� ,,'�`� ......... ..........I....... ....... . . . . . . . . . . . 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I .............. . .......... ..... ............................... ....C.?.... ... .......... ....I...... .......... ........... .......... ........... . ... .................I....I........ %]0196...... , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date map was drawn: 08_/_11_/_2012_ Instructions If you already have a diagram that shows all required information, you may include It, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly Identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in -tank liquid level probes (if used for leak detection). In the apace provided, note the date this Site Plan was prepared. Monkoring System Certification Page 4 of 4 12107 4 2/21/07 SYSTEM -SETUP - _ - - - - JUN 11. 2012 9:12 AM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE /TIME FORMAT MON DD YYYY HH:MM:SS xM PAN PACIFIC 185 COFFEE RD. BAKERSFIELD CA.93302 661- 589 -3200 SHIFT TIME I DISABLED SHIFT TIME 2 : DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED TANK PER TST NEEDED,WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE RE- ENABLE METHOD PASS LINE TEST LI,NE.,PER TST NEEDED WRN DISABLED LINE-ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET DISABLED ULLAGE: 90% DAYLIGHT SAVING TIME ENABLED START DATE MAR..:; WEEK 2 SUN STARt -TIME 2:00 AM END DATE NOV WEEK 1 SUN END TIME 2:00 AM SYSTEM - ,SECURITY CODE : 000000 MAINTENANCE HISTORY 'I'ANR 0, HART S'ECUR I TYy D I SA1'iL.ED CUSTOM ALARMS DISABLED SERVICE NOTICE DISABLED ISO 3166 COUNTRY CODE: MASS /DENSITY DISABLED COMMUNICATIONS SETUP - - PORT SETTINGS: NONE FOUND RS -232 END OF MESSAGE DISABLED IN -TANK SETUP T 1:DIESEL 350 PRODUCT CODE 1 THERMAL COEFF :.000450 TAN{ DIAMETER : I08.00 TAN{ PROFILE 4 PTS FULL VOL 14440 01.0 INCH VOL 11027 54.0 INCH VOL-. 6600 27.0 INCH VOL : 2432 - F4,OAT SIZE':, N . WAT$R WARNING 2.0 HIGH WATER'LIMIT: 4.0 MAX OR LABEL VOL: 1450 OVERFILL,I�IMIT 13718 HIGH PRODUCT 90% 1'2996 DELIVERY LIMIT 3000 LOW. PRODUCT 350 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: TANK TILT O,99 'PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS Tit: NONE LINE MANIFOLDED TANKS Ttt: NONE LEAK MIN PERIODIC: OQ LEAK MIN ANNUAL : 0% . 0 PERIODIC TEST TYPE TANDARD ANNUAL SAALARM DISABLED PERIODIC TALARMADISABLED GROSS TEST ALARM DISABLED AIVN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY. OFF TNK TST SIPHON BREAK :OFF DELIVERY DELAY 3 MIN PUMP THRESHOLD 10.00% LEAK TEST METHOD TEST ON DATE : ALL TANK OCT 9, 2008 START TIME : DISABLED TEST RATE :0.20 GAL /HR DURATION : 2 HOURS TST EARLY STOP:DISABLED LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP L 1:DIESEL DISPENSER TRI -STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L 2 :STP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 3:ANNULAR DUAL POINT HYDROSTATIC CATEGORY : ANNULAR SPACE L 4:FILL TRI -STATE (SINGLE FLOAT) CATEGORY : OTHER SENSORS OUTPUT RELAY SETUP R 1:DIESEL -STP TYPE: STANDARD NORMALLY' CLOSED . TANK ALARMS LQWH PRODUCT AALARM LlOdib SENSOR ALMS L ` I : FUEL ALARM L 2-FUEL ALARM L 1` :SENS0R OUT ALARM IL 2:SENSOR OUT ALARM L: [:SHORT ALARM L 2:SHORT ALARM PMC SETUP PMC VERSION: 01.02 VAPOR PROCESSOR TYPE NONE PROCESSOR CONTROL LEVEL: NONE SOFTWARE REVISION LEVEL VERSION 329.00 SOFTWARE# 346329 -100 -A CREATED - 08.10.09.17.08 NO SOFTWARE 1110DULE SYSTEM FEATURES: PERIODIC IN -TANK TESTS ANNUAL IN -TANK TESTS ALARM HISTORY REPORT - - - -- SYSTEM ALARM - - - -� PAPER OUT APR 27. 2012 9:12 PM PR I.NTER..ERROR APR 27, 2012 9:12 PM i x * END # # i i ALARM HISTORY REPORT - - -- IN -TANK ALARM - T 1:DIESEL OVERFILL. ALARM APR. 13, 2012 9:16 PM LOW PRODUCT ALARM MAY 2. 2012 8:57 PM DEC 16. 2011 12:31 PM OCT 14. 2011 4:37 AM HIGH PRODUCT ALARM APR 13, 2012 9:09 PM APR 13. 2012 3:59 PM FEB 28, 2011 12:27 AM DELIVERY NEEDED MAY 25, 2012 6:14 AM MAY 20. 2012 7!45 AM MAY 18, 2012 10:27 PM x x)�* X END X x x x x ALARM HISTORY REPORT - - - -- SENSOR ALARM - - - -- L 1:DIESEL DISPENSER DISPENSER PAN SENSOR OUT ALARM JUN 11. 2012 9:06 AN SENSOR OUT ALARM JUN 11, 2012 9:02 AM FUEL ALARM JUN 11, 2012 8;55 AM * * * * * END * * * * * ALARM HISTORY REPORT - - - -- SENSOR ALARM - - - -- L 2:STP STP SUMP SENSOR OUT ALARM JUN It, 2012 9:06 AM SENSOR OUT ALARM JUN 11. 2012 9:03 AM FUEL ALARM JUN 11. 2012 8:55 AM ALARM HISTORY REPORT - - - -- SENSOR ALARM - - - -- L 3:ANNULAR g ANNULAR SPACE SENSOR OUT ALARM JUN 11, 2012 9:06 AM SENSOR OUT ALARM JiIN ll. 2012 9:03 AM LOW LIQUID ALARM JUN 11, 2012 8:56 AM m ***** END tx**** ALARM HISTORY REPORT - - -- SENSOR ALARM -- .-- L 4:FILL OTHER SENSORS SENSOR OUT ALARM JUN 11. 2012 9:06 All SENSOR OUT ALARM JUN 11, 2012 9:03 AM FUEL ALARM JUN 11, 2012 8:54 AM **** *END***** ** ** *END***** SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing 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 the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Pan Pacific Date of Testing: 06/11/12 Facility Address: 1850 Coffee Road Facility Contact: Ken Wiley Phone: 661 -589 -2300 Date Local Agency Was Notified of Testing: 06/01/12 Name of Local Agency Inspector (if present during testing: Ernie Medina 2. TESTING CONTRACTOR INFORMATION Company Name: Cal- Valley Equipment Technician Conducting Test: Jerry Rangel Credentials': ❑ CSLB Contractor X ICC Service Tech. 0 SWRCB Tank Tester ❑ Other (Specify) License Number(s): 5309489 -UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: Measuring Tap Equipment Resolution: '/4" Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 Diesel Fill 2 3 4 Bucket Installation Type: ❑ Direct Bury X Contained in Sump ❑ Direct Bury ❑ Contained in Sump ❑ Direct Bury ❑ Contained in Sump ❑ Direct Bury ❑ Contained in Sum Bucket Diameter: 11" x 12" Bucket Depth: 10" Wait time between applying vacuum/water and start of test: 30 minutes Test Start Time (Ti): 9:30 am Initial Reading (RO: 5 3/4" Test End Time (TF): 10:30 am Final Reading (RF). 5 3/4" Test Duration (TF — Tj): 1 hour Change in Reading (RF - Rj): None Pass/Fail Threshold or No loss of water Criteria: 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 cent J& that all the Information contained In this report Is true, accurate, and in full compliance with legal requirements. Technician's Date: 06/11/12 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. CVE Cal- Valley Equipment 3500 Gilmore Ave. Bakersfield CA 93308 661 - 327 -9341 FAX# 661 -325 -2529 VAPORLESS MANUFACTURING, INC. LDT -890 Leak Detector Test Record Contractor: Ca-Valley Equipment Customer: Pan Pacific Date: 06/11/12 Location: 1850 Coffee Road Product: Diesel Technician: Jerry Ran el Submersible Pump Identification Manufacturer: Red Jacket Model No.: RJFX 1 DV Serial No.: Notes: Leak Detector Identification Manufacturer: Red Jacket Description: Diaphragm-type: Piston-type: Tamper -proof seal installed: Other Style Leak Detector: Notes: Leak Detector in Submersible Pump Test at Dis eraser Operating Pump Pressure (psi): 31 psi Gallons per hour rate: 3 gph Line pressure with pump shut off (psi): 17 psi Bleed -back Test with pump off (ml): 65 ml Step-through time to full flow (secs): 3 sec Leak detector stays in leak search position (Yes/No): Yes Leak Detector Test Pass / Fail Notes: Pass *Complete thermal expansion test be ore ailing leak detector