HomeMy WebLinkAbout2013 RESULTSMONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State ofCal(fornia
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 documcnl testing and servicing of monitoring equipment. A scparme cenification or repon must be prepared for each
monitoring system control panel by the technician who perfonns 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: #5562 Fastrip #6 Bldg. No.: ____ _
Site Address: 1640 South Chester Avenue City: Bakersfield, CA 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/~ervicing: 9/10/2013
B. Inventory of Equipment Tested/Certified
\...llt:t.:K UU: HIJIJI \J I IHU; UUA\;3 lU IIIUI\:ill\: 3 ]\;\,;Ill\: ~f..l\11 JIII\:IU 1113 J\:t,..l\:\113\:1 Yl'l.-\:Uo
Tank 10: 12,000 gal. Regular Tank ID: 12,000 gal. Regular 2
1811n-Tank Gauging Probe. Model: 847390-107 1811n-Tank Gauging Probe. \llodel: 84 7390-1 07
181 Annular Space or Vault Sensor. Model: 794390-420 181 Annular Space or Vault Sensor. Model: 794390-420
181 Piping Sump I Trench Scnsor(s). Model: 794380-208 181 Piping Sump I Trench Scnsor(s). Model: 794380-208
0 Fill Sump Sensor(s). Model: 0 Fill Sump Sensor(s). Model:
181 Mechanical Line Leak Detector. Model: FX-1V 181 Mechanical Line Leak Detector. Model: FX-1V
0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
181 Tank Ovcrfill/lligh-Level Sensor. Model· 847390-107 181 Tank Overfill/ High-Level Sensor. Model: 847390-107
0 Other {specify equipment type and model in Section Eon Page 2). 0 Other (spccif) equipment type and model in Section Eon Page 2).
Tank ID: 12,000 gal. Super Tank ID: 12,000 gal. Diesel
181tn-Tank Gauging Probe. Model: 847390-107 1811n-Tank Gauging Probe. Model: 847390-107
181 Annular Space or Vault Sensor. Model: 794390-420 181 Annular Space or Vault Sensor. Model: 794390-420
181 Piping Sump I Trench Sensor(s). Model: 794380-208 181 Piping Sump I Trench Scnsor(s). Model: 794380-208
0 Fill Sump Sensor(s). Model: 0 Fill Sump Scnsor(s). Model:
181 Mechanical Line Leak Detector. Model. FX-1V 181 Mechanical Line Leal.. Detector. Model: FX-1 DV
0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
181 Tank Overfill/lligh-Levcl Sensor. Model: 847390-107 181 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).
Dispenser ID: 1&2 Dispenser ID: 3&4
181 Dispenser Containment Sensor(s). Model: 794380-208 181 Dispenser Containment Sensor(s). Model: 794380-208
181 Shear Valve(s). 181 Shear Valvc(s).
0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser 10: 5 & 6 Dispenser ID: 7&8
181 Dispenser Containment Sensor(s). Model· 794380-208 181 Dispenser Containment Sensor(s). Model: 794380-208
181 Shear Valve(s). 181 Shear Val\c(s).
0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser 10: Transition Sump {South) Dispenser I D: Transition Sump {North)
181 Dispenser Containment Sensor(s). Model: 794380-208 181 Dispenser Containment Sensor(s). Model: 794380-208
0 Shear Valve(s). 0 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 fonn. 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): ~ System set-up ~ Alarm history report
Technician Name (print): Bradley Seykora Signature: ~ ~
Certification No.: B40738 License. No.~-=.::.04~9 ::..:0:...4.:....._ ____________ _
Testing Company Name: Confidence UST Services Phone No.: (800) 33:..:9:.._-9::..:9:.:3:..:0:...__ ____ _
Site Address: 1640 South Chester Ave., Bakersfield, CA 93304 Date of Testing/Servicing: 9/10/2013
Page 1 of 3
Monitoring System Certification
D. Results of Testing/Servicing
Software Version Installed: ...::3.=2.::..:9.:..::0..:.1 _____________ _
-"'"'" """"'""' ................. " •• •••JO, ..........................
181 Yes 0 No* Js the audible alarm operational? I I
181 Yes 0 No* Is the visual alarm operational?
181 Yes 0 No* Were all sensors visually inspected, functionally tested, and confirmed operational? I
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?
0 Yes 0 No* If alarms 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, does the turbine automatically shut down if the piping secondary containmenl
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) 181 Sumpffrench Sensors; 181 Dispenser Containment Sensors.
Did you confirm 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 of tank capacity does the alarm trigger? 90%
0 Yes* 181 No Was any monitoring equipment replaced? If yes, identifY specific sensors, probes, or other equipmenr replaced
and list the manufacturer name and model for all replacement parts 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 manufacturer'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 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 fl --heckr -·
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
0 Yes 0 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 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:
Page 3 of 3
I
Customer Address:
Jaco Hill
~f\0~.41, 0 (' ~usr ~ces.~
~OC*~WJ'TW~
Leak Detector Test Results Sheet
Work Order: 31265
Test Date: 9/10/2013
Site Address:
#5562 Fastrip #6
P.O. Box 82515
Bakersfield, CA 93380-2515
1640 South Chester Avenue
Bakersfield, CA 93304
Site Contact: Omero Garcia Phone: 661-393-7000 ICC No.: 8111231
Technician: Bradley Seykora Phone: 800-339-9930
Product Type LLDType Model Serial No. Check Bleed leak
Valve Off Ml. Rate
Holding Tested:
Pressure
Regular UNL Mechanical FX1V NA 17 PSI 50ml 3gph@
10 psi
Premium UNL Mechanical FX1V NA 13 PSI 35 ml 3gph@
10 psi
Diesel Mechanical FX1DV NA 14 PSI 50ml 3gph@
10 psi
3 gph@
10 psi
3gph@
10 psi
3gph@
10 psi
3gph@
10 psi
3gph@
10 psi
Technician Name: Bradl~ Technician No.:
Signature: ~ Date:
~
8111231
9/10/2013
Pass/Fail
Pass
Pass
Pass
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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 submiltal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: #5562 Fastrip #6 I Date ofTesting: 9/3/2013
Facility Address: 1640 South Chester A venue, Bakersfield, CA 93304
Facility Contact: Omero Garcia I Phone: 661-393-7000
Date Local Agency Was Notified of Testing: 8/21/2013
Name ofJ..?c~I}\~ency Inspector (if present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bradley Seykora
Credentials 1: IEl CSLB Contractor IEl ICC Service Tech. CJ SWRCB Tank Tester 0 Other (Specify)
License Number(s): CSLB #804904 ICC #8111231 ----
10
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: IEl Hydrostatic [J 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: r Direct Bury Direct Bury Direct Bury n Direct Bury
IEl Contained in Sump IEl Contained in Sump IEJContained in Sump IEJContained in Sump
Bucket Diameter: 12.00'' 12.00" 12.00" 12.00''
Bucket Depth: 13.25" 13.00" 13.00" 12.75"
Wait time between applying 5 min. 5 min. 5 min. 5 min. vacuum/water and start of test:
Test Start Time (T1): 1:00 P.M. 1:00 P.M. 1:00 P.M. I:OOP.M.
Initial Reading (RJ): 9.00" 9.00" 9.25" 9.00"
Test End Time (TF): 2:00P.M. 2:00P.M. 2:00P.M. 2:00P.M.
Final Reading (RF): 9.00" 9.00" 9.25" 9.00"
Test Duration (T F-T1): I hour I hour 15 min. I 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: IEl Pass OFail IEJ Pass 0 Fail IEl Pass 0 Fail IEl Pass 0 Fail
Comments-(include information on repairs made prior to testing, and recommendedfollow-up[orfailed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that alltlte information contained in this report is true, accurate, all(/ in full compliance with legal requirements.
Technic;an's s;gnatwco ~ Date: 9/1012013 ,
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
SITE PLOT PLAN for:
015-021-002928
#562 FASTRIP #6
1640 S. CHESTER AVE.
BAKERSFIELD, CA 93304
03/01/2012
1:
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4 ·12,000 GAL
STs
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CHE5T£R AVE.
rr
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BREAKE
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~~1'1 ~--·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· ·-·-·-·-·-·-·-·-·u·-·-·
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r ' ~ ~
EXISTING 20' ALLEY
' . ~--
LEGEND
L 1 87-1 STP
L2 87-1 ANNULAR
L3 DSLSTP
L4 DSL ANNULAR
LS 91 STP
L6 91 ANNULAR
L7 87·2 SIPHON STP
L8 87-2 ANNULAR
L9 UDC 1-2
L10 UDC 3-4
L 11 UDC 5-6
L12 UDC 7-8
L13 N TRANS SUMP
L 14 S TRANS SUMP
ESO
OFA • e
® * • • ®
*
EMERGENCY SHUT -OFF
OVERFILL ALARM
PRODUCT SPILL CONTAINER
VAPOR SPILL CONTAINER
ANNULAR
FIRE EXTINGUISHER
GAS METER SHUT-OFF
WATER METER SHUT·OFF
HEALY CAS
EVACUATION MEETING POINT