HomeMy WebLinkAbout2012 RESULTS7 '.)
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State ofCalifornia
Authority Cited: Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations
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 this date.
A. General Information
Facility Name: California Chevron
Site Address: 4100 California Avenue
Facility Contact Person: Sam Jouda
Make /Model of Monitoring System: Veeder -Root TLS 350
B. Inventory of Equipment Tested /CertifiedChecktheappropriateboxestoincafespecificequipmentinspected /serviced:
City: Bakersfield
Bldg. No.:
Zip: 93309
Contact Phone No.: 661 - 333 -0000
Date of Testing/Servicing: 2/14/2012
Tank ID: 10000 gal. Regular North Tank
x]
ID: 10000 gal. Regular South
In -Tank Gauging Probe. Model: 847390 -107X] In -Tank Gauging Probe. Model: 847390-107
x] Annular Space or Vault Probe. Model: 794390-409 X] Annular Space or Vault Sensor. Model: 794390 -409
x] Piping Sump / Trench Sensor(s). Model: 794380-420 x] Piping Sump / Trench Sensor(s). Model: Ronan
X] Fill Sump Sensor(s) Model: Ronan U Fill Sump Sensor(s). Model: Ronan
U Mechanical Line Leak Detector. Model:FX1y X] Mechanical Line Leak Detector. Model: FX1y
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
U Tank Overfill / High Level Sensor. Model: OPW 61 -SO X] Tank Overfill / High Leval Sensor. Model: 847390 -107
Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. type and model in Sec. E on Pg. 2)
Tank ID: 10000 gal. Regular (Siphon) Tank ID: 10000 gal. Super
x] In -Tank Gauging Probe. Mode1:847390-107 x] In -Tank Gauging Probe. Model: 847390 -107
x] Annular Space or Vault Sensor. Model: 794390-409 x] Annular Space or Vault Sensor. Model: 794380 -409
X] Piping Sump / Trench Sensor(s). Model:Ronan U Piping Sump / Trench Sensor(s). Model: Ronan
x] Fill Sump Sensors(s). Model:Ronan U Fill Sump Sensor(s). Model: Ronan
Mechanical Line Leak Detector. Model: x] Mechanical Line Leak Detector. Model: FX1y
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
X] Tank Overfill / High Level Sensor. Model:OPW 61 -SO x] Tank Overfill / High Level Sensor. Model: OPW 61 -SO
Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. typs and model in Sec. E on Pg. 2)
Dispenser ID: 1 & 2 Dispenser ID: 3 & 4
Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model:
LX] Shear Valve(s). LX] Shear Valve(s).
X] Dispenser Containment Float(s) and Chain(s). U Dispenser Containment Float(s) and Chain(s)
Dispenser ID: 5&6 Dispenser ID: 7 & 8
Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model:
x] Shear Valve(s). Shear Valve(s).
x] Dispenser Containment Float(s) and Chains(s). Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 9 & 10 Dispenser ID: 11 & 12
Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model:
x] Shear Valve(s). U Shear Valve(s).
LxJ Dispenser Containment Float(s) and Chain(s) X] Dispenser Containment Float(s) and Chain(s).
1fthe 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 /services in accordance with the
manufacturers' guidlines. Attached to this Certification is information (e.g. manufacturers' checklist) necessary to varify that
this information is correct and a plot plan showing the layout of monitoring equipment. For equipment capable of generating
such reports, 1 have attached a copy of the report; (check all that apply) x System Set -up _ Fx1 Alarm history report
Technician Name (print): Kristopher Karns Signature:c..
Certification No: 834106
Testing Company Name: Confidence UST Services, Inc.
Site Address: 4100 California Avenue, Bakersfield, CA 93309
License No: 804904
Phone No: 800- 339 -9930
Date of Testing/Servicing: 2/14/2012
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State ofCalifornia
Authority Cited: Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations
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 ofthis form to the local agency regulating UST systems
within 30 days of this date.
A. General Information
Facility Name: California Chevron
Site Address: 4100 California Avenue
Facility Contact Person: Sam Jouda
Make /Model of Monitoring System: Veeder -Root TLS 350
B. Inventory of Equipment Tested /CertifiedChecktireseappropriateboxtoIndicatespecificequipmentInspected /serviced:
Bldg. No.:
City: Bakersfield Zip: 93309
Contact Phone No.: 661 - 333 -0000
Date of Testing/Servicing: 2/14/2012
Tank ID: 10000 gal. Regular Diesel Tank ID:
U In -Tank Gauging Probe. Model: 847390-107 In -Tank Gauging Probe. Model:
x] Annular Space or Vault Probe. Model: 794390-409 Annular Space or Vault Sensor. Model:
x] Piping Sump / Trench Sensor(s). Model: Ronan Piping Sump / Trench Sensor(s). Model:
Fill Sump Sensor(s) Model: Fill Sump Sensor(s). Model:
U Mechanical Line Leak Detector. Ivlodel:FX1DV Mechanical Line Leak Detector. Model:
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
U Tank Overfill / High Level Sensor. Model: OPw 81 -SO Tank Overfill / High Leval Sensor. Model:
Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. type and model in Sec. E on Pg. 2)
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 Sensor(s). Model:
Fill Sump Sensors(s). Model: Fill Sump Sensor(s). Model:
Mechanical Line Leak Decector. 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 (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. typs and model in Sec. E on Pg. 2)
Dispenser ID: Dispenser ID:
Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model:
Shear Valve(s). Shear Valve(s).
Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s)
Dispenser ID: Dispenser ID:
Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model:
Shear Valve(s). Shear Valve(s).
Dispenser Containment Float(s) and Chains(s). Dispenser Containment Float(s) and Chain(s).
Dispenser ID: Dispenser ID:
Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model:
Shear Valve(s). Shear Valve(s).
Dispenser Containment Float(s) and Chain(s) 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 /seryices in accordance with the
manufacturers' guidlines. Attached to this Certification is information (e.g. manufacturers' checklist) necessary to varify that
this information is correct and a plot plan showing the layout of monitoring equipment. For equipment capable of generating
such reports, I have attached a copy of the report; (check all that apply) Q System Set -up U Alarm history report
Technician Name (print): Kristopher Karns Signature: , icai. ,,
Certification No: 834108 License No: 804904
Testing Company Name: Confidence UST Services, Inc. Phone No: 800 - 339 -9930
Site Address: 4100 California Avenue , Bakersfield, CA 93309 Date ofTesting/Servicing: 2[14[2012
D. Results of Testing /Servicing
Software Version Installed: 327.04
Complete the following checklist:
x] Yes No* Is the audible alarm operational?
x Yes No* Is the Visual alarm operational?
x Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational?
x Yes No* Were all sensors installed at the lowest point of secondary containment and positioned so that other
equipment will not interfere with their proper operation?
El Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) Hx N/A operational?
x Yes No* For pressurized piping systems, does the turbine automatically shut down ifthe piping secondary
N/A containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes:
which sensors initate positive shut -down? U Sump /Trench Sensors Dispenser Containment Sensors
Did you confirm positive shut -down due to leaks and sensor failure /disconnected? [X] Yes; No;
Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no
N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visual and audible at
the tank fill point(s) and operating properly? If so, at what percent of tank capasity does the alarm
trigger? %
Yes* Ix1 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.
Yes* I No Was liquid found inside any secondary containment systems designed as dry systems?
Product; Water. Ifyes, describe causes in Section E, below.
No* Was monitoring system set -up reviewed to ensure proper settings? Attach set -up reports, if applicable. RiYess
No* I Is all monitoring equipment operational per manufacturer's specifications?
In Section E below, discribe how and when these deficiencies were or will be corrected.
E. Comments:
F. In -Tank Guaging / SIR Equipment: [] Check this box if tank guaging is used only for inventory control.
Check this box if tank guaging or SIR equipment is installed.
This section must be completed if in -tank guaging equipment is used to perform leak detection monitoring.
Complete the following checklist:
x Yes No* Has all input wiring been inspected for proper enter and termination, including testing for ground faults? 4x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
x Yes No* Was accuracy of system product level readings tested?
EX Yes No* Was accuracy of system water level readings tested?
x] Yes No* Were all probes reinstalled properly?
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): Check this box if LLD's are not installed.
Complete the following checklist:
L] Yes No* For equip. start -up or annual equipment certification, was a leak simulated to varify LLD performance?
Check all that apply) Simulated leak rate: [x13 g.p.h.: 00.1 g.p.h.; 0.2 g.p.h.;
7x —Yes No* Were all LLD's confirmed operational and accurate within regulatory requinnents?
x Yes No Was the testing apparatus properly calibrated?
Yes No For mac amcal LLD's, does the LLD restrict product ow it detects a leak?
N/A
0—Ye _s No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak?
Lx] N/A
Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is
x] N/A disabled or disconnected?
Yes No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system
xj N/A malfunction or fails a test?
Yes No* For electronic LLD's, 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:
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SWRCB, January 2006
Spill Bucket Testing Report Form
Thisform is intendedfor use by contractors performing annual testing of UST spill containment structures. The completedform and
printoutsfrom tests (fapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: California Chevron Date of Testing: 2/14/2012
Facility Address: 4100 California Avenue, Bakersfield, CA 93309
Facility Contact: Sam Jouda I Phone: 661 - 333 -0000
Date Local Agency Was Notified of Testing: 1/18/2012
FName of Local Agency Inspector (rfpresent during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials: X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester Other (Spec)
License Number(s): 804904 5264406 -UT 09 -1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: X Hydrostatic Vacuum Other
Test Equipment Used: Lake Test Equipment Resolution:0.0625"
Identify Spill Bucket (By Tank
Number, Stored Product, etc.
1 Regular (North) 2 Regular (South) 3 Regular (Siphon) 4 Super
Bucket Installation Type: Direct Bury
X Contained in Sump
Direct Bury
X Contained in Sump
Direct Bury
X Contained in Sump
Direct Bury
X Contained in Sum
Bucket Diameter: 12.00" 12.00" 12.00" 12.00"
Bucket Depth: 13.75" 14.25" 14.00" 13.75"
Wait time between applying
vacuum /water and start of test:
5 min. 5 min. 5 min. 5 min.
Test Start Time (Ti): 9:30 AM 9:30 AM 9:30 AM 9:30 AM
Initial Reading (Ri): 9.25" 9.75" 8.25" 9.50"
Test End Time (TF): 10:30 AM 10:30 AM 10:30 AM 10:30 AM
Final Reading (RF): 9.25" 9.75" 8.25" 9.50"
Test Duration (TF — Ti): 1 hour 1 hour 1 hour 1 hour
Change in Reading (RF - Rj): 0.0" 0.0" 0.0" 0.0"
Pass /Fail Threshold or
Criteria:
0.0625" 0.0625" 0.0625" 0.0625"
Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail
Comments — (include information on repairs made prior to testing, and recommendedfollow -up forfailed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician's Signature: L., Date: 2/14/2012
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
SWRCB, January 2Q06
Spill Bucket Testing Report Form
Thisform is intendedfor use by contractors performing annual testing of UST spill containment structures. The completedform and
printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: California Chevron Date of Testing: 2/14/2012
Facility Address: 4100 California Avenue, Bakersfield, CA 93309
Facility Contact: Sam Jouda I Phone: 661- 333 -0000
Date Local Agency Was Notified of Testing: 1/17/2012
Name of Local Agency Inspector (rfpresent during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials: X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester Other (Specie)
License Number(s): 804904 5264406 -UT 09 -1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: X Hydrostatic Vacuum Other
Test Equipment Used: Lake Test Equipment Resolution:0.0625"
Identify Spill Bucket (By Tank
Number, Stored Product, etc.
1 Diesel 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: 12.00"
Bucket Depth: 15.75"
Wait time between applying
vacuum /water and start oftest:
5 min.
Test Start Time (Ti): 9:30 AM
Initial Reading (Ri): 8.25"
Test End Time (TF): 10:30 AM
Final Reading (RF): 8.25"
Test Duration (TF — Ti): I hour
Change in Reading (RF - Rj): 0.00"
Pass /Fail Threshold or
Criteria: 0FX0625
Test Result: Pass Fail Pass Fail Pass Fail Pass Fail
Comments — (include information on repairs made prior to testing, and recommendedfollow -up forfailed 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: i„c,ce Date: 2/14/2012
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
California Chevron
4100 California Avenue
Bakersfield, CA 93309
2/14/2012
1
10 9 12 11
3,5,8,10
20 20
3,5,8,1 3
6 5
8 7
3,5,12
20 20
3,5,8,11
4 3 2 1
20 20
3,5,9,14
4,5,015 O0B
4,5, 018 00
4,5,017 6
0
4,5,016 60
0
4,5,
019
O
o ,4
Isr
OFyc
6V
OO*UAMf1WMO0Ml.w, Invoice No.: 28869
Site: California Chevron
4100 California Avenue
Bakersfield, CA 93309
Repairs Requested: Re -test the Regular North FX1 V Line Leak
Detector.
Repairs completed: Re -test the Regular North FX1V Line Leak
Detector. The Controller to the Regualr South Turbine has been
pulled so that it will no longer run since the lines are manifolded, and
you can't have both Turbines running at the same time. Then the
Regular North FX1 V Line Leak Detector was re- tested and confirmed
operational.
Required Repairs, Still Pending: No further repairs are required.
Technician Name: Kristopher Karns
Signature:
Date: 2/22/2012