HomeMy WebLinkAbout2011 FMC RESULTSMONITORING SYSTEM CERTIFICATION
or Use & All At7' lhctions Wilton the .Gale ofCA71V6p7da
dwhority Cilul: Chaptw' 6.7, t-leallh and We #), Corte: Chapter lr, Oivisir >n 3. -ale 23. Califomio Co(k of Regulations
llnis fornn must be used to document testing and servicing of monitoring equipment. t\ sg)arntc certification nr report must be
o- -:! ed for Bch monitnrin s seem Control paihj by the ttchnician wlio performs the work. A wpy ul'this form nttcSt he pruvidcd
to the tank system owner /operator. Ilse owtterioperator must submit a copy of dais form to the local agency regulating UST systemsMihin30 (lays of this (late.
A. General Information
Facility Namc: Oswell Chervon
Site Address: 2700 0swell Street
Facility Contact Person: Rami
Makc/i,Io&l of Monitoring Systcnn: Veeder- Root TLS -350
B. Inventory of Equipment Tested /Certified
CNOVI, Ohl aw"113,116 "1 uW"t V"IfIr egnlpmral InmM.0 "lrN:
Bldg. No -
City. Bakersfield "Lip: 93306
Contact Phonc No.: 661 -871 -1200
Lratc ofTesting /Servicing: 6/9/2011
Tank 10:_L0000 gal. Regular rank 11): 10000 gal. Super
x] In -'tank Gauging Probe. Model : 847390 -107 n -Tani( Gauging Prohe. Model: 847390.107
Annular Space or Vault Probe. Model- Arnmlar Space or Vault Sensor. Model:
x] Piping Sump / Trench Sensor(s). Model: 794380 -208 x) Piping Sump / Trcnch Sensor(s). Model: 794380.208
x] Fill Sump Sensor(s) Model: 794380 -208 U t=ill Sump Se+nsorts). Mtxlcl: 794380 -208
x I Mm' hanical Line Leak Detector. Model: Electronic x] Mechanical Line Leak Detector. Model: Electronic
Electmtuc line Leak Detector. Model: Electronic Line Leak fk(eetor. Model:
x] Tank Overfill / High Level Senor. Model: 847390 -107 U lank Overfill / High Leval Sensor. Model: 647390 -107
Other (specify equip..t)x turd model in Sec. E on Pg. 2) Other (specify equip. type and nlndel in Sec. L on Pg. 2)
Tank III: 1000Ua1. Dlosol tank ID:
x] In -Tank Cnruging Probe. Model: 847390.107 In -Tank Gauging Prolx:. Model:
Annular Space or Vault Sensor. Model: D Annular Space or Vault Sensor. Model:
fx] Piping Sump / Trench Sensor(s). Model: 794380 -208 Piping Swnp / Trench Sensor(s). Model:
x] Dill Sump Senors(s). Model: 79430D-208 Fill Swnp Senwr(s). Model:
x i Mechanical Line Leak Dececior. Mule(: Electronic Mechsulical Line Leak Detector. Model:
Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model:
x] Tank Ovcrlill / High Level Sensor. Model: 947390 -107 Tank Overfill / High Level Sensor. Model:
Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. typs and rrlcxiel in Sec. 1•. on Pc. 2)
Dispenser ID: 1 & 2 Dispenser iD:_3 & 4 _
0 Dispenser Containment Sensor(s). Mtxlel: 794380 -208 L] Dispenser ConlaUuncnt Sensor(s). Model: 794380 -2D8
n Shear Valve( %). U Shear Valve(s).
Distcn -cr Containment Floats) and Chain( -). Dispenser Containment Floal(s) and Chain(s)
Dispenser 11): 5& 6 Dispenser I D:-7 $ 8
Lx] Iispenser Containment Sensor(s). fvlrKICI: 794380 -208 x) Dispenser Containment Sensor(s). Model: 794380 -208 _
x) Shear Valve(s). U Shear Valve(s).
Dispenser Containmcnl Float(s)and Chains(s). Dispenser Containment Float(s) and C l- iain(s).
Dispenser 11): Dispenser 1 D:
Dispenser Containment Sensor(s). Model Dispenser Containment Sensor(s). ivlodel:
Shear Valvc(s). Shear Valve(s).
Dispenser Containment Floai(s) and Chains) ' Dispenser Cawainnxni Float(s) and Chain(s).
1 f the facility contains more tanks or dispensers, copy this form. InLAxie information for every tank and dispenser at the facility.
C. Certification - i certify that the equipment identified io 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 anti a plot plan showing the layout of monitoring equipment. For equipment capable of Ceneraling
such reports, i have attached a copy of the report; (check all that apply) x rte- n Set -Up U Alarm hi epurt
Technician Name (print): Bryan A Solt Signature:
Ccrtificalion No: 1337501 License No- 804904
TestUig Company Nante: Confidence UST Services, Inc. Phone No: 800. 339.9930
Site Address: 2700 06we11 Street, Bakersfield, CA 93306 Date i t TeslinE/Servicing: 6/912011
1). Results of'resting /Servicing
Software. Version Installed: 329.01
Complete the following checklist:
U Yes No+ Is the audible alarm olvrational?
xl Yes No* Is tie Visual a an)i upctntiona '.
K Yes No* Were all sensors visually inspected, functionally tested, and confirmed oprrationa
s Yes No* Wereall sensors installed at the lowest point of seeonc try contai.ntucnt and posuioned so that cnher
equipment will not unterferc with tlicir prolvr operation?
El Yes H1 No* If alarms are relayed to a remote moiiikmng station, is all commuuications equipment (u.g. modern)
N/A op eruional?
xT Yes No* For pressurized piping systcros, does the turbine automatically shut dawn ifthe piping secondary
NiA containment monitoring system detects a leak, fails to operate, or is electrically disconnected? if yes:
which sensors initate positive shut -downy Suuir'rcich Sensors [x] pispxnser Containment ensors
Did you confirm positive shut -down due to leaks and sensor lailureldisconn:cted? [x] Yes; " No;
U Yes No+ For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no
NIA mechanical overfill prevention valve is installed), is the overfill warning alami visual and audible at
the tank fill points) and operating properly? if so, at what percent of tank capasity doca the alarm
trigger? `,u
yes* U No Was any nmmtonng equipment replaced? IfYes, i entity sp ecific sem-ors, pro s. or of ier egwpmeni
replaced and list the manufacturer name and mixlel for ail replacement parts in Section F:, helow.
Yes+ xj No Was liquid lound inside any secondary containment systems designed as dry systems?
Product; F] Water. if ves, describe causes in Section F. below.
x Vo4, Was monitoni% system set -tip reviewed to ensure proper settings. Atuch set -up reports, if applicable.
x Yc • No* is all monitoring equipment oNrational per manufacnircr's specifications?
In Section G below, discrihe how and when these deficiencies were or will be corrected.
F. Comments:
F. In -'Tank Cusgiug /SIR Equipment: [NJ Check this box iftank guaging is used only for inventory ccgorol.
Check this box if tank gutaging or SIR equipment is installed.
This section must be completed if in -tank gttaging equipment is used to perform leak detection monitoring.
Complete the following checklist:
In the Section 11, 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:
x] Yes
Yes No* alas all input wiring Ix:en it)s>eetcd for proper enter and terminatiin,incauding testing lior wowid f uits7X177, No* Were all tank gt aging probes visually inspected for damage and residue buildup?
Werr. all I.I.D's confirmed operational and accurate within regulatory requirments7
xj Yes No* Was accuracy of system product level readings tested'?
as the testing apparatus~ properly ca ihratec ?
x Yes No* Was accuracy ol'systeni water level readings tested?
I-or mac iantea _, _.Ds, (loes [lie .. restrict pi uct flOw ti it detects a leak'?
x Yes No* Were all probes reinstalled properly?
Yes No« Were all items nn the equipment manufacturer's maintenance checklist completed?
In the Section 11, 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:
x] Yes No* For equip. start -up or annual equipment certification, was a leak simulated to varify LLD performance?
Cheek all ihtw npph) Simulated leak rate: [c]a a.p.h.: 00.1 g.p.h.; 00.2 g.p.h.;
x Yes rl No* Werr. all I.I.D's confirmed operational and accurate within regulatory requirments7
X] Yes No* as the testing apparatus~ properly ca ihratec ?
cs o I-or mac iantea _, _.Ds, (loes [lie .. restrict pi uct flOw ti it detects a leak'?
x N/A
Nv'r For clecrronic I I-D's, does the turbine automatically shut off if the LLD detects a leak?
N/A
Yes No* For electronic LLD's, does the tut'bine automatically shut off ifarty portion of Ihr monitoring; system is
N/A disabled or discotuiected?
x] Yes No* For electronic I.LlYs, does the turbuie automatically shut off ifany portion of the moni(oring system
N/A mnlftnction or fails a lest?
Yee No* For electronic LLD's, have all accessible wiring cortnections been visually inspected'!
N/A
x Ycs 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.
Ii. Comments:
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Spill RucketTesting Report Form
SWW B..fanuary 2006
This form is intruded fur uc•c by cona•acv„rs pevforming annual tc-sting of US'Tspill r•ontaimpiew sa-rtctrtres. The completed fom; and
pri,nonts jr•onr Tests (ijapplic•ablv). should !,r provided to the fixilil.v awlierloperatorf v-submittal to the local r(c gt lator v elgenf -).
1. FACiI-.iTY INFORMATION _ _
Facility lvamc_ = 0swell Chcvron — f)atc of l ccting:
Facility Address. 2700 Oswell Street, Bakersfield. CA 933.06
FacilityCuntarC _Rani phone 661.871 -1200- --
Dale Laid Agency Was NoOGcd of festutg: 6/2/2011
Natne ni' l -ocal At:chtcy Inspector lijp,v.cent during tr.ctint;l: Ernie Median -
TES'T'ING CONTRACroR INFORMATION
Company Nantc:- Confidence UST Services, btc.
recluticlim C(atduclulg'Icst: Bryan A Self -- - -
C'redentialsl: ICI GSE.13 Contractor f7_11 ICC Service -reel). ci SWIWI.Vrank I•ester Other (Speci/v)
License Nuntlx;r(s): t'ti1.1311 804904 1CCP 8022804 1 -I 0 11-1756 -
3. SMA., 13 LTC KETTESTiNG INFORMAIJON
lest Method Used: L <1 Hydrostatic ' Vacuum Other
1 -est E- qurpment Uscd. Like Test (liytupment Resolution: 0.0625'
ldenti(v Spin 1 ucket (131 lank I Regular 1 Super 3 Diesel 4
Arumher. Stored l'r•mduct. etc.)
J Direct BuryBucketInstallationIypc: Direct Bury Direea Bury Direct Bur.v
ID] Conmined ut Sump Fx1 Contained in Sump Wx Contained in Sump Contained in Sump
12.00" Bucket Dintneter: 12.00" 12.00"
Bucket Depth: 12.00" 12.00" 12.00"
1lfait time between applying 5 min. 5 mm. 5 rnim
vacuunt/cvater and start oftesC
Tt Start Timc (Tr): es 9:00am 9:00am 9:00am
Initinl Reading 0i ): 9.75" - -- 9.75.. 10.00" —
Test End -Time rT, ): 10:00am — 10:003m -- 10:008111 - --
I final Rctululg W, ): 9.75' - 10.00" -- 9.75" —
rest Duration ('I 1 Ti): I hour I hour I hour
0.00" Change in heading (Rr- It,): 0.00" 0.00"
ail Ihreshold 1 r 0.0625" 0.0625" 0.0625' Criteria:
Test Result: Pass Fnfl 9 Pass 0 Fait D Pnss Fail 0 Pass 13 Fait
Cum men is _(incht(le itiformarion on repoi,.c „rade prim, to leslinL• and ,w•ommended lollow -up Ji,r Jailed tests) —
CERTIFICATION OF TE'CIfNiCIAN RESPONSMU FOR CONDUCTING THIS TESTING
1 erPGt cerlijp that all the information contained in this report is true, accm•ote, and in fdl compliance with legal regtrirenrenm
Technician's Signature: - Date:- _._ 6 /9/2011
r State laws and regulation~ do not cum tly require testing to be performed by a qualified contractor. However, local requirements
may W more stringent.