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Home My WebLink AboutFMC 5-29-15E Z UL • • tCi 0 vi Cf) M z E . CL N • Cf) z LD c CL c E Z UL • • tCi Cr vi 4 CO N co m E LD c C c cn a) -�e co co Z ■(D (D C V 4 E Z UL • • tCi I 0 mm_; • • • • r A m Cr vi 4 I 0 mm_; • • • • r A m N E c C c I-- F- >% E (D 0 CD k, E cn 0 10 E ® 0 0 cn cn 4.0 ch .1" 0 ch 0 *-0 cn 0 >% h- cn cn E r_ :® 0 o o 0 m CL UL tm N >% 0 > (D 0) 0 E 0 10 "o v a) 0 CL .0 r. a c 0 u-_ to 0 0 CZ > 0 E 0 a) 0 E zo UNDERGROUND STORAGE TANJ APPLICATION TO PERFORM ELD/LINE TESTING/ SS989 SECONDARY CONTAINMENT TESTING/TANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION (Please note that L these are separate � individual tests and will be charged per separate type test accordingly.) PERMIT 1/5-- eNHANCED LEAK DETECTIQN TANK TIGHTNESS PIN& kytff, r Al A iYI W Y AIDE FIELD FIRE DEPARTMENT Prevention Services 21.01. H Street Bakersfield, CA 93301 Phone: 661-326-3979 e Fax: 661-852-2171 Page 1 of I LINE TESTING S8 -989 SECONDARY CONTAINMENT FUEL MONrt-ORING CEF,T1FIrATI0N FD2095 (Rev 03/08) Alarm New & Modification (minimum charge) Wo Over 10,000 sq ft $0 .028 x sq ft so Sprinkler - New & Modification (minimum charge) 13 f Over 10,000 sq ft $0 .028 Xsq ft $ 96 (inspection only) [3 Sprinkler - Minor Modification (<10 heads) 0 Commercial Hood (New & UL 300 Upgrad e Modification) $235 ------ ---- — A §ftLo_o_ -1 Commercial Hood - Minor Modification (add/mQvip nozzle) $ 96 (inspection q nly) rr $ C3 Spray Booth (New & mod ifica t-ion) 7.35 ins installation) i�iT $180/tank i ppetion per installa I boveground Storage Tank C3 gro �Q ATI $ 96/tank Additional Tank log/tank [3 Aboveground Storage Tank (Removal, Mod,ar Inspectn, ATR $ n/Inspection) NX $878/tank 0 Underground Storage Tank- (Installatio MD $878/site Storage Tank (Modification) 0 Underground 5 MTM $167/site Cl Underground Storage Tank (Minor ModifirAtion) tTjt$573/tank [3 Underground Storage Tank (Removal) ------ 0 :1 . '— _$192 $598 /Catt. rot, $ 96/hr (2 hrs minimum) h,7Pr q/' I Mandated UST Testing: Fuel Mont Cert/ ystem NOTE: $96/hr for each type of test/per site/per UST s even if . scheduled at the same time ezii�spe af oil 0 ) Ul veil InTpiRion, or 96/hr #i s, go/tent Tent $121/hr (2 hrs minimum) $242. After-hours in fee 96/hr + (5 hrs min standby fee/insp) $576 inspection fee Pyrote0nic (1 permit per event, plus an e, o $96/hr during business hours) PY Alt,:s �d b �f/ i n, sp NqTE: After hours Pyrotechnic event inspection is (g) $I21/hr '��!�r�ninsta�ndb �Ieef'�� 6/hr 0 Re-inspection/Follow-up Inspection 9 �3 Portable LPG (Propane). of Cages? $ 961hr $235 D Explosive Storage -h fee $57/hr) $0,25/page a opying & F! e Research (File Researc miscellaneous 02 84 84 I MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited:- Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. i = ' is installed th@ fiwility, a -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: USA LIQUOR Site Address: 1720 S. UNION AVE. Facility Contact Person: Make /Model of Monitoring System: TLS -350 B. Inventory of Equipment Tested /Certified Bldg. No.: City: BAKERSFIELD Zip: 93307 Contact Phone No.: (661) 832 -0457 Date of Testing /Servicing: 5129/2015 uneck the appropriatC DOWS ur nJwLatc ULUjL c U. ...L......J Tank ID: 87 Tank ID: 91 ® In -Tank Gauging Probe. Model: V/R ® In -Tank Gauging Probe. Model: V/R • Annular Space or Vault Sensor. Model: V/R 420 ® Annular Space or Vault Sensor. Model: V/R 420 • Piping Sump / Trench Sensor(s). Model: V/R 208 ® Piping Sump / Trench Sensor(s). Model: V/R 208 ❑ Fill Sump Sensor(s). Model: N/A ❑ Fill Sump Sensor(s). Model: N/A ® Mechanical Line Leak Detector. Model: RED JACKET ® Mechanical Line Leak Detector. Model: RED JACKET ❑Electronic Line Leak Detector. Model: N/A ❑ Electronic Line Leak Detector. Model: N/A ® Tank Overfill / High -Level Sensor. Model: FLAPPER ® Tank Overfill / High -Level Sensor. Model: FLAPPER ❑ Other (specify equipment type and model in Section E on Page 2). ❑ Other (specify equipment type and model in Section E on Page 2). Tank ID: DSL Tank ID: ® In -Tank Gauging Probe. Model: V/R ❑ In -Tank Gauging Probe. Model: ® Annular Space or Vault Sensor. Model: V/R 420 ❑ Annular Space or Vault Sensor. Model: ® Piping Sump / Trench Sensor(s). Model: V/R 208 ❑ Piping Sump / Trench Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: N/A ❑ Fill Sump Sensor(s). Model: ® Mechanical Line Leak Detector. Model: RED JACKET ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: N/A ❑ Electronic Line Leak Detector. Model: ® Tank Overfill / High -Level Sensor. Model: FLAPPER ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other (specify equipment type and model in Section E on Page 2). ❑ Other (specify equipment type and model in Section E on Page 2). Dispenser ID: 1/2 Dispenser ID: 314 ❑ 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 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 Chain(s). ❑ Dispenser Containment Float(s) and Chain(s). *If the facility contains more tanxs or aispensers, COPY L►►►Z5 W1111. 1Ill., U %, 111 .1.1uk,1�11 .,,.... j •w » -- - - - -r- - -- - - -- - 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 % N r;�? Technician Name (print): EIVIND BYE Signature: Certification No.: 8143783 License. No.: 779267 Testing Company Name: LC SERVICES Phone No.: (559 ) 444 -1730 Testing Company Address: 3887 N. VALENTINE AVE. FRESNO CA. 93722 Date of Testing /Servicing: 5/29/2015 UN -036 —1/6 www.unidoes.org Rev. 01/17108 Monitoring System Certification Page 1 of UN -036 — 2/6 www.unidoes.org Rev. 01/17/08 Monitoring System Certification A Results of 'Testing /Servicing Software Version Installed: Cmmnlete the fnllnwinu checklist: • Yes ❑ No* Is the audible alarm operational? • Yes ❑ No* Is the visual alarm operational? • Yes ❑ No* I Were all sensors visually inspected, functionally tested, and confirmed operational? ® Yes ❑ 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., modern) ® N/A operational? ® Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ❑ 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) ® Sump /Trench Sensors; ® Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure /disconnection? ® 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 visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 95% ❑ Yes* ® 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* ® No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑ Product; ❑ Water. If yes, describe causes in Section E, below. ® Yes ❑ No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, if applicable ® Yes ❑ No* Is all monitoring equipment operational per manufacturer's specifications? x In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: UN -036 — 3/6 www.unidoes.org Rev. 0 1 A 7/08 Monitoring System Certification Page 2 of 4 UN -036 — 4/6 www.unidoes.org Rev. 01/17/08 Monitoring System Certification F. In -Tank Gauging / SIR Equipment: ❑ 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 and termination, including testing for ground faults? ❑ 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 F-1 No* Were all probes reinstalled properly? ❑ Yes E] No* Were all items on the equipment manufacturer's maintenance checklist completed? * In Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Com fete the followino checklist: ® Yes ❑ No* For equipment start -up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: ® 3 g.p.h.; ❑ 0.1 g.p.h ; [10.2 g.p.h. ® Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ❑ No* Was the testing apparatus properly calibrated? ® Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ® N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ® N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ® N/A or fails a test? ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ® N/A ® Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? x In Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: UN -036 — 5/6 Page 3 of 4 www.unidoes.org Rev. 01/17/08 Monitoring System Certification UST Monitoring Site Plan Site Address: 1720 S. UNION AVE. BAKERSFIELD CA. 93307 Date map was drawn: 5/29/2015. 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 space provided, note the date this Site Plan was prepared. Page 4 of 4 UN -036 — 6/6 www.unidocs.org Rev. 01/17/08 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 F A f TT ,ITV INFORM A TTON Facility Name: USA LIQUOR I Date of Testing: 5/29/15 Facility Address: 1720 S. UNION AVE BAKERSFIELD CA.933307 Facility Contact: Phone (661) 832 -0457 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): KRIS KARNS I rrFCrrTlvr_ r "NTRACTOR TNF(IRMATION Company Name: LC SERVICES Technician Conducting Test: EIVIND BYE Credentials': ❑ CSLB Contractor X ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Spec) License Number(s): 8143783 3_ SPILL. BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: I Equipment Resolution: Identify Spill Bucket (By Tank 1# 87 2# 91 3# DSL 4# Number, Stored Product, etc) X Direct Bury X Direct Bury X Direct Bury ❑ Direct Bury Bucket Installation Type: ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sum Bucket Diameter: 12" 12" 12" Bucket Depth: 14" 14" 14" Wait time between applying 15 MINUTES 15 MINUTES 15 MINUTES vacuum /water and start of test: Test Start Time (Ti): 9:OOAM 9:OOAM 9:OOAM Initial Reading (RI): 13" 13" 13" Test End Time (TF): 10:00AM 10:OOAM 10:00'AM Final Reading (RF): 3 1 " 137) 1 391 1 7 Test Duration (TF — TI): 1 H 1 HR 1 HR Change in Reading (RF - RI): 0 0 0 Pass /Fail Threshold or 002 .002 .002 Criteria: Test Result: Pass ❑Fail : X Pass ❑Fail Pass ❑Fail D Pass 1� Fail. 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. �`—� o Technician's Signature: Date: ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.