Loading...
HomeMy WebLinkAbout2015 RESULTS4007i0,*� 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. A s_parate certification or Mort must be prepared for each j monitoring stem 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: LUCKY 7 FOOD STORE Site Address: 2501 WHITE LN. City: BAKERSFIELD Facility Contact Person: ' MANJIT SINGH Make/Model of Monitoring System: TLS -350 INSP. - ERNIE MADINA B. Inventory of Equipment Tested/Certified Bldg. No.: Zip: 93304 Contact Phone No.: ( ) Date of Testing/Servicing: 2/26/2015 % -nccji twit S rV s-It Tank ID: MID GRADE 89 .Tank ID: REG87 • In -Tank Gauging Probe. Model: MAG ® In -Tank Gauging Probe. Model: LIAG • Annular Space or Vault Sensor. ® Piping Sump / Trench Sensor(s). ❑ Fill Sump Sensor(s). ® Mechanical Line Leak Detector. Model: 409 Model: 208 Model: Model: FX1 V Annular Space or Vault Sensor. ® Piping Sump / Trench Sensor(s). ❑ Fill Sump Sensor(s). ® Mechanical Line Leak Detector. Model: 409 Model: 208 Model: Model: FE -PETRO El Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector_ Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other (specify equipment type and model in Section E, on Page 2). ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other (specify equipment type and model in Section E on Page 2). Tank ID: PREM91 Tank ID: • in -Tank Gauging Probe. Model: MAG ❑ In-Tank Gauging Probe. Model: • Annular Space or Vault Sensor. Model: 409 ® Piping Sump / Trench Sensor(s). Model: 208 ❑ Fill Sump Sensor(s). Model: ® Mechanical Line Leak Detector. Model: FX1V ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other (specify equipment type and model in Section E on Page 2). ❑ Annular Space or Vault Sensor. Model: ❑ Piping Sump / Trench Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other (specify equipment type and model in Section E on Page 2). Dispenser ID: 112 ® Dispenser Containment Sensor(s). Model: 406 19 Shear Valve(s). ❑ Dispenser Containment Float(s) and Chain(s). Dispenser ID: 314 ® Dispenser Containment Sensor(s). Model: 406 ® Shear Valve(s). ❑ Dispenser Containment Float(s) and Chain(s). Dispenser ID: ❑ Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s). ❑ Dispenser Containment FIoat(s) and Chain(s). Dispenser ID: ❑ Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s). ❑ Dispenser Containment Float(s) and Chain(s). Dispenser ID: ❑ Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s). ❑ Dispenser Containment Float(s) and Chain(s). Dispenser ID: ❑ Dispenser Containment Sensor(s). Model: ❑ Shear Valve(s). ❑ Dispenser Containment Float(s) and Chain(s). *If the facility contains more tanu or dispensers, copy uus corm. j- uciuue uummautul tvx vv jLy Lau z. MA.& 41Jk,V13JV1 µv s ......__ J. 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): RICHARD MASON Signature: Certification No.: 5297857 -UT 1 B36880 License. No.: C611 D40 A 809850 Testing Company Name: RICH ENVIRONMENTAL Phone No.: (661) 392 -8687 Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date of Testing/Servicing: 2126115 Page 1 of 5 UN-036 —1/4 www.unidocsorg Rev. 01/17/08 Monitoring System Certification I A Results of Testing/Servicing Software Version Installed: 323.03 f mmnititp the fnllnwino rhp►rklict! ® Yes ❑ No* Is the audible alarm operational? ® Yes ❑ No* Is the visual alarm operational? ® Yes ❑ No* 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., modem) ® 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 ® NIA 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? % ❑ 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* 10 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 setup reviewed to ensure proper settings? Attach set up reports, if applicable ® 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: Page 2 of 5 UN -036 — 2/4 www.unidocs.org Rev. 01 /17/08 Monitoring System Certification F. In -Tank Gauging / SIR Equipment: {0Zt0'J ED 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 ❑ No* Were all probes reinstalled properly? Q Yes ❑ 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. VR/.ii AVW ® Yes W- fVYV.. ❑ No* a.. 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.; [10. 1 g.p.h ; ❑ 0.2 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? * In Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: UN -036 — 3/4 Page 3 of 5 www.unidoes.org Rev. 01/17/08 "7LD6 "o 0 Let wd m �di 6 B s c id :it..,! ta tdr-lbaw pag -W Y, it A� i 0.1 Y VC 4 .0 km 01 'U.I.g IA Alt%shi glebe spa, spl' Y, ar lt. -.,;. Im. Pan., In. AJ by. t" , MO INSW M. V. an " Wo b MA sl used tic- W6� 1 RICA ENVIRfINMENTAL 3305 BRITTAN ST. BAKERSFIELD, CA. 93308 OFFICE (661)326 -8402 FAX (661)326 -8934 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET W /0 #: FACILITY NAMIE: LUCKY 7 FOOD STORE FACILITY ADDRESS: 2501 WHITE LANE, BAKERSFIELD PRODUCT LINE TYPE: PRESSURE )oDwl�l PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL UNL87 L/D TYPE: FXIV YES 11 PASS SERIAL # 6251 NM89 L/D TYPE: FE -PETRO YES 10 PASS SERIAL # UNREADABLE PREM91 L/D TYPE: FX1V YES 10 PASS SERIAL # 9 787__ L/D TYPE: PASS YES SERIAL # FAIL I CERTIFY THE ABOVE TESTS WERE CONDUCTED ON THIS DATE ACCORDING TO RED JACKET PUMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMITATIONS. THE MECHANICAL LEAK DETECTOR TEST PASS / FAIL IS DETERMINED BY USING A LOW FLOW THRESHOLD TRIP RATE OF 3 GALLONS PER HOUR OR LESS AT 10 P.S.I. I ACKNOWLEDGE THAT ALL DATA COLLECTED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. TECHNICIAN: RICHARD MASON SIGNATURE: `� DATE: 2/26/15 scan' 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 (f applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency. I T A rTT .T'i'V TNW0RMAT10N Facility Name: LUCKY 7 FOOD STORE Date of Testing: 2/26/15 Facility Address: 2501 WHITE LN. BAKERSFIELD . Facility Contact. MANJIT SINGH Phone: Date Local Agency Was Notified of Testing: 1/13/15 i Name of Local Agency Inspector (af present during testing): _ _ _ . ......... . It WUQrrnvr rn vrru A PTnV INTnuMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RICHARD MASON Credentials': ❑ CSLB Contractor X ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Spec) License Number(s): 5297857 -UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: VISUAL Equipment Resolution: 0 2 PREM91 FILL 3 NM89 FILL 4 Identify Spill Bucket (By Tank LNumber, Stored Product, etc. 1 REG87 FILL Bucket Installation Type: X Direct Bury ❑ Contained in Sump X Direct Bury ❑ Contained in Sump X Direct Bury ❑ Contained in §ump El Direct Bury ❑ Contained in Sum Bucket Diameter: 12" 12" 12" Bucket Depth: 14" 14" 14' Wait time between applying vacuum/water and start of test: 30MIN 30NIIN 30MIN Test Start Time (T): 9:30 9:30 9:30 Initial Reading (R): IT, ITI 12" Test End Time (TF): 10:30 10:30 10:30 Final Reading (RF): 12" 12" 1T' Test Duration (TF — Tz): 60MIN 60MiN 60NEN Change in Reading (RF - R): 0 0 0 Pass/Fail Threshold or 0 0 0 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 certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: Date: 2/26/15 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. LEAK MIN PERIODIC: o LEAK MIN ANNUAL 0/0 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 15 MIN PUMP THRESHOLD 10-00% LEAK TEST METHOD -TEST ON'DATE ALL TANK JAW 1.- 1996 .-START TIME ' DISABLED TEST RATE 0.20 GAL/HR DURATION, 2 HOURS TST EARLY STOP:DISABLED LEAK ,TEST REPORT NO FORMAT RMAL LIQUID SENSOR•SETUP - - - - - - - - - - - - - L 1:87 STP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 2:89-STP TRI-STATE (SINGLE FLOAT) CATEGORY : STP-SUMP L 3:91 -STP. TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 4:87-ANNULAR I TRI-STATE (SINGLE FLOAT) CATEGORY .: ANNULAR SPACE L,5:91-ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 6:89-ANNULAR TRI-STATE (SINGLE FLOAT)' CATEGORY : ANNULAR SPACE MUSIC OUTPUT RELAY SETUP - - - - - - - - - - - - R 1:07 SHUTOFF* TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM R 2:91 SHUTOFF TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM R 3:89 SHUTOFF TYPE: . STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM RECONCILIATION SETUP - - - - - - - - - - - - AUTOMATIC DAILY CLOSING TIME: 2:00 AM PERIODIC RECONCILIATION MODE: MONTHLY TEMP COMPENSATION STANDARD BUS SLOT FUEL METER.TANK - - - - - - -- - - - - - TANK MAP EMPTY COMMUNICATIONS SETUP PORT SETTINGS: .:NONE FOUND RS-232 END OF MESSAGE DISABLED I N7TANK SET UP T I:UNLEADED 87 PRODUCT CODE, THERMAL COEFF :.000070 TANK DIAMETER 96-00 TANK PROFILE I PT FULL VOL 10080 FLOAT. SIZE: 4.0 IN. WATER WARN I NG 2.0 3.0 H16H -W LIMIT OR '. LABEL VOL: 10000 OV8RF I'LL LIMIT /o 9000 Hl-GH' PRODUCT 9500 DELIVERY LIMIT 10% 1000 Low PRODUCT 500 99 LEAK' ALA p M LIMIT' SUDDEN LOSS LIMIT: 99 TANK -TILT. 4.00 —1.00 p.ROBE OFFSET SIPHON MANIFOLDED TANKS 'NONE LINE MANIFOLDED TANKS T4 NONE LEAK MIN PERIODIC: 0/0 0 LEAK MIN ANNUAL 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST.FAIL i ALARM DISABLED GROSS TEST FAIL .. ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK.:OFF DELIVERY DELAY : 15 MIN PUMP THRESHOLD : 10-00% T 2:SUPER 91 PRODUCT CODE 2 THERMAL COEFF :.000070 TANK DIAMETER 96.00 TANK PROFILE 1 PT FULL VOL 10000: FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HIGH WATER LIMIT: '3.0 MAX OR LABEL VOL: 10000 OVERFILL LIMIT 90% • 9000 HIGH PRODUCT 95% • 9500 DELIVERY LIMIT 10y 1000 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 3.10 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TO: NONE LINE MANIFOLDED TANKS TO: NONE LEAK MIN PERIODIC: 014 0 LEAK MIN ANNUAL 00/0 0 toollot) PERIODIC TEST TYPE STANDARI ANNUAL TEST FAIL ALARM DISABLEI PERIODIC TEST FAIL ALARM DISABLE GROSS TEST FAIL ALARM DISABLE] ANN TEST AVERAGING: OF) PER TEST AVERAGING: OF) TANK TEST NOTIFY, OF] TNK TST SIPHON BREAK:OFl DELIVERY DELAY : 15 Mll PUMP THRESHOLD : 10-00. I T 3:SPECIAL 89 PRODUCT CODE THERMAL COEFF :.0000'e TANK DIAMETER TANK PROFILE FULL VOL 1001 FLOAT SIZE: 4.0 It WATER WARNING 2 HIGH WATER LIMIT: 3 MAX OR LABEL VOL: 1001 OVERFILL LIMIT 91 901 HIGH PRODUCT 91 95 DELIVERY LIMIT I 10 LOW PRODUCT 5 LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TANK TILT 4. PROBE OFFSET 0. SIPHON MANIFOLDED TANK TO: NONE LINE MANIFOLDED TANKS TO: NONE •- •-�' �.e^•_'!1!F!-'^RG+A!;L„+ti..w. ALARM HISTORY REPi�RT .-. s:- r s.+, s'- +' ` E,'." y- ..'+'s"",...,'""�w.•�r".•r"+k ALARM HISTORY REPORT . r��r�' __ - -_ SENSOR ALARM - - - -- E ----- SENSOR ALARM ------ L 1:87 STP L 4:87— ANNULAR - _ _........_... _ _ ........... ....... __ ......__ STP SUMP ANNULAR SPACE SENSOR OUT ALARM SENSOR OUT ALARM FEB 26, 2015 10:44 AM FEB 26, 2015 10:44 AM FUEL ALARM FUEL ALARM FEB 26, 2015 10:31 AM FEB 26. 2015 10:33 AM SENSOR OUT-ALARM SENSOR OUT ALARM SYSTEM SETUP JAN 15. 2014 1:40 PM MAR 2, 2014 9:01 PM — — — — — — — — — — — — FEB 26x 2015 9:15 AM t t SYSTEM UNITS ' U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYYY HH : MM : SS xM END �e ae.�e END€ LUCKY 7 25011 WHITE Lid BAKERSFIELD CA 93304 661- 397 -3722 SHIFT TIME 1 : DISABLED } SHIFT TIME 2 : DISABLED 6 SHIFT TIME 3;: DISABLED � t E SHIFT TIME 4 : DISABLED i TANK PER TST NEEDED WRN ! ALARM HISTORY! REPORT ALARM HISTORY REPORT DISABLED TANK ANN TST NEEDED WRN - -- -- SENSOR ALARM - - -T— - - -;— SENSOR'ALARM - -_ -- DISABLED L 2 :89 —STP L.5.91— ANNULAR •..STP.SUMP ANNULAR SPACE LINE RE— ENABLE METHOD • SENSOR OUT ALARM .SENSOR OUT ALARM r.. PASS LINE TEST . FEB 26, 2015 10:44 AM FEB 26r 2015 10:44 AM LINE PER TST NEEDED WRN FUEL ALARM FUEL ALARM DISABLED • FEB 26, 2G15.10:28 AM FEB 26. 2015 10:34 AM LINE ANN TST NEEDED WRN , DISABLED . ...- �:.�_.,,.�,;�...::_.u::. SETUP DtTi WRNI SE:NS€�R�t�UT• ��ARM " JAN 15, 2014 1:40 FM z PRINT TO VOLUMES JUN 9, 2014 ' ,9:17 AM ENABLED E ` TEMP COMPENSATION i VALUE (DEG F 60.0 STICK HEIGHT OFFSET DISABLED DAYLIGHT SAKI I NG TIME DISABLED END �€ �€ END SYSTEM SECURITY CODE : 000000 - , CUSTOM ALARM LABELS ' DISABLED SOFTWARE REVISION LEVEL VERSION 323.03 SOFTWARE# 346323 -100 =D CREATED — 03.08.06.08.10 ALARM HISTORY REPORT ALARM HISTORY REPORT NO SOFTWARE MODULE SYSTEM FEATURES: _ S -- — '— Etd�OR ALARM - - - -- - - - -- SENSOR ALARM - - - -- PERIODIC IN —TANK TESTS L 3:91 —STP' L 6:89— ANNULAR ANNUAL IN —TANK TESTS STP SUMP ANNULAR SPADE SENSOR OUT ALARM SENSOR -OUT ALARM .FEB 26r - 2015.10:44 AM FEB 26, 2016 10:44 AM FUEL ALARM - FUEL ALARM FEET 26. 2015 10:30 AM FEB 26� 2015 10:35 AM SENSOR OUT ALARM SENSOR OUT ALARM ,TAN 15, 2014 1:40 PM i FEB '. 2014 8:31 PM (407P3 MONITOR CERT. FAILURE REPORT SITE NAME: LUCKY 7 FOOD STORE DATE : 2/26/15 ADDRESS: 2501 WHITE LANE TECHNICIAN : RICHARD MASON THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS: NONE LABOR: NONE PARTS INSTALLED: NONE NAME: TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE.