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HomeMy WebLinkAboutFMC 20132013 -06 -20 00:25 B >3 Fax Server P 217 AppendIx VI (Copies of Monitoring System Certification form and UST Monitoring Plot Plan available at MONITORING SYSTEM CERTIFICATION For u6v ay mi,jurlsdiatlOns With/n the State Of 061lfamla uthorlty Cited., f;hopter 6.7, Health and Safety Code; Chapter 16, DIVISI rn 3, �'ltl�► 23, f�aNtQrrtlB �r�+dr� vi' Regulations This farm moat be used to document testing and servicing of monitoring riorm9� heequipment, copy o rwarale form maufetnbe prts�vlded tvtthe t2nk system each mordtoring system control panel by the technician who pe owner /orator. The owner /operator must submit a copy of this form to tt)e local agency regulating UST systems within 30 daye yr test date A, F aBngtel Information „•� .�. r� —,Bldg, No.! Facility Name: .......�-- t�-L.. 3�,� �..... -- Site Address; City. 0 b'�i�f� �fp: Farrtucy Coritaot Berson: corltact Phone No.; �taKe/IVtocfei of tdWrtttartng $ysid�m; ` ,, ~ '- 4 '^ Data of TestinV$erviolnp: ai Equtprttor Tart+ -. #_ i.%mAst6 ■nneitin wutament in 7sr~k iD; + tr Modal Tank 10, -t In -Tanis dauglii0 Proo. model: _ Most - VwTn,Tar,k (euging Probe. veMnul9r Space or VV 111 Sensor. "M3 Model: n Annular Spice or Vault Sensor, -1 Piping Sump I Trench Sonsor(s). Model: w- Piping sump / Trench Ssrurar(v? Model: `t FIII SUmp Sensor(><}. model, W"-Fpl sump F6ttaor( *)• emocht<nkW Lne LOU 041IN10r. Model: "—" -i Moohanica) LIAO Leak ©ete0l0r. -i ElectrordC Uns Leak 0otector. Modal: _.. Modal; 'i Electronic Line: Leak Ntwlior, �1rloUi 1 MelplrLe Sin Modet: 9actlon 2 . — � Tank Ov*riNl i Filch -Level Sensor. n Other s cl a ul ern and model Model: - in Section E an Page 2 't Crtf,$r #at and modal In 5 on E7a lank ID: -i In --rank (az In Probe, Model: _.,- -- - Tank ID; 1 In-Ta �suging Probe. 'i Annular Space or Vault Sensor.Modal: Modal: - � -- 'i Annular spm or Vault SOW. Model; --„ "I Piping Sump / Trench 8aneor(v). Model; r....--- .- .�.. --- i Piping Sump / Trench Sensor(s }. '1 Fill Sump S�enior (6). Model, ._- .--- --•- -- Model: I Fill Sum Seneor(v). "I Lure Leek Detoctar. Model; A�adsl:.„..,.__.- .-.- -- � Macii�tartlC91 Llrte•Leak Cielectorl Modal: M*Ch oel Electronic Line Leak Detvclor. Model: Electronic line Leak Date=, "t Tam C, vadill I High-Level Saneor. Model' Model: '1 Tank C3verfli{ 1 H1Sitki.+av� Sensor. Model; I "l i a and model in Section Eon Page � , 1. .4fu urn llra' mt ivrw end medal In Section E on Pa 2 Other * equipment DlspeAw 10: _,-,. V- owperwar Cont wear V00). DispenW ID; Mader: n Dispartssr Conta{nnwnt 9er*6r( *). "I $hear Vvlve(e). 'f l]t>r roar Contairvnent r"t s and Chal +t . 11316Pan>r*tl to: -i Dispenser 066wwwnt sereor {s }, Model: _ ..... -- -- -1 Shoo Valva(v), . - 7 Diecvrwor_CWainmant rlo&t * and Chain * - -- DlspenserID, -m- '11 Dispenser 15Q_ntdr1niant serwar(o). Model; - o AIYY(T). _ _. -. . - -J Disponssrill; I Dispenser Cont9Jnmuht Sarwr(s), Model; 't Shear Velve(a)1 _, - _ , ^L _ 1 -, -, 01*pen*er ID; �----� '1 D{spomrContainmentSansor(ef. Model: --_. -� - -I anaar Vaiv9(v). . . - r at the �''ff�ii•laclihy cartaln6 mpnt±ttuv�s prv�it�a�,lr /,rvrr .• .........._ --__ .. _ t1. certification - ! osrtlfy tnot the equipment Identified pgo In 9. manuiuomturore�h+Wklis'1*) note” r to witythat th * IntarmuVOIrua oourreect gu{d*llnes. Attrwhed tc this C#nKiat►tlon Is Informlrtlott (e.p. and * Plot Ptsn $howing the layout of monitorin0_6itamm9MI, For any *� wll mentty ble of gonsratlna such reports, l h *i+e 9160 ahp0#t6d a r,Qpy of tti6 repcttti fvh6ok alt thirf r•Ap1Y1 , Technician Nt f prlrtt)��- signature; C��... Oerdflcatlon No.: t License. No.: 686 ^ eg f _41� Tasdng Cantpany NWW-. 1 Phone No,.(_ }...,,., Tasting omp`- y Add Data of 'To>itingrServicing i,�szr- 0 revs; 12101 Monitoring System C*r0fiQN1I0M page I of 4 2/21/07 2413- 06 -2$ 08:5 B >3 Fax 5erver P 317 LLT C' F 5Z k r to f ' r Urn P 1. nisi, rarrng system Certification Page Z of 4 12107 D. Results of testing /Servicing ir:.3re Viertion installed: �ajn Mete the followin 2 Checklist: a; No` Is the 1101ble slarrr) operetlonal? _. �- -_. i yr-rvy No' Is the visual alarm Op9rational? ��...... Yes � No' Were all sensors visually inspected, (onationally tested, and tonflrmed gparational7 .., IQwq$t of socQndery oontainmont d positioned oo that other equipment will not interfere will) tnari i (es No' were ali senr;grs instailed lit point No. proper o eration? If alarms are relayed to a remote monitoring station, is all cGmmunir,$tiana equipment (e.g. modem) operati©nal? NIA Y,3': No' For Ofessurized piping systems, does the turbine autOrriatigally shut down if the piping gggqndery conteiirlment ms�rutoring systa� "� it is dlgConnected? If yes: which sensors iniiiale positive Shot -down? tG?NKA aU rh6f UVr,ry, N/A r detects a leak, tails to OpOrate, or electrically vrSurnpffrench sensors' w''-Dispenaer GOntalnmont Bensors. Did you confirm positive shut -down due to looks Mid *v "gor i 1'u� No' fsllureldlscvnnegtlon? fe3: No. Far tank +1y #tarns that utilize the, monitoring system $a the prlmary tank overfill warning device 0 -e• no mechanical overfill DreamBryn at the tank fill point(s) and operaatinp prOptrly? H so, at what percorrt N/A valve is Installtd), its the overfill wsrning ■larm vlalble and audible 11/0 i' No vt tank ca acs does the alarm rtt7 Was any mOnitorinq *quip m4nt roplaced? If yta� Id4ntity 6pbolfC ;gnsbfb, probes. or other equipment repl$ced antl iist the Yes' r - -• manufacturer narnt and modal for all re acemtnt arcs In Section E, below. y ( Product, W3tEr II contablM,0nt s stems designed as dry systems? Check alt that apply) found inside any socondmry� y g •; y,r•� {4S No No' Was Ifgr�id ,• . es, describe causes In section E h`0%'V Was s monitoring syste sat -up rcvlowed to ensure proper settings? Attach set up repon6, if appltcaala No' t4 ell monitoring e4uipment Operational per manufacturer's specifications? = —1r 5eclivn E below, describe how and when these detieiencits were ar wilt be corrected, E. Cornments: icl LA 15 -' LLT C' F 5Z k r to f ' r Urn P 1. nisi, rarrng system Certification Page Z of 4 12107 2013 -06 -28 08:25 B » Fax Server P 4/7 F. In -Tank Gauging I SIR EgUlpMont Q Check this box If tank gauging is used only for inventory control, a Check this box If no tank gauging or SIR equipment is installed. This Section must be completed if In -tank gouging equipment !S MCI to perform leek detection monitoring. earn lete the foll*wing checklist: IF Yes 1 0 No' I Has all input wiring been lnspectbd for proper entry and termination, Including feeling for ground faults? V Ye$ p V Yes D No' NV' VYefq III J*nF VauVfr1V PIU ai vwwa14r -- wttit► socuracy of system product level readings Weed? jvYes ❑ No' Was socuracy of system Water level readings lefited'? ._ gr, p No' Were all prOgi relnatalled properly? /'Yes Q No` Were ail Items on the equipment rnanvtocturer's rnvintenvnCo checklist aOmpleted? ' In the Sectlon H, below, describ; how and when these deflciencles were or will be corrected. G. Line Leak Detectors (LLD): -3 Check this box if LLDs are not installed. Corn late the followina No' checklist: s � � p n liriulsksd to verify LLD performance? (Cheek ari For equipment startup or annual ent r i� , e4 Q D NIA that apply) Simulated leak rate; gpP Q OA ti a -« 'Yes p No' Were all Uos confirmed operational and accurate within regulatory requirement*? as D No' was the taiting apparatus ptoperiy cdlibral;07 fey Q No' For mechanical LLD *, does the t-LD restrict product flow If It detects a leak? ❑ Yes ' d NIA No` For electronic LLOG, dQ04 the turbine automatically shut off if the LLD detect* s leak? d ry /A Nq+ For electronic LUN, does the turbine automatiCeJly shut off If any portion of the monitoring system is disabled or r�• Yes - N/A No' dlec nneycted? J=ar electronic LLDs, does the turbine auicmatioally shut off if any portion of the monitoring system malfunctions yr Yes o � K/A J�Jo* falls a teat? For *Iactronlc LLC�s, have all acGesaibie wiring oannecuons bderr visually inspected? Yes d sr Yea t3 Nla ware all items on the equipment manufacturer's melntenance shook {fat campleted'� • In the Section H, below, describe how and when these deftieno(es were ear will be corrected. Comments: Monitoring system Certification Face 3 of 4 3 12107 2/2 l /0 "1 2013 -06 -28 08:26 Fax 5 e ry e r P 517 • , ' •;S ii' ': +'il;� ?!�i "r�N'7'*4 ,.r. •1:'• ��:' r ! "r t�,�o'�;IJ'.: ''J"' ?�r�";r .: i,, Ilr:i n. , c•�i,'. .t , •,1 •''. .rY,•,i, ;,; •r:t f•. /;•�i•, .1 '+ ,. ,I ` •1 � � h.: •'S: r, '!'1 a�i rfi"�ty {•',�. i ,1� y�•,I hi+%••: "• .f.�l.. ,•'i;r;.•• 'ti. ,1 ,• r;, •, , ' , 1' � "� �' ',A .•�A�.+r.,�...r. •.,l••.+,,!• . •'y,�.•i Ire' I: ri .. : � • t:+ !3 .ei�'i�'•i6ti I'/' .i� 4+ •r •+,i �r.r� iyV -SINtr ll, , j• hfyl• »... ;IA. , � I •, � , `.J � r�Ji ,••'�i I J 1r,? d'��yy,� /p1, �'�1 Y :t ^�'At4!,�I �+gplye'Tyy ', i., ? r .. 1 ' '' i' • � 1'. 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'' "" '1' M��' .ti i,,, "•.+ •' ,r'�'1 •.. i,.�f ir...Y♦ '✓:'..r•�'' •... r •;. •t' I i r'�'i 'NP ,M "r, i�J•via�irti•:•: ,1S1i ,•Itl :'lyill r �'{: /r' 't i•'' •: +i `- r r yj'., 1 • A "o' {. i'.:: T Y � " .1 �h rl , y, r F m :. r`ti that eh .rNJf t�k�d: crrnitlort iru��tut1� Ikr fit per thoh this Page, with Maur Monitoring System it you alrssdy have 'd •, how'th � (� I- �`"�. t 4L tonk� #rlcmprrio': I ,lomy wintlly 14#tEpns of the tollawitV equipment, lF installed; � vrUfloo lon. On YOW ,iit+► plan, 1 (��l mvnitorh :, gym ooittral', putt ie; eui ''irk►. r i; lhk, unulsr op ;t mps� pstt>is�r pins, sAll� oantl►Inr�r�, or 'other ,� tindery ,ntal���••+�nt r,r ; m h�r�4�i QI`,�iAo !IIn� :I+�r�k it+►teotorc and•In-ttl`_ilquid Isvei• prOss,(if used Wr lo4k det+otion). ., in the space provWod,, *1 the d to tt►ls iRe P I rt wo* 'pro 1�id "•h ,, I' ' : ;r,r , " ' : . K. ,`. •'1'• ,.'i`•'�i.: �,rrY ,41!• +1,.. •�, •.I S'��`�. r,J , ••'h .,ll�l�.r 1'• , Morittorinpl system CsrtlTfaatfvn Papa 4 of 11201 . ' � r,'y .+. {'. ', 'vl: r'1 .•t *�� +k•l+�,t ;h �•�� :' •' � ~fir • ..li r, 1 -,: r'rA�.,l.ti •r1•., t`•, i;'r rlal�•, }. . • 4 2/21/07 2013 -06 -28 08:26 B >> Fax Server P 6/7 SWRCS, raiwary 20(.)6 Spill bucket Testing Report Form ;';rr��vrr1► is intendedfor use by contractors parfor -ming annual toning of UST spill containment structures. 'Che completed Turin wili ppj� Itopis front restr (if applhcable), should be provided to the facility owner /operator for subrrtlttal ttr the local eegulalory agenc:y-. 1. FACILITY INFORMATION FocihiV Narne: Date of T sting; F :tcility Address: 15 E tN a - F;Icility Contact: Phon 0 OIL 0 4 Dote Local Agency Was Natfled of Testing: n„, __ -... __. -I Nome of Local Agency Inspector (lfpresent during resting): S t• t ME IC> I t-w1 A 2. TESTING CONTRAMI INJFORMATION (_ ortlp;im- Naliie: 1 { I TceluII -dan Conducting Test: 1c- rr %D15 L C '+�Z �2: 1 L I_ C) „-- t_'tcdentials' : 0 CSLB Contractor VCC Service Tech. ❑ SWR.CB Tank Tester 0 Cither ('Specify) .. ..- ;_iccitsc Number(s): 5eX 5 'Tc 9- 3. SPILL BUCKET TESTING INFOR,MA,TION Test Method Used: 0 vactium 0 ot� r Test Equipment Used: „} t ' NJ f*1 L. Equipment Resolution: Idendfy Spill Bucket (By Tank I , t L 2 4 Stored Product, etc. B ut kct installation Type: 0 Direct Bury 0 Diroot Bury CJ oirect Bury Q Direct Duly wContaimad in Surn ❑ Cantain.ad in Sum ❑ Contained in SUMP, ❑ Coat ii�cd itr Sui>>y, 1 i3ucket Diameter; -- ' "---; Buc} ct Depth: Wait tulle betWcen $pplying ( � v:tckiuIn water and start of test: fYy t rwt►, 'rest Start Time 00 lttitittl Reading (RJ: �- Test End Time (TF): %.oc Mry - -- Final Reel ntg (R.F): '- -- "1'051 DurtltiOn (TF — Tt): H'trlu - �`1L'111�4 ill Reading (�F " �t)� •+'� .. pass/Fad Threshold or Cr-iterial _r. --- ww� Test Result: as D Fail 0 'ass ❑Fail ' 0 Pass 0 Fail ❑ Puss 0 It til C: om m exits — nclude in q?mT,0ort on re airs made prior to tsstln , and reoomrrsended a!lotiy -u or ailed tests] CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING 1 l,rre%y certify that till the inforrrc On contained in 41 ;ls report is true, accurate, and In full compliance with Iegal requirernents. Tecluticiait's Signature; :�" t Date:, C'CLq'a4JJ_Lt.. at,tw la\ti -s and regulations do not currently reg41re testing to be perlft�ra�ed by �t cit lif ieci contactor, awever, l4Gt�! reyuireniGrlts ttt:sti � ttzute �ttirl�,Cnt. 2013 -06 -28 08:26 B } Fax Server P 717 PAN PACIFIC 106 COFFEE RIB 13AKER2F I ELD CA , 93302 •�1 ! ';: - -- :__ 861 - �0�3 -320q SENSOR ALARM -- JUN 26, 2013 9;31 AM L 2.STP FUEL AL.AIRM • I JUN 26, 2013 9.:4.9.AM SY STVY1 STATUS )REPORT L 2 ;1: UEL ALARM PAN - PACIFIC '' 18a' Ct�FFEE �A •' SAXERSFIELD' Cfi,, 93302' SENSOR' ALARM - - -ti - 1JUN 2�ir'.2Q13 X9:19 AM I L 1: D I ESEL Dj SPEN8ER i DISPENSER PAN SENSOR OUT . ALARM _..... -' -- _...._... _. ..,. JUN 26.. 20I � • 9': 32 AM' '$LIBOR' AL:ARM ''-- -- .� L 1: D I ESEL D i SPEN8ER D I $PENSER 'FLAN FEEL ALARM JUN 26. 20131 91:20 All - - - -- $ENISOR� ALARM L 3;ANNULAR l ANNULAR SPAQ8 SE►�CR OUT ALARM rPAN •' P I JUN 26, 2013 ­9, �. FI � 1.. k 05 COFFEE. RD,, i ? - SAXERSF I ELD: CA'. 93302 ,,' 'c� I ■, ,.• UN ": �L'r Q•1''y.� %9•,.20•AM SEIsE R ALARM. L 2 ; S'TP . . , I t.. -��.- 'EEt R ALAPH STP SUMP "�:rr NNULAR .. I SE14BOR OUT ALARM - ' � XANI�III.,�F��r�Pf�CE' JUN 26. 2013. ,.9.32 Am" , LOW' L- IQUIL•ALAI�M'.(� � 4' -JUN t� ,: 2013' /}may ,N1�!+ny� /f.�yT ��.yy V��y'1`1w'' .,� .,.Fy•���,t:: •y1r,�'ryr��r,t �w+•r' r,y ;•.ygv n:•i }�',' SE •NOR .' 1 L 11.1 ,.• ,„.� ..f,• n '•I' i• 'l l' .r J~, r I .' '� 'S��V xM•�,'•1 •• '�1.. I•g1 . L 4 :I" I �I* UThiER SENSORS. 185:'. COFFEE SEI aOR OUT �i1.ARM niF XER5F.1 :9I.P 'C�1. JUN 26 ► 2013 9.32' AM ;„ ; �6. 1'! ��'9: *;20,0', •,'' „, � 2013-06-28 08:25 B W30 RowdMe Hwy # B Hakersfield, California 93308 Phone: 661 %8 2777 Fax: 661 W 2786 Fak >> Fax Server Tom. Bakersfield Cfty Fire — Emie Meclina Fam 852-2171 Re.- Pan Pacific 1850 Coffee Rd . . . ........ E3 UrgentO For Roview Vronm Kelly TackeU Uwft 6-28-13 Page= CM E3 Pkmse conunem 13 Memm R90Y 13 Maw Rocycle *Comnwpt-m Hi Emie, Attached are monitor certification results_ Please call if you have any questions. Thanks, Kelly P 1/7