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HomeMy WebLinkAboutFMC RESULTS 2016Testing and Inspection Certificate Tanknology Inc. 11000 North MoPac Expressway, Suite 500, Austin, TX 78759 800-800-4633 www.tanknology.com Page 1 of 1 Test Date 1/20/2016 Tanknology WO#SC1-3428625 Test Purpose COMPLIANCE Customer PO#PO 90087 CMX 151201-051 Customer Location MANSFIELD OIL CO. 1025 AIRPORT PARKWAY S.W. GAINESVILLE, GA 30501 CARMAX #7281 (CMX7281) 6801 Colony St Bakersfield, CA 93307 Attn: JORDAN WOODFIN Attn: Leah Burke- see email (678) 450-2125 (661) 282-3016 Test / Inspection Description Item Tested Date Tested Result Line Leak Detector (3 GPH) Tank 1 UNLEADED Line 1 UNLEADED 1/20/2016 Pass Impact Valve Inspection See test report for details 1/20/2016 Pass Leak Detection Monitoring System Inspection See test report for details 1/20/2016 Pass Spill Containment / Bucket UNLEADED SB 1 - Fill - Direct 1/20/2016 Pass E-Stop Inspection See test report for details 1/20/2016 Pass Tanknology Representative: JEFFREY KERTIS Technician: WILBERT CRISOSTOMO Telephone: (800) 964-0010 Technician Certification: (See forms) LDT 5000 Field Test Apparatus Line Leak Detector Test Page 1 of 1 Work Order:3428625 Date:1/20/2016 Site Name / ID:CARMAX #7281 / CMX7281 Address:6801 Colony St City:Bakersfield State:CA Zip:93307 Tank ID Product Product Line Tested From Existing/New Mechanical/Electronic Manufacturer/Model Serial No. Pump Operating Pressure (psi) Calibrated Leak (ml/min) Calibrated Leak (gph) Holding PSI *N/A for Electronic LD's Resiliency (ml) *N/A for Electronic LD's Metering PSI *N/A for Electronic LD's Opening Time (sec) *N/A for Electronic LD's Test Results 1 UNLEADED UNLEADED 1 1 Existing Electronic Veeder Root PLLD 312121 26.00 189.0 3.00 26.00 Pass Technician Comments: Technician Name:WILBERT CRISOSTOMO Certification #:1300 Technician Signature:Expire Date:1/15/2017 Environmental Compliance for Petroleum Systems © 2016 Tanknology Inc., Austin, TX.    All rights reserved.    tanknology.com Impact Valve Inspection Impact Valve Operational Inspection Work Order:3428625 Date:1/20/2016 Site Name/ID:CARMAX #7281 Address:6801 Colony St City:Bakersfield State:CA Zip:93307 Dispenser Number Grade Secure Mount? Valve Lock?Pass/ Fail Comments 1/ 87 Pass Fail Not Tested Technician Comments: Technician Name:WILBERT CRISOSTOMO Signature: Environmental Compliance for Petroleum Systems ©2016 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com Appendix VI (Copies of Monitoring System Certification form and UST Monitoring Plot Plan available at http://www.swrcb.ca.gov.) 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 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:CARMAX #7281 Bldg. No.: Site Address:6801 Colony St City:Bakersfield Zip:93307 Facility Contact Person:Leah Burke- see email Contact Phone No.:661-282-3016 Make/Model of Monitoring System:Veeder Root TLS-350 Date of Testing/Servicing:1/20/2016 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: Tank ID:1 UNLEADED - UNLEADED In-Tank Gauging Probe.Model:Mag Plus Annular Space or Vault Sensor.Model:303 Piping Sump / Trench Sensor(s).Model:323-304 Fill Sump Sensor(s).Model:323-304 Mechanical Line Leak Detector.Model: Electronic Line Leak Detector.Model:Veeder Root PLLD Tank Overfill / High-Level Sensor.Model:External/Flapper Other (specify equipment type and model in Section E on Page 2). Tank ID: In-Tank Gauging Probe.Model: 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). Tank ID: In-Tank Gauging Probe.Model: 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). Tank ID: In-Tank Gauging Probe.Model: 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:1 Dispenser Containment Sensor(s).Model:323-304 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). 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 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/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):WILBERT CRISOSTOMO Signature: Certification No.: B33025 License. No.:743160 Class 'A' Testing Company Name:Tanknology Phone No.:(800) 800-4633 Testing Company Address:11000 N. MoPac Expressway Suite 500 Date of Testing/Servicing:1/20/2016 Monitoring System Certification Page 1 of 4 12/07 D. Results of Testing/Servicing Software Version Installed:132.00 Complete the following checklist: 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* N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? Yes No* N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment 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* N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no 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* 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? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Monitoring System Certification Page 2 of 4 12/07 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 No*Were all probes reinstalled properly? 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. G. Line Leak Detectors (LLD): Check this box if LLDs are not installed. Complete the following checklist: Yes No* N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: 3 g.p.h.; 0.1 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* N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Yes No* N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Yes No* N/A For electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? Yes No* N/A For electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? Yes No* N/A For electronic LLDs, have all accessible wiring connections been visually inspected? 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: Page 3 of 4 12/07 Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors LG 163-1, Enc. II I.Results of Vacuum/Pressure Monitoring Equipment Testing This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of this form must be included with the Monitoring System Certification Form, which must be provided to the tank system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Manufacturer:Veeder Root Model:001 System Type: Pressure Vacuum Sensor ID S1 Component(s) Monitored by this Sensor:Product Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail S2 Component(s) Monitored by this Sensor:Vent Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail S3 Component(s) Monitored by this Sensor:Vapor Pipe Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail How was interstitial communication verified? Leak Introduced at Far End of Interstitial Space1 Gauge Visual Inspection Other (Describe in Sec. J, below) Vacuum was restored to operating levels in all interstitial spaces: Yes No (If no, describe in Sec. J, below) J. Comments (500 characters max. use additional sheets if needed): Page 4 of 4 1 If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice. WO: 3428625 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. FACILITY INFORMATION Facility Name: CARMAX #7281 Date of Testing: 1/20/2016 Facility Address: 6801 Colony St , Bakersfield, CA 93307 Facility Contact: Leah Burke- see email Phone: 661-282-3016 Date Local Agency Was Notified of Testing: 1/11/2016 Name of Local Agency Inspector (if present during testing): Shane Gardner 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY INC. Technician Conducting Test: WILBERT CRISOSTOMO Credentials1: CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Specify) License Number(s): 743160-5282036 3. SPILL BUCKET TESTING INFORMATION Test Method Used By: Hydrostatic Vacuum Other Test Equipment Used: VPLT Equipment Resolution: 0.00001 in. Identify Spill Bucket (By Tank Number, Stored Product, etc.) Bucket Installation Type: Bucket Diameter: Bucket Depth: Wait time between applying vacuum/water and start of test Test Start Time (TI): Initial Reading (RI): Test End Time(TF): Final Reading (RF): Test Duration(TF–TI): Change in Reading (RF–RI) : Pass/Fail Threshold or Criteria: Test Result: Spill Box # Tank 1 UNLEADED UNLEADED - Fill 1 - Direct - Below Grade in containment sump Direct Bury Contained in Sump 14.00 15.00 15 min 08:51:00 14.50 in. H20 09:51:00 14.50 in. H20 1 hr 0.00 in. H20 +/- 0.00 Pass Spill Box # Direct Bury Contained in Sump min +/- Spill Box # Direct Bury Contained in Sump min +/- Spill Box # Direct Bury Contained in Sump min +/- 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:1/20/2016 1State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. WO: 3428625 Emergency Stop (E-Stop / ESO) Periodic Inspection Facility Information Technician Information Site #: CARMAX #7281 CMX7281 Date: 1/20/2016 Address: 6801 Colony St Name: WILBERT CRISOSTOMO City / State: Bakersfield CA Technician Signature: The objective of this test is to provide assurance that the when the E-Stop switch is activated, all the fueling system circuits (turbines, and dispensers) are de-energized, and remain de-energized until they are re-set manually). The test procedures and guidelines shall be in accordance with the E-Stop Testing Process. SITE DATA 1 Number of E-Stop switches INSIDE of the building: 0 2 Number of E-Stop switches OUTSIDE of the building: 1 PERFORMANCE DATA Yes No NA 3 You have added or confirmed that all E-Stop locations are on the Site Diagram 4 Do all E-Stops shutdown power to ALL DISPENSERS 5 Do all E-Stops shutdown power to ALL STP's 6 Are ALL E-Stops clearly Labeled 7 Are the TURBINE BREAKERS clearly identified / labeled POST TEST 8 All equipment secured and any access ports, lids, enclosures are closed. 9 All safety barricades and test equipment has been properly removed 10 E-Stop was reset and all dispensing functions are normal E-Stop Inspection Results 11 PASS FAIL INCONCLUSIVE Comments (Clearly describe any deficiencies found) WO: 3428625 Site Diagram (This site diagram is for reference only and is not drawn to scale) Work Order:3428625 Site ID / Name:CMX7281 / CARMAX #7281 Address:6801 Colony St City:Bakersfield State:CA Zip:93307 W.O.# SC1-3428625 Cust Ref#: PO 90087 CMX 151201-051 Vr sticker