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HomeMy WebLinkAbout2016 FMC RESULTSTesting 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 6/7/2016 Tanknology WO#SC1-3431579 Test Purpose COMPLIANCE Customer PO# Customer Location CST BRANDS 685 WEST THIRD ST HANFORD, CA 93230 CORNER STORE 3074 3225 BUCK OWENS BLVD. HWY 99/HWY 58 BAKERSFIELD, CA 93301 Attn: Sandy Huff Attn: MANAGER-JOEL (559) 583-3298 (661) 324-9481 Test / Inspection Description Item Tested Date Tested Result Precision Line Tightness (.1 GPH) Tank T-1 Line 1 REGULAR 6/7/2016 Pass Precision Line Tightness (.1 GPH) Tank T-2 Line 1 PREMIUM 6/7/2016 Pass Precision Line Tightness (.1 GPH) Tank T-4 Line 1 Diesel 6/7/2016 Pass Precision Line Tightness (.1 GPH) Satellite Line 1 6/7/2016 Tested w/ Primary Precision Line Tightness (.1 GPH) Satellite Line 2 6/7/2016 Tested w/ Primary Precision Line Tightness (.1 GPH) Satellite Line 3 6/7/2016 Tested w/ Primary Precision Line Tightness (.1 GPH) Satellite Line 4 6/7/2016 Tested w/ Primary Precision Line Tightness (.1 GPH) Satellite Line 5 6/7/2016 Tested w/ Primary Line Leak Detector (3 GPH) Tank T-1 Line 1 REGULAR 6/7/2016 Pass Line Leak Detector (3 GPH) Tank T-2 Line 1 PREMIUM 6/7/2016 Pass Line Leak Detector (3 GPH) Tank T-4 Line 1 Diesel 6/7/2016 Pass Impact Valve Inspection See test report for details 6/7/2016 Pass Leak Detection Monitoring System Inspection See test report for details 6/7/2016 Pass E-Stop Inspection See test report for details 6/7/2016 Pass Tanknology Representative: JEFFREY KERTIS Technician: Axel Medina Telephone: (800) 964-0010 Technician Certification: (See forms) Product Line Tightness Test Page 1 of 1 Work Order: 3431579 Date: 6/7/2016 Site Name/ID: CORNER STORE 3074 / 3074 Address: 3225 BUCK OWENS BLVD. HWY 99/HWY 58 City: BAKERSFIELD State: CA Zip: 93301 Tank Information Test Method Customer Tank ID Product Name Delivery Type Test Pressure Test Start Time Test End Time Final Leak Rate Test Result(P/F/I) Test was performed per 3rd party certifications as specified in 40 CFR parts 280 and 281 Tank # 1 Line # 1 TLD-1 T-1 REGULAR Pressure 55 11:50 12:20 0.00 Pass Yes Tank # 2 Line # 1 TLD-1 T-2 PREMIUM Pressure 55 11:50 12:20 0.00 Pass Yes Tank # 4 Line # 1 TLD-1 T-4 Diesel Pressure 70 09:46 10:16 0.00 Pass Yes Tank # Line # Tank # Line # Tank # Line # Technician Comments: Technician Name:Axel Medina Certification #:56942 exp: 2/1/2017 Technician Signature: Environmental Compliance for Petroleum Systems ©2016 Tanknology Inc., Austin, TX.    All rights reserved.    tanknology.com Product Line Tightness Test Satellite Line Tightness Test Page 1 of 1 Work Order: 3431579 Date: 6/7/2016 Site Name/ID: CORNER STORE 3074 / 3074 Address: 3225 BUCK OWENS BLVD. HWY 99/HWY 58 City: BAKERSFIELD State: CA Zip: 93301 Satellite Line # Fueling From - To Product Name Delivery Type Test Pressure Test Start Time Test End Time Final Leak Rate Test Result(P/F/I) Test was performed per 3rd party certifications as specified in 40 CFR parts 280 and 281 Sat # 1 9 - 9 Sat DIESEL Pressure 70 09:46 10:16 0.00 Included with primary line test Sat # 2 10 - 10 Sat DIESEL Pressure 70 09:46 10:16 0.00 Included with primary line test Sat # 3 11 - 11 Sat DIESEL Pressure 70 09:46 10:16 0.00 Included with primary line test Sat # 4 12 - 12 Sat DIESEL Pressure 70 09:46 10:16 0.00 Included with primary line test Sat # 5 13 - 13 Sat DIESEL Pressure 70 09:46 10:16 0.00 Included with primary line test Sat # Technician Comments: Technician Name:Axel Medina Certification #:56942 exp: 2/1/2017 Technician Signature: Environmental Compliance for Petroleum Systems ©2016 Tanknology Inc., Austin, TX.    All rights reserved.    tanknology.com LDT 5000 Field Test Apparatus Line Leak Detector Test Page 1 of 1 Work Order:3431579 Date:6/7/2016 Site Name / ID:CORNER STORE 3074 / 3074 Address:3225 BUCK OWENS BLVD. HWY 99/HWY 58 City:BAKERSFIELD State:CA Zip:93301 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 T-1 REGULAR 1 6 Existing Mechanical Veeder Root FX1V 20508-3195 28.00 189.0 3.00 12.00 120.00 10 3.41 Pass T-2 PREMIUM 1 6 Existing Mechanical Veeder Root FX1V 30208-9410 28.00 189.0 3.00 14.00 145.00 11 2.73 Pass T-4 Diesel 1 13 Existing Mechanical Veeder Root FX1DV 30204-7281 45.00 189.0 3.00 45.00 400.00 14 2.17 Pass Technician Comments: Technician Name:Axel Medina Certification #:56937 Technician Signature:Expire Date:1/24/2019 Environmental Compliance for Petroleum Systems © 2016 Tanknology Inc., Austin, TX.    All rights reserved.    tanknology.com Impact Valve Inspection Impact Valve Operational Inspection Work Order:3431579 Date:6/7/2016 Site Name/ID:CORNER STORE 3074 Address:3225 BUCK OWENS BLVD. HWY 99/HWY 58 City:BAKERSFIELD State:CA Zip:93301 Dispenser Number Grade Secure Mount? Valve Lock?Pass/ Fail Comments 1/2 87 Pass Fail Not Tested 1/2 91 Pass Fail Not Tested 3/4 87 Pass Fail Not Tested 3/4 91 Pass Fail Not Tested 5/6 87 Pass Fail Not Tested 5/6 91 Pass Fail Not Tested 7/8 87 Pass Fail Not Tested 7/8 91 Pass Fail Not Tested 9/ 40 Pass Fail Not Tested none/ 40 Pass Fail Not Tested 9 Sat/10 40 Pass Fail Not Tested 10 Sat/11 40 Pass Fail Not Tested 11 Sat/12 40 Pass Fail Not Tested 12 Sat/13 40 Pass Fail Not Tested 13 Sat/ 40 Pass Fail Not Tested Technician Comments: Technician Name:Axel Medina 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:CORNER STORE 3074 Bldg. No.: Site Address:3225 BUCK OWENS BLVD.HWY 99/HWY 58 City:BAKERSFIELD Zip:93301 Facility Contact Person:MANAGER-JOEL Contact Phone No.:661-324-9481 Make/Model of Monitoring System:Gilbarco EMC Date of Testing/Servicing:6/7/2016 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: Tank ID:T-1 - REGULAR In-Tank Gauging Probe.Model:847390-107 Annular Space or Vault Sensor.Model:794380-420 Piping Sump / Trench Sensor(s).Model:794380-205 Fill Sump Sensor(s).Model:794380-208 Mechanical Line Leak Detector.Model:Veeder Root FX1V Electronic Line Leak Detector.Model: Tank Overfill / High-Level Sensor.Model:overfill alarm Other (specify equipment type and model in Section E on Page 2). Tank ID:T-2 - PREMIUM In-Tank Gauging Probe.Model:847390-107 Annular Space or Vault Sensor.Model:794380-420 Piping Sump / Trench Sensor(s).Model:794380-208 Fill Sump Sensor(s).Model:794380-208 Mechanical Line Leak Detector.Model:Veeder Root FX1V Electronic Line Leak Detector.Model: Tank Overfill / High-Level Sensor.Model:overfill alarm Other (specify equipment type and model in Section E on Page 2). Tank ID:T-4 - Diesel In-Tank Gauging Probe.Model:mag plus Annular Space or Vault Sensor.Model:794380-420 Piping Sump / Trench Sensor(s).Model:794380-208 Fill Sump Sensor(s).Model:794380-208 Mechanical Line Leak Detector.Model:Veeder Root FX1DV Electronic Line Leak Detector.Model: Tank Overfill / High-Level Sensor.Model:overfill alarm 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:1/2 Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID:3/4 Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID:5/6 Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID:7/8 Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID:9 Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID:9 Sat/10 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):Axel Medina Signature: Certification No.:56935 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:6/7/2016 Monitoring System Certification Page 1 of 4 12/07 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:CORNER STORE 3074 Bldg. No.: Site Address:3225 BUCK OWENS BLVD.HWY 99/HWY 58 City:BAKERSFIELD Zip:93301 Facility Contact Person:MANAGER-JOEL Contact Phone No.:661-324-9481 Make/Model of Monitoring System:Gilbarco EMC Date of Testing/Servicing:6/7/2016 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: 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). 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:10 Sat/11 Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID:11 Sat/12 Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID:12 Sat/13 Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID:13 Sat 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):Axel Medina Signature: Certification No.: 56935 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:6/7/2016 Monitoring System Certification Page 2 of 4 12/07 D. Results of Testing/Servicing Software Version Installed:20.04 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? 90% 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: Diesel filter sump Has a VR-208 (794380-208) liquid sensor that was tested and passed. Fill sumps are not programmed for positive shut-down. Monitoring System Certification Page 3 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 4 of 4 12/07 Emergency Stop (E-Stop / ESO) Periodic Inspection Facility Information Technician Information Site #: CORNER STORE 3074 3074 Date: 6/7/2016 Address: 3225 BUCK OWENS BLVD. HWY 99/HWY 58 Name: Axel Medina 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: 1 2 Number of E-Stop switches OUTSIDE of the building: 2 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: 3431579 Site Diagram (This site diagram is for reference only and is not drawn to scale) Work Order:3431579 Site ID / Name:3074 / CORNER STORE 3074 Address:3225 BUCK OWENS BLVD. HWY 99/HWY 58 City:BAKERSFIELD State:CA Zip:93301 W.O.# SC1-3431579 ovf W.O.# SC1-3431579 tapes W.O.# SC1-3431579 tapes W.O.# SC1-3431579 tapes W.O.# SC1-3431579 tapes