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HomeMy WebLinkAboutUST REP. 2/26/2013A. Appendix VI (Copies of Monitoring System Certification form and UST Monitoring Plot Plan available at http: / /www.waterboards.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. General Information Facility Name: ARCO Bldg. No.: Site Address: 3125 California Ave. City: Bakersfield Zip: Facility Contact Person: Contact Phone No.: Make /Model of Monitoring System: Veeder -Root TLS -350 Date of Testing /Servicing: 2 / 26 / 2013 B. Inventory of Equipment Tested /Certified ni.....11 1..............o'. * hnvnc to inelir'ta cnnfrifir_ a_nllinmant insnected /serviced: Tank ID: 91 UL Tank ID: 87 UL X In -Tank Gauging Probe. Model: Maq. X In -Tank Gauging Probe. Model: Ma-g. X Annular Space or Vault Sensor. Model: 794390 -409 X Annular Space or Vault Sensor. Model: 794390 -409 X Piping Sump / Trench Sensor(s). Model: 794380 -208 X Piping Sump / Trench Sensor(s). Model: 794380 -208 X Fill Sump Sensor(s). Model: 794380 -208 X Fill Sump Sensor(s). Model: 794380 -208 X Mechanical Line Leak Detector. Model: FX -1V Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: Tank Overfill / High -Level Sensor. Model: Others eci a ui ment a and model in Section E on Page 2). Others eci equipment type and model in Section E on Page 2). Tank ID: 87 UL Tank ID: X In -Tank Gauging Probe. Model: Maq. In -Tank Gauging Probe. Model: X Annular Space or Vault Sensor. Model: 794390 -409 Annular Space or Vault Sensor. Model: X Piping Sump / Trench Sensor(s). Model: 794380 -208 Piping Sump / Trench Sensor(s). Model: X Fill Sump Sensor(s). Model: 794380 -208 Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector, Model: PLLD Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: Tank Overfill / High -Level Sensor. Model: Other (specify,equipment type and model in Section E on Page 2). Other (s eci equipment type and model in Section E on Page 2). Dispenser ID: 1 -2 Dispenser ID: 7-89-10 X Dispenser Containment Sensor(s). Model: 794380 -208 X Dispenser Containment Sensor(s). Model: 794380 -208 X Shear Valve(s). X Shear Valve(s). Dispenser Containment Float(s and Chain(s). Dispenser Containment Floats and Chain(s . Dispenser ID: 3 -4 Dispenser ID: 11-1213-14 X Dispenser Containment Sensor(s). Model: 794380 -208 X Dispenser Containment Sensor(s). Model: 794380 -208 X Shear Valve(s). X Shear Valve(s). Dispenser Containment Floats and Chains . Dispenser Containment Floats and Chains . Dispenser ID: 5 -6 Dispenser ID: 15 -16 17 -18 X Dispenser Containment Sensor(s). Model: 794380 -208 X Dispenser Containment Sensor(s). Model: 794380 -208 X Shear Valve(s). X Shear Valve(s). Dispenser Containment Floats and Chains Dispenser Containment Floats and Chains . *If the facility contains more tanks or dispensers, copy this form. Include information for every tanK and dispenser at ine 1auuny. 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, 1 have also attached a copy of the report; (check all that apply): X System set -up X Alarm history report Technician Name (print): Bruce W. Hinsley Signature: .. r Certification No.: A25212 License. No.: 971259 Testing Company Name: _Advanced Compliance Phone No.:(661) 706 -4321 Testing Company Address: 3707 Littlefalls Ct. Bakersfield Ca. 93312 Date of Testing /Servicing: 2 / 26 / 2013 Monitoring System Certification Page 1 of 4 12/07 2/21/07 D. Results of Testing /Servicing Software Version Installed: 328.03 VU1111piltumv LIIG lullvn/lll H %_,IN nw'li. X Yes No* Is the audible alarm operational? X Yes No* Is the visual alarm operational? X Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational? X Yes No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their Yes No* proper operation? If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? X N/A X Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system N/A detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (Check all that apply) X Sump/Trench Sensors; X Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure /disconnection? X Yes; No. Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no mechanical overfill prevention X N/A 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 Yes* X No of tank capacity does the alarm trigger? % 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* X No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product; Water. If es, describe causes in Section E, below. X Yes No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, if applicable X Yes No* Is all monitoring equipment operational per manufacturer's specifications? _*_In Section E below, describe how and when these deticiencies were or wm oe corrected. E. Comments: Monitoring System Certification Page 2 of 4 12/07 2/21/07 F. In -Tank Gauging / SIR Equipment: X 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. Comnlete the followina 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. C`mmnlata tha Mllnwinn r-har-klict- - -- -- - - -- - - -- X Yes ---- - - - - -- - ❑ No* -- For equipment start -up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all ❑ N/A that apply) Simulated leak rate: X 3 g.p.h.; ❑ 0.1 g.p.h ; 0 0.2 g.p.h. X Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? X Yes ❑ No* Was the testing apparatus properly calibrated? X Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A X Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A X Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or ❑ N/A disconnected? X Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or ❑ N/A fails a test? X Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A X 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: Monitoring System Certification Page 3 of 4 12/07 2/21/07 Monitoring System Certification UST Monitoring Site Plan Site Address: ARCO 3125 California Ave. Bakersfield, Ca. 93304 .N. . . . . . . . .................... .................... ..................... .................... ............................... ............................... ............................... ............................... .7 . . . . . . . 2 J . . . . . . . . . . . . . . . . 9 3 U IBC 1 �- --=UDC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1$ .......... 17. . ....... . . . ........ 6 5 . . . . . . . . . . . . . . . . ................. . . . . . . . . . . . . . . . . . . . .Annular . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TP. . 1• UL. . . . . . . . . . . . . . . . . . . . ............Sump T91' ....................... . . . . . . . . . . . . . . . ............... O ; UL Mas -ter . . . . . . . . . . . . . . . ...........o....... . . . . . . . . . . . . . . . . . p ........................ 87• UL Slave . . . . . . . . . . . . . . . . on. F'il� . . .Sip ................ .................... . Sump.. .. Sump ......................... ............................... . . . . . . . . . . . . . . California-Avenue . . . . . . . . . . . . . . . . . . . . . . . . . . . Date map was drawn: 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 of 05/00 Compliance Advanced 3704 Littlefalls Ct. Bakersfield, Ca. 93308 661- 706 -4321 Fax# 661 -589 -9329 VAPORLESS MANUFACTURING, INC. LDT -890 Leak Detector Test Record Contractor: Advanced Compliance Customer: ARCO Date: 2/26/2013 Location: 3125 California Ave. Bakersfield, Ca. Product: 87 UL Technician: Bruce W. Hinsley Submersible Yum wentiticanon Manufacturer: Redjacket Model No.: Serial No.: Notes: Leak Detector Identification Manufacturer: Redjacket Description: PLLD Diaphragm-type:. Piston -type: Tamper -proof seal installed: Other Style Leak Detector: Notes: Teak Detector in Submersible Pump Test at Dispenser Operating Pump Pressure (psi): 27 (para. 15) Gallons per hour rate: 3.0 (para. 22) Line pressure with pump shut off (psi): 18 (para. 23) Bleed -back Test with pump off (ml): 110 (para. 26) Step- through time to full flow (secs): N/A (para. 30) Leak detector stays in leak search position (Yes/No): N/A (para. 42) Leak Detector Test Pass / Fail Notes: Pass *Complete thermal expansion test before failing leak detector Advanced Compliance 3704 Littlefalls Ct. Bakersfield, Ca. 93308 661 - 706 -4321 Fax# 661 -589 -9329 VAPORLESS MANUFACTURING, INC. LDT -890 Leak Detector Test Record Contractor: Advanced Compliance Customer: ARCO Date: 2/26/2013 Location: 3125 California Ave. Bakersfield, Ca. Product: 91 UL Technician: Bruce W. Hinsley Submersible Pum p Identification Manufacturer: Redjacket Model No.: Serial No.: Notes: Leak Detector Identification Manufacturer: Redjacket Description: FX -1 V Diaphragm -type: Piston-type: Tamper -proof seal installed: Other Style Leak Detector: Notes: Leak Detector in Submersible Pump Test at Dispenser Operating Pump Pressure (psi): 26 (para. 15) Gallons per hour rate: 3.0 (para. 22) Line pressure with pumpshut off (psi): 18 (para. 23) Bleed -back Test with pump off (ml): 140 (para. 26) Step-through time to full flow (secs): 3 (para. 30) Leak detector stays in leak search position Yes/No): Yes (para. 42) Leak Detector Test Pass / Fail Notes: Pass *Complete thermal expansion test before failing leak detector 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: ARCO Date of Testing: 2/26/2013 Facility Address: 3125 California Ave. Bakersfield, Ca. Facility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency Inspector (if present during testing): Ester Duran 2. TESTING CONTRACTOR INFORMATION Company Name: Advanced Compliance Technician Conducting Test: Bruce W. Hinsley Credentials': X CSLB Contractor ❑ ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Specify) License Number(s): 971259 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: Visual Equipment Resolution: Identify Spill Bucket (By Tank Number, Stored Product, etc.) 1 87 UL Dual 2 87 UL Dual 3 91 UL 4 91 UL FBucket Installation Type: Direct Bury X Contained in Sump Direct Bury X Contained in Sump Direct Bury X Contained in Sump Direct Bury X Contained in Sump Bucket Diameter: 12" 12" 12" 12" Bucket Depth: 14" 14" 14" 14" Wait time between applying vacuum /water and start of test: 10 min. 10 min. 10 min. 10 Min. Test Start Time (TI): 10:00 10:00 10:00 10:00 Initial Reading (RI): 10.0" 9.50" 09.50" 09.75" Test End Time (TF): 11:00 11:00 11:00 11:00 Final Reading (RF): 10.0" 9.50" 09.50" 09.75" Test Duration (TF — TI): 1 Hr. 1 Hr. 1 Hr. 1 Hr. Change in Reading (RF - RI): 0.0" 0.0" 0.0" 0.0 Pass/Fail Threshold or Criteria: 0.25" 0.25" 0.25" 0.25" Test Result: X Pass 0 Fail X Pass ❑ Fail X -Pass . ❑ Fail X Pass ❑ 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. Technician's Signature: 4/ ��1 Date: 2/26/2013 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. BAKERSFIELD FIRE DEPARTMENT o 2 10 1 H STREET o BAKERSFIELD, CA. 93301 o 661 - 326 -391 1 "Serving the Community for Over a Century" NOTICE OF ANNUAL "CERS" SUBMISSION REQUIRED WITHIN 30 DAYS April 2, 2014 B E R S F I D F IRE ARTM #Jr Mr. Larry Martin Asian Auto Service 4800 New Horizon Blvd. www.HakersfieldFire.us Bakersfield, CA 93313 e-mail: firefbakersfieldfire.us This Information is now due for annual update re- submittal within the next 30 days. BAKERSFIELD FIRE DEPARTMENT o 2 10 1 H STREET o BAKERSFIELD, CA. 93301 o 661 - 326 -391 1 "Serving the Community for Over a Century" NOTICE OF ANNUAL "CERS" SUBMISSION REQUIRED WITHIN 30 DAYS Dear Business Owner: Douglas R. Greener ® Fire Chief ® To remain in compliance with State Law, you must annually review and re- submit your hazardous materials facility and inventory information. The State uses a web - based program, known as the California Environmental Reporting System (CERS). Deputy Chief Tyler Hartley Operations /Training /Arson This Information is now due for annual update re- submittal within the next 30 days. 661- 326 -3655 Since you have hazardous materials in excess of 55 gallons of a liquid, 500 pounds of a solid, 200 cubic feet of a compressed gas and /or any amount of hazardous Deputy Chief Ross Kelly waste, please review this information on -line, make any changes if needed, or if Fire Prevention /EMS /USAR the existing data is correct, verify again this year by just clicking the Submit button. 661 - 326 -3652 The purpose of periodic reporting of chemical inventory information is to ensure the Bakersfield Fire Department has information that's not more than a year old. Fire Department Headquarters HOW TO BEGIN 2101 H Street, Floor 1 Bakersfield, CA 93301 (661) 326 -3911 (main) 1. Start by going to the CERS Central Home page at: (661) 852 -2170 (fax) http://cers.calepa.ca.gov/ Fire Department Community 2 Select Business Portal Sign -In. Services / Public Information 2101 H Street, Floor 1 3. If you have already entered information into CERS then enter your user Bakersfield, CA 93301 name and password. (661) 326 -3688 (office) (661) 852 -2170 (fax) 4. Select your business and Start or Edit your Submittal. You can start a re- Fire Prevention Division submittal based simply on your last one. Make any changes if needed, but most importantly, please Submit your annual update at this time! 2101 H Street, Floor 2 Bakersfield, CA 93301 (661) 326 -3979 (main) NOTE: A CERS Guidance Document is attached with this letter. (661) 852 -2171 (fax) If you need any assistance, please feel free to contact us at (661) 326 -3970. Fire Training Division 5642 Victor Street (ODFTF) Sincerely, Bakersfield, CA 93308 (661) 399 -4697 (main) (661) 399 -5763 (fax) Arson Division Howard H. Wines, III 2101 H Street, Floor 2 Prevention Services Director Bakersfield, CA 93301 (661) 326 -3911 (main) Attachment: CERS Guidance Document (661) 852 -2172 (fax) BAKERSFIELD FIRE DEPARTMENT o 2 10 1 H STREET o BAKERSFIELD, CA. 93301 o 661 - 326 -391 1 "Serving the Community for Over a Century"