HomeMy WebLinkAbout2017 FMCDISPENSER SUMP TEST
MONITOR CERTIFICATION
11000 N. MoPac Expressway, Suite 500
Austin, Texas 78759
Phone: (512) 451-6334
Fax: (512) 459-1459 Date Printed and Mailed: 7/27/2017
BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
INSPECTOR ERNIE MEDINA
1501 TRUXTUN AVE.
BAKERSFIELD, CA 93301
Test Date: 7/14/2017
Order Number: 3436579
Dear Regulator,
Enclosed are the results of recent testing performed at the following facility:
7-ELEVEN 37942
3225 BUCK OWENS BLVD., HWY 99/HWY 58
BAKERSFIELD, CA 93301
In an effort to keep all our record keeping and reporting requirements as current as possible,
Tanknology kindly requests you notify Dawn Kohlmeyer in writing at dkohlmeyer@tanknology.com
when your CUPA requires all records to be submitted electronically via the CERS database. Your
assistance in this endeavor is greatly appreciated.
Testing performed:
Sincerely,
Dawn Kohlmeyer
Manager, Field Reporting
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:7-ELEVEN 37942 Bldg. No.:
Site Address:3225 BUCK OWENS BLVD., HWY 99/HWY 58 City:BAKERSFIELD Zip:93301
Facility Contact Person:Joel Contact Phone No.:661-325-0176
Make/Model of Monitoring System:Gilbarco EMC Date of Testing/Servicing:7/14/2017
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced:
Tank ID:T-4 - Diesel
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:Veeder Root FX1DV
Electronic Line Leak Detector.Model:
Tank Overfill / High-Level Sensor.Model:EXT 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).
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:
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).
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):Franscico Castro Signature:
Certification No.:B37663 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:7/14/2017
Monitoring System Certification Page 1 of 3 12/07
D. Results of Testing/Servicing
Software Version Installed:
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:
RE-TEST ON DIESEL OVERFILL ONLY
Monitoring System Certification Page 2 of 3 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 3 12/07
SWRCB, January 2002 Page 1 of 1
Secondary Containment Testing Report Form
This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate
pages of this form to report results for all components tested. The completed form, written test procedures, 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: 7-ELEVEN 37942 Date of Testing: 7/14/2017
Facility Address: 3225 BUCK OWENS BLVD., HWY 99/HWY 58 , BAKERSFIELD, CA 93301
Facility Contact: Joel Phone: 661-325-0176
Date Local Agency Was Notified of Testing:
Name of Local Agency Inspector (if present during testing):
2. TESTING CONTRACTOR INFORMATION
Company Name: TANKNOLOGY INC.
Technician Conducting Test: Franscico Castro
Credentials: CSLB Licensed Contractor SWRCB Licensed Tank Tester
License Type: A / UT License Number: 743160 / 8026747
Manufacturer
Manufacturer Training
Component(s)Date Training Expires
VPLT PRECISION EQUIPMENT
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made
UDC # 3/4 X
UDC # 3/4 X
Component Pass Fail Not
Tested
Repairs
Made
If hydrostatic testing was performed, describe what was done with the water after completion of tests:
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements
Technician's Signature:Date:7/14/2017
WO: 3436579
SB 989 TEST WATER REMOVED FROM SITE.
SWRCB, January 2002 Page 1 of 1
7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING
Test Method Developed By: UDC Manufacturer Industry Standard Professional Engineer
Other (Specify)
Test Method Used By: Pressure Vacuum Hydrostatic
Other (Specify)
Test Equipment Used: VPLT Equipment Resolution: 0.00001 in.
UDC Manufacturer:
UDC Material:
UDC Depth:
Height from UDC Bottom to Top
of Highest Piping Penetration:
Height from UDC Bottom to
Lowest Electrical Penetration:
Condition of UDC prior to
testing:
Portion of UDC Tested1
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?*
Turbine shutdown response time
Is system programmed for fail-
safe shutdown?*
Was fail-safe verified to be
operational?*
Wait time between applying
pressure/vacuum/water and
starting test
Test Start Time:
Initial Reading (RI):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading (RF-RI) :
Pass/Fail Threshold or Criteria:
Test Result:
Was sensor removed for testing?
Was sensor properly replaced and
verified functional after testing?
UDC #3/4
BRAVO BOX
Metallic
10.00
2.00
0.00
OK
4"ABOVE
Yes No NA
00:00:00 sec
Yes No NA
Yes No NA
15 min
08:15:00
0.05560 in.
08:30:00
0.05460 in.
15 min
-0.00100 in.
+/- 0.00200
Pass
Yes No NA
Yes No NA
UDC #3/4
BRAVO BOX
Metallic
10.00
2.00
0.00
OK
4"ABOVE
Yes No NA
00:00:00 sec
Yes No NA
Yes No NA
1 min
08:16:00
0.05460 in.
08:31:00
0.05400 in.
15 min
-0.00060 in.
+/- 0.00200
Pass
Yes No NA
Yes No NA
UDC #
Yes No NA
sec
Yes No NA
Yes No NA
min
+/-
Yes No NA
Yes No NA
UDC #
Yes No NA
sec
Yes No NA
Yes No NA
min
+/-
Yes No NA
Yes No NA
Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests)
1 If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must
be tested.
WO: 3436579
7-Eleven Test Water Log
Work Order:
Site Name/ID:
Address:
City:
3436579
7-ELEVEN 37942
3225 BUCK OWENS BLVD., HWY
99/HWY 58
BAKERSFIELD
Date: 7/14/2017
State: CA Zip: 93301
Work Performed:ATG, Disp Sump, SB989 or Sumps
Was Test Water left on site?
Yes
Test Fluid Transported Off Site by Tanknology
Transported off Site by Other Company
No Water used
If Yes describe how much water and how contained?
If Yes who and when did you contact from site to report the water?
If Transported Off Site by Tanknology how much was hauled? Removed two: five gallon buckets from
site.
If Transported Off Site by Other Company what company and how much water?
Technician Signature: Date: 7/14/2017
WO: 3436579
Site Diagram
(This site diagram is for reference only and is not drawn to scale)
Work Order:3436579
Site ID / Name:37942 / 7-ELEVEN 37942
Address:3225 BUCK OWENS BLVD., HWY 99/HWY 58
City:BAKERSFIELD State:CA Zip:93301
W.O.# SC1-3436579