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Home My WebLink About2018 FMC RESULTS Emergency Stop Switch Operation Inspection Facility: Costco Wholesale #688 Date:5/15/18 Address: 3800 Rosedale Hwy Testing Company: W.S.K. & Sons Inc City, State, Zip: Bakersfield CA 93308 Tester Name: Bill Karras This procedure is to verify the operation of all emergency stop switches/buttons (E-stops). Each E-Stop must disconnect power to the dispensers, submersible turbine pumps (STPs) and all non-intrinsically safe electrical equipment in classified areas. Test each E-Stop separately. See PEI/RP1200, Section 11 for the inspection procedure. E-Stop Number or ID 1 2 3 Location Data Hut South Planter North Planter 1. E-stop labeled and located where easily accessible? X Yes No X Yes No X Yes No 2. System is fully powered and in normal operating condition? X Yes No X Yes No X Yes No 3. After activating E-stop, power has been disconnected from: 3a. All dispensing devices on all islands? X Yes No X Yes No X Yes No 3b. All STPs for all fuel grades? X Yes No X Yes No X Yes No 3c. All power, control and signal circuits associated with the dispensing devices and the STPs? X Yes No X Yes No X Yes No 3d. All other non-Intrinsically safe electrical equipment in classified areas surrounding fuel dispensing devices? X Yes No X Yes No X Yes No 4. All intrinsically safe electrical equipment remains energized after E-stop activation? X Yes No X Yes No X Yes No 5. After testing, has E-stop been reset and power reestablished to normal operating condition? X Yes No X Yes No X Yes No A "No" to lines 3a-3d indicate a test failure. Test Results: X Pass Fail X Pass Fail X Pass Fail Comments: Tester's Signature William Karras Date: 5/15/18 Revised 11/03/2014 UST System Impact Valve Testing Location Name: Costco Wholesale #688 Date: 5/15/18 Address: 3800 Rosedale Hwy City:Bakersfield State: CA Dispenser Number Product Grade Impact Valve Secure? Impact Valve Locks? Test Result Comments 1 / 2 All Yes Yes Pass 3 /4 All Yes Yes Pass 5/6 All Yes Yes Pass 7/8 All Yes Yes Pass 9/10 All Yes Yes Pass 11/12 All Yes Yes Pass 13/14 All Yes Yes Pass 15/16 All Yes Yes Pass Revised 10/22/2014 UST Sump Extinguisher Verification Location Name: Costco Wholesale #688 Date: 5/15/18 Address: 3800 Rosedale Hwy City: Bakersfield State: CA Extinguisher is in place and Secure? Extinguisher arrow is in the Green? Comments Tank Sumps 87 A Turbine Sump Yes Yes 87 A Fill Sump Yes Yes 87 B Turbine Sump Yes Yes 87 B Fill Sump Yes Yes 91 Turbine Sump Yes Yes 91 Fill Sump Yes Yes Additive Tank Sump Yes Yes Diesel Sumps Yes Yes Other Tank Sump: Other Tank Sump: Under Dispenser Containment Sumps Dispenser 1/2 Yes Yes Dispenser 3/4 Yes Yes Dispenser 5/6 Yes Yes Dispenser 7/8 Yes Yes Dispenser 9/10 Yes Yes Dispenser 11/12 Yes Yes Dispenser 13/14 Yes Yes Dispenser 15/16 Yes Yes Dispenser 17/18 Dispenser 19/20 Dispenser 21/22 Dispenser 23/24 Other Miscellaneous Containment Sumps Vent Box Yes Yes Additive Sump: Yes Yes Other Sump: Other Sump: Page 1 of 1 rev. 11/06/2014 Aboveground Additive Tank Inspection Checklist Location Name: Costco Wholesale #688 Date: 05/18/18 Address: 3800 Rosedale Hwy City: Bakersfield State: CA Tank ID: 266490 Manufacturer: Containment Solutions Capacity: 1200 Gallons Yes No N/A 1. Tank outer shell in good condition with no cracks, corrosion, deformation or signs of leaks? X 2. Paint is in good condition with no signs of blistering or peeling? X 3. Tank supports are in good condition with no cracks or signs of damage? X 4. Tank foundation is in good condition with no signs of settlement? X 5. Concrete pad is in good condition with no cracks or spalling? X 6. Grounding strap secured and in good condition? X 7. Emergency vents move freely and vent passageways are unobstructed? X 8. Valves and fittings are in good condition with no visual damage, signs of corrosion or leaks? X 9. All piping connections are tight with no signs of leaks? X 10. All wiring connected to the tank is in good visual condition? X 11. Spill containment boxes are in good condition with no visual damage? X 12. Liquid level sensing device/tank probe is operable? X 13. Overfill prevention device id operable? X 14. The audible visual alarm is operational? X 15. Release detection sensors are operable (list senor locations and model numbers in the comment section below)? X 16. Secondary containment is free of liquid and debris? X Comments: Print Name Signature Date Technician Bill Karras 5/15/18 UNDERGROUND STORAGE TANK OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT FORM Type of Action:Installation Inspection Repair Inspection 36 Month Inspection VII. FACILITY INFORMATION CERS ID:Date of Inspection: Business Name (Same as Facility Name or DBA): Business Site Address:City:Zip: VIII. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician (Print as shown on ICC Certification):Phone: Contractor/Tank Tester License #:ICC Certification Number: Overfill Prevention Equipment Inspection Training and Certifications (List all applicable certifications): IX. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Test Method Used Manufacturer Guidelines(Specify): Industry Code or Engineering Standard (Specify): Engineered Method (Specify): Number Of Attached Pages:Attach the inspection procedures and all documentation required to determine the results. Tank ID (by tank number, product, etc.) Tank diameter (Inches): Is fill piping secondarily contained? Is vent piping secondarily contained? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Overfill Prevention Equipment Manufacturer(s): What is the overfill prevention equipment response when activated? Shuts off Flow Restricts Flow A/V Alarm(Check all that apply) Shuts off Flow Restricts Flow A/V Alarm Shuts off Flow Restricts Flow A/V Alarm Shuts off Flow Restricts Flow A/V Alarm Are flow restrictors installed on vent piping?Yes No Yes No Yes No Yes No At what level in tank will overflow prevention activate (in inches from tank bottom)? What is the percent capacity of tank at which overflow prevention activates? Is the overfill prevention in proper operating condition to respond when substance reaches the appropriate level? Yes No* *(Specify in section V) Yes No* *(Specify in section V) Yes No* *(Specify in section V) Yes No* *(Specify in section V) X. SUMMARY OF INSPECTION RESULTS Overfill Prevention Inspection Results:Pass Fail Fail Fail FailPassPassPass XI. COMMENTS All items marked "Fail" must be explained in this section. Any additional comments may also be provided here: XII. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS INSPECTION I hereby certify that the overfill prevention equipment was inspected in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637.2 and all information contained herein is true and accurate. UST Service Technician Signature Revision Date: 4/11/2018