HomeMy WebLinkAboutFMC 2019CERS = Celihmia Envirn r|6rrtal Rc{rtnirr, SvslE n lD = khntifl.rti6rl ICC = hr.rn irnalCn'lP Cdrncil Y=Y'rN=N.! NA = Nt*arY{ieHe
7608 Fruitvale Avenue, Bakersfield, CA. 93308
A separate Monitodng System Certilication Form must be for each syslem contol
Veeder Root
Tank ID: 87 Unleaded
nunbel
E ln-tank Gauging (SW Iank)
I Annula.or Vault Sensor
n VPH Sensor
Ex Mechanical LLD
n Electronic LLD
n VPH Sensor
I Sump Sensor
E VPH Sensor (Sump)
E vPH Sensor (Piping)
! Sump Sensor
E vPH Sensor (sump)
E VPH Sensor (Piping)
E Sump sensor
E vPH sensor
n vPH sensor
E Sump Sensor
I VPH Sensor (Sump)
Tank lD:
I ln-tank Gauging (Sl4/ Tark)
I Annular Space or Vault Sensor
E vPH sensor
n Mechanical LLD
n Electronic LLD
n VPH Sensor
I Sump Sensor
f] vPH sensor
E VPH Sensor (Piping)
E Sump Sensor
! VPH Sensor (Sump)
E vPH Sensor (Piping)
E Sump Sensor
n VPH Sensor
E vPH sensor
E Sump Sensor
E VPH Sensor (Sump)
lD = klenlifi.rtirn S\^,= SiimliEr..ella.l \,/pH E Va.:rn rnlp7n(srrpllv.lrnstitic I I D = UrF hak dFJEcJd
ffirlNr
MONITORING SYSTEM CERTIFICATION FORi, (Pase 3 ot6)
Devlce Model #Monitoring DEvice Used Device ltlod€l #
Vent/fransitign Sump lD:Vent/Trangltion Sump lD:
E Sump Sensor E sump Sensor
E vPH sensor n VPH Sensor
UDc lD: l/2 UDc lD: 3/4
E Electronic Sensor 794380-208 El Electronic senso.794380-208
E uechanica, Device E Mechanical Device
E VPH Sensor n vPH Sensor
UDC IO:UDC ID:
f] Ebctronic Sensor ! Electronic Sensor
E Mechanical Device O Mechanical Device
E vPH sensor E vPH Sensor
UDC ID:UOC ID:
E Eleclronic Sensor E Electronic Sensor
E Mechanical Device E Mechanical Devico
D vPH Sensor E vPH Sensor
UOC ID:UDC ID:
E Electronic Sensor E Electronic Sensor
E Mechanical Device E Mechanical Device
! vPH Sensor E vPH Sensor
Other ltionitored Component lOi Other Monltored Component lD:
n Othet (Specry in section Vll.)a Alhet (Specify in section vll.)
Other Monitored Component lD:Other Monitored Component lD:
D olhet (Specify in section Vll.)E othet (Specify in section Vll.)
Other Monitored Component lD:Other Monltored Component lD:
D Othet (Specify in section Vll.)E Othet (Specry in sction V .)
lnclude infonnation for every underground saorage tank component monitored by this monitoring sys,'t-m control panel. ff the monilorlng
syatem contol panel monllors more components than this form accgmmodates, additlonal copies ol thase pages may be attached,
VII. COMMENTS
Use this section to provide any additional comnents about the inventory of the equipment cedifted.
lb= lder*ifi.ri.n vPH =Vednrrirplrl.srrlrllv.llYa.tric.llDC = I lrl.hr{fi.rf;nser.Jlrfailtnalrf
iilonitoring Device Used
SYSTEM
TANK
FORM
Ihis seclioa l,Ust 6e ifa is used to leak detection
Are the visual and audible alarms operational?
sensors move freely,
sensors equipment will not interfere
Was monitoring system set-up reviewed to ensure
Was the monitoring panel's backup battery visually inspecled, functionally tested, and confirmed operational?
Does the flow offuelstop at the dispenser if a leak is detected in the under-dispenser contalnment?
if the piping system to operate or
Does the turbine automatically shut down ifthe piping secondary containment monitoring system detecls a leak?
Which sensors initiate positive shut down? (Check a that apply.) El sump I Under-dispenser containment
lf alarms are relayed to a ,emote monitoring station, is all communications equipment (e.9. modem) operational?
tx.
{ANK
complete this
Check this box if NO tank gauging equipment is installed. (Do not complete this section.)
This section must be
Has all input wiring been proper entry and termination, including
ensure that floats mgve
Was accuracy of system's product level readings tested?
was accuracy of system's wate. level readings tested?
reinstalled
Were all items on the manufadure/s maintenance checklist
and
Y = Yc. N = No NA = N.* Ar!.llhrhlc
UNDERGROUND STORAGE TANK
MONITORING SYSTEM CERTIFICATION FORM
XII. LINE LEAK DETECTOR TESTINGU Check this box it line leak detectors (LLD) are NOT installed. (Do not complete thi.s section.)
fhis section must be comolated if LLD9 are installe.t.Y N NA
Was a leak simulated to verify LLO performance?
tcheck a thdt aoolv.) Simulated leak rate verified: El 3GPH E0.1 GPH fl0.2GPH txj tr tr
Was the testing apparstus properly calibrated?a tr tr
For emergency generator tank swtems, does the LLD create an audible and visual alarm when a leak is deteded?tr n a
For mechanical LLDS, does the LLD restrict the flow through the pipe when a leak is deteded?a tr tr
For electronic LLOS, does the turbine automatically shut offwhen a leak is detecled?n U lvl
For electronic LLDs, does the turbine automatically shut off if any ponion of the monitoring system is disabled or disconnected?n n a
For elec{ronic LLDS, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test?tr D a
For electronic LLDS, have all accessible wiring conneclions been visually inspected for kirks and breaks?tr tr tr
Were all items on the equipment manufadure/s maintenance checklist completed?x tr tr
Were all LLDS confirmed operational within regulatory requirements?Ixl n !
For anv answer of "N" above, describe in secrion Xlll how and when ,rese issues were or will be corrected,x .COMMENTS
XIV. VACUUM / PRESSURE/ HYDROSTATIC MONITORING EQUIPMENT TESTING
tr Check this box if VPH monitoring is NOT use d. (Do not complete this section.)
fhis seclion must be completed if VPH monltoing is used to pefiorm leak deaectioo monitoing,
System Type (irark allthat apply.) D Vacuum ! Pressure n Hydrostatic
Sensor lD lnterstitial Communication
Test
E Pass n Fail E Pass E rait
E Pass E Fait n Pass i Fait
E Pass E Fail fl Pass E Fait
E Pass E Fail I Pass E Falt
Ll Pass LJ Fa[E Pass E Fait
E Pass fl Fail fl Pass D Fail
E Pass ! Fail E Pass C rait
fl Pass ! Fait E Pass E rait
E Pass n Fail n Pass D Fail
fl Pass E Farl E Pass E rait
E Pass I Fail E Pass E Fail
L l Pass Ll larl n Pass E Fail
How was interstitial communication verified?E Simulated leak at far ends ofthe interstitial space.
E Other (Descrbe t e method in section xV below.)
L-l Visual lnspection
E Gauge
Was the vacuum or pressure restored to operating levels in all interstitial spaces? [ Yes E No (Descnbe lhe reason io sectton XV below.)
Fot anv answet of "FAIL" above. descrlbe in section XV how and whe, ,lrese ,ssdes were or will be correcaed.XV. COMMENTS
GPH = Gallarrs rFr h.xrr Y = Yec N = N6 NA E N.* rrtrliceHF VPH = Vac.Ir rnlPrF.<r'rrfilv.lnrsrri. lD = Llerlrif,cri.r'
Sensor Functaonality
Test
Date site map was Prepared:
containnent areas.
you atreaOy ttaie a site plan that shows all required infomation,.y.ou may than this page, with yout Monttonng Jystem tE, tn"alelt
)ations oi the fottowing equipnent, if insta ed: 1) monitoing'ii#.'|iZ-i,ti]iiii[iioiiiugun"r"tayoutoftanksandpiiingandcle.arlyidenfulocationsofthefollowingequipnentiinstattect:1)montpnng
system cont^,t panets; 2) inlanx trquia rciet iiiii tiiiell.i i"ii d"t""tiil , ! 9'9"2 !:!!:!':t::!!.y!-Y:^y:Y:,:::?y!'2f::::3y::*'g"i#i,h"iiiid,'6'ill,iJ,i';:;;;i;;,; tii;;;;;;6i;;,,*;;;,i;;t;,tiiiii1.6; t a"'u",onitorinsvapor recovery pipins; 8) deviees nonitoins
Gin^iitiri "i*p": el devices m6nit;iig iiiei-iispen"r, "ont"imenti io1 ine'leax aet,ctorc; and 11) devices monitodng anv othet secondary
Monitoriog System Certi{ication
UST Monitoring Site Plan
Site Address:
Date map was draw ,, -l- Zu ,-J
".
Instructions
If you already have a diagram that shows all required information, you may include it, rather than this page, rvith your Monitoring
System Ceniication. On your sire plan, show the general layout of tanks and piping. Clearty identi$ locations of the following
equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill
.ontiin".., 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 proYided, note the date this Site Plan was prepared.
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t \-036 {/.1 $i}n.uoidocs.org Rev.0l/17108
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FORM (Page I of l)
Type ofAction fl lnstallation Test n Repair Test E 12 Month Test
CERS ID Date of Spill Container Test
01t26t19
Business Name (Same as Facility Name or DBA-Doing Business As.)
Bakersfield City Schools
Businsss Site Address
'1501 Feliz Drive
City
Bakersfield
ZIP Code
93307
II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION
Name of UST Se.vice Technician Performing the Test (Prjinf as sfiown on the ICC Cedification-)
Jerry Rangel
Phone #
(661) 327 - 9341 ex
Contraclor/Tank Tester License #
998733
ICC Ce(ification #
8160834
ICC Certification Expiration Date
08124t19
Spill Container Testing Training and Certifications (List applicable cedifications.)
OPW
III, SPILL CONTAINER TESTING INFORMATION
Test Method Used:
! Manufacturer Guidelines: (Specify)
E lndustry Code or Engineering Standard: (Spec,,}?)
L Engineered Method (Specify)
Atlach the testing procedures and all documentation required to deaemine the resulb.# ofAttached Pages
Tank lO: (By tank numbe\ stored product, etc.)87 Unleaded Diesel
Spill Container Manufaclurerl OPW OPW
Method of Cathodic Protection
B Non-Metallic
n bolation
fl other
(Specify in sectton v.)
El Non-Metallic
fl lsolation
E other
(specry in section V.)
fl Non-Metallic
E lsolation
n otner
(Specify in section V.)
E Non-Metallic
E lsolation
n other
(Specify in section V.)
lnside Oiameter of Spill Containe.: (lrcrEs)11 tt
Depth of Spill Container (lnches)14 10
Does the spill container have a 5 gallon capacity?EYes ENo El Yes E ttto Eyes ENo EYes ENo
Method to Keep Spill Container Empty
El Drain Valve
n Onsite Pump
fl otner
(SD€cify in section V.)
EI Drain Valve
E onsite Pump
D other
(Specify ih section v-)
I Drain Valve
E Onsite Pump
fl otner
(S,ecE in seclion V )
E Drain Valve
! Onsite Pump
n other
(Speci{y in section v-)
IV. SUMIUIARY OF TESTING RESULTS
Spill Container TESI Results El Pass I Fail I Pass E Fait Ll Pass L.l r-arl D Pass n Fait
v. coliMENTs
All items matked "Fail" above must be explained in lhis section, Any additiondl comments may also be provided here.
VI. CERTIFICATION BY UST SERVICE TEI CONDUCTING THIS TESTING
I her6by certify that the splll containers were teat€d in accordance with Califomla Code of Regulations, title 23, dlvision 3, chapter 16, section
2637.1 and allthe information contalned herein b accurate.U"r""*r*ry:Z
,-.4 a'
the facility.ffs more page may
CFRS = .,lifttrnle EnuiTrtrrErif:l REry'.lirrt SurrEm lt} = ktai ifil.alim IBT= I lrrhrrrrx,'ylsltr*ehnk.ICC= lrtn n rir*iJ Crrla C'.xrrn
I. FACILITY INFORMATION
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TANX TILT : [.OB
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