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HomeMy WebLinkAbout705 UNION AVENUE (8)90--55 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State ofCalifornia Authority Cited.• Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations This form must he used to document testing and servicing of monitoring equipment. A separate certification or report must be Mared for each monitoringsystem control panel by the technician who performs the work. A copy ofthis 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 oftest date. A. General Information Facility Name: Kern County Superintendent of Schools Bldg. No.: Site Address: 705 South Union Avenue City. Bakersfield Zip: 93307 Facility Contact Person: Scott Bohannon Contact Phone No.: (661) 852 -5811 Make/Model ofMonitoring System: Incon TS -1000 Date of Testing/Servicing: 6/14/2012 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to Indicate specific equipment lusnected/serviced: Tank ED: 87 Unleaded Tank ID: Diesel In -Tank Gauging Probe. Model: TSP -LL2 In -Tank Gauging Probe. Model: TSP -LL2 Annular Space or Vault Sensor. Model: TSP -ULS Annular Space or Vault Sensor. Model: TSP -ULS Piping Sump / Trench Sensor(s). Model: TSP -ULS Piping Sump / Trench Sensor(s). Model: TSP -ULS Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: PLD Mechanical Line Leak Detector. Model: PLD Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: Flapper Tank Overfill / High -Level Sensor. Model: Flapper Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2). Tank ID: Tank ID: In -Tank Gauging Probe. Model: In -Tank Gauging Probe. Model: Annular Space or VaultSensor. Model: Annular Space or Vault Sensor. Model: Piping Sump / Trench Sensor(s), Model: Piping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: 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: Other (specify equipment type and model in Section E onPage 2). Other (specify equipment type and model in Section E on Page 2). Dispenser ID: 112 Dispenser ID: 314 Dispenser Containment Sensor(s). Model: TSP -ULS Dispenser Containment Sensor(s). Model: TSP -ULS Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: 6/6 Dispenser ID: 718 Dispenser Containment Sensor(s). Model: TSP -ULS Dispenser Containment Sensor(s). Model: TSP -ULS ShearValve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Ifthe 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 Mulpment. For any equi ment capable of generating such reports, I have also attached a copy ofthe report; (check all that apply): System set -up Alarm history report Technician Name (print): Jerry Rangel Signature: Certification No.: ICC: 5309489 License. N . 92173 , Haz Testing Company Name: Redwine Testing Services, Inc. Phone No.: (661) 327 -9341 Testing Company Address: 3500 Gilmore Avenue, Bakersfield, CA. 93308 Date ofTesting/Servicing: 6/1412012 Page 1 of 4 UN -036 — 1/4 www.unidocs.org Rev. 01 /17108 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: Complete the foliowin 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* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) N/A operational? Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? Ifyes: 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* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no N/A 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 oftank capacity does the alarm trigger? % 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. Ifyes, describe causes in Section E, below. Yes No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, ifapplicable 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: This facility performs a line test instead of having positive shutdown. Page 2 of 4 UN -036 — 2/4 www.unidoes.org Rev. 01117/08 Monitoring System Certification 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 Section H, below, describe how and when these deficiencies were or will he corrected. G. Line Leak Detectors (LLD): Com lete the follo ine checklist: Check this box if LLDs are not installed. Yes No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? N/A Check all that apply) Simulated leak rate: ® 3 g.p.h.; [10. 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? 19 Yes No* For mechanical LLDs, does the LLD restrict product flow ifit detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut offifthe LLD detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled g N/A or disconnected? Yes No* For electronic LLDs, does the turbine automatically shut off ifany portion ofthe monitoring system malfunctions N/A or fails a test? Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? In Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: UN -036 — 314 Page 3 of 4 www.unidoes.org Rev. 01/17/08 I. Monitoring System Certification UST Monitoring Site Plan Site Address: 705 South Union Avenue, Bakersfield, CA. 83307 Date map was drawn: 6/14/2012. 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 4 of 4 UN -036 — 4/4 www.unidoes.org Rev. 01/17/08 SWRCB, January 2006 Spill Bucket Testing Report Form This form is intendedfor use by contractors performing annual testing ofUST spill containment structures. The completedform and printouts from tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Kern County Supt. Of Schools Date of Testing: 06/14/12 Facility Address: 705 South Union Avenue, Bakersfield, CA Facility Contact: Scott Bohannon I Phone: 661- 852 -5811 Date Local Agency Was Notified ofTesting: 06/06/12 Name ofLocal Agency Inspector (fpresent during testing): Esther Duran 2. TESTING CONTRACTOR INFORMATION Company Name: Cal -Valley Equipment Technician Conducting Test: Jerry Range[ Credentials': CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other (S ec' ) License Number(s): ICC: 5309489 3. SPELL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic Vacuum Other Test Equipment Used: Measuring tape Equipment Resolution: 1/4" Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 unleaded fill 2 diesel till 3 4 Bucket Installation Type: X Direct Bury Contained in Sump X Direct Bury Contained in Sump Direct Bury Contained in Sump Direct Bury Contained in Sum Bucket Diameter: 11" 11" Bucket Depth: 11" 11 19 Wait time between applying vacuum/water and start of test: 30 minutes 03 minutes Test Start Time (T): 10:00 am 10:00 am Initial Reading (RO: 8" 7 %s" Test End Time (TF): 11 :00 am 11:00 am Final Reading (RF): 8" 7 '/1" Test Duration (TF - Ti): I hour 1 hour Change in Reading (RF - R,): None None Pass/Fad Threshold or Criteria: No loss of level No loss of level Comments -(include ir1fbrmation on repairs madeprior to testing, andrecommendedfollow -upforfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certi, fy that all the Information contained to this report is true, accurate, and infull compliance with legal requirements. Technician's Signature: 4L °=- ' -- Date: -06 /14/12 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. CVE Cal- Valley Equipment 3500 Gilmore Ave. Bakersfield CA 93308 661 - 327 -9341 FAX# 661 - 325 -2529 VAPORLESS MANUFACTURING, INC. LDT -890 Leak Detector Test Record Contractor: Ca-Valley Equipment Customer: Kern County Supt. Of Schools Date: 06/14/12 Location: 705 S. Union Avenue Product: Unleaded Technician: Jerry Ran el Submersible Pump Identification Manufacturer: FE Petro Model No.: Serial No.: Notes: Leak Detector Identification Manufacturer: FE Petro Description: 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): 27 psi Gallons per hour rate: 3 &ph Line pressure with pump shut off (psi): 22 si Bleed -back Test with pump off (ml): 275 ml Step-through time to full flow (secs): 3 sec Leak detector stays in leak search position (Yes/No): I Yes Leak Detector Test Pass / Fail Notes: Pass Complete thermal expansion test beforefailing leak detector CVE Cal- Valley Equipment 3500 Gilmore Ave. Bakersfield CA 93308 661 - 327 -9341 FAX# 661 - 325 -2529 VAPORLESS MANUFACTURING, INC. LDT -890 Leak Detector Test Record Contractor: Ca-Valley Equipment Customer: Kern County Supt. Of Schools Date: 06/14/12 Location: 705 S. Union Avenue Product: Diesel Technician: Jerry Ran el Submersible Pump identification Manufacturer: FE Petro Model No.: Serial No.: Notes: Leak Detector Identification Manufacturer: FE Petro Description: 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): 35 psi Gallons per hour rate: 3 gph Linepressure with pump shut off (psi): 32 psi Bleed -back Test with pump off (ml): 140 ml Step-through time to full flow secs : 3 sec Leak detector stays in leak search position (Yes/No): Yes Leak Detector Test Pass / Fail Notes: Pass Com lete thermal expansion test beforefailing leak detector