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HomeMy WebLinkAbout402 CHESTER (3)Lj a z, MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State ofCalifornia r v Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be Prepared for each monitorine system 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 ofthis form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: ONE STOP MOBIL Site Address: 402 S. CHESTER Bldg. No.: City: BAKERSFIELD Zip: 93304 Facility Contact Person: GIL Make /Model ofMonitoring System: INCON - INSP. ON SITE ESTHER B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicatespecific equipment inspected/serviced: Contact Phone No.: (661) 835 -9544 Date ofTesting/Sery icing: 2/27/2012 Tank ID: REGULAR 87 Tank ID: PREMIUM 91 In -Tank Gauging Probe. Model: MAO In -Tank Gauging Probe. Model: MAG Annular Space or Vault Sensor. Model: LS- Annular Space or Vault Sensor. Model: LS-3 Piping Sump / Trench Sensor(s). Model: LS-3 Piping Sump / Trench Sensor(s). Model: LS -3 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: FX1V Mechanical Line Leak Detector. Model: FX1V 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 Vault Sensor. Model: Annular Space orVault 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 on Page 2). Other (specify equipment type and model in Section E on Page 2). Dispenser ID: 112 Dispenser m: 314 El Dispenser Containment Sensor(s). Model: 001 Dispenser Containment Sensor(s). Model: 001 Shear Valve(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 Floats) 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 Floats) and Chain(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 -1 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): ® System set -up Alarm hi tort' report Technician Name (print): RYAN MASON Signature: Certification No.: 8029371 -UT License. No. 611 D 0 809850 Testing Company Name: RICH ENVIRONMENTAL Phone o.: (661) 392 -8687 Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date ofTesting/Servicing: 2/27/2012 Page 1 of 5 UN -036 —1/4 www.unidomorg Rev. 01/17/08 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: .99909 Com lete the followine 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? 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* 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; R 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 applicableLesNo* 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: Page 2 of 5 UN -036 — 2/4 www.unidocs.org Rev. 01/17/08 Monitoring System Certification F. In -Tank Gauging / SIR Equipment: 4E661-- r 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 ofsystem 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 be corrected. G. Line Leak Detectors (LLD): Com lete the following checklist: Check this box ifLLDs are not installed. 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, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? Yes No* N/A For electronic LLDs, 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 Section H. below. describe how and when these defiirienries were nr will he rnrrerter{_ H. Comments: UN -036 - 3/4 Page 3 of 5 www.unidois.org Rev. 01/17/08 q5532,> r, Monitoring SystemCftka6w; UST: * it ring Site plan siteAddieik 402 & OMM,.. tf'you ahWharve adram• duovdww ey9l cW. a pw War sum Carvers; or :of6e 6dwffit e -ml. Mbm:Cif usedPN! 4W- j ,o :Ibz&l d. nabs# '.pOn g -i. RICH ENVIRONMENTAL 5643 BROOKS CT. BAKERSFIELD, CA. 93308 OFFICE (661)392 -8687 FAX (661)392 -0621 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET W /0 #: FACILITY NAME: ONE STOP MOBIL FACILITY ADDRESS: 402 S. CHESTER BAKERSFIELD, CA. 93304 PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL UNL87 L/D TYPE: RED JACKET YES 10 P.S.I. PASS SERIAL # 4761 PREM91 L/D TYPE: RED JACKET YES 10 P.S.I. PASS SERIAL # 7142 L/D TYPE : _ PASS YES SERIAL # FAIL L/D TYPE: PASS YES SERIAL # FAIL I CERTIFY THE ABOVE TESTS WERE CONDUCTED ON THIS DATE ACCORDING TO RED JACKET PUMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMITATIONS. THE MECHANICAL LEAK DETECTOR TEST PASS / FAIL IS DETERMINED BY USING A LOW FLOW THRESHOLD TRIP RATE OF 3 GALLONS PER HOUR OR LESS AT 10 P.S.I.1 ACKNOWLEDGE THAT ALL DATA COLLECTED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. TECHNICIAN: RYAN MASON SIGNATURE: DATE: 2/27/12 653 /V I SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing of USTspill containment structures. The completedform and printoutsfrom tests (fapplicable), should beprovided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: ONE STOP MOBIL I Date of Testing: 2/27/12 Facility Address: 402 S. CHESTER BAKERSFIELD, CA. 93304 Facility Contact: GIL Phone: (661) 835 -9544 Date Local Agency Was Notified ofTesting: Name of Local Agency Inspector (fpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RYAN MASON Credentials: CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other (Specify) License Number(s): 8029371 -UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic Vacuum Other Test Equipment Used: VISUAL Equipment Resolution: 0 Identify Spill Bucket (By Tank Number, Stored Product, etc. ) 1 REGULAR 87 -FILL 2 PREMIIUM 91- FILL 3 4 Bucket Installation Type: X Direct Bury D Contained in Sump X Direct Bury Contained in Sump Direct Bury Contained in Sump Direct Bury Contained in Sum Bucket Diameter: 12" 12" Bucket Depth: 14" 14" Wait time between applying vacuum/water and start oftest: 30 MIN 30 MIN Test Start Time (Tj): 0900 0900 Initial Reading (Rt): 10" 10" Test End Time (TF): 1000 1000 Final Reading (RF). 10" 10" Test Duration (TF —Tj): 1 -HOUR l -HOUR Change in Reading (RF - Ri): 0 0 Pass/Fail Threshold or Criteria: 0.00 0.00 Test Result: X Pass Fail X Pass Fail Pass Fail Pass D Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailedtests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and infull compliance with legal requirements. Technician's Date: 2/27/12 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. ONE STOP MOBIL MART. 402 S. CHESTER BAKERSFIELD, CA. 93304 SITE # 805 835 -9544 2/27/2012 11:02 AM TANK. SETUP REPORT TANK NO. 1 8000 GAL UNLEADED SUP TANK TYPE JOOR TANKSTANKDIMS111.5 X 191 TANK SIZE 8000 TANK SHAPE CYLINDER DIAMETER 111.50 LENGTH 191.00 PRODUCT UNLEADED SUP OFFSET P 0.91 OFFSET W 0.91 MANIFOLD NONE PROBE STD 113 FLOATS 2 Ft OAT TYPE GASOLINE GRADIENT 8.9633 SENSOR LENGTH 113 HIGH LIMIT 96.00 LOW LIMIT 358.00 HIGH HIGH 90.00 LOW LOW 168.00 WATER LIMIT 4.00 TEMP COMP API 6B/548 API GRAVITY 51.30 ALPHA 320.00 NO. RTDS 5 RTD LOC 1 12.90 RTD LOC 2 34.80 RTD LOC 3 51.60 RTD LOC 4 68.10 RTD LOC 5 86.90 STRAPPING INCHES, 0.000 5.000 10.000 15.000 20.000 25.000 30.000 35.000 40.000 45.000 50.000 55.000 60.000 65.000 70.000 75.000 80.000 85.000 90.000 95.000 100.000 105.000 110.000 DATA GALLONS 0.0 128.4 358.1 648.4 983.4 1353.2 1750.4 2169.2 2604.7 3052.4 3508.2 3968.3 4428.9 4886.4 5336.9 5776.5 6200.8 6605.1 6983.8 7330.1 7635.1 7885.3 8053.6. ONE STOP MOBIL MART. 402 S. CHESTER BAKERSFIELD, CA. 93304 SITE # 805 835 -9544 2/27/2012 11:04 AM TANK SETUP REPORT TANK NO. 2 12000 GAL UNLEADED REG TANK TYPE JOOR TANKS TANK DIMS 111.5X 258.5 TANK SI2E 12000 TANK SHAPE CYLINDER DIAMETER 111.50 LENGTH 258.50 PRODUCT UNLEADED REG OFFSET P 2.25 OFFSET W 2.25 MANIFOLD NONE PROBE STD 113 FLOATS 2 FLOAT TYPE GASOLINE GRADIENT 8.9731 SENSOR LENGTH 113 HIGH LIMIT 99.00 LOW LIMIT 535.00 HIGH HIGH 102.00 LOW LOW 252.00 WATER LIMIT 4.00 TEMP COMP API 66/546 API GRAVITY 63.50 ALPHA 320.00 NO. RTDS 5 RTD LOC 1 12.90 RTD LOC 2 34.80 RTD LOC 3 51.60 RTD LOC 4 68.10 RTD LOC 5 86.90 STRAPPING DATA INCHES GALLONS 0.000 0,0 5.000 173.8 10.000 484.7 15.000 877.6 20.000 1331.0 25.000 1831.4 30.000 2369.0 35.000 2935.9 40.000 3525.2 45.000 4131.1 50.000 4748.0 55.000 5370.7 60.000 5994.1 65.000 6613.3 70.000 7223.0 75.000 7817.9 80.000 8392.2 85.000 8939.4 90.000 9451.9 95.000 9920.6 108.000 10333.4 105.000 10672.0 110.000 10899.7 ONE STOP MOBIL MART. 402 S. CHESTER BAKERSFIELD, CA. 33304 SITE # 805 835 -9544 2/27/2012 11:07 AM SYSTEM SETUP REPORT SOFTWARE VERSION 0.9910 LOCATION 1 ONE STOP MOB LOCATION 2 IL MART. STREET 1 402 S. CHEST STREET 2 ER CITY 1 BAKERSFIELD CITY 2 STATE CA. ZIP CODE 93304 SITE # 305 835 -9544 VOL UNITS GALLONS LEVEL UNITS INCHES TEMP UNITS FAHRENHEIT TIME STYLE 12 HOUR DATE STYLE MM /DD /YY DAYLIGHT SAV ENABLED SET TIME 11:07 AM SET DATE 02/27/2012 NO. TANKS 2 LEAK LIMIT 2.00 THEFT LIMIT 10.00 DELIV LIMIT 200.00 SNTNL MODE OFF START SNTNL 12100 AM END SNTHL 12:00 AM DELIV DELAY 15 REPORT DELIV ENABLED REPORT ALRRS ENABLED REPORT TESTS ENABLED NO. OF ALARMS 10 PRINT INTERVAL 5.00 MODE CHAN 1 NATIVE BAUD CHA14 1 1200 DATA BITS 1 8 STOP BITS 1 1 PARITY 1 NONE SECURITY 1 ACCESS 1 PHONE 1 REDIAL 1 DISABLED ACCESS 2 PHONE 2 REDIAL 2 DISABLED ACCESS 3 PHONE 3 REDIAL 3 DISABLED ACCESS 4 PHONE 4 REDIAL 4 DISABLED DIAL DELIV DIAL ALARM DIAL LEAK bUMV !NVTRY NONE 137" TIME1 INVTR 12 :00 AM STD RELAY TIME2 INVTR 12:00 AM ALARM 1 ON 7(/ TIME3 INUTR INURC 12:00 AM NONE ALARM 2 ON ONE STOP MOBIL MART. TIME1 INVRC 12 :00 AM ALARM 3 ALARM 4 ON ON S402S. CHESTERS. TIME2 INVRC 12 :00 AM ALARM 5 ON BAKE402 D ELD 9330493 TIME3 INVRC 12 :00 AM ALARM 6 ON 8CA. SITE 4 SCHD DLHST TIME1 DLHST NONE 12:00 AM ALARM 7 ALARM 8 ON ON 27/20i22tALARM 11:19 A TIME2 DLHST 12:00 AM HISTORY REPORT TIME3 DLHST 12:00 AM STD 10:18 FSCHDALHSTNONEALARM1S.U. SUMP 2'27/2012 TIME1 ALHST 12:00 AM ALARM 2 S.U.AN.SPACE R.U- AN.SPACE TIME2 ALHST 12:00 AM ALARM 3 R.U. SUMP 10 :19 FTIME3ALHST12 :00 AM ALARM 4 R.U.AN.SPACE 2/27/2012 SCHD ACT AL NONE' ALARM 5 NONE S.U.AN.SPACE TIME1 ACTAL TIME2 ACTAL 12:00'AM 12 :00 AM ALARM 6 NONE 2r27/Z012 10:19 TIME3 ACTAL 12:00 AM ALARM 7 ALARM 8 NONE NONE S.U.AN.SPACE SCHD ALST TIME1 ALST NONE 12:00 AM SENSOR TYPE 2/27/2012 16:49 TIME2 ALST 12:00 AM SENSOR 1 STD POWER DOWN TIME3 ALST 12:00 AM SENSOR 2 STD 2/27/2012 10:49SENSOR3STD CONFIDENCE 99.0% SENSOR 4 STD POWER UP LEAK TEST SCHD TEST 0.10 SENSOR 5 STD 2/27/2012 10 :49 TANK 1 LAST DAY SENSOR 6 SENSOR 7 STD STD SYSTEM FAIL TANK 2 LAST DAY SENSOR 8 STD HO PROBE TIME TEST TANK NO. 1 TANK 1 TANK 2 11:00 PM 11 :00 PM CONTROL OUTPUT 2/2772012 10 :51 GRACE PERIOD 0 S.U. SUMP ALARM TIMEOUT 30 LOW,LOW 1 NONE 2/27/2012 1915, HIGH LIM ON LOW LOW 2 NONE S.U.AN.SPACE LOW LIM HIGH HIGH OFF ON LOW 1 NONE 2/27/2012 10:5' LOW LOW ON LOW 2 NONE R.U. SUMP WATER LIM LEAK LIM ON ON HIGH WTR 1 NONE 20122 /2 ?//27 /20 10;5 SYSFAIL ON HIGH WTR 2 NONE SPACER THEFT ON HIGH 1 NONE HIGH 2 NONERELAY TIMEOUT 30 HIGH HIGH 1 NONENIGHLIMONHIGHHIGH2NONELOWLIiMOFF HIGH HIGH OFF SYSTEM FAIL NONE LOW LOW OFF WATER LIM ON STD 1 ALL LEAK LIM ON STD 2 ALL SYSFAIL ON STD 3 ALL THEFT OFF STD 4 ALL STD 5 ALL STD ALARM STD 6 ALL ALARM 1 ON STD 7 ALL ALARM 2 ON STD 8 ALL ALARM 3 ON ALARM 4 ON ALARM 5 OFF ALARM 6 OFF ALARM 7 OFF ALARM 8 ON MONITOR CERT. FAILURE REPORT SITE NAME : ONE STOP MOBIL DATE : 2/27/12 THE FOLLOWING COMPONENTS WERE REPLACED/REPAJED TUOMPLETE TESTING. REPAIRS : NONE LABOR: NONE PARTS INTALLED : NONE NAME: TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE.