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Home My WebLink About1125 COFFEE ROAD (12)11000 N. MoPac Expressway, Suite 500 Austin, Texas 78759 Phone: (512) 451 -6334 Fax: (512) 459 -1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR CRAIG PERKINS 1501 TRUXTUN AVE. BAKERSFIELD, CA. 93301 Test Date: 11/08/2011 Order Number: 3187770 Dear Regulator, ia5 D -T c — Z'C Date Printed and Mailed: 12/06/2011 Enclosed are the results of recent testing performed at the following facility: CHEVRON 203576 1125 COFFEE RD. BAKERSFIELD, CA. 93308 Testing performed: Monitor Certification Sincerely, Dawn Kohlmeyer Manager, Field Reporting 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. If more than one monitoring system control panel Is Installed at the facility, 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: CHEVRON 203576 Site Address: 1125 COFFEE RD. Facility Contact Person: PATTY Make /Model of Monitoring System:TLS 350 B. Inventory of Equipment Tested /Certified Check the appropriate boxes to indicate specific equipment inspected /serviced City: BAKERSFIELD CA Zip: 93308 Contact Phone No: 588 -9066 Date of Testing /Service: 11/08/2011 Work Order Number: 3187770 Tank.ID: TanklD: In -Tank Gauging Probe. Model: In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Piping Sump/Trench Sensor(s). Model: Piping Sump/Trench Sensogs). 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 OverFlll /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). Tank ID: Tank ID: In -Tank Gauging Probe. Model: In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Piping Sump/Trench Sensor(s), Model: Piping Sumprrrench 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 : 7 -8 Dispenser ID: M Dispenser Containment Sensors) Model: VI -406 Dispenser Containment Sensors) Model: MShear Valve(s). Shear Valve(s) Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chaln(s). Dispenser ID: Dispenser ID: FIDispenser Containment Sensors) Model: Dispenser Containment Sensors). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser ID: QDispenser 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). 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 Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): IX System set -up D Alarm history report Technician Name (print): EDWIN PINEDA N USignature: - Q (I ...r.a. •y Certification No.: 8026748 -UT License. No.: 743160 (Class 'A' General Enginering Contractor License) Testing Company Name:Tanknology Phone No.: (800) 800 -4633 Site Address: 11000 N. MoPac Expressway, suite 500, Austin, TX 78759 Date of Testing /Servicing: 11/08/2011 Monitoring System Certification Page 1 of 3 Based on CA form dated 03/08 Site Address 1125 COFFEE RD. D. Results of Testing /Servicing Software Version Installed: Complete the following checklist: Monitoring System Certification Date of Testing /Service: 11/08/2011 El Yes D No • Is the audible alarm operational? El Yes No Is the visual alarm operational? 0 Yes 171 No • Were all sensors visually inspected, functionally tested, and confirmed operational? Q 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 E] No' E] 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 R Yes E] No' N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (Le.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 0 Yes' 0 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. El Yes' M 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. a Yes No • Was monitoring system set -up reviewed to ensure proper settings? Attach set -up reports, if applicable. Q Yes No Is all monitoring equipment operational per manufacturers' specifications? In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: Only the sensor for Disp# 7/8 was tested. Page 2 of 3 Based on CA form dated 03/08 Monitoring System Certification Site Address: 1125 COFFEE RD. F. In -Tank Gauging / SIR Equipment Check this box if no tank gauging or SIR equipment is installed. Date of Testing /Service: 11/08/2011 F] Check this box if tank gauging is used only for inventory control. E] 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? EjYes 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 EJNo • Were all probes reinstalled properly? Yes No Were all items on the equipment manufacturers' 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 0.1 g.p.h E]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 manufacturers' 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 Based on CA form dated 03/08 Tanknology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 512) 451 -6334 FAX (512) 459 -1459 TEST DATE:11 /08/11 WORK ORDER NUMBER3187770 CLIENT:CHEVRON PRODUCTS COMPANY SITE:CHEVRON 203576 COMMENTS Witness Testing with Inspector Ernie Medina Bakersfield Fire at dispenser 7/8, 406 sensor. Testing confirmed with "ROSALEE" and Inspector Medina on 11/7/11. Technician checked in with 2ndSite and WO # 111108 -195 was given. All tests passed. please note that Disp# 7/8 was open upon arrival. PARTS REPLACED QUANTITY r2 DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS'IESTED a b HELIUM PINPOINT'LEAK TESTaRESULLTS Printed 12/06/2011 07:08 MTUTTLEPrinted12/06/2011 07:08 MTUTTLE j SITE DIAGRAM Tanknology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 512) 451 -6334 FAX (512) 459 -1459 TEST DATE: 11/08/11 WORK ORDER NUMBER3187770 CLIENT:CHEVRON PRODUCTS COMPANY SITE: CHEVRON 203576 3 < 1>#4 #5< 1>#6 #11< 1>#12 CANOPY 1 < 1>#2 #7< 1>#8 #9 10 03 m D cn C mo z cn m OD C cn ZD C Z DC7r— Z m L L e ( 82K OA D OF L3 87 L6 STP 12KO O O O Z w L4 91 L5 STP OA lO OV FO sA 12K DUMP - STER C -STORE I N S AIR/ breakers TLS ICEH2OCARWASH Printed 12/06/2011 07 :08 MTUTTLE