The URL can be used to link to this page

Home My WebLink About1800 GOLDEN STATE AVENUE (2)t 9 Appendix VI Copies of Monitoring System Certification form and UST Monitoring Plot Plan available at httpl /www.waterboards.ca.aov.) MONITORING SYSTEM CERTIFICATION ForUse By AllJurtadctions Within the State ofCalifornia 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 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 ownerloperator must submit a copy ofthis form to thelocal agency regulating UST syatems within 30 days oftest date. A. Generallnfomuition Facility Name: A )ti r P; Bldg. No.: Site Address: l &e) r ca l GlGt7 =4-r A,ze- may: Zip: Facility Contact Person: irjzour Contact Phone No.: I Make /ModelofMonitodng System: TLS 5ra Date ofTestinglServicNg: B. Inventory of EquipmentTested/CeMed Check the appropriate boxes to Indicate specific equipment Inspeetod/serviced: TanklD: Tank ID: 4n -Tank Gauging Probe. Model: In -Tank Gauging Probe. Model: II rmuler space or vaultSensor. delMOW: A--VW Annular Space or Vault Sensor. Model: Piping Sump I Trench Sersogs). Model: _2dff Piping Sump I Trench Sensor(s). Model: F01 Sump Sensor(s). Model: FlII Sump Sensor(s). Model: W- Pechancal Line Leak Detector. Model: Mechanical Una Leak Detector. Model: Electronic Una Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: Tank Overfill / High-Level Sensor. Model: Other (specil'yequiPmenttvoeand model In Section Eon Paaa2ll. Other (specify equk= type and model In Section Eon Page 2). Tank to: Tank ID: In -Tank Gauging Probe. Model: In -Tonle Gauging Probe. Model: Annular Space orVault Sensor. Model•. Annular Spaceor VaultSensor. Model: D Piping Sump / Trench Sensor(s). Model: Piping Sump / Trench Sensorial. Model: Flfi Sump Sensor(s). Model: FlII Sump Senors). Model: MechanicalUna LeakDetector. Mode(: D Mechanical Line Leak Detector. Model: D Electronic Una Leak Detector. Model: Electronic Una Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: D Tank Overfill/ Hlghdevel Sersor. Modal: Other = ectulpmenttype and model InSection E on Page 2). Other (specify equipmentD22 and model In Section Eon Pane2). Dispenser to, Dlsperhw ID: B- sparser Con1 —I.I. t Sensor(.). Model: Dspensar ContalnmerrtSensor(s). Model• W -Shear Valve(s). D Shear Valve(s). DispenserContainment Floats and Chai s . Dispenser Containment Floats and Chain(s). Dispenser Dispenser ID: mo Dlsperrser Containment Senors). Model: Dispenser ContalmnectSensor(a). Model: ShearVeh*s). ShearVotve(s). Containment Floats and Chaln s . D Dispenser Containment Floats and Chats a . sponsorto: DispsnaerlD: rD Dispenser Containment Senors). Model: Disperser ContalmnentSennsor(s). Mode(: ShearValve(s). ShearValve(s). Dispense! Containment Float(s) and Chains D' user Containment Fl s and Chain a . 11 the facility contains more tanks or dispensers, copy this forth. Include Information for every tank and dispenserat the facility. C. Certification - I certify that the equipment rdantTled In this document was Inspoeted/servlced In accordance with the manufacturers' guldallnes. Attechod to this Certification Is Information (e.g. manufacturers' checid") necessary to verily that this Information Is correctandaPlotPlanshowingthelayoutofmonitoringaulpment. For ary pIpment capable of generating such reports, I have also attached a copy of the report (checkaft that appfyh WSystom set-up per history rep Technician Name (print): j, jie /_r( leerL Signature: Certification No.: it 3"N169 License. NZ—' QL/ n 7 K -&, Testing Company Name: Prone No.:( t Zi-9s s// Testing Company Address: $'lA n .,,1 ',AU, iia ofToslinglServicing: f12/ 2u 2J1Rfi Monitoring systemCertification Page 1 of4 1ZV? 2/21/07 D. Results of 7esting/Servicing Software Version Installed: i 24. n rig IM. thw fnllrwlnn rMrYlla}- f' Yes No" Is the audible alarm operational? ge res No* Is the visualalarm operational? 9K _Yes No' Were all sensors visually Inspected, funclonalty tested, andconfirmed rational? Yes Cl No" Were all sensors Installed at lowest point ofsecondary containment and postiioned so that otherequipment will not Interfere with their properoperation? Yes No* 0,- jWA If alarms are relayed to a remote monitoring station. Is all commurkationa equipment (e.g. modem) operational? Yes EK No" For pressurized piping systems, does the turbine automatically shut down If the piling secondary containment monitoring system WA detects a leak, failsto operate, or Is electrically disconnected? Ifyea: which sensors Initiate positive shut -down? (Check all that apply) SumplTrench Sensors; Dispenser Cordainment Sensors. Old you confirm positive shirt -down due to leaks and sensor failure/disconrekdlon? ores; No. Yee For lank systems that utilize the monitoring system as the primary tank overfillwarning device (I.e. no mechanical overfill prevention WA valve is Installed), Is theoverfill warning alarm visible and audible atthe tank fill point(s) and operating property? Ifso, at what percent oftank capacity does the alarm Moor? % Yea' No Was any monitoring equipment replaced? If yea, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement pads In Section E below. Yes" Cl No Was Aquld found Inside any secondary containment systems designed as dry systems? (Check af/ thatapply) Product; Water. If es describe causes in Section E. below. Yes No' Was monitoring s set-up reviewed to enure proper eedi gs? Attach setup reports, ifapplicable Yes No" t Is all monitoring equipment operational permanufactureft specification? In Section Ebelow, describe how andwhen these deficiencies were orwill be corrected. E Comments: Monitoring System Certification Page 2 of 4 141`07 2 2/21/07 F. In -Tank Gauging / SIR Equipment: @""Checlk this box iftankgauging is used only for Inventory control. Check thisbox 4no tank gauging or SIR equipment is Installed. This section must be completed Nin -tank gauging equipment Is used to perform leak detection monitoring. r•........rdo µo r..u.e.a.,.. tio,•ru• Yes No' Has all input wiring been inspected for proper entry and termination, Including testing for ground faults? 0 Yes No' Were all tank gauging probes visually Inspected for damage and residuebuildup? 0 Yes 0 No' Was accuracy ofsystem product level readingstested? Yes No' Was accuracy ofsystem water level readings tested? Yes No' Were all probes reinstalled property? 0 Yes No' Were all items on the equipmentmanufacturer'smaintenance checklist completed? In the Section H, allow, describe how and when these deficiencies were orwlll be" corrected. G. Line Leak Detectors (LLD): Check this box if LLDs are not installed. rA.—J &n the fallnwkna erwr_klinN Yes No' N/A For equipment start-up or annual equ' ant cerli ication, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leek rate: g.p.h.; 0.1 g.p.h ; 0.2 g.p.h. m.qs No Were all LLDs confirmed operational and accurate within regulatory requirements? LKY No' Was the testing apparatus property calibrated? Yes NO, D NIA For mechanical LLDs, doesthe LLD restrict product flowif it detects a leak? Yea 0NNo'_ automaticallyForelectronicLLDs, doesthe turbine automatically offifthe LLDdetects a leak? Yea too'. -. A For electronic LLDs, does the turbine automatically shut off If any portion of the monitoring system is disabled or disconnected? Yes tip-- A For electronic LLDs, does the turbine automatically shut off W any portion of the monitoring $"tam malfunctions or fails a test? Yes N¢ A For electronic LLDs, have all accessible wiring connections been visually inspected? ea No' Were all items on the equipment manufacturer's maintenance checklist oompieted? In the tiscuon M, DBlow, aeacnae now ana wean irises aenciencies were orwill be corrected. H. Comments: Monitoring System Certification page a of4 12107 3 2/21/07 Monitoring System Certification c UST Monitoring Site Plan site Address: I fort-) cIdeA. d1s ffv-' g akfxS r.ifI r- 4]'09 Date mapwas drawn: IP—1 1 -242fU 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 oftanks and piping. Clearly Identify locations ofthe 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 (it used for leak detection). to the space provided, note the date this She Plan was prepared. Monitoring System Certlflcation Page 4 of4 12/07 4 2/21/07 SWRCB, January2W6 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing ofLISTspill containment structures. The completedform and printoutsfrom tests (fapplicable), should beprovided to thefacility owner /operatorforsubmittal to the localregulatory agency. 1. FACILTi'1' INFORMATION Facili Name: Date ofTesting: Facility Address: Facility Contact: Phone: Date Local Agency Was Notified ofTesting: Name ofLocal Agency Inspector (fpresent during testing): 2. TESTING CONTRACTOR INFORMATION Co Name: Technician Conducting Test Credentials: P<9'LB Contractor _ ICC Service Tech. SWRCB Tank Tester Other (specify License Number(s): / 3. SPILL BUCKET TESTING INFORMATION Test Method Used drostatic Vacuum Other Test Equipment Used: 1,415 Equipment Resolution: Identify Spill Bucket (By Tank Number, Stored Produ eta 1 2 3 4 Bucket Installation Type: Pnect Bury Contained in Sump Direct Bury Contained in Sump Direct Bury Contained in Sump Direct Bury Contained in Sum Bucket Diameter: Bucket Depth: Wait time between applying vacuum/water and start oftest: Test Start Time (TO: Initial Reading (R): Test End Time (TF). Final Reading (RF); Test Duration (TF — TO: Change in Reading (RF-Ri): Pass/Fail Threshold or Criteria: Teat Itesulti ` v B' -ass, - q BaU, ... Pass 1?ap Pups tlk 1 Q,;Pass 01 xll. Comments — (include information on repairs made prior to testing andrecommendedfollow-upforfailedtests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING L hereby certify that all the litformadon contained In this report is true, accurate, and infullcompliance with legal requirements. Technician's Signature: Date: lto -LZ- 2810 State laws andregulations do not currently require testing to be performed by a qualified contractor. However, local requirements may by mnrr ctrin aunt CVE Cal- Yu11ey Equipment 3500 Gilmore Ave BaJEerr, field CA 93308 661 -327 -9341 FAX# 661 -325 -2529 VAPORLESS MANUFACTURING, INC. LDT 2Q Leak Detector Test Record Contra lU- ZL—?Dto 1,90o rotderi *w recc%hnic' L/p Submersible Pmmp IdeattlScatlou Is/mafacttuet / Model No. Serial Number LeakDetector Ideut dcation Manufacturer poecrimian Other Style LeakDetecOor DbPkaSm-tYPe Piatoa -typo Tamper-proofsmd i stallod? Yes No Leak Detector In Submersible Pmap Test at Dispenser 1. Opetathv Pump Prone 2 (p— 15) 2. Gallonsperhour raw ___,l (pats. 22) 3. Line press= with pump shut off j7_ nsi (pare. 23) 4. Bleed a& Teat withpump off I Quo tn) (pace. 26) S. Step -d=K%h time to full flow ? sacoteds (pace. 30) 6. Leak detector stays in leaksearch podtkm (pata.42) YesJG No LEAK DETECTOR TEST iNote: Pan - t404daloeoor fits britpnmwt Rea e[,eskdebecoor8lskctpiobool f 1 i LEAK -TEST METHOD - - - - TEST ON DATE : ALL TANK JAN 29, 2009 i START TIME : DISABLED h TEST RATE :0.20 GAL/HR j DURATION : 2 .HOURS TST EARLY STOP:DISAHLED LEAK TEST.REPORT FORMAT NORMAL i LIQUID SENSOR SETUP L i:ANNULAR SPACE TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE PMC SETUP PMC VERSION:. 01.02 VAPOR PROCESSOR TYPE NONE PROCESSOR CONTROL LEVEL: NONE SOFTWARE REVISION LEVEL VERSION 329.01 SOFTWARE# 346329 -100 -B CREATED - 09.01.29.15,44 140 SOFTWARE MODULE SYSTEM FEATURES: PERIODIC IN -TANK TESTS ANNUAL IN -TANK TESTS L 2:STP SUMP ALARM HISTORY REPORT TRI -STATE (SINGLE FLOAT) ; - - - -- SYSTEM ALARM - - - -- CATEGORY : STP SUMP i PAPER OUT f SEP 30, 2010 1:12 PM L 3:EAST'DISPENSER UDC PRINTER ERROR TRI -STATE (SINGLE FLOAT) i SEP 30, 2010 1:13 PM CATEGORY : DISPENSER PAN ' " L 4:WEST DISPENSER UDC TRI -STATE (SINGLE FLOAT) I CATEGORY : DISPENSER PAN i i x x x x x END x x x x x L 2:STPSUMP STP SUMP FUEL ALARM OCT 22, 2010 9:51 AM FUEL ALARM OCT 22, 2010 9:32 AM FUEL ALARM JUL 13, 2010 8:25 AM x x x x x END x x x x x ALARM HISTORY REPORT SENSOR ALARM --- L 3:EAST DISPENSER UDC DISPENSER PAN FUEL ALARM OCT 22. 2010 9:51 AM FUEL ALARM OCT 22, 2010 9:26 AM SENSOR OUT ALAR01 NOV 25, 2009 12:20 PM A x x x x END x x x x x ALL:SHORT ALARM 1 i i i' 1` OUTPUT RELAY SETUP ALARM HISTORY REPORT ALARM HISTORY REPORT R 1:DIESEL STP TYPE: SENSOR ALARM - - - -- SENSOR ALARM - - -- STANDARD L 1:ANNULAR SPACE { UDC NORMALLY -CLOSED ANNULAR SPACE DISPENSER PANFUELALARM' SENSOR OUT ALARMOCT22, 2010 9:51 AM OCT 22, 2010 9:54 AM IN -TANK ALARMS ALL:HIGH WATER ALARM FUEL ALARM SENSOR OUT ALARM ALL:LOW PRODUCT ALARM OCT P2, 2010 9:42 AM OCT 22, 2010 9:53 AM LIQUID SENSOR ALMS JUNL24 010 FUEL 'ALARM ALL:SENSOR OUT ALARM 11:24 AM OCT 22. 2010 9:51 AM ALL:SHORT ALARM 1 i i M SYSTEM SETUP OCT 22, 2010 10:30 AM SYSTEM UNITS ! U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE /TIME FORMAT MON DD YYYY HH:MM:SS kM COACH AMERICA 1600 GOLDEN STATE AV 1BAKERSFIELD.CA 93301 SHIFT TIME 1 12:01 AM SHIFT TIME 2 DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED Ij LINE RE- ENABLE METHOD PASS LINE' TEST LINE PER TST NEEDED WRN i '- DISABLED LINE ANN TST NEEDED WRN DISABLED SYSTEM SECURITYiCODE : 000000 MAINTENANCE HISTORYDISABLED TANK CHART SECURITY j( DISABLED CUSTOM ALARMS1DISABLED j{ SERVICE NOTICEDISABLED ISO 3166 COUNTRYCODE: MASS /DENSITY DISABLED COMMUNICATIONS SETUP RS -232 END OF MESSAGE DISABLED AUTO DIAL ALARM SETUP i IN -TANK SETUP- T 1:DIESEL COMM BOARD 2 (FXMOD> PRODUCT CODE 1 THERMAL COEFF 000450 j TANK DIAMETER 111.00 TANK PROFILE 1 PT FULL VOL 12064 PRINT TC VOLUMES 1 PORT SETTINGS: ENABLED COMM BOARD 2 (FXMOD> TEMP COMPENSATION BAUD RATE 1200 VALUE (DEG F ):„ 60.0 PARITY ODD STICK HEIGHT OFFSET PAOp BIT I STOP DISABLED DATA LENGTH: DATA TILLAGE: 90k RS -232 SECURITYCODE : DISABLED H- PROTOCQL DATA FORMAT j DIAL TYPE TONE HEIGHT DAYLIGHT SAVING TIME ANSWER ON I RINGMODEMSETUPSTRING ENABLED START DATE { DIAL TONE INTERVAL: 32 MAR WEEK 2 SUN: START TIME 12.'00 AM RECEIVER SETUP; END DATE_ NONEJ40VWEEK1SUN END TIME . 2 :00 AM 1' RE- DIRECT LOCAL PRINTOUT DI3A LED ' ii I EEURO y ROTOCOLI PuF I X r tttt AUTO DIAL TIME SETUP: NONE FLOAT SIZE: 4.0 IN. WATER WARNING 2.5 HIGH WATER LIMIT: 4.0 MAX OR LABEL VOL: 12064 OVERFILL LIMIT 95% 11460 HIGH PRODUCT 90% 10857 DELIVERY LIMIT 12% 1447 LOW PRODUCT 300 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 060 PROBE OFFSET 0,.00 i SIPHON MANIFOLDED TANKS Tit: NONE LINE MANIFOLDED TANKS jT#: NONE LEAK MIN PERIODIC: 0Y. ?' Dt LEAK MIN ANNUAL 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLEC GROSS TEST FAIL ALARM DISABLEC! ANN TEST AVERAGING: OFF' PER TEST AVERAGING: OFI' TANK TEST NOTIFY: OFI' TNK TST SIPHON BREAK:OF1 DELIVERY DELAY 3 Ml F?UMP,THRFSHOLD 10.00 I