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Home My WebLink About2051 TAFT HWY (4)ooau nuseuaia nwy a rs Bakersfield, California 93308 Phone: 661 568 2777 Fax; 661 588 2786 Fax To: Pax: Phone: Bakersfield Fine Dept — Ernie Medina From: Kelly Tackett 852 -2171 Gaeta 1 -31 -12 Re: Arco Taft Hwy Pages: CC: O UMuntO For Review Plea" Commmd Cl Pleaae Reply Please Reoyole Comanent4m Attached are copies of test results. Please call it You have any questions. Thanks, Kelly SA d 90) << Z 60 lE-10 -ZIOZ BSSR, Inc. U0.51LI Kuscsdale Hwy., ll 13, Bakersfield, CA 93308 Phone (661) 588.2777 Fax (661) 588 -2786 MONITORING SYSTEM CERTIFICATION For Use 6y All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, Callfornita Code of Regulardons This form must be used to document testing and servicing of monitoring equipment. A separate certlftoation or report must be prepared lui each monitoring system control panel by the techniclan 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 lest date A General Information Facility Name: fi co ftY1 rY1 YAy-T (' N -4 Bldg. No.; Side Address. ,6 5 7 is 17 T 1-1 (,y `/ city: BAKt= z-y, E li- Q zip: U Z 1. Facility Contact Person: JAI Contact Phone No.: (6 6 i I Make/Modal of Monitoring System: vEEDER -112 0T Date of Teeting/Servicing: I I rl[55/ rAO1•-Z a Inventory of Equipment Tested/Cartined Check the approprlate boxes to Indicate speclftc eautoment InSDectadlserviced, Tank 10: S yNt_EADE0 62,000 Tank ID: TAVJK a PtZCmlir2n 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 I Trench Sensor(s). Model: faM sump $enser(s) Model Ci A An w Sump Sensor(a). Model: Qp5Z0 Lb Mechanical Line Leak Detector. Model: Mechanical Una Leak Detector. Model: ago itarRT C" Electronic Line Lank Detector. Modal: Electronic Una Leak Detector. Model: Tank Overfill I ftht -Level Sensor. Model' Tank Overfill / High,- Level Sensor. Model: Other (specify equipment type and model in Section E on Page 2). Other od ad erd and model In Section E on Pogo 2). Tank 10:A a uC 11rJlEA(1E t7 "'o-80 Tank ID: ImTank Gauging Probe, Model: In -Tank auging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model; Piping Sump / Trench Senwr(s), Model: Piping Sump / Trench Sensor(s). Model. NO Sump SeA$e /($). Model: aZnood I b Fill Sump Sensor(a). Model; Mechanical Line Leak Detector, Model: RENJACIlan F'"I Mechanical Line Leak Detector. Model; Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model; Tank Overrll / Hlgh,Level Sensor. Model: Tank Overfill / High -Level Sensor. Model: Other (spit6fy agulpimoritt and model in Section E on Page 2). Other a ul men: tvj>9 and model in Section E on Page 2 . Dispenser,lt7 Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor( &), Model: Shear Valve($). Shear Valve(s). Dispenser containment Float(s) and Chain(s), Dis Aar Containment Flosl s and Chein(s). Dispenser ID: Dispenser fD: Dispenser Containment Sensor(s), Modal: Dispenser Containment Senacr(s), Model: Shear Valve($). Sheer Volvo (a). Uis onsef Cgntainmertt Floats and Chein s), Disponser Containment Floe: s end Chains . Dispenser 10: Dispenser 1D: Dispenser Containment Stimor(e). Model: Dispensor Containment $onsor(s), Model: _ _ „ •, Sheer Valve(s). Shear Valve(s). Dispenser Containment Floats and Chains 04porisor Containment Floats and Chain(*), If the facility contains more lanks or daspensors, copy this form. Include Information for every tank slid dispenser at the faeillty. C. Certification - 1 certify that the equipment Iderttifled In this document was Inspectecilserviced In accordance with the manufacturers' guldellnes. Attached to this CerOffeation Is Information (s,g, manufacturers' ohaoklists) necessary to verity that this Information Is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have Also attached a copy of the report; (check sit that apply): system set-up Alarm history report Technician Name (print): bill I C) 'T"ACK E TY Signature: Certification No.: U 1 ILA _5 License, No,: Tustrng Company Name: arz,33 Z 1 r C- Phone No.:( b b t ) 15 f..+'' PJ - CAI Testing Company Address:. 6630 o Jo'36 LE Hw`l it 5 Dato or ioaling/Servicing: Monitoring System Certification Page 1 of 4 12)07 2/'_ 11`07 S/Z d SOD « LI 60 IE- 10 -ZIOZ a,,vxs ./r"*i^q/Ser,mou LU m, w' VVmo all llm°"'"''w tll"vm lowest »^;Al lmocnnd"ry containment and *os*io`" that "v=°v"=mem W' .... ..^,,°,.^v.. Nv' ularnis afo,. "ivyQU I,a'.cniote rionitoring *ta'. .' N.^ . lQuot, 10,14 to opefalu Or $ 00;Ifst;ully disconnected? If yes: wnion fieotQiz, itutiaic positive viul-oown tCoeck ma rt! Jwno1rencn Sew.orti, u,-' Dispenser Containment Soltsvez Did you confirm poSitiVe Shut-down ULAI 10 I41;JW1j jjiO omnoitmc TH — mo^2m^ oo) `^ 00r 91:60/BO-ZIOZ F, In -Tank Gauging / SIR Equipment U Check this box If tank gauging is used only for Inventory control. 0 Check this box if no tank gauging or SIR equipment Is Installed This section must be completed It irt-tank gauging equipment is used to perform leak detection monitoring. Comalate the following chacltllst- U Yes 0 No' Has-oil Input wlring been Inspected for proper entry and termination, including testing for ground (suits? 0 Yes U No' Were all tank gauging probes visually Inspected for damage and residue buildup? Yee 0 No' Was accuracy of system product level readings tested? Yes 0 No' Was accuracy of system water level readings testW Yes 0 No' Were all probes relnatel ed properly? Yes 0 No' Were all Items on the equipment manufacturer's maintenance checklist completed? . III uie 0G6;IVn r,, oeluw, oevume now ano wnen to m aenciencies were or WIn De correctea. G. Line Leak Detectors (LLD): -1 Check this box if LLDs are not installed. ComDlete the lollowlna checkllat V Yes 0 No' For equipment start -up or annual equipment owtftatlon, wet a teak simulated to verify LLD performance? (Check ail 0 N/A that apply) Simulated leak rate: P13 g.p.h.; 0 0,1 g.p.h ; 0 0.2 g.p.h. Yes n No' ere all LLDe confirmed operational and accurate within regulatory requirements? SY Yes 0 No' Was the tasting apparatus properly callbrated? Yes 0 No' For mechanical LI.D@, does the LLD restrict product flow If it detects a leak? NIA L Yes No* For electronic LLDs, does the turb ne.automatically shut off ifthe LLD detects a leak? N/A Yes 0 No' For electronic LLDs, does the turbine automatically shut off If any portion of the monitoring system is disabled or Gy NIA diaconnw4ed? 1 Yes 0 No' For electronic LLDs, does the turbine automatically shut off It any portion of the monitoring system malfunctions or pr NIA falls a test? 0 Yea U No' For electronic LLD@, have all accessible wiring connections been visually in@pected? 9 N/A co'ye,j U No' Were all Memo on the equipment manufacturer'e maintenance checklist oomplateci? In the Section H, below, describe how and when these deficiencies were or will be corrected. H, Comments, Monitoring System Certifiastion Pegs 3 of 4 17/07 3 2/21/07 5/b d 80D << 8160 [E- IO -ZIOZ Munitorinu System C'erfineAtinn UST Monitoring Site Plan Site Address: 2 0 PRoDtx. $-4 Y. C)201QOQ b. 3 Q` . . . .....I. f..... !2,,0a. . . . . . . . . . . . 0. QRpf3o- . .L6 ........... C1 :. a. , qy" (1..... g.....,.....t'.[.... .,....,..... V.. . l,l . . . . . , . . . . . T. Date snap was drawn: t 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 lmc leak dctectors; and in -tank liquid level probes (if used for leak detection), In the space provided, note the dote this Site Plan was prepared, Page q of 4 Mau S/S d 80D « 6160 lE- 10 -ZIOZ