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HomeMy WebLinkAbout2301 H STREET (7)14-23(o, OP MONITORING SYSTEM CERTIFICATION For Use By All Jurisdicdons Within the Shale ofCalifo)wia Authority Cited, Chapter 6.7. Health andSafety 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 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 ofthis form to the local agency regulating UST systems within 30 days of this date. A. Genera[ Jtlformation Facilit- y Name: White Water Car Wash Site Address: 2301 H Street City: Bakersfield Bldg. No.: Zip: 93301 Facility Contact Person: Julio (Manager) Contact Phone No.: 661- 343 -1706 Make /Model of Monitoring System: EBW 13. )nventory of Equipment Tested /CertifiedCrwekikrappropriateAo,es io Wirafe ,puificpuipm l lmprtiedfienitevl: Date ofTesling/Servicing: 2/25/2008 Tank ID: Regular Tank ID:. Plus L] In -Tank Gauging Probe. Mode): 846390-107 Lx] In-'rank Gauging Probe. Model: 846390 -107 x] Annular Space or Vault Probe. Mode):vacuum Lx] Annular Space or Vault Sensor. Model: vacuum L] Piping Sump / Trench Sensor(s). Model: Ronan Piping Sump / Trench Sensor(s), Model: Ronan U Fill Sump Sensor(s) Model: U I' ill Sump Sensor s). Model: x] Mechanical Line Leak Detector, Model:FX -1V Lx] Mechanical Line Leak Detector. Model: FX•1v Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: L] Tank Overfill / High Level Sensor. Model:OPw61 -SO U T'ank Overfill / High Leval Sensor. Model: OPW 61-SO E] Other (specify equip. type and model in Sec. E on Pg. 2 ) CD Other specify equip. type and model in Sec. C, on Pg. 3 Tank ID: Super Tank ID: x] In -Tank Gauging Probe. Model846390.107 In= rank Gauging Probe. Model: Lx] Annular Space or Vault Sensor, Model vacuum Annular Space or Vault Sensor. Modc1: L) Piping Sump / Trench Sensor(s). ModekRonan Piping Sump / Trench Sensor(s). Model: L] Fill Sump Sensors(s). Model: Fill Sump Sensor(s). Model: x1 Mechanical Line Leak Dececlor. Mode):FX -1V Mechanical Line Leak Detector, Model: Electronic f..ine Leak Detector. Model: Electronic Line Leak Detector. Model: Lxj 'rank Overfill / hligh Level Sensor. Model:OPW 61 -SO Tank Overfill / High Level Sensor. Model: Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip, typs and model in Sec. I. on Pg. 2) Dispenser ID: 1 & 2 Dispcnscr ID: 3&4 nx Dispenser Containment Sensor(s). Model: Beaudreau 406 Lx] Dispenser Containment Sensor(s). Model: Beaudreau 406 n Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s) Dispenser i.D: Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chains(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser J D: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chains) 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 /services in accordance with the manufacturers' guidlines. Attached to this Certification is information (e.g. manufacturers' checklist) necessary to varify that this information is correct and a plot plan showing the layout of monitoring equipment. For equipment capable of generating such reports, I have attached a copy of the report; (check all (hut apply) System Alarm history report Technician Name (print): Matthew Jennings Signature: Certification No: 835445 License No: 604904 Testing Company Name: Conndenco UST Services. Inc. Phone No: 600-339 -9930 Site Address: 2301 H Street, Bakersfield, CA. 93301 Dale of Testing/Servicing: 2/25/2006 w D. Results of Testing /Servicing Software Version installed: Unknown Complete the following checklist: Yes n No* Is (lie audible alarm operational? Yes No* is the Visual alarnm operational? X Yes No* Were all sensors visually inspected, functionally tested, and confinned operational? Yes No* Were all sensors installed at the 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) Hx NIA operational? x Yes No* For pressurized piping systems, does the turbine automatically shut down ifthe piping secondary N/A containment monitoring system detects a leak, fails to operate. or is electrically disconnected? if yes: which sensors inilale positive shut -down? U Sump/Trench Sensors Dispenser Containment Sensors Did you confirm positive shut -down due to leaks and sensor failure /disconnected? Lx] Yes: No: Yes No* For tank systems that utilize the monitoring system as die primary tank overfill waning device (i.e. noL`_1 NSA mechanical overfill prevention valve is installed), is the overfill warning alarnm visual and audible at the tank fill point(s) and operating properly? if so, at what percent of tank capasity does the alarm trigger? 90 % Yes* U No Was any monitoring equipment replaced? IF Yes, t enti 'y speci is sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E. below. Yes* U No Was liquid found inside any secondary containment systems designed as dry systems" Product; Water. if yes, describe causes in Section F., below. x N * Was monitoring system set -up reviewed to ensure proper settings? Attach set -up reports. r app nca e. x YeFI Is all monitoring equipment operational per manufacturer's specifications? In Section E below, discribe how and when these deficiencies were or will be corrected. E. Comments: The soRware version was not legible. Sensors are not manufactured by the monitoring panel The probes did not communicate with the monitor when disconnected. F. [n -Tank Guaging /SIR Equipment: Cx) Check this box if tank guaging is used only for inventory control. Check this box if lank guaging or SI R equipment is installed. This section must be completed if in -tank guaging equipment is used to perform leak detection monitoring. Complete the following checklist: X1 Yes 0 No* Has all in ut wiring, been inspected for proper enter and termination,including testing for ground faults? x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup? ED Yes Fxj No* Was accuracy of system product level readings tested? o Yes x No* Was accuracy of system water level readings tested? x Yes No* Were all probes reinstalled properly? U Yes 1 Nol Were all items on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. C. Line Leak Detectors (LLD); Check this box if LLD's are riot installed. Complete the following checklist: L] Yes No' For equip. start -up or annual equipment certification, was a leak simulated to varify LLD performance? Check all 1hof 7/p/y) Simulated leak rate: [33 g.p.h.: 0.1 g.p.h.: 0.2 g.p.h.; Yes U No" Were all LLD's confirmed operational and accurate within regulatory requirments? o Was the testing apparatus proper y cat rate '? o For machanical LLD's. oes t e LL restrict product tow tt il etects a ea . nsN A o* For electronic LLD's. does the turbine automatically shut off if the IA.D detects a leak? L] N/A Yes No* For electronic LLD's. does the turbine automatically shut off if any portion of the monitoring system is x N/A disabled or disconnected? Yes Lj No" For electronic LLD's. does the turbine automatically shut off if any pot7ion of the monitoring system x] N/A malfunction or fails a test? Yes No* For electronic LLD's, have all accessible wiring connections been visually inspected? XI NIA x Yes I Lj No Were all items on the equipment manufacturer's maintenance checklist completed? In the section II, below, describe how and when these deficiencies were or will be corrected. H. Comments: When probes were disconnected (here was no registration or communication to the monitor about the probes being disconnected. ex.( probe out). The Regular, Plus, and Super leak detectors all need to be replaced. They do not restrict the flow to the turbin at a leak of 3 GPFI SWRCB, January 2006 Spill Bucket Testing Report Form This fo'or is inlendedfor use by contractor's pe+forming annual lesling ofUST spill contair+menl struclares. The completed form and printorns f •onr lesls (ifapplicable), should be provided to thefacility to the local regulatory agency. I. FACILITY INFORMATION Facility Name: White Water Car Wash Date ofTesting: 2/25/08 Facility Address: 2301 1 -1 Street Facility Contact: Julio(Manager) Phone: (661)343 -1706 Date Local Agency Was Notified ofTesting: 2/08/08 Name of local Agency Inspector (rfpresent during testing): Kern County Fire Dept. 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services INC. Technician Conducting Test: Matthew Jennings Credentials: U CSLB Contractor x ICC Service Tech. fl SWRCB Tank Tester 11 Other (S recifv) License Number(s): 5302760 -UT 3. SPILL BUCKET TESTING LN) ORMATiON Test Method Used: x Hydrostatic 0 Vacuum i Other 1'est Equipment Used: Equipment Resolution: Identify Spill Bucket ( /3v Tank Number. Stored Product, etc.) I Regular 2 Plus 3 Super 4 Bucket Installation Type: x Direct Bury 0 Contained in Sump x Direct Bury U Contained in Sunip x Direct Bury 0 Contained in Sump i1 Direct Bury j Contained in Sum Bucket Diameter: 12.00" 12.00" 12.00" Bucket Depth: 13.25" 13.00" 13.25" Wait time between applying vacuum /water and start of test: IS min. 15 min. 15 rain. Test Start Time (T,): 9:30 AM 9:30 AM 9:30 AM Initial Reading (R,): 1 8.00" 8.25" 8.50" Test Ind 'time (Tr): 10:30 AM 10:30 AM 10:30 AM Final Reading (R,:): 8.00" 8.25" 8.50" Test Duration (T,- -T,): I hour I hour I hour Chance in Reading, (RF-- R,): 0.0" 0.0" 0.0" Pass /Fail Threshold or Criteria: 0.0625 0.0625 0.0625 Test Result: X Pass Fail x Pass Fail x Pass 0 Fail Pass Fail Con) mcnts — (include inlorvnation on repairs made prior to resting, acrd reconuuerrded follow -upfor J "ailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING l herehp cerliry that a/1 the imforrnatiom contained in this report is true, accurate, and in full compliance with legal requirenrerrts• Technician's Signature: Date: 2/25/08 State laws and regulations do not currently require testing to be perfunned by a qualified contractor. However, local requirements may be more stringent.