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MONITORING SYSTEM CERTIFICATION
For .Use By AI Jurisdictions Withinah,e State'ofCalifornia
Autharity,Cited., Chapter 6.7,.Health irnd'SafetyCode ,Chapter Id, DlvUhq 3; Title23 ,California. Code ofRegulations
This form must b used to document,testwg wid servicing ofmonitoring: equipment ,A separate certification •or regort must be,prepsred for each
monitarin¢ sti stetti control panel bytkie technician who:performsthe work. A copy of,this.form must beprovided to. the teak system owner /operator:,
The ownedo" d'r mush' ubmit'a co ofthisform;to'theaocal; perrtt , py: agency regulating;iJST_systems within Wdays oftest'date:
A. General' 1 ;reformation
f;
Facility Name: ; BASHAAR'S CHEVRON Bldg. No:: .
Site.,Addess; 2301 PANAMA LANE` 'City: BAKERFIELD Zip 93307,-
Facility Contact!Person: Cotrtact:Phone No: .
Make/Model of jv[onitoring System: 'TLS460 Date..of. Testing /Servicing: 8122/2011
B. Inventor.'of_Equipment Tested/Ce- tified
Cheek the annionriate bores to indfeate:soecite.eouinmeni insoecie&serviced:
Tank ID: UNL87 Tartk;ID: PLUS89 "`
0it -Tank Gaugin Probe, Nlod&I: MAG1 In-TankGauging'Probe., Model: MAGI...
13 Annular'Space Vaul(scrtsor. Model AnnularSpace or'Vault Sensor. Model:
Piping -Sump ITiench Sensor(s). Model Z08;. Piping Sump /•Trench Sensor(s): Model'. 208
FilLSump:Sensor(s): IVlodel
i
F.ill'Sump.Sensor(s).. Model:
Mechanical Lint Icak Detector. 'Model RED JACKET Meohanical.I:ine leak Detector. Model: RED JACKET
Q ElectronicLine. :eak:Dctector. Model :. electronic Line:Leak:Detector: MbdeL,.
Tank Overfdt / Eigh -Levct Scnsor.. ; Model,, Tank:OverfillJ "High Level Sensor. Model;:
other (specify , uipinent type:and modet m SectioroE on Pago 2).. Othcn( specify equipment type an& &del in Sectiori'Edo Page 2).
Tank ID: PRENI91. Tank'ID: TRANSITION' UIVIR ..
C In- Tank,Gaugtn;Probe. Model; MAGI In -Tank GaugingProbe. Model :. MAG1
5 ace 0 Vau .. Annular ftSp .ensor. ModeG Annular Spacaor,Vault,Sensor. Model`. _...
Pipiag ;Sump /iIench Sensor(s), Model• -208 Piping Sump / Drach Sensor(s). Model: RONAWSENSOR ,
Eiii Sutttp Sensdr(s). Model. ' Fill Sump Sensor(s). Model::
lvlechanical Line Leak Detector., Model: RED JACKETU4 Mechanical Line`leakDetector. Model-
Line t eakbetector. Model: Electronic,:Line Leak Detector. ivfodel:
Tank Over811 / igh -Level Sensor. Model; TankOverfill,/ High,-Level Sensor: Model
3 Other.(specify a uipment type and model inSewdnE on,Pagc:2j: Otber'(s ,., i m meet_ anii_model m;SecuonE oit Page 2): pec $ eq , P t3'Pc... g
Dispenser IM, 112' Dispenser M 314
Dispenser Contpinment Sensoiit Model: OIS-0,1 Dispenser Containmcm °Sensor(s).. :Model:. 908
Shear Valves) Shear<Valvc(s).,
O'Dispens r Contkinment Float(s).and;Ctiain(s); Dispenser ContautmentFloat(s); and Chain(s)..
Dispenser ID: 16 Dispenser ID;. 718
Dispenser Conti nment Sensor(s).. :Model . :DiS -01 Dispenser Containment'Sensor(s):. Model; DiS -01
Shear Valve(s). Shear-V,&e(sj.
Dispenser Containment )71oat(s) and'Chain(s): Dispenser:Containmcnt:Float(s} end Ctiain(s):
Dispenser :ID: Dispenser ID:.
Pe mmentr,Sensor(s) lvlodel: Dispenser Containment Sensor(s)., Model;
Shcai heatValve(s). I Dispenser Cont nment.Floet(s) 04,Chain(s). p'tspenserContainmentFloat(s) and Chaltt(s).
If the facility co "tains`moretanksor'dispensers, copy this- form:. Include,information.tor every- tank and dtspe.nser`attne taciuty.
C.. CertlflC$tlon, -1certify that the equipment identifredU this document was inspected /serviced in accordance withthe manufacturers'
guidelines.
III
Attached to_,ihis. Certification ra information (e.g.; ,manufacturers: checklists) necessary to verify that this; information is
I. correet,"hnd'a Plot Pliih" owing,thelaytipt of,monIfi
r
g: uipment, 'F.or any, equipment;capable of generating such repots, Thave it
attached a.copyof the report; (checkaUtltatApply): System_set =up, Z,Alsirni history I report
Technictan,Name (print)._ RICHARD. MASON S, gure! ?' _
Certification No:: 83688015297857 =UT License No.; C I:D40 -809850-
Testing Company Name ...RICH ENVIRONMENTAL Phone No (661)°3.92-8687
i
Testing Company Address: 5643:BROOK$`CT: BAKERSFIELD, CA:93,3,08: Date of TestingiSen+icing 8/22/2011
Page 1 of 5
W". ldos Rev..01 /17/08. a 103 —1/4
MonitoxingSyst6. Certification
j,
D. Results of;Testing/Servicing
Software: Versiontanstalled 8.65
Cem leteAhe1ollowin checidist:;
Yes ('] Hp* is the :audiliiealatm ;operational ?`
Yes, C1 Ni* is the visual ala'rm';operational?
Yes. 0 N * Were all. sensors.visually.iis .ected, functionally tested,:
Y.es 0 Np+ Were all sensors,.installed at;lowi st powt of;secpndary c
not interfere with theiuproper operation ?.
Yes. NP" If alarms are relayed ;to a remote monitoring ?station
A operational? 1`11
i333
ifirmed`.operational?
ment and positioned so that other equipment will
All :'Communications: equipment (e.g., . modem)
Yes N, • , con ' For pressurized piping .systems, does-the tuirbine automatncally'.shut down if:the:piping seFondary tainment
NIA monitoring' system detects a> leak! fails io,operate,.or,is electrically disconnected? Ifyes::which:sensors initiate
positive shut -down? '(Check all that{apply). P. SumpTrench Sensors; [3 D spenserContaininent'Sensors.
Did,.you confirm,posifiye;shuf- down-due,to leaks: arid';sensor; failure/disconneciion? ® 'Yes; C] No.
Yes For tank systems that utilize the monitoring system a §, the pximary tank overfill warning .device; (i.e., no
p N/A mechanical overfill prevention valve is installed); is the overfill warning alarm visible °and.audible- at;.the tank
fall point(6),and.ope aUng properly? Ifso;,at What:percent,of,t* capacity does the alarm`trigger? %.
Yes* o Was any:monitoririg ;equipment replaced? Ify6 ,,Jdentify specific sensors, ,probes, or other equipment replaced
and; 14Ae manufacturer name and model, for.all replacement partsjn Section E, below.
Yes* o Was liguid:found;inside any'secondary containment systems designed as dry - systems? '(Check all than apply]
El Prodact;: Water: If.yo describe causesin S.ectigwE :, ielow..
Yes o* Was,monitor-mg system set=up reviewed:to,ensure -pro r- setdiigs? Attach'set up reports, ifapplicable
Yes o'' Is all monitoring ;equipmerit,operational per.manufacturer's specifications?
In We ion E below, describe.how'and *,hedtfiese deficiencies were:or will be;corrected:
E. Co bmenis:
Rev. 01[17M
wnitor ng`5ystem Certification 33 3
I`
F. 1:n -Tank gauging /- S1REquipments Check this box;iftank gauging is used only for inventory" control:
Check.tlus boz. ifno; tank: gauging: 4. SIR.equipment is "installed.
This section ust'be.completed.if:ia -tank gauging;equipment is used,to,perfgrm.leak detection monitoring.
i
Complete the following checklist:
Yes p "Nc'' Has all input, wiring lieen; nspecteti for proper. entry and,tenninanon,.includi'ngtesting:for ground fautts?
Yes p Nm *< Weye: A tank robes visuall uts etedfor - damage' -and residue buildup: tPtulg P y Pe
Yes ; N ; * Was accuracy_of system product level .readings tested?
Yes. j] "N¢* . Was`accuracy:of system,water level:readtngs tested?
S: Yes p 'No* Were all_ probes reinstalled properly?
Yes O Np"' , Were all:itetns on the equiptnem in maintenance checklist completed ?.
In Section H, pelow,. describe pow and when;these.deficie„ncies were! or.will.be corrected:
G. - Line Lead Detectors LDL ).. Check'this box -if LLDs are not nstalled.
Fmmnleteahe fr'Ohwinw checklist;
S Yes, np For equipment start -up or : annual :equipment certification;: was a:leak; simulated to verify LLD .performance?
NSA Check all ttiat apply) Simulated'leak`zate:`. ®3 g:p:h:; p 0; Lg. 'A, `02 g,p.h.
S Ye,s El N'P Were all LLDs confirmed operational and accurate within regulatory requu'ements?
Yes 34* Wasthe.testing apparatus properly calibrated?
Yes p.: does,the LI D'restrict.prodmt- flow: -if it, detects a leak ?'
Q Yes 0'140* For'electxon c LLDs °the uibine autoniarically'shutof ifthe LLD'detects a leak?
4A
does
Yes ? 0 o¢ For electronic , LLDs, does off'if`any portion of systezii is disabled
jp or disconnected?
p Yes 2 0* For;electromc LLDs;; does the turbine'automatically shutoff ifany.po tion of tbe'monitorutg system malfunctions
jp or fails a rest?
Yes I o* For. electronic LLDs,, have all.accessible wring connections be@n::visually inspected?
NSA
S Yes, C] o" Were;alfitems on the :equipment'manufacturer's maintenance checklist completed?
1n; Section. Hl belowj:desc.ribe:how,and when these deficiencies were.of,,willi lie:corr&ted.
H. COmme 'ts:
RICH ENVIRONMENTAL;
5.643 BROOKS CT BAKERSFIELD; C.A. 933'08
OF IGE (661,)392 -8.687 FAX (661.)392= :062:1
PRODUCT LINE LEAK.DETECTOR:TEST
WORK SHEET
WIN:
F' CILITYNA1NE:, BASRA:AR'S' CHEVRON
FACILITY ADDRESS: 230.1. PANAMA.LANE. BAKERSFIELD _
P tOD;IICT LINE TYPE; PRESSURE-
P ODVCT LEAK DETECTOR:TYPE TEST TRIP PASS
BELOW P.&L OR,
SERIAL,NIJMBE)Z; 3 G:P:H. FAYL,
UNL87 LID TYPE;;; MECHANICAL, YES' 10 PASS
I: SERIAL #,RED JACKET
PLUS $9 L/D.TYPE': MECHANICAL YES 1,p PASS
SERIAL" # RED "JACKET
I'PREM91 L/D:TYPE MEC11AN!CAL YES 1p PASS
SERIAL # RED JACKET
YPE: YES; PASS
8FRIllAL.k NO FAIL
I CERTIFY; THE ABOVE.TESTS` WERE.CONOUCTED ON THIS: DATE ACCORD.IN.G "TO RED
jlZ- i(o, P,UIVLPS FIELD TEST A:PPARATUS TW -INC PROCEDURE AND;. LIMITATIONS.
TIIHE MECHANICAL LEAK DETECTOR TEST PASS / FAIL:I ..DETERMINED BY USING A.
OWFLOW. THRESH. OLD TRIP RATE'OF 3 GALLONS PER HOUR,OR'.LESS AT IO P S.1. 1
ACKNOWLEDGE`THAT`ALL.DATACOLLECTED IS TRUE AND,CORRECT TO THE BEST
CIF. MY :KN,OWLEDC.E.,
rECHN10AN RICHARD- .MASON _. .
S ICNATURE: DATE: 8/22/t l
r
k333
SWRCB,.January,200.
Spill Bucket Testing 10port form
usebycontractorsperforM;gg an4Wf6t ting:ofa1,Tspill cOrrtainineitt structures. The completedform.and
plicuble }, should be'provtded`to thefacil ry ownerIoperator.f6r,subh.ittdCto:the local rejzulatory agency:.
i .
2: TESTING .CONTRACTOR 1[NF0RMATI6N'
ompany N' e:' RICH ENVIRONMENTAL,
l. ,; FACILITY 'INFORMATION
Facility Name: BASHAAWS :CHEVRON Date ofTesting: 8122/11
Facility Address:. 2301 PANAMA`LANE,;BAKERSF..IELD
Facility Cont et:- Phone:
Date Local - gency W.as Notified ofTesting: 7/19111
Name of'Loc l Agency, Inspector (fpresent during testing):
i .
2: TESTING .CONTRACTOR 1[NF0RMATI6N'
ompany N' e:' RICH ENVIRONMENTAL,
echnician {onducting °Test: RICHARD MASON
dentiaC CSLB,Contractor X ICCService "Tech. ,SWRC.13 :Tank Tester .Other °(Spec) IC
icense N. utr tier(s): 5297,8.57 UT
Used: VISUAL EEgdiptnent-Rewlufon:.0
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR,CONDVCTINC THIS::TESTING
1 hereby ce(ify thatch iheanformadon,contalned In thu r'eport.&. rue,.`accuratte; `and'it! fiull; compliance with legal.requirements.
Technician s Signature: Date: 8/22/11
State . lawsa'h regulations do not currently`aeguire.testingto.tie performed- by-a.qualified.contractor: However, local requirements
may be more stringen..t..
3,:.... SPILL BUCKET TESTING:INFORMATION
Test - Method UUsed- X Hydrostatic• G Vacuum: G Other
Test Equipment U Used: VISUAL E Egdiptnent-Rewlufon:.0
Identify Spil(BUcket,($y TTank 31 , 2 . 44 .... .
Buaket(rista llation.Typet X Direct,Bury XX.Direct Bury XX`DirecfBury nn Direct Bury
Bucket 0ia tjeter.,: II:2 112" 112"
Bucket Dept : 116" 116" ffib"
Wait time bdtween aapplying" 330 MIN" 330 MIN — MIN.
Test,Start Ti : e (TI): : 00' 11:00
Initial; Readilig. ( Ri 11.01 rr& 110"
Test End Ti ee (TF): 22:00" 22'.00 22 :00
Final Readi ' F) TO" 110" II V
Test D- urati*w ( T- T) 11 HOAR 11- HOUR 11 -H.OUR
Change:in.R " adih&,QZr R, }; 00. 00 00-
Pa&sLFail Th " esNold'or 00:00 44,00 + 0.00
a.1 tLtJN' ": a t+ •R'1 a ') .J 4i,,r +
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR,CONDVCTINC THIS::TESTING
1 hereby ce(ify thatch iheanformadon,contalned In thu r'eport.&. rue,.`accuratte; `and'it! fiull; compliance with legal.requirements.
Technician s Signature: Date: 8/22/11
State . lawsa'h regulations do not currently`aeguire.testingto.tie performed- by-a.qualified.contractor: However, local requirements
may be more stringen..t..
9tjtTtll. .SET QP
0k: AUG 22', `20,11 47 PM
0 -
j -,
iUNjo
R'N,7TANY SETUP c & SYSTEM UNIT5
UpOP-r ,SETT I NGpis., S.
GESYSTEMLAIGIJA
om— ebAdRb
ENGLIISH'
STEM DPkTEv'T imE fORMAT. RODQ,Ql" CODE_ R 400: IJD ATE, 1Y HHM014:DD `yl -MM; S$: XM
TAW
HFRMAL COEFF OCJ0700
DI-AMETER 95. 0*0
PAR I-TY ,:EVEN',-,
SOP 'I STOPOP'SIT : DATA, BA CHEVRONPWPROFILE, I PT tATA LENGTH: 7
FULL OL 5960, RZ= 232,1' sECURFTY
CODE ; DA SABLED
40t4T SIZE: 4.,Q IN. IOW . BOARD. '6 SHIFT N ME- I 11 QO Pl'1
BALID 'RATE 1200'
ODD. HIFT'TI'HE 2 ?- 00 AI"I
IATER LJARNJ,`NG 2,:0
I CH 'L)ATER- L .11 Ml T' 31.0.
ITY STOPTopBIVT SHIFT TJME 3 D'l SABLED
SkfFT TIME 4 DISABLED:
DATA:.LEWGTH - 7 VATA
MAk OP LABEL VOL,: 5900_ 7 stcjdp I Ty T
I
AN . K':PER TSIT NjiEDED, 0'.,).ERF,lLL LIMIT 95?/4 DE - DISABLEDCol DISABLED
5481 T . ANK ANN TS'r "NEEDED WRN04GHPRODQQT9W
80, UT .'TRANSMfT 8ETTINGS: D,l 1,3ABLED
I
jELJ-VERY LJHI-T 0.
399 AUTO LEAK ALA LINE RE-ENADLE METW)D
PASS LINE TEST
OW, -PRODUCT e3oG
DI SABI;Eb.- , AUTO HlGH WATER,144MIT LINE PER TS:T N011ED WRNEpix-6LAPH Lfhft: 149,
SUlJDEN. LOSE LI:Pll,;T,: 60
DI;SAB .
OVERFILL - LL LIMI-TAUTO-:OVERFI al SABLED: NEEDED . WRN. I'liE ANN TSTTANKTILT3.50
PROBE QFP88T 0.00,
DISABLED
iWT('LOW :PRODUCT DISABLED
D' ILSABLEDAUTOTHEFT LIMIT PR'l NT TC VOLUMES,
EIIA13LEDHANIFOLDED 'TANKS.
1,10 NE
DISABLE
AUTO, DELI VEF, - 8tART TEMP CO1'lRt jSATION:!' NE'MANTFOLDEr, TANKS DISABLED, , END VALUE' '(DEG F ) *. 60. 0
Tg' N014E AUTO DELIVER'? OFFSETSTICKHEIGHT
DISABLED.._..
AUTO -EXTE Q D
LLABLED90%
LEAlf," MiN PER101) I Cl t%
99
bjsABLED .
AUTO EXXTERNAL I.14pu of H- pRbTOCOL DATA :FORMAT
LEA)C 111 N ANNUAL Plo
DISABLED.
AUTO., . ALARMSENSoRFUELA iEIGHT 1 NG T IMEJAYLI'GHT PAV - 99 DISABLED ,
AUTO SENSOR WATER ALARM DT$ABLED
I'RECT L6CAL PRINTOUT
E-R I Of, Q C TE13 TYPE,
DISABLED
OUT 'ALARM DISABLED
D1 SABLED EQRO pROWOL EF IX,
NNUAL TEST . FrAiLokm 'DaABLb
TE5TFAI L STEM 8ECU?ITYERJ`Obfb
ALA H vlABLED DE 000000'
bR09S TEST FARIL
i kLA M WSABLED RS43ZIND' OF l-wI'NTENP'ANCE HISTORY
DISABLED
T) TSABLED
IVN TEST AVERAG I NG. OFF,
TEST AVERAPING OFf T6NK CHART SEcuRM
FINK TEST, NOT 1 t`Y: OFF Dj: SABLED'
fNk -fs-r S I P;HON BREAK :'OFF' CUSTOM HLARHSI
kELIVERY DELAY, IZ mlN DISABLED
MP'THRESHOLI) 1-0, 00%:
8ERV I,E: NOT'i CE
D, I$ABLEP
I S0 66 (- QUNTRN`
ASS IDEPIS 177
DISABLED
I
I. :PUTPUT RELAY .SETUP
R ,L: SNUTIiJtJN
STANDARDALARMHI §Tu1?:]' ,REpop'f I fORN1hLL GLGSEli:
SEN
SUhS'
1p
E480P r L ;P RF
SSTP L
rI +
L
9
LU .
I D SENSOR ALr12FUELALARM, SOR OL ALARMAU'} 22. 3 j1 ! I :'33 pm ..
FUEL ALAR IIP1: AUG 22.
SENSOR ALcU ,ARr r FSEF15. X10 g 36 'AM _.,...
OAK TES I l ry£T HOD
TES'C 6J1 EK
TFi1VK
PISOR E I UlT
ALARM, HISTn :Y IREFORT ;TART TIME :0 2U GwLiHR s L FRtSSURE SEP6 Ok, TEST R6TE 06RIS
7 EfJSi) r t F1RI1. - - DURAT I Otd H. r TEGC3FY Vfr POR PRE, URE
L 1:'LUS Op : D! SABL'.E]) fSTiRLY Sf H]'OR; Pc7.L`I$HER5`PP Sl r l II t`ATEG0RY vaP'4R VALVESENOROUTrLARMREPORT "FORMAT
AUi'' 27. 2r 1 1:.34, FM 1 EAK TEST Nt3kMAL s 8 hTf °l.
FUEL ALARM . 0ATEPOR,`Y ATM P SEr4tij)
6W ?2;,. ' U,I
SENSOR.OUT LARI'l
SER I.S. i ou. 9:,35 AM =
S
NL;EA;EI' 1,.1QU1D l;t+l c?k ;aETiJ Y _
L.,p Ft1 .IrI`uF'
TRI ESTATE., t S l rlul E ,FL.OHT , PIw vt,R' '104:: 01 : 02
A I E6OR STP ;SUZ° P
VFi3k
ER- R;zJT P I:.ItiHER2 :,
IT ALA'y x'36. L 2:PLU tSI.rrtE aAT
tI GS (11Q. I"lR t;= STATE `Sump, y ..
Et, 15 - Gt+TE OR1l ;INAI !S I S TIMES
DELAY; M; NjITES:_ I- L 3 or11.E+t E.
rRI „ TATE 4S I h1GL E FLOAT )
CATE!UR`f STP SUMS
r 1:F Frn H1r3 ukY F'E>?4kT' ....w --
a1= MF.Rf t L q p I.pI 11G SUMP ,
L q :P'Ip 1 .Pl(?RN1AL'L1' C LO.MG ti!'iP
1pl'Pl-S ,4P CATEGORY
FUEL ALAR01.1 SOFTWAREI :3A- Ft"t SGFTC REV tSION Ll~!. EL. A 2 .. VERS:I ON 324.01.
SOFT61ARE# NL3 9y -1 uO-B' FUEL LANr111 1;'25` .Pt~I Ql2EAT`EL? 09 ,:01r1UG' ;2 I
p.UEL tiLA r'1 : 3b h>h: NO 5OFTWAR1 MODULE.
SF I. ,;-01 U SYSTEM FEATURES
PERIODIC IN- TAjJK I T' S
ANNUAL IN-TANK IST
I-
I
MONITOR CERT.. FAILURE REPORT
a.
SITE`'NAME`: BASHAAR'S CHEVRON DATE.-:o':,8/22f
ADDRESS : 2, 01 PANAMA LANE 'TECHNICIAN :.:RICHARD: MASC
CI fY -: BAKERSFIELD. SIGNATURE:
FOLLOWING COMPONENTS WERE REPL- ACERM'EPAIRED'TO COMPLETE
STING.
i
REPAIRS: k / 9 .jJ'E7—
PARTS INSTALLED : `
I `
TITLE:
ST NATURE
rftv.ABOVE TAKE$ FULL:RESPONSIRILITY OF NOTIFYING
APPROPRIATE PARTY TO` HAVE: CORRECTIVE.'ACTION,'TAKEN TO.REPAIR
T LISTED PR0BLEMS, ANVNOTIFYING RICH ENVIRONMENTAL FOR
ANY NEEDED RETESTING. THIS ALSO;RELEASES RICH ENVIRONMENTAL OF
FINES OR.PENALTIES:OCCURING- FROM,,NON= COMPLIANCE.
A ICOPY-OF THIS DOCUMENT I3AS BEEN LEFT ON— SITE,F.OR'YOUR
C.ONVIENENCE:
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