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HomeMy WebLinkAbout3301 WIBLE ROAD (5)MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions 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 ofthis 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 this date. A. General Information Facility Name: HP Go Go Site Address: 3301 Wible Road Facility Contact Person: Alondra Hernandez Make /Model of Monitoring System: Veeder -Root TLS -350 B. Inventory of Equipment Tested /CertifiedChecktheappropriateborestoindicatespecificequipmentinspected /serviced: City: Bakersfield Bldg. No.: Zip: 93309 Contact Phone No.: 661 - 835 -8044 Date of Testing /Servicing: 01/19/2012 Tank ID:_10000 gal. Regular #1 Tank ID: 10000 gal. Regular #2 x] In -Tank Gauging Probe. Model: 847390-107 x] In -Tank Gauging Probe. Model: 847390 -107 Lx] Annular Space or Vault Probe. Model: x] Annular Space or Vault Sensor. Model: x] Piping Sump / Trench Sensor(s). Model: 794380-208 x] Piping Sump / Trench Sensor(s). Model: 794380 -208 Fill Sump Sensor(s) Model: Fill Sump Sensor(s). Model: J Mechanical Line Leak Detector. Model: FX1y x] Mechanical Line Leak Detector. Model: FE Petro Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: xl Tank Overfill / High Level Sensor. Model :OPW 81SO x] Tank Overfill / High Leval Sensor. Model: OPW 61SO Other (specify equip. type and model in Sec. E on Pg. 2) Other (specify equip. type and model in Sec. E on Pg. 2) Tank ID: 10000 gal. Super Tank ID: x] In -Tank Gauging Probe. Model:847390 -107 In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: x] Piping Sump / Trench Sensor(s). Mode): 794380-208 Piping Sump / Trench Sensor(s). Model: Fill Sump Sensors(s). Model: Fill Sump Sensor(s). Model: x] Mechanical Line Leak Detector. Model:FXIV Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: X] Tank Overfill / High Level Sensor. Model:OPW 61SO 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. E on Pg. 2) Dispenser ID: 1 & 2 Dispenser ID: 3&4 n Dispenser Containment Sensor(s). Model: 794380- 208 x] Dispenser Containment Sensor(s). Model: 794380 -208 X] Shear Valve(s). x] Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s) Dispenser ID: 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: t Dispenser ID: Dispenser 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 -1 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. F equi ment capable of generating such reports, 1 have attached a copy of the report; (check all that apply) x Sys m S [x] Alarm history report Technician Name (print): Douglas Young Signature: Certification No: A32755 License No: 804904 Testing Company Name: Confidence UST Services, Inc. Phone No: 800.S4-9930 Site Address: 3301 Wible Road, Bakersfield, CA 93309 Date of Testing/Servicing: 01119/2012 D. Results of Testing /Servicing Software Version Installed: .04 Complete the following checklist: x] Yes No* Is the audible alarm operational? x Yes F1 No* Is the Visual alarm operational? x Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational? x Yes No* Were all sensors installed at the lowest point ofsecondary 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 N/A operational? x Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary N/A containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initate positive shut -down? Sump /Trench Sensors [x] Dispenser Containment Sensors Did you confirm positive shut -down due to leaks and sensor failure /disconnected? [X] Yes; No; Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no rx I N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visual and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capasity does the alarm trigger? L90 % U Yes* 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. Yes* No Was liquid found inside any secondary containment systems designed as dry systems? Product; Water. If yes, describe causes in Section E, below. Ex] No* I Was monitoring system set -up reviewed to ensure proper settings? Attach set -up reports, if applicable. LxJ Yes I Ej No* I 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' Replaced the Veeder -Root 208 sensor in the UDC of dispenser # 1/2 due to broken wire at the sensor. This site is equipped with OPW 61 SO Overfill Prevention Devices (Flapper Valves) F. In -Tank Guaging / SIR Equipment: [x] Check this box if tank guaging is used only for inventory control. Check this box if tank guaging or SiR equipment is installed. This section must be completed if in -tank guaging equipment is used to perform leak detection monitoring. Complete the following checklist: X] Yes For equip. start-up or annual equipment certification, was a leak simulated to varify LLD performance? No* Has all input wiring been inspected for proper enter and termination,including testing for ground faults? x Yes No* No* Were all tank guaging probes visually inspected for damage and residue buildup? x Yes Was the testing apparatus properly calibrated? No* Was accuracy of system product level readings tested? x Yes No* Was accuracy of system water level readings tested? x Yes No* Were all probes reinstalled properly? x] Yes I No* 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. G. Line Leak Detectors (LLD): Check this box if LLD's are not installed. Complete the following checklist: x Yes No* For equip. start-up or annual equipment certification, was a leak simulated to varify LLD performance? Check all that apply) Simulated leak rate: 3 g•p.h.: 00.1 g.p.h.; 0.2 g.p.h.; x Yes No* Were all LLD's confirmed operational and accurate within regulatory requirments? x Yes No* Was the testing apparatus properly calibrated? x] Yes No* For mechanical LLD's, does the LLD restrict product flow if it detects a leak? N/A Yes No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? Lx] 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 No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system U N/A malfunction or fails a test? Yes No* For electronic LLD's, have all accessible wiring connections been visually inspected? U N/A x Yes Lj No 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. H. Comments: The Regular #I Leak Detector was tested while isolated from Regular #2 and PASSED The Regular 42 Leak Detector was tested while isolated from Regular #I and PASSED Due to the fact that Regular #I and Regular 92 product lines are manifolded, it, the normal operating configuration both Leak Detectors failed to detect the required 3 gph @ 10 psi leak when tested. it was for this reason that Regular #2 was removed from service until the piping configruation has been corrected. HP GO 909 14`4 GALS T ',:1i(ILF"—DED2 ULLAGE = 3301 WIBLE PE., ALS OUTPUT Jull, 90% ULLrAGE= 7909 BAK'ERSFIELL; CA 9r-7,309 IJLI AGE 9 4.6 33fil 1"31BLE RD TC VOLUPIE = 1421 661 -397 -4 1: ', ULLt-(,E= 17- 1 ri9FII HE I GHT = BAKE F I EI - F1 'a: %:31_1'4 1 NC:HES' R I : P,' "S I T PI E H I IT 1- 1,0 li TC I -: 1211 TRJ WATER = 6r.1- 39'? -s155( GALS T,"PE: JA I `J 19 - '201 '2' 1 1 : 17 A41 I 1;JATER = 0.00 1 NC HE- S 3TAJ'JL "IRL WATER 03L. 0 GALS I NC-'HESTEMP = 621 . 0 DEG F j klATEP SYSTEM STHTLIS REPORT L 2 :L !I 1 4 TEMP TRI-2,THTE REPORT ALL FUtJG'TIONS NORIIAL PAN ALL :FUEL f;LhPll sUT LHATI I NVENTOR,l REPORT L 3 : 87 - ITI : UNLEADED 1 TRI-21'1'iiTEVOLUME23' 3 1 t-IC' 'LS Cl'h'FEG-"-R,' 2;TP 'SUIP T I jifji,EHEIED I ULLAGE 7540 CALS oc"ILUIE = 8;3g 90% ULLA)GE= 650 GALS IJLL6','E = 532' TC' %)OLUME = a -3, ALS L 2-11 T PHEIGHT = O. 1'- I NC, HES, Tl-' ,iOLIJJ'JE 0 WATER VOL = 0 HE I C;HT WATER' = 0. 00 1 NCHE" c-• JATER VOL = 0 TEPIP = 59.5 DEC F WATER = L(. oc, I (--iCHE2i L 5 87 _'FP TEMP = DEC, F T 2':PREIllUl-1 VOLUME 13 1 GALS ULLAG'E = 9059 GALS kjLUME p G; L;-', 90% ULLkGE= 80'--'1 GALS HL';'3 TC VOLUME = I :30e, GALS 903"' IJLL 4(-l'C= c C HE I GHT = 17.44 1 1+-'HES Ti_ ',,?,JLUIlE 13'' 1 WATER VOL = 0 GALS HEIGHT t_. INCHES 1.•JATER = 0. 00 1 NCHES ' 1.,IHTER %)OL Lt GAL:_ TEMP = 63.6 DEG F i, ` 'TEF-Ir Cl. 00 1 1'4CHES TEMP F T :3: UNLEADED2 VOLUME = 14`4 GALS T ',:1i(ILF"—DED2 ULLAGE = 8947 ALS OUTPUT90% ULLrAGE= 7909 t -, ALS IJLI AGE 9 4.6 j-i L- TC VOLUPIE = 1421 Ci:iL'S 1: ', ULLt-(,E= 17- 1 ri9FII HE I GHT = 18 . 47 1 NC:HES' R I : P,' "S I T PI E H I IT 1- 1,0 li TC I -: 1211 WATER = 0 GALS T,"PE: HE I (-;HT r_, I 1;JATER = 0.00 1 NC HE- S 3TAJ'JL "IRL WATER 03L. 0 GALS I NC-'HESTEMP = 621 . 0 DEG F j klATEP c). oo DEC FTEMP END ALL :FUEL f;LhPll sUT LHATI Fii WIBLE RE, B,-jl::Ek2_lFl ELI, 9"'309 661 -397-4553 LEAj_. TENT' REPORT T SERI HAL 111111 304214b TEE-IT Al TH = 2. 0 HR" ST,R'r VOLUIE _ 2 : TEMI = 57. F TDIP = 518 2 F sT-,')ERl()r,V:i; 2.-4 0 14 0.07 0.04 TEST' RE-.,ULT',l_*, RATE = CjX:_ I-,AL,, HR 0. ;AL HR TEc'l I 1,•v'L 0.20 HI' FLtii iFECD(F DEL P., `EP.`,` TEMP HANGS I HP r v GC_". 3301 L.-JIBLE RE, DAYER21:I ELE, 9:3.2'CII-A E61- 3 }37-a55`3 JAN 19. 2012, J I A&-1 LEAK TE:1:7T REF""RT T 2: PREPI 1101 PROBE 'SERIAL TEST 12-IT"RI'll-46 Tl1 "',E: AN ' 15 - '2012 121 : ClCl n- rl LEf'-Jl,__lTH = 2L' .0 HREI VOLUME = 1468.':4 START TEMP = 63. 2 F END TDIP = 63 . 2, F EST ER I ':) fiS 2 -40.61, _cI.I_IFI Cl. C10 LEAK MST RESULT:: RATE = 0.0o l_;r-iL HR 5.20 AL, HR TE21 I Oi. 2i GAL HR Ff-61,:- 401,11 I-E'v'EL TF-T s HP Go a09 3301 WIDLE RE, D"K FPSF I ELL C" 93:3 C19 I, El 1 -397 -- 4 5 klAt'l 1', 20 1'2, 9:21 All LLHK TMT REP,DPT T I :UNLD DEDI 1PR,"BE SERI 61- 1,10-1 4541 TEST TI PIE : JAN 15 - 21012 00 11 TE I' LENGTH = .2 . cl HR Q'TRT = 1066.1 _,illL START TD-IF, = 6 0 F END TDIF, = 62'.1 F rE,--;T - PERICU" 2-:1 11. 00 CI 02-1 U. C, I LEAK TEST RE(ULT2; RATE = 0. 00 C,AL,, HR Ci. -0 GAL , HR TE '-T I l'4Vl_ li.'CI GAL, HR FLh,G2_,.: LOW LE%.,,'EL TF_!,.T ERRI.)R END AkP,l H I 22,70F."' F-EF,'-'RT SEN20R iLHRM 5:87-2 STP rP OUMP ENSOR OUT r'_lLHRM lN 19. 2012, y:E9 A)M UEL ALHRM W-1 19. 2012' 9:54 UT HL.,F.,(,l 8. 2010 .3: C.5 Pt"I i , f END 7-. , * * k H I ST(__)R"i REF ORT EI-)SOR L 6: OTHER SE1,12joRS x. X * END x. * *. - x )- * * END X ;- . * * ALr`iRrI HI'STOR"I" REP,:_>RT HLAR11 HISTW ' REP-',,RT HLhRPlI HISTOP"Z REPC,,RT L 3:87-1 STP STP SUMP STP 'SUt"IP DISPENER., PAN SENSOR L I: D ISP I p,Fj,j:op OUT HLHPIvI HI'l DISPENSER PIA11.1 JAI'l 19. 2012 g:!S,-) SENSC)R' OUT AL Rtl jAj-4 19, 2012 9:53 All FUEL ALARM JAN 19. 201 ICI:46 "'M FUEL ALARM DEC 8- SEP4SOR OUT ALARM 4. '201'", Jw,) 1SA( °1 SENSOR OUT (iD(iRM SP-ISOR OUT HI-HRI"I ji4i 19. 21012 10:41 AP11 DEC 8• '2010 3:05 FUEL ADARll JAI,.i 19, '201,2 I0::,6 Wl x )- * * END X ;- . * * ALr`iRrI HI'STOR"I" REP,:_>RT END x x * * END * ;- * 3k _ HLAR11 HISTW ' REP-',,RT L 4:91 STP STP SUMP L ":DISP `-4 SENSOR OUT 2012 9:59 DISPENER., PAN SENSORI'D. OUT JAN 19, 120112, 9:51; k1l FUEL j)LARI'l jAj-4 19, 2012 9:53 All FUEL ALARM JAN 19. 21F112 9:55 AM DEC 8- SEP4SOR OUT ALARM DEf, S. 2010 3:05 Pf") END x x * * END * ;- * 3k _ i-iL4211 H! 2',T RLr G+.'T L IS : 87 -2, STP STF, .-IIAIP Er0R OUT AI DEC S. 20ICl 3: C15 f 1.1 FUEL. HL-HRI-I EjEc: 8. 2010 1 :2a PM FUEL iLii-ARl-) 1109 2, 11. 2009 l2 :sa 2H t fil-H.F.111 L ILsrpEllSPEII'SER PrIHTPSUMP SEAC)IR OUT r-IL"R11,11 DEC e, 2010DLB. Hilo 5 FfJEl- D e, . L'fj I f IDEC', 8 2010 ul-I 119 FLIEL ALRT-1 MAR 24. 20101- 23 - - - 1 -A .- 21-HY:i 9:47 AII fil-H.F.111 END ALA II NlSTO REP)R-r L I 4:91 STP Ell SPEII'SER PrIH sUMP DEC e, 2010 2:135 I-TI FUEL ALHRII HDARII D e, . L'fj I fI P, 20]o I FUEL f-1 MAR 24. 2010 23- 2000 12:5i PG END ALA II NlSTO REP)R-r ENE' i-iDAPrl REPaF. L 2:1-118P jlS*F,Ef*-I':,-,ER PW-I OUT HDGRPI DECI D - -I --, : ol, F-1-12clIL F U PI. I i Ell': 8. 2010 2 :G7 FTI w * .1 F'j"I[l * * * * + L I Ell SPEII'SER PrIH DEC e, 2010 2:135 I-TI FUEL ALHRII D e, . L'fj I fI 2 :59 Ff-lj FUEL r,-iLHR,,pq MAR 24. 2010 a :25 P-1 ENE' i-iDAPrl REPaF. L 2:1-118P jlS*F,Ef*-I':,-,ER PW-I OUT HDGRPI DECI D - -I --, : ol, F-1-12clIL F U PI. Ii Ell': 8. 2010 2 :G7 FTI w * .1 F'j"I[l * * * * + SWRCB, January 2006 Spill Bucket Testing Deport Form Thisform is intendedfor use by contractors performing annual testing of UST spill containment structures. The completedform and printouts from tests (ifapplicable), should be provided to thefacility owner /operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Hp Go -Go Date of Testing: 01/19/2012 Facility Address: 3301 Wible Road, Bakersfield, CA Facility Contact: Alondra Hernandez Phone: 661- 835 -8044 Date Local Agency Was Notified of Testing : 12/28/2011 Name of Local Agency Inspector (ifpresent during testing): Ernie Medina 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. Technician Conducting Test: Doug Young Credentials: M CSLB Contractor x ICC Service Tech. 0 SWRCB Tank Tester Other (Spec) License Number(s): CSLB# 804904 ICC# 8043499 Tank Tester #90 -1076 3. SPILL BUCKET TESTING INFORMATION Test Method Used: 121 Hydrostatic Vacuum Other Test Equipment Used: Lake Test Equipment Resolution: 0.0625" Identify Spill Bucket (By Tank Number, Stored Product, etc.) 1 Regular #1 2 Premium 3 Regular #2 4 Bucket Installation Type: Direct Bury x Contained in Sump Direct Bury x Contained in Sump Direct Bury O Contained inSump Direct Bury Contained in Sum Bucket Diameter: 12" 12" 12" Bucket Depth: 13.25" 12.75" 12.75" Wait time between applying vacuum /water and start of test: 5 Min. 5 Min. 5 Min. Test Start Time (Ti): 9: I Oam 9: l Oam 9: I Oam Initial Reading (Rj): 10.50" 10.00" 10.25" Test End Time (TF): 10: l oam 10: l Oam 10: l oam Final Reading (RF): 10.50" 10.00" 10.25" Test Duration (TF — Ti): 1 hour 1 hour 1 hour Change in Reading (RF - Rj): 0.00" 0.00" 0.00" Pass /Fail Threshold or Criteria: 0.0625" 0.0625" 0.0625" Test Result: x Pass Fail Pass Fail x Pass Fail Pass Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the inLormatipn contained in this report is true, accurate, and infull compliance with legal requirements. Technician's Signature: Date: 01/19/2012 State laws and regulations do not Vrrently reyire testing to be performed by a qualified contractor. However, local requirements may be more stringent.