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Appendix VI
Copies of Monitoring System Certification form and UST Monitoring Plot Plan available at ht1w /Awm.waterboards.ca.aov.)
MONITORING SYSTEM CERTIFICATION
ForUse ByAll Jurisdictions Within the State ofCalifomia
Authority Cited. Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, T7tle 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 owner/operator mustsubmit a copy of this form tothe local agency regulating UST systems within 30 days of test date.
A. General Information
Facility Name: Bakersfield City Polite Dept Bldg. No.:
Site Address: 1601 Trudun Ave. City: Bakersfield Zip:
Facility Contact Person: Contact Phone No.:(
Make/Model of Monitoring System: Veader -Root TLS -350 Date ofTesting/Servicing: 10 f 11 / 2010
B. Inventory of Equipment Tested /Certified
ehe .k the hnuae h. 1-11 d. —lfli —in.nnno I..a..e.•b.uve...l.•e . r•
Tank to: 87 UL TTank to-.
X In -Tank Gauging Probe. MModel: Man, 00 In -Tank Gauging Probe. MModel:
X Annular Space orVaultSensor. MModel: FRPAnnular Sensor. AnnularSpace or Vault Sensor. MModel:
X Piping Sump / Trench Sensor(s). MModel: 208 Piping Sump / TrenchSensor(s). MModel:
D Flti Sump Sensor(s). MModel: 00 Fill Sump Sensor(s). MModel:
X Mechanical Line Leak Detector. MModel: PLD Mechanical Una Leak Detector. MModel:
Electronic Una Leak Detector. MModel: 00 Electronic Una Leak Detector. MModel:
Tank Overfill / High -Level Sensor. MModel: 00 TankOverfill / High -Level Sensor. MModel:
Other (specify ui endtoe and model In Section E on Pe 2). Other We and model In Section Eon Page 2).
Tank ID: TTank 10:
In -Tank Gauging Probe.. MModel: 00 In -Tank Gauging Probe. MModel:
D AnnularSpace orVault Sensor. MModel: AnnularSpace or Vault Sensor. MModel:
Piping Sump / Trench Sensor(s). MModel: Piping Sump / Trench Sensor(s). MModel:
Flfi Sump Sensor(s). MModel: Fill Sump Sensor(s). MModal:
Mechanical Una Leak Detector. MModel: Mechanical Una Leak Detector. MModel:
Electronic Una LeakDetector. MModel: 00 Electronic Una Leak Detector. MModel:
Tank Overfill / Hlgh -Level Sensor. MModel: Tank Overfill / High -Level Sensor. MModel:
0 Other equipmenttype and model In Section E on Page 2). Other (specify equipment type and model in Section Eon Page 2).
DepenserlD: 1 DDispenserlD:
X Disperser ContainmentSensor(s). MModel: Stand Alone Dispenser ContainmentSensor(s). MModel:
X Shear Vatve(s). Shear Valve(s).
Dls rear ContaklmentFloats and Chain(s). Dispenser Containment Float(s) and CCtsln s .
Dispenser ID: 2 DDispenser 10:
Dispenser Containment Sensor(s). MModel: Stand Alone Disperser ContainmentSensor(s). MModel:
0 Shear Valve(s). CCl Shear Valve(s).
enaer Containment Float(s) and Chain(s). sspenser Containment Floats and CChain(s).
Dispenser ID: DDispenser IM.
0 Dispenser Containment Sensor(s). MModel: 00 Disperser Containment Sensor(s). MModel:
0 Shear Velve(s). Shear Valve(s).
Dispenser Containment Floaqsj and Chains 00 r Cantafnm 9M Floats and Chains .
nun. —ay wrunum mare W." w urspermcre, wpy urm imam. rruauae ulrurmeuan wr every mm ana amparmw err ma recaury.
C. Certification - I eerily that the equipment ktenh6ed In this document was Idapectediservioed In accordance with the manufacturma'
guidelines. Attached to this Certification Is Information (a g. manufacturers' checklists) necessary to veft that this Information Is correct
and a Plot Plan showing the layout of monitoring equipment For anyequipmentcapable of generating such reports, I have also attached a
copy ofthereport; (checkailthatapply): 0 System set-up Alarm history report
Technician Name (print): Bruce W. Hinalev Slgrwtu e: % u-
Certification No.: A25212 License. No.: 921733A HAZ_
Testing Company Name: Cal - Vallav Equipment Phone No.:(6611 327 -9341
Testing Company Address: 3500 Gilmore Aye. Bakersfield. Ca 93308 Date of TestinglServiang: 10 / 11 / 2010
Monitoring System Ceditation Page 1 of4 12107
1 2/21/07
SWRCB, January 2006
Spill Bucket Testing Report Form
Thisform is intendedfor use by contractorsperforming annual testing ofUSTspil/ containment structures. The comp /etedform and
printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1 VA4rn ITV 1VVn12MATir1N
Facility Name: Bakersfield City Police Dept Data ofTesting: 10 /11/1010
Facility Address: 1601 Truttun Ave.
Facility Contact: Phone:
Date Local Agency Was Notified of Testing:
Name ofLocal Agency Inspector (ifpreseru during testing):
2_ TFSTiNG CONTRACTOR MMUMATION
Co Name: Cal - Valley Equipment
Technician Conducting Test: Bruce W. Hinsley
Credentials': X CSLB Contractor D ICC Service Tech. D SWRCB Tank Tester D Other eci
License Number(s): 921733A
3. SPILL BUCKET TF.STINt7 YNF0RMATt0N
Test Method Used: X Hydrostatic D Vacuum D Other
Test Equipment Used: Visual Equipment Resolution:
Identify Spill Bucket (By Tank
Number StoredProduct etc
1 87W 2 3 4
Bucket Installation Type: X Direct Bury
D Contained in Sump
D Direct Bury
D Contained in Sump
D Direct Bury
D Contained in Sump
D Direct Bury
D Contained in Sum
Bucket Diameter: 11"
Bucket Depth: 11"
Waittime between applying
vacuum/water and start oftest: 10 min.
Test Start Time (Tj): 09:30
Initial Reading (RO: 9.25"
Test End Time (TF): 10:30
Final Reading (RF): 9.25"
Test Duration (TF - TO: I Hr.
Change in Reading (RF - R): 0.0"
Pass/Fail Threshold or
Criteria: 0.25"
lnl,i!•,!iN 4r 'HS'° 4, ... i d .. V • .....:A!KV•N rn..i .. 7'lC CT.+.•
V ra..
Comments - (include information on repairs madeprior to testing, and recommendedfollow -upforfailedtests)
CERTIFICATION OF TECHMCMN RESPONSIBLE FOR CONDUCTING THIS TESTING
Ihereby cen* that all the Information containedin this report is true, accurate, andinfkdl compliance with legal requirements
Technician's Signature: -A .. t- Date: 10 /11/2010
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may M __ afri-t
D. Results ofTestinglServlcing
SoftwareVersion Irretelled: 346234 -100 -e
Comoleiothe following checklist:
X Yes No' Is the audible alarm operational?
X Yes No' Is the visual alarm operational?
X Yes No" Were allsermors visually Inspected, functionally tested, end confirmed o rstional?
X Yes 0 No' Were all sensors Installed at lowest point of secondary cortte nmentF. positioned so that other equipment will not interfere with their
properoperstion?
0 Yes 0 No- It alarmsam relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational?
X WA
Yes X No' For pressurized piping systems, does the turbine automatically slut down if the piping secondary containment monitoring system
0 WA detects a teak, fails to operate, orIs electrically disconnected? Ifyes: which sensors initiate positive shutdown? (Checkallthat apply
X Sumprrrench Sensors; Dispenser Containment Sensors. Did you confirm positve shut -down due to leaks = sensor
fellureldisconnedion? X Yes; No.
0 Yes No' For tank systems that utilize the monitoring system as the primary tank overfill warning device (I.e. no mechanical overfill prevention
X NIA1 valve is Installed), Is the overfill waming alarm visible and audible at the tank fill polm(s) and operating prepw Ifso, at what percent
of tank capacitydoes the alarm r? %
Yes' X No Was any monitoring equipment replaced? tf yes, identify specific sensors, probes, or other equipment replaced and list the
manufacturer name and model foran replacement parts in Section E. below.
0 Yes' Was liquid found inside any secondary containment systems designed as dry systems? (Check allthat apply) 0 Product; 0 Water. if
x No yes, describe causes in Section E, below. .
X Yes 0 No' Was monitoring system seHrp reviewed toensure propersettings? Attach setup reports, if applicable
X Yes NW Is all monitoring equipment operational per manufacturer's specifications?
In Section E below, describe how and when these deficiencies were or will be corrected.
Comments:
Perronned Product line testing.
Monitoring System Cort"Ication Page 2 of 4 12107
2/21/07
F. In -Tank Gauging / SIR Equipment X Checkthis box ittankgauging is used only for inventory control.
Check this box if no tank gauging or SIR equipment is installed.
This section must be completed ifin -tank gauging equipment is used to perform leak detection monitoring.
CnTntaht the fnllnwinn rh—kll t-
Yes No' Has all input wiringbeen inspected for proper entry and termination, including testing for ground faults?
Yes No` Were alltank gauging probes visually inspected fordamage and residue buildup?
Yes No' Was accuracy ofsystem product level readings tested?
Yes No' Was accuracy ofsystem water level readings tested?
Yee No' Were all probes reinstalled properly?
Yes No* Were all items on the equipment manufacturer's maintenance checklist completed?
In me aecuon n, oeiaw, aescnDo now and when these aeticlencias Were or will becorrected.
G. une Leak Detectors (LLD): Check this box if LLDs are not installed.
Cmmnlata tha fnllm im chv .kllaf-
X Yes IW Forequipment start -up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all
N/A thatapply) Simulated leak rate: X 3 g.p.h.; 0.1 g.p.h ; 0.2 g.p.h.
X Yes No' Were all LLDs confirmed operational and accurate within regulatory requirements?
X Yes No' Was the testing apparatus property calibrated?
X Yes No' For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
N/A
No' For electronic LLDs, does the turbine automatically shut offifthe LLD detects a leak?
X NIA
No- For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or
X N/A disconnected? Ly; No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or
X WA fails a test?
No' For electronic LLDs, have all aocessibis wiring connections been visually inspected?
X WA
No' Were all Items on the equipment manufacturer'smaintenance checklist completed?
In the Section H, below, describe how and when these deficiencies were orwill becorrected.
H. Comments:
Monitoring System Certification Page 3 of 4 12107
3 2/21(07
r;
CAL- VALLEY EQUIPMENT
3500 Gilmore Avenue
AES PLT —100R Bakersfield, CA 93308
Ph#661- 327 -9341
Fax#661- 325 -2529
NAME: Bakersfield Police Dept. LINE #1: 87 UL TECHNICIAN: Bruce W. Hinsle
ADDRESS: 1601 Truxtun Ave. LINE #2:
87 UL
LICENSE #: 90 -1069
CITY/ ST.: Bakersfield, Ca. LINE #3:
0.000
TEST DATE: 10/11/2010
THE CONVERSION CONSTANT IS FOUND BY: (60 MIN/HR) / (3790/MIL/GAL) = 0.0158311 (MIN/HOUR (GAL/MIN)
Divide the volume differential by the test time (15 minutes) and multiply by 0.0158311, which will convert the volume differential from milliliters per
minute to gallons per hour. The conversion constant causes the millimeters and minutes to cancel out
PRODUCT TIME PSI START VOL
ml
END VOL
ml
TEST VOL
DIFF. ml
GPH GAINILOSS (ml) PASS FAIL
87 UL 09:25 50 210 210 0 0.000 X
09:55 50 210 210 0 0.000 X
COMMENTS:
PRODUCT TIME PSI START VOL
ml
END VOL
ml
TEST VOL
DIFF. ml
GPH GAIN /LOSS (ml) PASS FAIL
COMMENTS:
PRODUCT TIME PSI START VOL
ml
END VOL
ml
TEST VOL
DIFF. ml
GPH GAINlLOSS (ml) PASS FAIL
COMMENTS:
I declare under penalty ofperjury that I am a licensed tank tester in the State ofCalifornia and XLw t
that the information inthis report is true and correct to the best ofmy knowledge.p
CI L
Cal- Valley Equipment
3500 Gilmore Ave.
Bakersfield CA 93308
661 - 327 -9341 FAX# 661 - 325 -2529
VAPORLESS MANUFACTURING, INC.
IMT -990 Len Detector Teat Reenrd
Contractor: Cal-Valley Equipment Customer: Bakersfield. Police Dept.
Date: 10/11/2010 Location: 1601 Truxtun Ave.
Bakersfield, Ca.
Product: 87 UL Technician: Bruce W. Hinsle
Submersible Pum Identification
Manufacturer: RedJacket Model No.:
Serial No.: Notes:
Leak Detertnr Mentifientian
Manufacturer: Red'acket Description:
Di hra - e: Piston-type: PLD
Tamper -proof seal installed: Other Style Leak Detector:
Notes:
Leak Detector in Suhmerxihie Pumn Text at Dinnenaer
Operating Pump Pressure (psi): 26 para. 15
Gallons per hour rate: 3.0 para. 22
Line pressure with pump shut off (psi): 23 para. 23
Bleed -back Test with pump off (ml): 55 para. 26
Step-through time to full flow secs : 3 ara, 30
Leak detector stays in leak search position (Yes/No): Yes para. 42
Leak Detector "Pest
Pass / Fail Notes:
Pass
Complete thermal expansion test be ore ailing leak detector
SENSOR ALARM -----
L29*DIESEL STP2 SUMP
STP SUMP
FUEL ALARM
OCT 9, 2010 8:29 PM
SENSOR ALARM
L28:DIESELI FILL SUMP
ANNULAR SPACE
FUEL ALARM
OCT 9., 2010 8:33 Pm
SENSOR ALARM - - - --
SENSOR ALARM ----- L36:DIESEL3 FILL..SUMP
L30:DIESEL STP2 SUMP DW PIPING SUMP
STP SUMP
PIPING
FUEL ALARM OCT 9, 2010 8:33 PM
OCT 9, 2010 8:29 PM
SENSOR ALARM ---
L24:DIESEL STPI SUMP
STP SUMP
FUEL ALARM
OCT 9, 2010 8:30 PM'
SENSOR ALARM -----
L32:DIESEL2 FILL SUMP DW
STP SUMP
FUEL ALARM
OCT 9, 2010 8:34 PM
SENSOR ALARM -7
L31:DIESEL2 FILL SUMP
PIPING SUMP
FUEL ALARM
OCT 9. 2010 8:32 PM
I.
f msoI -ALARM -----
Q37:DIESEL3"-FILL'SUMP DWVIPINGSueo';'.
FUEL ALARM,I
T 9, 201b 8:36 PM
4ml, DW
FUEL :f1lARM
OCT 91 2010 8:40 PM
SENSOR ALARM -----
L47:PIESEL5 FILL SUMP DW
PIPING SUMP
FUEL ALARM
OCT 9,' 2010 8'42 PM
SENSOR ALARM -----
L47:DIESEL5 FILL SUMP DW
I.
PIPING SUMP.,
FUEL ALARM
OCT 9, 2010 8:45 PMSENORALARM
SENSOR ALARM ----- L41:DIESEL4 FILL SUMPIL26:DIESELl FILL SUMP'- PIPING SUMP
PIPING SUMP FUEL ALARM
FUEL ALARM OCT 9. 2010 8:34 PM
OCT 9, 2010 8:31 PM I
SENsit' LARM -----
SENSOR ALARM ----- DIESE5, L SUMP
L25:DIESEL STPI SUMP DW ING SUM
STP SUMP LIQUID A,A;RM ..
FUEL ALARM i 9. 201 B:3%PM
OCT 9, 2010 8:32 PM
SENSOR ALARM -7
L31:DIESEL2 FILL SUMP
PIPING SUMP
FUEL ALARM
OCT 9. 2010 8:32 PM
I.
f msoI -ALARM -----
Q37:DIESEL3"-FILL'SUMP DWVIPINGSueo';'.
FUEL ALARM,I
T 9, 201b 8:36 PM
4ml, DW
FUEL :f1lARM
OCT 91 2010 8:40 PM
SENSOR ALARM -----
L47:PIESEL5 FILL SUMP DW
PIPING SUMP
FUEL ALARM
OCT 9,' 2010 8'42 PM
SENSOR ALARM -----
L47:DIESEL5 FILL SUMP DW
I.
PIPING SUMP.,
FUEL ALARM
OCT 9, 2010 8:45 PM
SENSOR ALARM - - - -- j
L33:DIESEL2 ANNULAR 1ANNULARSPACE
LOW LIQUID ALARM
OCT 9, 2010 6:46 PM
i
SENSOR ALARM - - - --
L38:DIESEL3 ANNULAR'
ANNULAR SPACE
LOW LIQUID ALARM
OCT 9, 2010 6:46 PM
SENSOR ALARM --
L43:DIESEL4 ANNULAR
ANNULAR SPACE
LOW LIQUID ALARM
OCT 9, 2010 6:46 PM
SENSOR ALARM - - - --
L46:DIESE 5 ANNVLAR
ANNULAR SPACE
LOW LIQUID ALARM
OCT 9, 2010 6:47 PMT /
SENSOR ALARM - - - --
L39:D1ESEL STP4 SUMP
STP SUMP
FUEL ALARM
OCT 9. 2010 8:13 PM
SENSOR ALARM - - - --
L40:DIESEL STP4 SUMP DW
STP SUMP
FUEL ALARM
OCT 9, 2010 8:13 PM
SENSOR ALARM -- - - - ^,f
L34:DIESEL STP3 SUMP
STP SUMP
FUEL ALARM
OCT 9, 2010 8:144' PM
SENSOR
ALAAPM ------ L35 :DIESEL STP3
STP SUMP
FUEL ALARM
OCT '3. 2.010 6:
SENSORSENSOR ALARM - - - -- SENSOR ALARM - - - --
L44:DIESEL STP5 SUMP L45:DIESEL STP5 SUMP DW
STP SUMP STP SUMP
FUEL ALARM FUEL ALARM
OCT 9, 2010 5:52 PM OCT 9, 2010 8:12 PM
I
SENSOR ALARM - - -- _ SENSOR ALARM - -- --
ESELI ANNULAR tI L44:DIESEL STP5 SUMP
ANNULSTPANNULARSPACE SUMP
LOW LIQUID ALARM FUEL ALARM
OCT 9, 2010 6:45 PM OCT 9, 2010 8:12 PM
SENSOR ALARM - - - -- j
L33:DIESEL2 ANNULAR 1ANNULARSPACE
LOW LIQUID ALARM
OCT 9, 2010 6:46 PM
i
SENSOR ALARM - - - --
L38:DIESEL3 ANNULAR'
ANNULAR SPACE
LOW LIQUID ALARM
OCT 9, 2010 6:46 PM
SENSOR ALARM --
L43:DIESEL4 ANNULAR
ANNULAR SPACE
LOW LIQUID ALARM
OCT 9, 2010 6:46 PM
SENSOR ALARM - - - --
L46:DIESE 5 ANNVLAR
ANNULAR SPACE
LOW LIQUID ALARM
OCT 9, 2010 6:47 PMT /
SENSOR ALARM - - - --
L39:D1ESEL STP4 SUMP
STP SUMP
FUEL ALARM
OCT 9. 2010 8:13 PM
SENSOR ALARM - - - --
L40:DIESEL STP4 SUMP DW
STP SUMP
FUEL ALARM
OCT 9, 2010 8:13 PM
SENSOR ALARM -- - - - ^,f
L34:DIESEL STP3 SUMP
STP SUMP
FUEL ALARM
OCT 9, 2010 8:144' PM
SENSOR
ALAAPM ------ L35 :DIESEL STP3
STP SUMP
FUEL ALARM
OCT '3. 2.010 6: