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Home My WebLink AboutFMC RESULTS 2020Appendix VI Underground Storage Tank Monitoring System Certification Form CERS = California Environmental Reporting System, GPH = Gallons Per Hour, ID = Identification, ICC = International Code Council, LLD = Line Leak Detector, NA = Not Applicable, SW = Single- Walled, UDC = Under-Dispenser Containment, UST = Underground Storage Tank, VPH = Vacuum/Pressure/Hydrostatic Page 1 of 6 TYPE OF ACTION ☐☐☐☐Installation ☐☐☐☐Repair XXXX12 Month 1. FACILITY INFORMATION CERS ID 10023802 Certification Date 11/19/2020 Facility Name Circle K Facility Address 5600 Auburn Dr. City Bakersfield ZIP Code 93306 2. SERVICE TECHNICIAN INFORMATION Company Performing the Certification B&T Service Station Contractors Phone 805-929-8944 Mailing Address 630 S. Frontage Rd. Nipomo, CA 93444 Service Technician Performing Test Michael A. Molacek Contractor/Tank Tester License Number 902034 ICC Number 9175943 ICC Expiration Date 11/15/2021 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date Veeder Root TLS 350 Tech C27901 10/29/2022 Catastrophic Testing Technician #4640 04/06/2022 OPW EVR UST 0178491 06/24/2021 4.CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST I hereby certify that the monitoring system is operational in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2638; that required supporting documentation is attached; and all information contained herein is accurate. Service Technician Signature Date 11/18/2020 Total # of Pages 5.MONITORING SYSTEM AND PROGRAMMING Underground Storage Tank Monitoring System Certification Form Page 2 of 6 A separate Monitoring System Certification Form must be prepared for each control panel. Make of Monitoring System Control Panel Veeder Root Model of Monitoring System Control Panel TLS 350 Software Version Installed 334.01 Attach the post-certification reports if the monitoring system is capable of generating either;XXXXMonitoring System Set-up XXXXAlarm History Report Yes No NA All monitoring equipment is operational per manufacturer’s specifications? XXXX ☐☐☐☐ Secondary containment systems arefree of damage, debris, or liquid? XXXX ☐☐☐☐ Are the audible and visual alarms operational? XXXX ☐☐☐☐ All sensors have been: 1) visually inspected for wiring kinks, breaks andresidual buildup on floats; and 2) tested for functionality and confirmed operational? XXXX ☐☐☐☐ ☐☐☐☐ Are all sensors installed to detect a release at the earliest opportunity in the secondary containment? XXXX ☐☐☐☐ ☐☐☐☐ The monitoring system set-up was reviewed,and proper settings confirmed? XXXX ☐☐☐☐ ☐☐☐☐ Was the monitoring control panel’s backup battery visually inspected, functionally tested, and confirmed operational? XXXX ☐☐☐☐ ☐☐☐☐ Does the flow of fuel stop at the dispenser if a release is detected in the under-dispenser containment? XXXX ☐☐☐☐ ☐☐☐☐ Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically disconnected? XXXX ☐☐☐☐ ☐☐☐☐ Does the turbine automatically shut down if the piping secondary containment monitoring system detects a release?Which sensors initiate positive shut down? (Check all that apply)XSump XUDC XXXX ☐☐☐☐ ☐☐☐☐ If monitoring system alarms are relayed to a remote monitoring center, is all communication equipment operational? XXXX ☐☐☐☐ ☐☐☐☐ Describe all answers marked “No” or “Fail”and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Underground Storage Tank Monitoring System Certification Form Page 3 of 6 6. SENSOR TESTING RESULTS List only sensors tested on date of this certification. List “Sensor ID” as labeled in system programming. Additional copies of this page may be attached to accommodate all sensors tested. Sensor ID Sensor Model Component(s) Monitored Pass Fail L1 VR 208 87 Annular XXXX ☐☐☐☐ L2 VR 208 87 STP XXXX ☐☐☐☐ L3 VR 208 89 Annular XXXX ☐☐☐☐ L4 VR 208 89 STP XXXX ☐☐☐☐ L5 VR 208 91 Annular XXXX ☐☐☐☐ L6 VR 208 91 STP XXXX ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ Describe all answers marked “No” or “Fail” and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Underground Storage Tank Monitoring System Certification Form Page 4 of 6 7. LINE LEAK DETECTOR TESTING ☐☐☐☐Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) Simulated release rate verified: (Check all that apply.) XXXX3 GPH ☐☐☐☐0.1 GPH☐☐☐☐0.2 GPH Yes No NA Has the testing apparatus been properly calibrated? XXXX ☐☐☐☐ ☐☐☐☐ For emergency generator tank systems, does the LLD create an audible and visual alarm when a leak is detected? ☐☐☐☐ ☐☐☐☐ XXXX For mechanical LLDs, does the LLD restrict the flow through the pipe when a release is detected? XXXX ☐☐☐☐ ☐☐☐☐ For electronic LLDs, does the turbine automatically shut off when a release is detected? ☐☐☐☐ ☐☐☐☐ XXXX For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ☐☐☐☐ ☐☐☐☐ XXXX For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a tightness test? ☐☐☐☐ ☐☐☐☐ XXXX For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? ☐☐☐☐ ☐☐☐☐ XXXX Were all items on the equipment manufacturer’s maintenance checklist completed? XXXX ☐☐☐☐ ☐☐☐☐ Were all LLDs confirmed operational within regulatory requirements? XXXX ☐☐☐☐ ☐☐☐☐ LLD ID LLD Model Lines Monitored Pass Fail T1 FX2V 91 XXXX ☐☐☐☐ T2 FX2V 89 XXXX ☐☐☐☐ T3 FX2V 87 XXXX ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ Describe all answers marked “No” or “Fail” and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Underground Storage Tank Monitoring System Certification Form Page 5 of 6 8. IN-TANK GAUGING TESTING XXXXCheck this box if tank gauging is used only for inventory control. ☐☐☐☐Check this box if NO tank gauging equipment is installed. (Do not complete this section if either box is checked.) Yes No NA All wiring has been: 1) visually inspected for kinks, breaks and proper entry and termination; and 2) tested for ground faults? ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely, functionally tested, and confirmed operational? ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ Was accuracy of system’s product level readings tested? ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ Was accuracy of system’s water level readings tested? ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ Were all probes reinstalled properly? ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ Were all items on the equipment manufacturer’s maintenance checklist completed? ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ Probe ID Probe Model Tanks Monitored Pass Fail ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ 9. COMMENTS 10. MONITORING SITE PLAN Describe all answers marked “No” or “Fail” and proposed remedy. List all monitoring equipment either replaced or repaired.