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Home My WebLink AboutFMC 2019MONITOR CERTIFICATION SPILL BUCKET TEST 11000 N. MoPac Expressway, Suite 500 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 Date Printed and Mailed: 7/12/2019 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR KRIS KARNS 1501 TRUXTUN AVE. BAKERSFIELD, CA 93301 Test Date: 6/21/2019 Order Number: 3446773 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN 37942 3225 BUCK OWENS BLVD., HWY 99/HWY 58 BAKERSFIELD, CA 93301 In an effort to keep all our record keeping and reporting requirements as current as possible, Tanknology kindly requests you notify Dawn Kohlmeyer in writing at dkohlmeyer@tanknology.com when your CUPA requires all records to be submitted electronically via the CERS database. Your assistance in this endeavor is greatly appreciated. Testing performed: Sincerely, Dawn Kohlmeyer Manager, Field Reporting UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 1 of 6) This form must be used to document testing and servicing of underground storage tank (UST) monitoring equipment. A copy of this form must be provided to the UST owner or operator. The owner or operator must submit a copy of this form to the local agency regulating the USTs within 30 days of the date of the monitoring system certification. I. FACILITY INFORMATION CERS ID 10134880 Date of Monitoring System Certification 6/21/2019 Business Name (Same as Facility Name or DBA-Doing Business As.) 7-ELEVEN 37942 Building # Business Site Address 3225 BUCK OWENS BLVD., HWY 99/HWY 58 City: BAKERSFIELD Zip: 93301 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of Company Performing the Certification TANKNOLOGY INC. Phone # (800) 800-4633 Ext. Mailing Address 11000 N. Mopac Expressway #500, Austin, TX 78759 Name of UST Service Technician Performing the Certification (Print as shown on the ICC Certification.) Edwin Pineda Contractor/Tank Tester License # Class A General Engineering 743160 ICC Certification # 8373052 ICC Certification Expiration Date 6/17/2021 Monitoring System Training and Certifications (List all applicable certifications.) Expiration Date Tanknology Certification Level III ATG Operability Training Certification Exam 63535 06/24/2021 ICC CA UST Service Technician 8373052 06/17/2021 Franklin Fueling Phil-Tite EVR Ph 1 Systems 1002653708 06/28/2020 Bravo SWAT 001 01/16/2022 III. RESULTS OF TESTING/SERVICING Indicate and attach the following reports if the monitoring equipment is capable of generating either. Monitoring System Set-up Alarm History Report Y N NA Was any monitoring equipment replaced? (If "Yes,"identify the specific devices replaced and list the manufacturer and model for all replacement parts in section IV below.) Was damage, debris, or liquid found inside any secondary containment systems? (If "Yes," describe what was found in section IV below.) Is all monitoring equipment operational per manufacturer's specifications? (If "No," describe why in section IV below.) IV. COMMENTS If directed to use this section, describe how and when the issues were or will be corrected. V. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the equipment identified in this document was inspected/serviced in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2638 and all information contained herein is true and accurate. Attached to this certification is information (e.g., manufacturers' checklists, monitoring system set-up, alarm history report, etc.) necessary to verify that this information and the site plan showing the layout of UST system is complete and accurate. UST Service Technician Signature CERS=California Environmental Reporting System, ID=Identification, UST=Underground storage tank, ICC=International Code Council UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 2 of 6) VI. INVENTORY OF EQUIPMENT CERTIFIED A separate Monitoring System Certification Form must be prepared for each monitoring system control panel. Make of Monitoring System Control Panel Gilbarco Model of Monitoring System Control Panel EMC Software Version Installed Check the appropriate boxes to indicate specific equipment inspected/serviced. Monitoring Device Used Device Model # Tank ID: T-1 Gasoline - Regular (By tank number, stored product, etc.) In-tank Gauging (SW Tank) Annular Space or Vault Sensor VPH Sensor Product Piping Mechanical LLD Electronic LLD VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Fill Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Vent Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Vapor Recovery Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Monitoring Device Used Device Model # Tank ID: T-2 Gasoline - Premium (By tank number, stored product, etc.) In-tank Gauging (SW Tank) Annular Space or Vault Sensor VPH Sensor Product Piping Mechanical LLD Electronic LLD VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Fill Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Vent Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Vapor Recovery Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Monitoring Device Used Device Model # Tank ID: (By tank number, stored product, etc.) In-tank Gauging (SW Tank) Annular Space or Vault Sensor VPH Sensor Product Piping Mechanical LLD Electronic LLD VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Fill Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Vent Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Vapor Recovery Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Monitoring Device Used Device Model # Tank ID: (By tank number, stored product, etc.) In-tank Gauging (SW Tank) Annular Space or Vault Sensor VPH Sensor Product Piping Mechanical LLD Electronic LLD VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Fill Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Vent Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) Vapor Recovery Piping VPH Sensor (Piping) Sump Sensor VPH Sensor (Sump) CERS=California Environmental Reporting System, ID=Identification, UST=Underground storage tank, ICC=International Code Council UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 3 of 6) Monitoring Device Used Device Model #Monitoring Device Used Device Model # Vent/Transition Sump ID: Vent/Transition Sump ID: Sump Sensor Sump Sensor VPH Sensor VPH Sensor UDC ID: 1/2 Electronic Sensor Mechanical Device BRAVO FLOAT VPH Sensor UDC ID: 5/6 Electronic Sensor Mechanical Device BRAVO FLOAT VPH Sensor UDC ID: 3/4 Electronic Sensor Mechanical Device BRAVO FLOAT VPH Sensor UDC ID: 7/8 Electronic Sensor Mechanical Device BRAVO FLOAT VPH Sensor UDC ID: Electronic Sensor Mechanical Device VPH Sensor UDC ID: Electronic Sensor Mechanical Device VPH Sensor UDC ID: Electronic Sensor Mechanical Device VPH Sensor UDC ID: Electronic Sensor Mechanical Device VPH Sensor Other Monitored Component ID: Other Monitored Component ID: Other(Specify in section VII) Other(Specify in section VII) Other Monitored Component ID: Other Monitored Component ID: Other(Specify in section VII) Other(Specify in section VII) Other Monitored Component ID: Other Monitored Component ID: Other(Specify in section VII) Other(Specify in section VII) Include information for every underground storage tank component monitored by this monitoring system control panel. If the monitoring system control panel monitors more components than this form accommodates, additoinal copies of these pages may be attached. VII. COMMENTS Use this section to provide any additional comments about the inventory of the equipment certified. ON SITE TO TEST ONLY BRAVO FLOATS ON 1 TO 8 CERS=California Environmental Reporting System, ID=Identification, UST=Underground storage tank, ICC=International Code Council UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 4 of 6) VIII. MONITORING SYSTEM AND PROGRAMMING This section must be completed if a monitoring panel is used to perform leak detection monitoring.Y N NA Are the visual and audible alarms operational? Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, functionally tested, and confirmed operational? Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Was monitoring system set-up reviewed to ensure proper settings? Was the monitoring panel's backup battery visually inspected, functionally tested, and confirmed operational? Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically disconnected? Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? Which sensors initiate positive shut down? (Check all that apply.) Sump Under-dispenser containment If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? For any answer of "N" above, describe in section IX how and when these deficiencies were or will be corrected. IX. COMMENTS Use this section to provide any additional comments about the inventory of the equipment certified. X. IN-TANK GAUGING TESTING Check this box if tank gauging is used only for inventory control. (Do not complete this section.) Check this box if NO tank gauging equipment is installed. (Do not complete this section.) This section must be completed if in-tank gauging is used to perform leak detection monitoring. Y N NA Has all input wiring been inspected for kinks and breaks in the cables and for proper entry and termination, including testing 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? For any answer of "N" above, describe in section XI how and when these deficiencies were or will be corrected. XI. COMMENTS Use this section to provide any additional comments about the inventory of the equipment certified. Y = Yes, N = No, NA = Not Applicable UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 5 of 6) XVI. LINE LEAK DETECTOR TESTING Check this box if line leak detectors (LLD) are NOT installed. (Do not complete this section.) This section must be completed if LLDs are installed.Y N NA Was a leak simulated to verify LLD performance? (Check all that apply.) Simulated leak rate verified: 3 GPH 1.1 GPH 0.2 GPH Was the testing apparatus properly calibrated? For emergency generator tank systems, does the LLD create an audible and visual alarm when a leak is detected? For mechanical LLDs, does the LLD restrict the flow through the pipe when a leak is detected? For electronic LLDs, does the turbine automatically shut off when a leak is detected? For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? Were all items on the equipment manufacturer's maintenance checklist completed? Were all LLDs confirmed operational within regulatory requirements? For any answer of "N" above, describe in section XIII how and when these issues were or will be corrected. XIII. COMMENTS XIV. VACUUM / PRESSURE/ HYDROSTATIC MONITORING EQUIPMENT TESTING Check this box if VPH monitoring is NOT used. (Do not complete this section.) This section must be completed if VPH monitoring is used to perform leak detection monitoring. System Type (Mark all that apply.) Vacuum Pressure Hydrostatic Sensor ID Component(s) Monitored by this Sensor Sensor Functionality Test Interstitial Communication Test Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail How was interstitial communication verified? Simulated leak at far ends of the interstitial space. Other (Describe the method in section XV below.) Visual Inspection Gauge Was the vacuum or pressure restored to operating levels in all interstitial spaces? Yes No (Describe the reason in section XV below.) For any answer of "N" above, describe in section XIII how and when these issues were or will be corrected. XV. COMMENTS GPH = Gallons per hour, Y = Yes, N = No, NA = Not applicable, VPH = Vacuum/Pressure/Hydrostatic, ID = Identification UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 6 of 6) XVI. MONITORING SITE PLAN Date site map was prepared: If you already have a site plan that shows all required information, you may include it, rather than this page, with your Monitoring System Certification Form. The site plan must show the general layout of tanks and piping and clearly identify locations of the following equipment, if installed: 1) monitoring system control panels; 2) in-tank liquid level probes (if used for leak detection); 3) devices monitoring tank annular spaces or vault; 4) devices monitoring product piping; 5) devices monitoring fill piping; 6) devices monitoring vent piping; 7) devices monitoring vapor recovery piping; 8) devices monitoring vent/transition sumps; 9) devices monitoring under-dispenser containment; 10) line leak detectors; and 11) devices monitoring any other secondary containment areas. SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN 37942 Date of Testing: 6/21/2019 Facility Address: 3225 BUCK OWENS BLVD., HWY 99/HWY 58 , BAKERSFIELD, CA 93301 Facility Contact: Joel Phone: 661-324-9481 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY INC. Technician Conducting Test: Edwin Pineda Credentials1: CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Specify) License Number(s): A-743160-8373052 3. SPILL BUCKET TESTING INFORMATION Test Method Used By: Hydrostatic Vacuum Other Test Equipment Used:Equipment Resolution: Identify Spill Bucket (By Tank Number, Stored Product, etc.) Bucket Installation Type: Bucket Diameter: Bucket Depth: Wait time between applying vacuum/water and start of test Test Start Time (TI): Initial Reading (RI): Test End Time(TF): Final Reading (RF): Test Duration(TF–TI): Change in Reading (RF–RI) : Pass/Fail Threshold or Criteria: Test Result: Spill Box # Tank T-1 REGULAR - Fill 1 - Direct - Grade level in containment sump Direct Bury Contained in Sump 12.00 15.50 5 min 08:30:00 15.00 in. H20 09:30:00 15.00 in. H20 1 hr 0.00 in. H20 +/- 0.00 Pass Spill Box # Tank T-2 PREMIUM - Fill 1 - Direct - Below Grade in containment sump Direct Bury Contained in Sump 12.00 15.50 5 min 08:30:00 15.00 in. H20 09:30:00 15.00 in. H20 1 hr 0.00 in. H20 +/- 0.00 Pass Spill Box # Direct Bury Contained in Sump min +/- Spill Box # Direct Bury Contained in Sump min +/- Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature:Date:6/21/2019 1State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. WO: 3446773 UNDERGROUND STORAGE TANK SPILL CONTAINER TESTING REPORT FORM (Page 1 of 1) Type of Action Installation Test Repair Test 12 Month Test I. FACILITY INFORMATION CERS ID 10134880 Date of Spill Container Test: 6/21/2019 Business Name (Same as Facility Name or DBA-Doing Business As.) 7-ELEVEN 37942 Business Site Address 3225 BUCK OWENS BLVD., HWY 99/HWY 58 City: BAKERSFIELD Zip: 93301 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification.) Edwin Pineda Phone # (800) 800-4633 Contractor/Tank Tester License # Class A General Engineering 743160 ICC Certification # 8373052 ICC Certification Expiration Date 6/17/2021 Spill Container Testing Training and Certifications (List applicable certifications.) ICC - CA UST Service Technician 8373052 06/17/2021 Franklin Fueling - Phil-Tite EVR Ph 1 Systems 1002653708 06/28/2020 III. SPILL CONTAINER TESTING INFORMATION Test Method Used: Manufacturer Guidelines: (Specify) Industry Code or Engineering Standard: (Specify) PEI RP 1200 Engineered Method: (Specify) Attach the testing procedures and all documentation required to determine the results. # of Attached Pages Tank ID: (By tank number, stored product, etc.) Spill Container Manufacturer: Method of Cathodic Protection Inside Diameter of Spill Container: (Inches) Depth of Spill Container: (Inches) Does the spill container have a 5 gallon capacity? Method to Keep Spill Container Empty IV. Spill Container Test Results Fill T-1 REGULAR Franklin/EBW Non-Mettalic Isolation Other (Specify in section V) 12 15.5 Yes No Drain Valve Onsite Pump Other (Specify in section V) Fill T-2 PREMIUM Franklin/EBW Non-Mettalic Isolation Other (Specify in section V) 12 15.5 Yes No Drain Valve Onsite Pump Other (Specify in section V) Non-Mettalic Isolation Other (Specify in section V) Yes No Drain Valve Onsite Pump Other (Specify in section V) Non-Mettalic Isolation Other (Specify in section V) Yes No Drain Valve Onsite Pump Other (Specify in section V) SUMMARY OF TESTING RESULTS Pass Fail Pass Fail Pass Fail Pass Fail V. COMMENTS All items marked failed above must be explained in this section. Any additional comments may also be provided here. VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS I hereby certify that the spill containers were tested in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637.1 and all the information contained herein is accurate. UST Service Technician Signature If the facility has more components than this form accommodates, additional copies of this page may be attached. CERS=California Environmental Reporting System, ID=Identification, UST=Underground storage tank, ICC=International Code Council Site Diagram (This site diagram is for reference only and is not drawn to scale) Work Order:3446773 Site ID / Name:37942 / 7-ELEVEN 37942 Address:3225 BUCK OWENS BLVD., HWY 99/HWY 58 City:BAKERSFIELD State:CA Zip:93301