HomeMy WebLinkAboutFMC 2019cERs=Celiftrria Er$dlY|tlrlentd Rc rlir|1 svslnrYr lD = l,lerri6.rli()o lcc = lnterrdl.Yd c.t b cdrfjl Y =Yea- N ' ilrr NA = t'lr,' erY$"tle
ANK
MONITORING SYSTEM CERTIFICATION FORM
INVENTORY OF
for each contfol Panel.Monitoing System Cefiillcation Fom must be
Veeder Root
the
Tank rD: 87 Unleaded
tank
E ln-1ank Gaugjng (StY fark)
I Annular Space or Vault Sensor
E VPH sensor
E Mechanical LLD
E Electronic LLD
E VPH sensor
E Sump Sensor
E vPH Sensor (Sump)
E VPH Sensor
E sump Sensor
I VPH Sensor (Sump)
Vent
D vPH sensor (Piping)
I sump Sensor
E vPH Sensor (Sump)
Vapor Rscovery Piping
E vPH Sensor
E Sump Sensor
fl vPH Sensor (Sump)
Tank tD: Waste Oll
tank
i lntank Gauging (S1,7 lal,k)
Ex Annular Space or Vault Sensor
f] VPH Sensor
E MechanicalLLD
E Electronic LLD
E VPH Sensor (Piping)
EJ Sump Sensor
fl vPH Sensor (Sump)
E vPH sensor
E Sump Sensor
! vPH Sensor
fl vPH sensor (Piping)
C Sump Sensor
E vPH Sensor (Sump)
fl vPH Sensor (Piping)
E sump Sensor
n vPH Sensor (Sump)
lO = l.lentif.rim Silr= Sirrrle.r.rallerl \,/PH = Vacr rln/Ptt sr rtt/lhr.lrBialic LLD = I lne laek.Lac.rtrr
Monito.ing Device usqd Device Model #Monitoring Device Used Devlce Model {
VenUTransition Sumo lD:Vent/Transition Sump lD:
E Sump Sensor E Sump Sensor
E vPH sensor fl vPH sensor
UDC lD: 1/2 UDc lD: 3/4
I Electronic Sensor 794380-208 El Electronic Sensor 794380-208
E Mechenical Device E Mechenical Device
D vPH sensor E vPH Sensot
UDC lD: 5 UDC lD: 6
I Electronic Sensor 794380-208 El Electronic Sensor 794380-208
f] Mechanical Device n Mechanical Device
n VPH Sensor E VPH Sensor
UDC ID:UDC ID:
n Ebctronic Sensor I Electronic Sensor
! Mechanical Device E Mechanical Device
E VPH Sensor E vPH sensor
UDC ID:UDC ID:
E Electronic Sensor E Electronic Sensor
E Mechenical Device E Mechanical Device
E VPH Sensor fl VPH Sensor
other trtonitored componsnt lor East lube tfans sump other MonitorBd component lo: West lube tfans sump
I Othet (Specify in section Vll.)794380-208 I Olhet (Specw in section Vll.)794380-208
other MonitoIod componont lD: North lube tlans sump Other lronitored Componont lD:
I Olhet (Specify in section Vll.)794380-208 a o/Lhet (Specify in section Vll.)
Other t'iionitor€d Component lD:Other Monitored component lD:
A Olhet (Specity in seclion Vll.)D Olhe( (Specify in section Vll.)
lnclucte lnformallon for every undorground storage tank component monitored by thls mon ortng system control panel- lf the monltoring
system control panel monitors more components than lhis lorm accommodates, additional coples of these pagea may be attached.
vil.COiNMENTS
Use this section to provide any additional comments about the inventory ol the equipment ceiified.
Lube Oil has 3 transition sumps with 794380-208 sensors
lD = ldehlifi.rinn VPH = Vacl .rrPrE sr ,rE+hrdrEtati.- t |rx: = tln hr.icrnn a. .rl.firrncrll
@RAGETANK
MONITORING SYSTEM CERTIFICATION FORM (Pase3of 6)
This seclion must be ifa is us€d fo leak detection
Are the visual and audible alarms operational?
allsensors buildup to ensure
all sensors equipment not
Was monitoring reviewed to ensure
Was the panel's backup battsry visually inspected, functionally tested, and conlirmed
Does the flow of fuel stop at the dispenser if a leak is detecled in the underiispenser containment?
monitoring syslem fails to operate or is
Ooes the turbine automatically shut down if the piping secondary contalnment monitoring system detecls a leak?
Which sensors initiate positive shut down? (Check all that apply.) EI Sump E UnderJispenser containment
lf alarms are to a remote monitoring station, is all communications equipment (e.9. modem) operational?
box iftank gauging is used control.
Check this box if NO tank gauging equipment is installed. (Do nol complete this section.)if is used lo leak detecaion
and for proper entry and
faults?
Were all in-tank gauging probes to ensure
confirmed
Was accuracy ofsystem's product level readings tested?
Was accuracy of system's water level readings tested?
Were all probes reinstalled properly?
Were all items on the manufaclurer's maintenance checklist
xt.COMMENTS
Y = Ypa N = N. NA = N.* Anrri.aHe
UNDERGROUND STORAGE TANK
IIIIONITORI NG SYSTEM CERTI FICATION FORM (pase E or 6)
XII. LINE LEAK DETECTOR TESTING
U Check this box if line leak deteclors (LLD) are NOT installed. (Do rot cgmpleta this section.)
fhis section must be complgted if LLDS erc installed,Y N NA
Was a leak simulated to verify LLD performance?
(Che* a that aoply.) Simulated leak rate vermed: R3GPH n0.1 cPH n0.2GPH tr tr tr
Was the testing apparetus properly calibrated?tr tr
For emergency generatgr tank systems, dogs the LLD crsate an audible and visual alarm when a leak is deteded?tr tr M
For mechanical LLDS, does the LLD restrict the flow through the pipe when a leak is detected?tr n n
For electronic LLDS, does the turbine automatically shut off when a leak is debcted?tr tr E
For electronic LLDS, does the tulbine automatically shut off ifany portion ofthe monitoring system is digabled or disconnecled?tr tr B
For eleclronic LLDS, does tfie turbine automatically shut off ifany poiion of the monitoring system malfunctions or fails a test?tr tr tr
For eleclronic LLDS, have all accessible wiring connections been visually jnspected for kinks and breaks?n tr a
Were all items oa the equipment manufaclure/s maintenanc€ checklist completed?tr tr tr
Were all LLDS confirmed operational within rggulatory requirements?I29 tr tr
For any answer of "N" above, descibe in secfion Xltl how and when lhese issues were or ril be correcaed.XIII. GOMMENTS
XIV. VACUUM/ PRESSURE/ HYDROSTATIC MONITORING EQUIPMENT TESTING
tr Check this box if VPH monitoring is NOT use d. (Do not complete this section.)
This s*tion must be completed il VPH monitorlng is used to peiorm leak delecfioo monitoing.
System lype (Nrlark atlthat apply.) E Vacuum ! Pressure n Hydrostatic
Sensor lD Component(s) Monitored by this Sensor Sensor Functionality
Test
lnterstitial Communication
Test
E Pass E Fait fl Pass E Fait
E Pass E Fait L Pass ! Fail
E Pass fl Fail E Pass E Fait
E Pass E rait E Pass E Fail
fl Pass E Fait E Pass E Fail
I Pass E Fail n Pass ! Fail
[l Pass Ll Fa ll Pass n Fail
E Pass E rait E Pass I Fail
E Pass E Fait E Pass I fait
E Pass E rait E Pass E rait
E Pass E Fait n Pass I Fail
fl Pass E Fail E Pass fl rait
How was interstitial communication verified?E Simulated leak at far ends ofthe interstitial space.
E Other (Describe the method in section XV betow.)
E Visual lnspeclion
E Gauge
Was the vacuum or pressure restored to operating levels an all interstitial spaces? E Yes ! No (Descibe the reason in section XV betow-)
For any answer of "FAIL" above, descibe ln secuon Xl/ how and wrren (rese issu€s were gr witl be corecTed.xv COMMENTS
GPH = Galkmr rs h.x rr Y=Yeq N=N.| NA=Nr|. ,rlrJirr e. VPH = Vad n rnlPrt.st rrpilh,rlryxiafii lr) = klcntitr rri.lrl
Monitoring System Certifi cation
UST Monitoring Site PIan
Site Address:
Date map was dralv ", 3' "Z* I q
Instructions
If you already have a diagram that shorys all required information, you may include it, rather than this page, with your Monitoring
System Certification. On your site plan, show the general layout of tanks and piping. Clearly identi$ locations of the follorving
equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenset pans, spill
containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (ifused
for leak detection). In the space provided, note the date this Site Plan was prepared.
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