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Home My WebLink AboutRE-TEST 2018MONITOR CERTIFICATION 11000 N. MoPac Expressway, Suite 500 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 Date Printed and Mailed: 10/2/2018 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR KRIS KARNS 1501 TRUXTUN AVE. BAKERSFIELD, CA 93301 Test Date: 9/27/2018 Order Number: 3442971 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: SAM'S CLUB # 4819 (SC4819) 5625 GOSFORD ROAD BAKERSFIELD, CA 93313 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 Appendix VI (Copies of Monitoring System Certification form and UST Monitoring Plot Plan available at http://www.swrcb.ca.gov.) MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California 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 of this 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 test date. A. General Information Facility Name:SAM'S CLUB # 4819 Bldg. No.: Site Address:5625 GOSFORD ROAD City:BAKERSFIELD Zip:93313 Facility Contact Person:Asset Protection Manager Contact Phone No.:661-654-8565 Make/Model of Monitoring System:Veeder Root TLS-350 Date of Testing/Servicing:9/27/2018 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: Tank ID:87 NORTH - UNLEADED In-Tank Gauging Probe.Model: Annular Space or Vault Sensor.Model: Piping Sump / Trench Sensor(s).Model: Fill Sump Sensor(s).Model: Mechanical Line Leak Detector.Model:Red Jacket FX1V Electronic Line Leak Detector.Model: Tank Overfill / High-Level Sensor.Model: Other (specify equipment type and model in Section E on Page 2). Tank ID: In-Tank Gauging Probe.Model: Annular Space or Vault Sensor.Model: Piping Sump / Trench Sensor(s).Model: Fill Sump Sensor(s).Model: Mechanical Line Leak Detector.Model: Electronic Line Leak Detector.Model: Tank Overfill / High-Level Sensor.Model: Other (specify equipment type and model in Section E on Page 2). Tank ID: In-Tank Gauging Probe.Model: Annular Space or Vault Sensor.Model: Piping Sump / Trench Sensor(s).Model: Fill Sump Sensor(s).Model: Mechanical Line Leak Detector.Model: Electronic Line Leak Detector.Model: Tank Overfill / High-Level Sensor.Model: Other (specify equipment type and model in Section E on Page 2). Tank ID: In-Tank Gauging Probe.Model: Annular Space or Vault Sensor.Model: Piping Sump / Trench Sensor(s).Model: Fill Sump Sensor(s).Model: Mechanical Line Leak Detector.Model: Electronic Line Leak Detector.Model: Tank Overfill / High-Level Sensor.Model: Other (specify equipment type and model in Section E on Page 2). Dispenser ID: Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser Containment Sensor(s).Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser Containment Sensor(s).Model: Shear Valve(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 - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers’ guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check all that apply): System set- up Alarm history report Technician Name (print):Franscico Castro Signature: Certification No.:B37663 License. No.:743160 Class 'A' Testing Company Name:Tanknology Phone No.:(800) 800-4633 Testing Company Address:11000 N. MoPac Expressway Suite 500 Date of Testing/Servicing:9/27/2018 Monitoring System Certification Page 1 of 4 12/07 D. Results of Testing/Servicing Software Version Installed:333.05 Complete the following checklist: Yes No*Is the audible alarm operational? Yes No*Is the visual alarm operational? Yes No*Were all sensors visually inspected, functionally tested, and confirmed operational? Yes No*Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes No* N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? Yes No* N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) Sump/Trench Sensors; Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? Yes; No Yes No* N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? % 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? (Check all that apply) Product; Water. If yes, describe causes in Section E, below. Yes No*Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable Yes No*Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: s-2 smart sensor retest only Monitoring System Certification Page 2 of 4 12/07 F. In-Tank Gauging / SIR Equipment: Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Yes No*Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes No*Were all tank gauging probes visually inspected for damage and residue buildup? Yes No*Was accuracy of system product level readings tested? Yes No*Was accuracy of system water level readings tested? Yes No*Were all probes reinstalled properly? Yes 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 LLDs are not installed. Complete the following checklist: Yes No* N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: 3 g.p.h.; 0.1 g.p.h; 0.2 g.p.h. Yes No*Were all LLDs confirmed operational and accurate within regulatory requirements? Yes No*Was the testing apparatus properly calibrated? Yes No* N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Yes No* N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Yes No* N/A For electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? Yes No* N/A For electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? Yes No* N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes 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: Probes and Leak Detectors not tested today. Page 3 of 4 12/07 Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors LG 163-1, Enc. II I.Results of Vacuum/Pressure Monitoring Equipment Testing This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of this form must be included with the Monitoring System Certification Form, which must be provided to the tank system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Manufacturer: V/R Model: TLS-350 System Type: Pressure Vacuum Sensor ID s-2 Component(s) Monitored by this Sensor:87 N vent Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: Pass Fail Interstitial Communication Test Result: Pass Fail How was interstitial communication verified? Leak Introduced at Far End of Interstitial Space1 Gauge Visual Inspection Other (Describe in Sec. J, below) Vacuum was restored to operating levels in all interstitial spaces: Yes No (If no, describe in Sec. J, below) J. Comments (500 characters max. use additional sheets if needed): Page 4 of 4 1 If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor, vacuum/pressure has been demonstrated to be communicating throughout the interstice. WO: 3442971 Site Diagram (This site diagram is for reference only and is not drawn to scale) Work Order:3442971 Site ID / Name:SC4819 / SAM'S CLUB # 4819 Address:5625 GOSFORD ROAD City:BAKERSFIELD State:CA Zip:93313 W.O.# SC1-3442971 Cust Ref#: .