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HomeMy WebLinkAboutPost Major Mod Testing 10-31-20Testing and Inspection Certificate Tanknology Inc. 11000 North MoPac Expressway, Suite 500, Austin, TX 78759 800-800-4633 www.tanknology.com Page 1 of 1 Test Date 10/30/2020 Tanknology WO#SC1-3452998 Test Purpose POST CONST Customer PO# Customer Location WALMART/SAM'S CLUB DEPT. 9641 2101 SE Simple Savings Dr. BENTONVILLE, AR 72716 SAM'S CLUB # 4819 (SC4819) 5625 GOSFORD ROAD BAKERSFIELD, CA 93313 Attn: TARA STEGALL Attn: Asset Protection Manager (479) 277-8205 (661) 654-8565 Test / Inspection Description Item Tested Date Tested Result Precision Tank Tightness Tank 87 NORTH UNLEADED 10/30/2020 Pass Precision Tank Tightness Tank 87 SOUTH UNLEADED 10/30/2020 Pass Precision Tank Tightness Tank T3: 91 PREMIUM 10/30/2020 Pass Precision Tank Tightness Tank DIESEL DIESEL2 10/30/2020 Pass Precision Line Tightness (.1 GPH) Tank 87 NORTH Line 1 UNLEADED 10/30/2020 Pass Precision Line Tightness (.1 GPH) Tank 87 SOUTH Line 1 UNLEADED 10/30/2020 Pass Precision Line Tightness (.1 GPH) Tank T3: 91 Line 1 PREMIUM 10/30/2020 Pass Precision Line Tightness (.1 GPH) Tank T3: 91 Line 2 PREMIUM 10/30/2020 Pass Precision Line Tightness (.1 GPH) Tank DIESEL Line 1 DIESEL2 10/30/2020 Pass Line Leak Detector (3 GPH) Tank 87 NORTH Line 1 UNLEADED 10/30/2020 Pass Line Leak Detector (3 GPH) Tank 87 SOUTH Line 1 UNLEADED 10/30/2020 Pass Line Leak Detector (3 GPH) Tank T3: 91 Line 1 PREMIUM 10/30/2020 Fail Line Leak Detector (3 GPH) Tank T3: 91 Line 1 PREMIUM 10/30/2020 Pass Impact Valve Inspection See test report for details 10/30/2020 Pass Emergency Shut Off Switch Inspection See test report for details 10/30/2020 Pass Tanknology Representative: Mark Lindsey Technician: Patrick Pfrang Telephone: (800) 666-2176 Technician Certification: (See forms) VacuTect Tank Tightness Test page 1 of 1 Work Order:3452998 Date:10/30/2020 Site Name/ID:SAM'S CLUB # 4819 SC4819 Address:5625 GOSFORD ROAD City:BAKERSFIELD State:CA Zip:93313 Tank Information Customer Tank ID Regulatory Tank ID Product Category Product Name Gallons Capacity Tank Type Tank Walls Compartmentalized Siphon Tank Vents included with test Test Start Time Test End Time Water ingress (Y/N) Bubble ingress (Y/N) Ullage ingress (Y/N) Test Result (P/F/I) 87 NORTH UNLEADED 87 NORTH Gasoline - Regular UNLEADED 19781 Fiberglass Doublewall (factory) No No not tested 12:08:00 13:33:00 No No No Pass 87 SOUTH UNLEADED 87 SOUTH Gasoline - Regular UNLEADED 19781 Fiberglass Doublewall (factory) No No not tested 12:08:00 13:33:00 No No No Pass T3: 91 PREMIUM T3: 91 Gasoline - Premium PREMIUM 11904 Fiberglass Doublewall (factory) No No not tested 13:47:00 15:01:00 No No No Pass DIESEL DIESEL2 DIESEL Diesel DIESEL2 7901 Fiberglass Doublewall (factory) No No with this tank 13:47:00 15:01:00 No No No Pass Yes No diagnostic only - Test was performed per 3rd party certifications as specified in 40 CFR parts 280 and 281. Technician Comments : All tank tests pass. Technician Name Patrick Pfrang Certification #44648 Technician Signature Environmental Compliance for Petroleum Systems ©2020 Tanknology Inc., Austin,TX. All rights reserved. tanknology.com Product Line Tightness Test Page 1 of 1 Work Order: 3452998 Date: 10/30/2020 Site Name/ID: SAM'S CLUB # 4819 / SC4819 Address: 5625 GOSFORD ROAD City: BAKERSFIELD State: CA Zip: 93313 Tank Information Test Method Customer Tank ID Product Name Delivery Type Test Pressure Test Start Time Test End Time Final Leak Rate Test Result(P/F/I) Test was performed per 3rd party certifications as specified in 40 CFR parts 280 and 281 Tank # 1 Line # 1 TLD-1 87 NORTH UNLEADED Pressure 50 12:42 13:12 0.00 Pass Yes Tank # 2 Line # 1 TLD-1 87 SOUTH UNLEADED Pressure 50 12:42 13:12 0.00 Pass Yes Tank # 3 Line # 1 TLD-1 T3: 91 PREMIUM Pressure 50 12:42 13:12 0.00 Pass Yes Tank # 3 Line # 2 TLD-1 T3: 91 PREMIUM Pressure 50 12:42 13:12 0.00 Pass Yes Tank # 4 Line # 1 TLD-1 DIESEL DIESEL2 Pressure 50 14:06 14:36 0.00 Pass Yes Tank # Line # Technician Comments: Lines pass. Technician Name:Patrick Pfrang Certification #:44642 exp: 4/6/2022 Technician Signature: Environmental Compliance for Petroleum Systems ©2020 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com LDT 5000 Field Test Apparatus Line Leak Detector Test Page 1 of 1 Work Order:3452998 Date:10/30/2020 Site Name / ID:SAM'S CLUB # 4819 / SC4819 Address:5625 GOSFORD ROAD City:BAKERSFIELD State:CA Zip:93313 Tank ID Product Product Line Tested From Existing/New Mechanical/Electronic Manufacturer/Model Serial No. Pump Operating Pressure (psi) Calibrated Leak (ml/min) Calibrated Leak (gph) Holding PSI *N/A for Electronic LD's Resiliency (ml) *N/A for Electronic LD's Metering PSI *N/A for Electronic LD's Opening Time (sec) *N/A for Electronic LD's Test Results 87 NORTH UNLEADED 1 2 Existing Mechanical Red Jacket FX1V 307098751 40.00 189.0 3.00 22.00 300.00 14 10 Pass 87 SOUTH UNLEADED 1 10 Existing Mechanical Red Jacket FX1V 307098752 40.00 189.0 3.00 22.00 125.00 15 2 Pass T3: 91 PREMIUM 1 2 Existing Mechanical Vaporless LD-2000 17021315 40.00 189.0 3.00 40.00 350.00 0 0 Fail T3: 91 PREMIUM 1 2 Replacement Mechanical Red Jacket FX1V 104192098 40.00 189.0 3.00 40.00 360.00 14 8 Pass Technician Comments: Failed and replaced T3 91 leak detector. Adjusted LD2000 2 times but was unable to get LD to pick up 3 gph leak. Replaced with RJ FX1V as all other products. Technician Name:Patrick Pfrang Certification #:44637 Technician Signature:Expire Date:4/6/2022 Environmental Compliance for Petroleum Systems © 2020 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com Impact Valve Inspection Impact Valve Operational Inspection Work Order:3452998 Date:10/30/2020 Site Name/ID:SAM'S CLUB # 4819 Address:5625 GOSFORD ROAD City:BAKERSFIELD State:CA Zip:93313 How Inspected: Line Test NFPA 30A PEI RP1200 Other Dispenser Number Grade Secure Mount? Valve Lock?Pass/ Fail Comments 1/2 87 Pass Fail Not Tested 1/2 91 Pass Fail Not Tested 3/4 87 Pass Fail Not Tested 3/4 91 Pass Fail Not Tested 5/6 87 Pass Fail Not Tested 5/6 91 Pass Fail Not Tested 7/8 40 Pass Fail Not Tested 7/8 87 Pass Fail Not Tested 7/8 91 Pass Fail Not Tested 9/10 87 Pass Fail Not Tested 9/10 91 Pass Fail Not Tested 11/12 87 Pass Fail Not Tested 11/12 91 Pass Fail Not Tested 13/14 87 Pass Fail Not Tested 13/14 91 Pass Fail Not Tested 15/16 40 Pass Fail Not Tested 15/16 87 Pass Fail Not Tested 15/16 91 Pass Fail Not Tested Technician Comments: Impact valve test on both new dispensers only, dispenser 1/2 and 9/10. Technician Name:Patrick Pfrang Signature: Environmental Compliance for Petroleum Systems ©2020 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com Sam's Club Emergency Stop (E-Stop / ESO) Periodic Inspection Facility Information Technician Information Site #: SC4819 Date: 10/30/2020 Address: 5625 GOSFORD ROAD Name: Patrick Pfrang City / State: BAKERSFIELD CA Technician Signature: SITE DATA 1 Number of E-Stop switches INSIDE the building: 1 2 Number of E-Stop switches OUTSIDE the building: 2 3 Call Alarm Central at 479-273-4600 a.Press 1 for Alarm Central b.Then press 4 for Technician c.Then press 2 to speak to personnel d.Tell the operator you want the Sam's Club / Wal-Mart Gas Station account for club membership SC4819 put on test. e.They will ask for a password which is: 9350. f.Record the Alarm Central persons name and the time that you spoke to them(Pre Alarm) Laura 09:14:00 PERFORMANCE DATA Yes No NA 4 You have added or confirmed that all E-Stop locations are on the Site Diagram 5 Do all E-Stops shutdown power to ALL DISPENSERS 6 Do all E-Stops shutdown power to ALL STP's 7 Are ALL E-Stops clearly Labeled 8 Are the TURBINE BREAKERS clearly identified / labeled POST TEST 9 All equipment secured and any access ports, lids, enclosures are closed. 10 All safety barricades and test equipment has been properly removed 11 E-Stop was reset and all dispensing functions are normal 12 Call Alarm Central at 479-273-4600 a.Ask if Alarm was Received and if Yes, advise that testing is complete b.Record the Alarm Central persons name and the time that you spoke to them(Post Alarm) Laura 09:48:00 E-Stop Inspection Results PASS FAIL INCONCLUSIVE Comments WO: 3452998 Site Diagram (This site diagram is for reference only and is not drawn to scale) Work Order:3452998 Site ID / Name:SC4819 / SAM'S CLUB # 4819 Address:5625 GOSFORD ROAD City:BAKERSFIELD State:CA Zip:93313 Appendix 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 12 Month 1. FACILITY INFORMATION CERS ID Certification Date Facility Name Facility Address City ZIP Code 2. SERVICE TECHNICIAN INFORMATION Company Performing the Certification Phone Mailing Address Service Technician Performing Test Contractor/Tank Tester License Number ICC Number ICC Expiration Date 3.TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date 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 Total # of Pages 4 10027021 10/30/2020 SAMS CLUB #4819 5625 GOSFORD RD BAKERSFIELD 93313 TANKNOLOGY INC.800-800-4633 11000 N. Mopac Expressway #500, Austin, TX 78759 Patrick Pfrang Class A General Engineering 743160 8202676 02/08/2021 Tanknology Certification Level III ATG Operability Training Certification 01/30/2022 ICC CA UST Service Technician 8202676 02/08/2021 Veeder Root VR Level 4 A29052 05/09/2021 10/30/2020 6 Underground Storage Tank  Monitoring System Certification Form Page 2 of 6 5.MONITORING SYSTEM AND PROGRAMMING A separate Monitoring System Certification Form must be prepared for each control panel. Make of Monitoring System Control Panel Model of Monitoring System Control Panel Software Version Installed Attach the post-certification reports if the monitoring system is capable of generating either; Monitoring System Set-up Alarm History Report Yes No NA All monitoring equipment is operational per manufacturer’s specifications? Secondary containment systems are free of damage, debris, or liquid? Are the audible and visual alarms operational? All sensors have been: 1) visually inspected for wiring kinks, breaks and residual buildup on floats; and 2) tested for functionality and confirmed operational? Are all sensors installed to detect a release at the earliest opportunity in the secondary containment? The monitoring system set-up was reviewed, and proper settings confirmed? Was the monitoring control panel’s backup battery visually inspected, functionally tested, and confirmed operational? Does the flow of fuel stop at the dispenser if a release 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 release? Which sensors initiate positive shut down? (Check all that apply) Sump UDC If monitoring system alarms are relayed to a remote monitoring center, is all communication equipment operational? Describe all answers marked “No” or “Fail” and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Veeder Root TLS-350 333.05 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 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 Describe all answers marked “No” or “Fail” and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 L19 749380-208/304 DISP 1-2 4 L20 749380-208/304 DISP 9-10 4 s1 330020-485 87 N PRODUCT 4 s3 330020-485 87 S PRODUCT 4 s5 330020-485 VAPOR RETURN 4 s6 330020-485 91 PRODUCT SOUTH 4 s7 330020-485 91 PRODUCT NORTH 4 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.) 3 GPH 0.1 GPH 0.2 GPH Yes No NA Has the testing apparatus been 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 release is detected? For electronic LLDs, does the turbine automatically shut off when a release 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 tightness 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? LLD ID LLD Model Lines Monitored Pass Fail Describe all answers marked “No” or “Fail” and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 4 4 4 4 4 4 4 4 4 4 T1 87 N RJ FX1V T1 87 NORTH 4 T2 87 S RJ FX1V T2 87 SOUTH 4 T3 91 RJ FX1V T3 91 LINES A & B 4 T4 DIESEL RJ FX1DV T4 DIESEL 4 Underground Storage Tank  Monitoring System Certification Form Page 5 of 6 8. IN-TANK GAUGING TESTING Check 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 Describe all answers marked “No” or “Fail” and proposed remedy. List all monitoring equipment either replaced or repaired. 4 Test on new dispenser install sensors only, despernsers 1-2 and 9-10. Sump sensors VR 208 and brine sensors VR 304. Test on vacuum sensors that monitor all prodcut lines and vent line, s1, s3, s5, s6 and s7. Released vacuum from far point for all vacuum sensors and compared before and after vacuum levels. No alarms created. Upon arrival s1 87 product line vacuum module had a fault alarm. Replaced vacuum module, all functions normal. Failed and replaced T3 91 leak detector. Replaced Vaporless LD2000 with Red Jacket FX1V. Not test on ATG's. Underground Storage Tank  Monitoring System Certification Form Page 6 of 6 10.MONITORING SITE PLAN Date site plan was prepared: If a site plan has been prepared 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 identify locations of the monitoring panel, and all leak detection equipment and monitoring locations. Include a legend for all symbols depicted. W.O.# SC1-3452998 ATG tapes W.O.# SC1-3452998 W.O.# SC1-3452998 W.O.# SC1-3452998 W.O.# SC1-3452998 W.O.# SC1-3452998 W.O.# SC1-3452998 Ovf W.O.# SC1-3452998 Parts