The URL can be used to link to this page

Home My WebLink About4101 Truxtun FMC 04-20-21Appendix 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 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 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 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 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. Monitoring System Certification UST Monitoring Site Plan sire Address: 4101 Truxtun Avenue, Bakersfield, CA. 93301 .5';? . 1e^*t5 7\\3!r..- ?n9 v0q :qnr.i:. . 33ca,l I - c,., i il,..r"r+. 5do.'s 7iq t(o -q rq ii ,,,.,,,, 87 :: a$ oo. \oAae'36 03-.TIli!.. f Lu -.?<' 1'a6getz' fu't't" Date map was drawn', _l_l Instructions If you already have a diagram that shows 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 identifo locations of the following equipment, if installed: monitoring system control panelsi sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used fbr leak detection). In the space provided, note the date this Site Plan was prepared. Page 4 of 4 www.unidors.orgt'N-036 {/{Ite\. 0l/lll08 04 20 21 CVE Cal- Valley Equipment 3500 Gilmore Ave. Bakersfield CA 93308 661 -327-9341 FAX# 661 -325-2529 VAPORLESS MANUFACTURING, INC. LDT-890 Leak Detector Test Record Technician Date Pass / Fail Product Manufacturer Leak rate Operating pressure Line pressure (pump off) Facility Address Bleed back (pump off) Step through time to full flow Stays in leak search position 5','5TEl'1 F-TETUF trPE :tr, lU!1 tr4E Hll SYETEf.I N I TEU.F. LiiSTEI'l Li-lf ltLLHiiE Ef'']GLIEH =i EiTEI'l ITATE.,T I l'lE Fllll'l*T i"laill EIr 'li1i"r HH:lll'l:sFl :il'] Li I T'i lfEF . '!gFIr41[I TEU]{TON A\/E. E*IIEFEEEF I Ir riA " 9t:rL.ll Eh I -3!E -tT15 i-rrlFI "1'llrli I .:HIFT'1']I'1E: 5trtFT Tlf lE l E]HI L1 T]I]E '1 l HI.lI I ELI 1:iT ILIIiHELEI]Trtl]: Hllll Tll'I I:HELEI r-rr- l'll"iL r',1 I LrATI nl,jlj ?Elrfj _ P ]FT ,JETT I I.ICE : r- lH Eri)ilFll E Hlll FirlTE fnFrlT?l-iTirl E I T I HTH LEII-; f H F]FJ.E! I SE[T]"]E I TYUIILE : TT I fiAELEFLTF NLTFI,,IAL STATEi HIGH REI-:EI;EF SETUI : N,iIIE 1 N-T-tlli iE-l lLl 'I r:rltllEnlEI,rFl L r-lr- T irE TIlEF:I]HI-'iTEFF T|t1]: I I Hl'lE'f EFi THtlll FFI FILE FULL , i--,LE!.5 I I,]'-lH ulL55,? INCH 1JNL !E.E I ll,-:H ;DL EI /lJT :T*E' L"IATEE L,JAE I,1 I I lG H I Gl-i I]ATEn LInIT 1 ,I.]L -UU 11!.iE4 TTE 1'lL!il T..i n :T5rl .1 .U I . 1 i F_ -SAT 9r,D _ I,IO NEl ETi]FE L*TA 4.0 I' 1,'jriEl-EJi l,inHEl.ElI 1ITHELEII I IiTiELEII IIEEI EI I, FIII t,lEELrt'I ip IIEE!EI I, FiI,] r.tEEtlE[r l.I-tIl I.I " 'F LAEEI" 1' L:- EF]F I LI,. L I 11i I 1 4 rBil 1Zl 1 q D..r: :l:llji _i I .!! : ]U ,,: :,r9r 4.1_ . lJl H i GH FEII -IIT TJELI IEE,Y LII,l]T LOL,J PRIJT]U..7 LEHI<: ALAEI'1 L I I'1i T L I tlE FE EI]HELE llEl f'lt-if FHEE LlllE TE:r'l iLiltf Etl l- - i.::E l.I f 1l I : THIi]: TILT : PR(.iEE |IFFSE'I : L 1 I,']E I EH T.,T'I! I:]HELE! L I llE Allll 1!T I' IijHELEIL I!f1L fl llH tl l Fr Ll-L,Fltr TrilU:ir T d : tinllEl.l llE llnlt I F l.l EI li"illl:i I s : t,lollE LEHI: f li ll I'E,1.1 -il,l : r-r i,., 1 LE$i: Iri l,l Hl'll'l HL : :r:n:- l.Eh I -rltl TElil lrlE ;rUI rli HI.II.]I -L TL:]T FH I L -1.i!tll h l:-HELEI I F-E I L,f, I -r 'l'Elj] FH I 1- FiLHEI"I Irl li*ELEI GFI - !J TEIi'T F' IL hLrFJ'] I 1r-inEI-Etl r.!'ll1 TE:I HirEF.H l i Ila : IFF I EFI IEET H rEFtii .; I itLr : _ FF 1-I.I].: TEET I']i)T I F"' : FF Ti.ll'. ltil i: lI'H: ll Elitlill:: -FF FEL1 iEIi, LIEI-H',' : i fllllI ..ll,lp T FtEljrH|t.I : 1rt " : _11- PFi 1 r,lT Tr UrlLUt,lES EI"IHBLED TEI']F ..I ]I.1F]ENFjHT I ON!*Ll-lE i IrEL-:l F )r 60.I ET I I-:I: HE ] 'JHT OFFEET IT I SAELE! H-! ElTn'joL l,FTil FOEI'IAT HE i (HT IrfiYLIi.;HT F-rA\/l f,l{j TltlE EIIAELEIFTART TTHTEAFF l"lEEl.i l Blltl ST.iRT T I I,1E! : r_r[ *i']EIi! DHTEi]CT I"]EE}i E ELII] Ei,ltr T I l"lE!: ]]|] *l] EE-tr I FECT L0aAL PR I I^lT[]lT tT ] F]AELEIT EUE|} PE T I]C|-IL FEEF]}' F] .-I L]ET.]I'1 ALARI^'] LHEELH T] I EAELEIT HUT: lr I HI- l t I tE iiE f t.rF : Il ,illE E5 !;: EI,tIr F IlEFit*i-iE IT I SHEI-EII AUTO D I *L TLARI,] FJETLIP_ _ 'I 2 :Ir I ESEL -Ni) . : FE,::bUi_rT artrE THEEIIiIL i:OEFFT*I']i: D I AI']ETERTHN}. }EOF ] LEFULL !.LES.5 I Ni:I H UNLE9.? I I.IL--H VOL:9.9 I l!'-:H liiL FL .tAT ::I I3E : L,]*TEF] IiRN I I,IG H I L;H L.]ATEE L I I.l IT Flflii nE LttBEL ,r'il i]UERFILL LIIIIT HI rjH FEODUCT I]EL ] \IER! LII]IT LOLJ FR EUI:]T LEAI{ ALARI"I L I I.1I T FJ UTTTTE I"I LOF]S L I 11 I T : LE*1:_TEET I'1ETH,I]II TEa-iT llll IriiTE : HLL THI\IXJHi,t 1, l9lr, STHET TII'lE : DiBHELEII TE-.-TT EI1TE : I , !t L]AL HF I ].]EAT I '.}I,1 : ! H:II IFE TST E*RLY ET,II' :DISHELEI! LEA}I TE1JT EEI.1,1FT FNEI]*T ll'iR[']AL LI LLI II.EEI,]BNE -BETUF L l:ut.lLE*trEtj sTp TEl -STATE ( 5I N(ILE FLI]']T )ilriTEL;OR'r : ijTF 5Ul'1P L :: UNLEIiDED Alll',lul-nR TEI _STATE (SI NGLE FLOAT} i,:ATEEORY ; ANI.ILILAR ST,H':;E L 3:DIESEL ST[' TEI -STATE {S I I,IGLE FLOAT } CATEG$RY : STP SL]I1P L 4:DIESEL ftI'IIIIILAR TE t _STITTE (S I I,,I(]LE FLOAT } LIATEGORY : HI'II'II]LAR SPTCE IUTPLIT-FEI,*I !EI'I . - - R 1 : UI.ILEATTED.gTP STHNTTHEIl l,llRI'IALLY rlLllSEIr I N-THI,I}i HLARIIFJ, ,;PlilH l,lgTER ilLriFI']T I : LOI,J F'F0DUL:T rrrl.*Fl'1 L i I,U I LI NEt,tEIE *LI.ISL 1 :FUEL ALARf']L I : iiEllS0R tlUT ALAkI IL ?:SEI,ISOR ',iUT HLBRI']L 1:SHOET ALfiFIIL I :BHORT nLAEI'l F] 2:t]IESEL FJTF T'/PE: ST*l..ltrHEtr NDEI"IALLY r::LOSED I ll-Trilix *LARlliiT !:HIGH t"lHTEF ALARI'IT 3 : L0t"t PEf_ltruf_rT ALHFl"l LIcTUID SEI,IEOR ALl"lFiL I] : FUEL ALFRI']L :1 : i:1EtlStR ll lT iiLARl'1L .I :SEI,ISOR OUT ALARI'IL 3 :SHORT ALARI"IL 4:EHiRT HLAFI'I R t: FEt{iTE EEA.,r!, STAI,]T'AED I'IOFJ'IALLY 'lLOsEIl I I']-TANH ALSHI1S ALL : LOI.I I RotrLjT ALARI,] LIcrulD sEliEoR Al-t"ls *LL : FUEL ALAEI.I *LL : EEI,IFJi]R iUT gLiiRI.1 ALL:3HORT ALAFI-] ! .008q70 I4TE3 120!x 7 40rl 2 750 4. L:r I I,t. 3.04.rl 1478: E 59i 1 { 0.13 I0e,; 13304 E469 THflli TILT i- PFt - EE i-jFFSET : 3r t',l !5 LI. !E u.t.t_ s I PHilf,l t"lAt,lt FtlLtrED TAlllisTS: N'NE L I I.JE I,IAI'1I FOLIIED THI',]HFJT$: I']ONE LEAH lt I t"l PEF I |}tr I {] : Oe;:D LEFII: f.1l ll AI,I'IL|AL : Dri:t_l T,EEIOII' TEST TIPE STAI'lIrHE! i]I.1NU*L TEHT F* I L ALAFlrl D I Fi,+ELED FEEIO!I' TEST FAI L ALAEI'I 0l Ii*ELEfl L.;RIFJE TEET FA I L ALHEI"] IT I SflELEt] ANN TEFJT H!'EEfiG I I'IG : OFF PER TEET HUEEAI]j I II.j : T]FF l AtlH IEET tltlT I FY : i:)FF Tllll TST 5l F'Hil;Fl EEEAII:OFF DELI'TERY DELH\' : ] NI I,,] FUI,IP THRESHNLIT : I O. Ot , FEL:0r^1r I L I Hr I oN lElul _ _ uTullfiT I tr LrA I L'r' [L(]E I l,ta";TII.1E: 2: ljD AI.1 FER I Otr l._r REtrON.jlLIiiTInN TEIII -ruH!,Etil-iHT I i-rlI l:.T*llLHFI] ELIE iLiT-F'UEL I1ETEF _Tr+1,111 THHi: llriP EI.IPT i SNF T,JARE HEVIEINI..] LENEL1/EES I0ll I l! . 1-rl EnFTr,.rAREC a4E 1 2:- 1 0Lr-,:l TIFEHTEIT - n.r.,. 1 I .15. 15. 17 I,ID .JiFTLdARE I'I{.lD ULE F]'T,ETEII FEATUREE : FEF I UIil rl IN-TANI: TESTS fit,lNUilL I N-Tirll): TEFiTS ALAHI"] H I ST: R! RE}iOF]T - -- I N-T*l,lH riLftRIl ----- T i : L]tiLEtrtrED HI{JH FRULUL:T HLHEI']IEf !7, tn19 E:!J FtlNOU !2, r.0lb E:07 *t,l I I'IUAL I ! FUEL LEVEI.OCT I !. gu3! E :44 ill.l ALrr.i !1. 2D1B 6:tB At1APR 33. rl.ilE 1:1? F,t"l PEOEE i]UTJUL 5, lrltr B:!t Ptl.JuL 5. ltll9 8:18 t,t"tJUL 5. :DIE E:I.]l] AI'I I]EL I VEEY I,]EEI,EDAFR tE, r[!l t:t.] Fr.1/1FE E, !rl: I 9 : !u *f,1 l,lHE 30, 2rl? I 6 : 'a.r7 iltl ALiTF]I.] H I ET -]FY NEPI.F]T -- FiEl.lSOE HLAEr.1 --- -L I : L- I,,]LE*NE]] ETP ETI- =UI'IPSEIII]OF] i]UT HLARI] HAR 30, 2O:O E::: AI'I FUEL ALARI"I I,IAE 50, !r:r!rl B: I I At'l FUEL HLHFI.] JUN 11, :rj19 lil:59 Ht'1 lirtiElltJ:(**** iiirtii(E|,10riIi{X I ] :IITE :I"lOIITHLY r.i;:i ii EllI } *; t,t ! HPEFI Dl.lTtjEr'] :, lr:rtrl FF] I I.]TEE EHFTI)RLEr-r 2. lLr:LlE*TTEEI i E '.JFFJAr,r l. lrgb -LHRI"I H IsTi.]R r FEI -iR.f -- - LiYFiTEH HLHFJi 3:12 Pt'l B: III *1,1 ALEFI1 HIB'Ii.IE'I FEPNF'I I f,t -THr,tl: ALAF|,t ----- T ! : I]I EEEL *Ni . ! UUERF I LL ALARI,T.lUI,l 11. 2013 l3:5I I,t1 H 1 GH PEODUI-]T AL*EI.1JUN 11, rntS 12:5[ Pt1 PROEE OUT._l.lL 5. !r..ltB E:Lrn AI'1 TTEL I UERY I.,IEEDET]*PR I 3, !u31 3 : !E F,t1I.IAR 18. ?tt!t E : tlJ. rlt'lFEE :5. ?021 3 : 17 PI"l HLHFI'] HI ST{-1Fr- EEPI,IRT ----- F-rEI^]SDF riLHRr'] -----L Z: UNLEHIEIj ANI,iULHR iri,]I.]ULHR 9FACE sENgOR NUT fiLAEI'] IiHR 30, 3r:r!11 6 : 3! Al"l FUEI. HL*RI'] i'1AR 30, r0:0 B:1! Al'1 FUEL ALHEI'1tliR r0. ?0![ 7 : !E Ar.r l.i,i*tEllDxr;(*r -tii:txEllD;irxxx TTLAEI] HISTTIEI/ FEP1:LRT ----- EEf,,rFir: E ALAEt,t -----L 3:T)IESEL STP SEI'lllOFl llUT AL*El"l I"]AR 38, 20?O B : 3! At1 FUEL ALARI"I r"lAE 30, !ll:0 E:1J rlt{ FUEL PLARI.I I,IHY 10, !B1S 4:18 AI,1 i i+*tEllI)!rrxi HLHFI,I H I5T(:)8,], REPORT ----- FiEHSDR AL*Et"t -----L 4 ;DIEEEL AI,]I,]_]LfrE AllllULHE SPACE SEltstiR i.iUT *LAFtl,l IiAR 50, fDlB B:32 r.rl.1 FUEL *LHEI'] IIAY 1u, 2r119 4:10 At"l FUEL ALAEI1l"r*Y 10. 20lq :r:58 *t1 ;tx*i{*El,{tlrl'xx