The URL can be used to link to this page

Home My WebLink About4101 Truxtun FMC 08-09-21Appendix 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 08 09 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 SYSTEI.I SETUF, I N*TFNK SETUP_ T I : UNLEATJETT PRODUCT CODE THERI"IAL .:OEFI' TAI.IK TI I AI'1ETEE TTTNI.I PROF I LE FULL V L89,5 I I'JI]H VOLE9.7 I NIIH VOLI!.8 I NCH VOL I , Ir]rlTrlrl 119.384 PT|J 7 4ll rl!?5:r 4.8 IN. 4.0IJUI'II{ EOi]R! Er.lUI, RATE I,AR I TY .JT P EIT I {E-SA'I 9600 NONE1 STOP AUrl 9, r0!1 ?:31, Atl SrE'I'E|'1 Ut,t I Tsu.-q. EYF_rTEf't L* N _; u*._;E EI']GL I5H n'lSTEl"l DfiTE. T I I'tE FOEHATllnl'l L! '1 1yy HH :t,[,1 : ES ,pl CIT! ._rllEp. !Akt,41[I TRU}1TON AVE.EfiHEF5ERFID CA.,-13309E,61 326-3795 EH]FT TII,IE 1 IJH I FT TII"IE :.]IJHIFT TIIJE T IiH 1FT T]I.IE 4 D I S*BLEL D I FJHBLETT! I SABLErT TiI BABLEI) ai_)t"lt'juN I uAt' t 0ltE ,lElrl _ _ PORT SE'IT I l'lGri : FL:}AT EIZT]: tlii IEE l,,lHEN I llll H I L]H flTER L I I"1I T I']AX OR LAEEL VOL OVERFILL LIMIT HIGH PFODUCT TiELtVERY LIMIT Luh ! ROFLITjT LEIrH *L*Rf.l l. ELrlrtrEt{ Loss TFIITT: TIL1, NATA LENGTH: B DATA ES-!32 SEI]UR I TY CODE : D I SAELED T1TR I,IORI'IAL ETATE: HIGH FECEIVEE SETUP: NONE It"llT:LIIIIT 14043gl'/i 1330'l 458! 3ll0 4,lE 0, B0 'I Hlli: t'EFt lltT Ir I liHEl_Elr l nr.lll HIli,t Tt:tTI I fTIHELEI IIJEEI]ED I^IRII l'rEEtED r,iRf.t PRDBE NFFSET : LI I'IE EE.EIIAELE I{ETH{ OT,ASS LII{E TEST L I I,lE PEE TrlT HEErJED URNDI SHBLED L I I.IE ANI.,I Tn-T NEETTEIT I,JRI,I D I SAELE! !'li I l',rT Ttr VOLUI,IE9 ENHELEI] TEI1I. COI{PEf,,]SAT 1 i]I!VALUE {I]EG F ): E[.I]ST I CK HE I I:;HT OFFI.JETII I EAELEI] H-t ROTrlL-nL I,HTrr Fi-rRI,]HT HE ITJHT DAYL I I:HT SAVING TIIlEEI,I*ELED START TTATEAPR lJEEX I SUI,ISTAFT TI I']E! : 00 Af"l EI,.]D T1ATENNT L'JEE}I 6 SIINEND T II'1E!: tlD AI'1 F]E.DIFECT LOTj*L Ph I NTOUT T] I EAELED EURN PR*TO|-rOL PI?EF'I:( S I PHOI,I I"IAI\IIFOLDED T*I,]KBTS: NONE LI ITE I'IAN I FOLDED TANKSTB: NUNE LEAK l"l I l.l PER I OIi I Ll : O%:0AUTO DIAL TII"IE SETUP: NONE FS-:32 El,ltr ,JF I'IEES'qGE LII ETELEI] .rdT - _LrrnL .tl-"tklr_SET. t'_ _ LEA},i I'1I N ANI.IU*L :[l i L FEF i ]D 1 '-' TEET TI'FE - riU I t:H *I.]IiUgL TEST FA I L ALAEI,I L I EAELED I,EE I ODI Ll TEST FAIL ALAEI"I tr I SAELED fJRISS TEET FAI L ALARI.I T1I SAELED ITNN TEST AVERAG I I,IG : OFF FEE IEST AVERA'JI I.IG : OFF T*I.IK TEST NOT ] FV : {IFF TN}i TET EIPH.'\I,I EEEITK:OFF I,EL l VEE! I,ELA\' : 5 l"1l N PUI1P THREF:iHOLI) : 1I]. DO9d CUSTOI"I I1LFEI'I LAEELS D I SAELED T ?:DlESEL_I'IO,: PROTTUCT CODE THEEI"IAL COEFFTINH D I *I,]ETER,IHIIH PRDF I LE FULL VtrL89.5 lNCH VOLE5.7 I NCH VOL!9,8 I l,lrlH VOL FLOAT iJI ZE: IJATEF I,JARN I I,IG H I t;H I4JATEE L I I'll T I,I8' OE LAEEL UOL OVERF I LL LI I"lIT HIGH PROITUCT DELIVERII'LIf'1IT LOH FEODUCT T,ETIH ffL*RI,1 LIHIT: FJ UTIDE I'] LOEE L I I''] I T : TTIN}I TILT :- PROEE OFFSET : LEAH_rEEr,lErloll _ _ - _ TEIJT Of,] LA'TE : ALL TAI^]HJAI'I L 1996rlT*RT T I l'lE : tr ISiiELED TEST RATE : IJ . iI] GAL ,HR r,UEATIill,l : ! H0URS TST EAELY STOP:OISABLEIT LEA}I TEST REF,OET FOEI'IAT IiOEI,]AL Lr(ruID_EEr,rsrR_EET!P, _ _ L I:UI{LE*DET] STP TEI.ETATE (SINGLE FLOAT } CATEGT}RY I STT' SUI"1F L 2: UNLEADETT ANNULARTEI.9TATE (SI NGLE FLOA'I) CHTEGORY : AI,INULAE SPACE L 3:!IEEEL ETP TRI -ETATE ( i] I NGLE FLOAT) .ATEGORV : gTP SUI'IP L'I :DIESEL AI'.II\IULAF TR t _gTTITE (S I I.IGLE FLOAT i CrtTEi]OFY : IIIINULHR SFACE N I...]TFU'I REL*! F-'ET t !1 E I : Ul.lLEnLE!-gTP T?T'E : FjTAtltIHRIr llnFt'li1LL'1 ILUgEI' I i,l-TAl'l!: HLaEI'1ST i:HIIJH LNATER hLilEI'1T 1 : LOIJ FF{lt]U[:T ALAEI'] LINUID SEI,]SOR ALI"]5L 1:FUEL ALf,RIlL I : SEI'ISUF: OUT ALARI']L ::EENS+R UT *LAFI']L 1:PHOET II1LAFI'1L !:FHOET ALAEII F 2:DIESEL STP STAIit)AEt] t,t(iEt.lALLY L-rLt]SE!r I I'1_TAI,IK ALAFI1ST !:H1t'H LNflTER ']LAFII'IT ! : LI]I,i PRI TULTT *LAEI''l LIOUlt, SENEOR ALl"lSL 3:FUEL ALARI'IL ]:gEI.lS R OUT HLARI1 L. 4 : SEI'JE0R llT ttl-Ar{l 1 L ! ISH(]ET ALARI,IL 4:SHORT ALHRI'I R 3:FEI"]i]TE EEAL:IOTI iiTAl'ltAEtr ti1-1EI'lfl LL"/ r :Lf EEtr I I.I-TAI{K fILAFI']g ALL : LtlL,l I'FCtrLLrT AL*Flf'l LIi)UI U SEI,.ISOR ALI'15 ALL:FUEL ALARM ALL : EEI'ISOI? OLIT AL*RI'I ALI-:sHORT ALAEIl 2 . n0[470 4 FTSl4'/83 12023 7400 ??EO 4.0 IN. 4,tl 95h l4iJ4rl 9A|4 l3rl04 alIti 5469 3009!g9 D. D[ I] I PH$N I,1AI,]] FOLTIED TANHFJTC: NOI{E L l r.lE flHl.l l FOLIrED TFTNXETB: NONE LEAIi f'll ll F'ER I otr I c : 0!i:B LEAtr: I'II N ANI.IUAL : B'':0 PERIOT]II-: TEST TYFE 5TA I,IDARTi HNI'IUAL TEST F* I L ALAEI'] II I BAELETI PEEIODIC TES FTiIL ALARI.I DI SAELETI *E+FIT TEET FA I LgLHRf'] I)I SAELET] ANN TEET AVEEfi.i I l,lc : OFF PER TEST AVERAG I I'IG : OFF TAI'lli TEET l!0TIF,: oFF ,TNK TST EIPHNN EREAX:OFF IJEL I VEEY DELAY : 3 I'1I I'IpullF THRE,',IHOLIr : 10.[0h I"lOtrE :IIONTHL\i REroNLrrLrATloN lrlrl _ - AUTI]I.1AT I C] TIF1 I LY CL{.]F I I,IGTII']E: E :Ut:l At'l PER I IDI C RECOI,IC i LI A'I I OI! iTL*PH HIETOEy REPOFT ---- I It-TAfll: *L*Etl -___, T 1 : I-IIILEADEIT H I EH !,ROTUI:TT HLARI"]JUL 19, ?!21 5:31 AI'1DEC 27, 1019 E:23 l,t"lNOU :2, :016 E:0? Atl I NV{TL ] D FUEL LEVELJUL 14, r!!l 10:ilg itt.1ut:T 1!, !r_.120 6:44 Atl*uG 21. E018 E,:18 At'] PROEE OUTJUL ?9, 2021 Il:09 At1JUL 5. zr'119 B:23 FHJUL 5, 2019 B:IB PI"] IIEL i \,?EEI IIEEI/EDAllG 5. ::021 1 1 : 57 HtlJUL 28" zD?l 12:33 llt"lJUL lu, !0?l 6: l4 HI'l ' ixr(r{XENDx*XXj{ :rtxxEllt) li ir i( * iii**Elllrx**trrt TEI'IP COMPENSAT I OI,,I ETFl,lt'HR! EUS ELOT.FUEL_I.1ETEE-TANi( TfrI'']X I.IAP EMI'TY SNFTI']ARE EE\/ IFJ] iT,I LEI/EI" \ /EEFi 1 ]-1t,l 1 !3 . u? Fii-rFT|,IAREl l{E 1 23- 1 UIJ-tl LTFEATED - lt!. I I.tE. 1E. l7 Il{,i Sa-}FTLltlRE I"IOIiULE Ei/:JTEI1 FEATUFES : PER I OT,I L- I I,I_T*NH TESTE ANNUAL I I]-THIIL TESTS *LAEI,1 HIFJI'{]RY REFOFT ----- sYsTEI.l ALARtl -----PAPER OUTJUL 30, !021 l0:31 AI'1 FR I i.iTER ERROEJUL 30, zBl?t 1[:21 At1 EATTERY IE OFFJAN I ^ 19!6 E:0Ll ttPl *LHEI.1 HI BTOEY REPOHT ----- SEIISOE irl.*Rl"l --- -L I :UNLEADES STF =TP SUI,IPgETUF IIAT* hARI,I I IIGJUL 2S. rDrl il:31 FI'l FJETUP DATA LNARI,]I NGJUL ?9, !B:I q:29 Pl'l SET UP DATA L,JAR N I I..IGJUL 2S. 2D21 4:28 PI'I i * } t r EllI X i r * r ALARI'I HISTORV REPOET ---_ I I,,I_TANK ALARII ,__-- T 2:DIEEEL-IlO.! OVEEF I LL ALARI'IJUI'.I ll, 2013 l?;52 F,t4 H I GH PEODUI]T ALARI.IJUN 11, :013 12:50 PI.1 PEOEE OUTJUL 5, !111 8 5 : 0u Al.t T]EL I VEEY NEEDED*uG 4. 2021 ? : 27 AI'lJUL I5, ?021 I:57 AtlJUN E6. 2021 5 : OB AI'1 ALAPI"I HISTNFY EEPORT ---- EEI'EOE ALAFI'I -----L ? : UIILEAITEIJ FNNIJI-AR AI,]I,,]ULAR FJFA'.:E FUEL ALARI,IAUG 9, !0!1 7:93 Ar'l FUEL ALARI.I AUG 9, ?t121 7 : 33 Al"1 SET tIF D*TA t']*RI'1I T,IG JUL ?9, !021 4:11 pPl xxx}xEt.ltlrxxxx *LriFlll H I FiTOE,' RE! 0ET ----- sEI,]S(]R AL*F|1 .-- -L !:TTIEEEL ETI' STF, S UI"1P EETt]F DIITA I,JBEI,1I l.{IJJUL 2-q, 2l,l!l 9:41 *l'l SENET}FI OUT AL*HI,] AFR :tl, ztl:l lo:1: Hl"l FUEL ALARI,I nPE ?0. ?[?l 1r:r:D: Al"l ii;irElllii*+l( ALAEI'] HISTORY REPORT ----- sE[soR ALARfl --"--L 4:DIESEL AI.INIJL*R AI.INULAR EPACEFUEL IILAFT,]flr_lrj 9, ?r:t! 1 ? : 27 HI.1 FUEL ALAEI']JUL X0. zt:t!1 7:32 AI'l FUEL FLAEI"IJUL 38, !021 ?:tl At"l ixFxxEl,llr}xx*ri