HomeMy WebLinkAboutFMC 2022 REPAIRAppendix 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
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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
10172773 06/06/2022
BIll Wright Toyota
5100 Gasoline Alley Drive Bakersfield 93313
Nwestco LLC (800) 339-9930
2209 Zeus Court, Bakersfield, CA 93308
Matt Story
1073967
9118985 02/27/2023
FFS 1015653711 04/13/2023
06/06/2022 2
Underground Storage Tank
Monitoring System Certification Form
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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
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9. COMMENTS
Describe all answers marked “No” or “Fail” and proposed remedy.
List all monitoring equipment either replaced or repaired.
܆܆
Tank 1 Incon 87 tank
Performed post repair inspection of INCON ATG probe for T1 87 grade tank, removed probe and ensured probe accuracy,
also ensured probe entered a high product alarm, post repair inspection witnessed by Inspector Peter Armagost and
violation was signed off as corrected, INCON TS 1001 alarms cleared when probe was returned to tank and site is fully
functioning. MS 6/6/2022 Truck #1908