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HomeMy WebLinkAboutFMC 2022IMPACT VALVE LEAK DETECTOR LINE TEST MONITOR CERTIFICATION SPILL BUCKET TEST 11000 N. MoPac Expressway, Suite 500 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 Date Printed and Mailed: 10/7/2022 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR KRIS KARNS 1501 TRUXTUN AVE. BAKERSFIELD, CA 93301 Test Date: 10/4/2022 Order Number: 3457893 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 Product Line Tightness Test Page 1 of 1 Work Order: 3457893 Date: 10/4/2022 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 (psi) Test Start Time Test End Time Final Leak Rate (gph) 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 1 UNLEADED Pressure 50 11:32 12:02 0.00 Pass Yes Tank # 2 Line # 1 TLD-1 2 UNLEADED Pressure 50 11:32 12:02 0.00 Pass Yes Tank # 3 Line # 1 TLD-1 3 PREMIUM Pressure 50 11:32 12:02 0.00 Pass Yes Tank # 4 Line # 1 TLD-1 4 DIESEL2 Pressure 50 11:32 12:02 0.00 Pass Yes Tank # Line # Tank # Line # Technician Comments: Technician Name:Patrick Pfrang Certification #:95-1590 exp: 6/30/2023 Technician Signature: Environmental Compliance for Petroleum Systems ©2022 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com LDT 5000 Field Test Apparatus Line Leak Detector Test Page 1 of 1 Work Order:3457893 Date:10/4/2022 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 1 REG UNLEADED 1 7 Existing Mechanical Red Jacket FX1V 307098751 37.00 189.0 3.00 18.00 180.00 12 3 Pass 2 REG UNLEADED 1 16 Existing Mechanical Red Jacket FX1V 307098752 37.00 189.0 3.00 18.00 180.00 11 3 Pass 3 PREMIUM PREMIUM 1 7 Existing Mechanical Red Jacket FX1V 104192098 38.00 189.0 3.00 19.00 200.00 11 3 Pass 4 DIESEL DIESEL2 1 7 Existing Mechanical Red Jacket FX1DV 111136174 29.00 189.0 3.00 18.00 120.00 9 8 Pass Technician Comments: Technician Name:Patrick Pfrang Certification #:44637 Technician Signature:Expire Date:3/9/2025 Environmental Compliance for Petroleum Systems © 2022 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com Impact Valve Inspection Impact Valve Operational Inspection Work Order:3457893 Date:10/4/2022 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: Technician Name:Patrick Pfrang Signature: Environmental Compliance for Petroleum Systems ©2022 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com Tanknology, Inc.800-964-1250 11000 N Mopac Expy #500 Austin, Tx 78759 Patrick Pfrang 10027021 10/04/2022 SAM'S CLUB # 4819 5625 GOSFORD ROAD BAKERSFIELD 93313 Class A General Engineering 743160 8202676 02/03/2023 08/27/2023 12/06/2023 10/04/2022 6 Veeder Root:ATG Technician (A29052) Veeder Root:Red Jacket Mechanical Line Leak Detector (A25092) Veeder Root TLS-350 336.02 L1 UNLD T1 INT SPACE L2 L3 UNLD T1 STP SUMP 794380-304 L4 L5 L6 L7 PREM DIES T3 T4 INT L8 L9 PREM T3 STP SUMP 794380-304 L10 L11 L12 UDC FP 3-4 794380-304 L13 UDC FP 5-6 794380-304 L14 UDC FP 7-8 794380-304 L15 UDC FP 11-12 794380-304 L16 UDC FP 13-14 794380-304 L17 UDC FP 15-16 794380-304 L18 VENT BOX 794380-304 L19 L20 UDC FP 9-10 794380-304 s1 87 N PRODUCT s2 87 N VENT HIRT LINE s3 87 S PRODUCT 87 S VENTs4 794380-303 UNLD T1 FILL SUMP 794380-304 UNLD T2 INT SPACE UNLD T2 FILL SUMP 794380-304 UNLD T2 STP SUMP 794380-304 PREM T3 FILL SUMP 794380-304 DIES T4 FILL SUMP 794380-304 DIES T4 STP SUMP 794380-304 UDC FP 1-2 794380-304 794380-208 794380-208 794380-303 794380-208 794380-208 794380-303 794380-208 794380-208 794380-208 794380-208 794380-208 794380-208 794380-208 794380-208 794380-208 794380-208 794380-208 794380-208 794380-208 330020-480 330020-480 330020-485 330020-485 s5 VAPOR RETURN s6 s7 91 PRODUCT NORTH s8 s9 s10 s11 DIESEL VENT 330020-485 91 PRODUCT SOUTH 91 VENT 91 LINE TO VENT BOX DIESEL PRODUCT 330020-486 330020-486 330020-486 330020-486 330020-480 330020-480 T1 T1 UNLEADED T2 T3 PREMIUM T4 DIESEL Red Jacket FX1V T2 UNLEADEDRed Jacket FX1V Red Jacket FX1V Red Jacket FX1DV All tank and dispenser sumps have Veeder Root 2 to 1 sensor input box for sensors. Each sump has a VR 208 and VR 304 sensor including the vent sump. 10/04/2022 10027021 10/04/2022 SAM'S CLUB # 4819 5625 GOSFORD ROAD BAKERSFIELD 93313 Tanknology, Inc.800-964-1250 11000 N Mopac Expy #500 Austin, TX 78759 Patrick Pfrang 743160 8202676 02/03/2023 04/02/2023 PEI RP1200 FILL BUCKETS 10/04/2022 2 OPW:EVR Phase 1 T1 UNL FILL T2 UNL FILL T3 PRE FILL T4 DSL FILL OPW OPW OPW OPW SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: SAM'S CLUB # 4819 Date of Testing: 10/4/2022 Facility Address: 5625 GOSFORD ROAD , BAKERSFIELD, CA 93313 Facility Contact: Asset Protection Manager Phone: 661-654-8565 Date Local Agency Was Notified of Testing: 9/1/2022 Name of Local Agency Inspector (if present during testing): Peter Armagost 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY INC. Technician Conducting Test: Patrick Pfrang Credentials1: CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Specify) License Number(s): 743160 3. SPILL BUCKET TESTING INFORMATION Test Method Used By: Hydrostatic Vacuum Other Test Equipment Used: LAKE TEST Equipment Resolution: 0.0625 in. Identify Spill Bucket (By Tank Number, Stored Product, etc.) Bucket Installation Type: Bucket Diameter: Bucket Depth: Wait time between applying vacuum/water and start of test Test Start Time (TI): Initial Reading (RI): Test End Time(TF): Final Reading (RF): Test Duration(TF–TI): Change in Reading (RF–RI) : Pass/Fail Threshold or Criteria: Test Result: Spill Box # Tank 1 UNLEADED - Fill 1 - Direct - Grade level in containment sump Direct Bury Contained in Sump 12.00 14.00 15 min 08:39:00 12.50 in. 09:39:00 12.50 in. 1 hr 0.00 in. +/- 0.00 Pass Spill Box # Tank 2 UNLEADED - Fill 1 - Direct - Grade level in containment sump Direct Bury Contained in Sump 12.00 14.00 15 min 08:39:00 12.50 in. 09:39:00 12.50 in. 1 hr 0.00 in. +/- 0.00 Pass Spill Box # Tank 3 PREMIUM - Fill 1 - Direct - Grade level in containment sump Direct Bury Contained in Sump 12.00 14.00 15 min 08:39:00 12.50 in. 09:39:00 12.50 in. 1 hr 0.00 in. +/- 0.00 Pass Spill Box # Tank 4 DIESEL2 - Fill 1 - Direct - Grade level in containment sump Direct Bury Contained in Sump 12.00 14.00 15 min 08:39:00 12.50 in. 09:39:00 12.50 in. 1 hr 0.00 in. +/- 0.00 Pass Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature:Date:10/4/2022 1State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. WO: 3457893 Site Diagram (This site diagram is for reference only and is not drawn to scale) Work Order:3457893 Site ID / Name:SC4819 / SAM'S CLUB # 4819 Address:5625 GOSFORD ROAD City:BAKERSFIELD State:CA Zip:93313 W.O.# SC1-3457893 ATG tapes W.O.# SC1-3457893 W.O.# SC1-3457893 W.O.# SC1-3457893 Test Duration Test Pressure P/F Threshold Tank Annular - Vacuum 1 hr, 20k or less tank 10" hg 0 loss, int dry before and after test Tank Annular - Vacuum 2 hr, >20k tank 10" hg 0 loss, int dry before and after test Line Annular - Pressure 1 hr 5 psi 0 loss STP Sump - Hydro 1 hr 4" above highest penetration or sidewall seam less than 1/8" over hour, settle time of 15 minutes minimum prior to starting the test UDC Sump - Hydro 1 hr 4" above highest penetration or sidewall seam less than 1/8" over hour, settle time of 15 minutes minimum prior to starting the test Spill Bucket - SW Vac 1 min 30" wc no greater than 4" wc vaccum decay - bucket must be dry Spill Bucket - SW Hydro 1 hr within 1.5" of top of the bucket less than 1/8" over hour, settle time of 5 minutest minimum prior to starting the test Spill Bucket - DW Vac 1 min 15" wc no greater than 3" wc vaccum decay - int must be dry