HomeMy WebLinkAboutFMC 2022 COLD START (OLD TANKS)Appendix Vl
Underground Storage Tank
Monitoring System Certification Form
TYPE oF ACTION E lnstallation ffi Repair ffi te Month
CERS = California Environmental Reporting System, GPH = Gallons Per Hour, lD = ldentification,
ICC = lnternational Code Council, LLD = Line Leak Detector, NA = Not Applicable, $W = Single-
Walled, UDC = Under-Dispenser Containment, UST = Underground Storage Tank,
VPH = Vacuum/PressurelHydrostatic
Page 1 of6
1. FACILITY INFORMATION
CERS ID Certification Date
lan2t22
Facility Name
7-11
Facility Address
9600 BRIMHALL RD
City
BAKERSFIELD
ZIP Code
93312
2. SERVICE TECHNICIAN INFORMATION
Company Performing the Certifi cation
BSSR INC
Phone
661-588-2777
Mailing Address
6630 RO$EDALE HWY. BAKER$FIELD,CA. 93308
Service Technician Performing Test
NATHAN HOLMAN
Contractorffank Tester License Number
872812
ICC Number
8111067
ICC Expiration Date
8t2A24
3. TRAINING AND CERTIFICATIONS
Manufacturer and Test Equipment Training Certifications Expiratian Date
VEEDER ROOT LEVEL 4 4t25t23
4, CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST
t hereby ceftify thatthe monitaring sysfem is opentional 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
$n2i22
Total# of Pages
U nderground Storage Tan k
Monitoring System Certification Form
Descnbe all answers marked "Na" or.Fail' and proposed remedy ln Secfion 9.
List all monitoring equipment either replaced or repaired in $ection 9
5. MONITORING SYSTEM AI
A separate Monitoring System Certification Form must be prepared for each control panel.
Make of Monitoring System
Control Panel
VEEDER ROOT
Model of Monitoring System
Control Panel
TLS 350 PLUS
Software Version lnstalled
336.02
Attach the post-certifrcation reports if the monitoring system is capable of generating
either; ffi Monitoring System Selup ffi Alarm History Report ..NA
All monitoring equipment is operational per manufacturer's specifications?m ffi
Secondary containment systems are free of damage, debris, or liquid?m ffi
Are the audible and visual alarms operational?m m
All sensors have been: 1) visually inspected for wiring kinks, breaks and residual
buildup on floats; and 2) tested for functionality and confirmed operational?m m ffi
Are all sensors installed to detect a release at the earliest opportunity in the
secondary containmenf?m m ffi
The monitoring system set-up was reviewed, and proper settings confirmed?m m m
Was the monitoring control panel's backup battery visually inspected, functionally
tested, and confirmed operational?m m m
Does the flow of fuel stop at the dispenser if a release is detected in the under-
d ispenser containmenf?m m ffi
Does the turbine automatically shut down if the piping secondary containment
monitoring system fails to operate or is electrically disconnected?m m n
Does the turbine automatically shut down if the piping secondary containment
monitoring system detects a release? Which sensors initiate positive shut down?
(Check allthat apply) ffi Sump ffi UOC
m ffi m
lf monitoring system alarms are relayed to a remote monitoring center, is all
communication equipment operational?m ffi ffi
Page 2 of 6
No
Underground Storage Tank
Monitoring System Certification Form
List only sensors fesfed on date of this certification. t,'sf "Sensor lD" as labeled in system
programming. Additionalcopr'es of this page may be attached to accommadate a// sensors fesfed.
Sensor /D Sensor Model Component(s) Monitored Pass Fail
L1 352 RUL STP m ffi
L2 420 RUL ANNULAR m m
L3 352 PUL STP m ffi
L4 420 PUL ANNULAR m m
L7 352 1-2 m m
L8 352 34 m m
L9 352 5-6 Ell m
LI0 352 7-8 ffi ffi
Ll1 352 9-10 m m
L12 352 11-12 m ffi
L13 352 RUL FILL m m
L14 352 PUL FILL m m
ffi m
m ffi
m m
m m
m m
ffi m
m m
n m
m mtm
ffi m
ffi ffi
Describe all answers marked "No" or "Fail" and proposed remedy in Section 9.
List all monitoring equipment either replaced or repaired in Section I
Page 3 of 6
Underground Storage Tank
Monitoring System Ceftification Form
Describe all answers marked nNa" ar.Fail' and proposed remedy in Section 9.
List all monitoing equipment either replaced or repaired in Secfion 9
ffi Check this box if line leak detectors ARE NOT installed. fDo not complete this secfion.)
Simulated release rate verified: (Check allthat apply.)
ffi e cpn m 0.1 GPH ffi o.a opH
Has the testing apparatus been properly calibrated?m m m
For emergency generator tank systems, does the LLD create an audible and visual
alarm when a leak is detected?m m m
For mechanical LLDs, does the LLD restrict the flow through the pipe when a
release is detected?il m m
For electronic LLDs, does the turbine automatically shut off when a release is
detected?m m m
For electronic LLDs, does the turbine automatically shut off if any portion of the
monitorinq svstem is disabled or disconnected?m m m
For electronic LLDs, does the turbine automatically shut off if any portion of the
monitorinq svstem malfunctions or fails a tightness test?m ffi m
For electronic LLDs, have all accessible wiring connections been visually inspected
for kinks and breaks?m m m
Were all items on the equipment manufacturer's maintenance checklist completed?m m m
Were all LLDs confirmed operationalwithin regulatory requirements?m m ffi
LLD ID I LLD ModeI lines Monitored Pass Fail
m m
m ffi
m ffi
m ffi
m m
m m
m m
m m
m E]
m m
m ffi
m m
Page 4 of 6
7. LINE LEAK DETECTOR TESTING
Yes No NA
U nderground Storage Tank
Monitoring System Certifi cation Form
a
ffi Cneck this box if tank gauging is used only for inventory control.
ffi Cnecf this box if NO tank gauging equipment is installed.
(Da not complete this section if either box rs checked.)
,Yes,
All wiring has been: 1) visually inspected for kinks, breaks and proper entry and
termination: and 2) tested for qround faults?ffi m m
Were all in{ank gauging probes visually inspected for damage and residue buildup
to ensure that floats move freely, functionally tested, and confirmed operational?m ffi m
Was accuracy of system's product level readings tested?ffi ffi m
Was accuracv of system's water level readings tested?r m m
Were all probes reinstalled properly?r ffi m
Were all items on the equipment manufacturer's maintenance checklist completed?r ffi m
Prabe lD Probe Model Tanks Monitored Pass Faililm
m m
m m
m ffi
m m
m m
q
Descnbe all answers marked uNoo ar "Fail" and proposed remedy.
List all monitoring equipment either replaced ar repaired.
FMC AFTER COLD START
Page 5 of 6
No NA
TLtlgo
OCT 12, 2O22 tg:48 Arlt
1.'847L9 7-LL 32776
9600 BRIMHALL
BAKERSFIELD CA 9?3L2
80687875sO5Agt
PRIORIry ALARM HISTORYID CATEGORY DESCRIPTION
L 4 ANNULAR PUL ANNULAR
L 4 ANNULAR PUL ANNULAR
L 2 ANNULAR RUL ANNULAR
L 2 ANNULAR RUL ANNULAR
114 PIPE PUL FILL SUMP
114 PIPE PUL FILL SUMP
113 PIPE RUL FILL SUIVIP
113 PIPE RUL FILL SUMP
11.1 DISP PAN DISP 9-14
111 DISP PAN DISP 9-10
T 2 TANK RUL
T 2 TANK RUL
T 2 TANK RUL
T 2 TANK RUL
T 2 TANK RUL
T 2 TANK RUL
T 2 TANK RUL
T 2 TANK RUL
T 2 TANK RUL
T 2 TANK RUL
SYSTEM
T 3 TANK PUL
SYSTEM
TILZW
OCT 12, 2O22 7A:.49 tt{
L84779 7-LL 32376
960A BRIMHALL
BAKERSFIELD CA 933L2
8068787554500t
HON-PRIORITYID CATEGORY
L 1 'STP SUMP
L 1 STP SUMPt 3 STP 5UI4P
ALARM HISTORY
DESCRIPTION
RUL STP SUMP
RUL STP SUMP
PUL STP SUMP
ALARM TYPE
FUEL ALARM
FUEL ALARI'4
FUEL ALARM
FUEL ALARM
FUEL ALARM
FUEL ALARM
FUEL ALARM
FUEL ALARIY1
FUEL ALARM
FUEL ALARM
LOW PRODUCT ALARM
LOW PRODUCT ALARM
LOW PRODUCT ALARM
LOId PRODUCT ALARM
LOhI PRODUCT ALARM
LOW PRODUCT ALARH
LOhI PRODUCT ALARI4
LOH PRODUCT ALARM
L0til PR0DUCT ALARM
LOId PRODUCT ALARIJI
BATTERY IS OFF
LOW PRODUCT ALARM
BATTERY I5 OFF
STATE DATE
CLEAR LCI-L7-22
ALARl,l LO-L2-22
CLEAR 7O-L2-22
ALARM LO.T2.22
cLEAR tO-L2-22
ALARM tO-!2-22
cLEAR t0-72-22
ALARPI TO.LZ-zz
cLEAR 7A-12-22
ALARII'I 1CI.L2-22
cLEAR LO-04-22
ALARM L0.04.22
CLEAR 9.OL-22
ALARM 8-3T.22
CLEAR 8-27-22
ALARM 8.27-22
CLEAR 8-20-22
ALARM 8.20.22
CLEAR 8-95-22
ALARM 8=66.22
CLEAR 2-T3-2L
ALARM 2-13-23.
ALARM 2-L3.2I
TIHE
16:39AM
t0:39AM
10:38AM
10:38Alvl
10:35AM
LO:34Af{.
1O:34Ail1
10:34AM
1O: 31AM
10131Af"1
8:02PM
7:09PM
3:54AM
8:50PM
10:03Atl
9:04AM
4:33PM
2:49PM
9: t3PM
7 z!2Pt4
8r08AM
8:05AM
8:60A1'1
ALARM TYPE
LIQUID WARNING
LIQUID h'ARNING
LIQUID WARNING
STATE DATE TIME
CLEAR LA-L2-22 10:36Alvl
ALARM tO-L2-22 10:35AM
CLEAR tO-tZ-Lz 10l35Aq
L 3 STP SUI,IP
112 DISP PAN
112 DISP PAN
L1O DISP PAN
L1O DISP PAN
L 9 DISP PAN
L 9 DISP PAN
L 8 DISP PAN
L 8 DISP PAN
L 7 DISP PAN
L 7 DISP PAN
T 2 TANK
T 2 TANK
SYSTEIvI
SYSTEM
SYSTEM
SYSTEM
OTHER
OTHER
T 2 TANK
T 2 TANK
T 2 TANK
T 2 TANK
OTHER
OTHER
T 2 TANK
T 2 TANK
T 2 TANK
T 2 TANK
OTHER
OTHER
T 2 TANK
T 2 TANK
T 2 TANK
SYSTEM
SYSTEM
SYSTEM
SYSTEM
T 2 TANK
T 2 TANK
T 2 TANK
T 3 TANK
T 3 TANK
PUL STP SUMP
DrsP 11-12
DISP 11.12
DISP 7.8
DISP 7.8
DISP 5-6
DISP 5-5
DISP 3-4
DISP 3.4
DISP 1.2
DISP 1-2
RUL
RUL
RUL
RUL
RUL
RUL
RUL
RUL
RUL
RUL
RUL
RUL
RUL
RUL
RUL
RUL
PUL
PUL
LIQUID WARNING
LIQUID T,',ARNING
LIQUID !'IARNING
LIQUID WARNING
LIQUID I.JARNING
LIQUID hJARNING
LIQUID WARNING
LIQUID WARNING
LIQUID }'IARNING
LIQUID hJARNING
LIQUID WARNING
DELIVERY NEEDED
DELIVERY NEEDED
PRINTER ERROR
PAPER OUT
PRINTER ERROR
PAPER OUT
ISD VAPOR LEAK WARN
IsD VAPOR LEAK h'ARN
DELIVERY NEEDED
DELIVERY NEEDED
DELIVERY NEEDED
DELIVERY NEEDED
ISD VAPOR LEAK I,IARN
ISD VAPOR LEAK WARN
DELIVERY NEEDED
DELIVERY NEEDED
DELIVERY NEEDED
DELIVERY NEEDED
ISD VAPOR LEAK WARN
IsD VAPOR LEAK WARN
DELIVERY NEEDED
DELIVSRY NEEDED
DELIVERY NEEDED
PRINTER ERROR
PAPER OUT
PRINTER ERROR
PAPER OUT
DELIVERY NEEDED
DELIVERY NEEDED
DELIVERY NEEDED
INVALID FUEL LEVEL
DELIVERY NEEDED
ALARM LA-T2.22
CLEAR LA.L2.22
ALART4 t6-L2-22
cLEAR tO-L2-22
ALARM 1A-1,2-22
cLEAR tA-t2-22
ALARM LA.L2-22
CLEAR LA.L2-22
ALARM 10.L2.22
cLEAR tA-L2-27
ALARM tg-12-22
cLEAR LO-04-22
ALARM tA*A4-22
CLEAR t0-A4-22
cLEAR Lg-A4-22
ALARM tA-04-22
ALARM tA-44-22
CLEAR 9-30-22
ALARM 9.27.22
CLEAR 9-OL-22
ALARM 8-3T.22
CLEAR 8-34-22
ALARM 8-29-22
CLEAR 8-29-22
ALARlvl 8-28-22
CLEAR 8-27-22
ALARM 8.26-22
CLEAR 8-20-22
ALARm 8-20-22
CLEAR 8-16-27
ALARM 8116-22
CLEAR 8.T3-22
ALARM 8.73.22
CLEAR 8-A9-27
CLEAR 8.Q9.22
CLEAR 8-A9-22
ALARM 8-99-22
ALARM 8-49-22
ALARM 8.O9.22
CLEAR 8.06.22
ALARM 8.06-22
ALAR},I 2.L3-2L
ALARM Z.T3.2L
10:35Alvl
t0:33At4
10:33Altl
10:31Alu1
10:30AM
16:30AM
10:39AM
10:29A1'1
10:29AM
10:28Avl
L9:25All
8:03PM
4:53PM
L1.:23AM
11:23Avl
11:2tAM
11:21AIvl
12:23PM
6:04AM
3:55A1"1
5:07PM
4:55AM
8:43PM
6:Q4l*4
6:03AM
t0:CISAl,l
8:20PM
4:35PM
11:40AM
12:36PM
6:03AM
2:32P14
!2:37PN
9:24AM
9:18AM
9:18AM
9: 18AM
9:18Avl
6:10AM
9:15PM
3:22Pt4
8:O5Alvl
8:05AM
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