The URL can be used to link to this page

Home My WebLink About2023 FMC Appendix 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 5 TYPE OF ACTION ☐ Installation ☐ Repair ☒ 12 Month 1. FACILITY INFORMATION CERS ID 10130596 Certification Date 6/30/2023 Facility Name Wilson Mobil Facility Address 3620 Wilson Rd. City Bakersfield ZIP Code 93309 2. SERVICE TECHNICIAN INFORMATION Company Performing the Certification Advanced Compliance Phone 661-706-4321 Mailing Address 4007 Brae Burn Dr Bakersfield Ca. 93306 Service Technician Performing Test Bruce W. Hinsley Contractor/Tank Tester License Number 971259 ICC Number 8032698 ICC Expiration Date 6/25/2025 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date Veeder-Root 3/19/2024 Redjacket LLD 12/9/2023 VMI 1/18/2024 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 6/30/2023 Total # of Pages 5 5. MONITORING SYSTEM AND PROGRAMMING Underground Storage Tank Monitoring System Certification Form Page 2 of 5 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 Software Version Installed 333.06 Attach the post-certification reports if the monitoring system is capable of generating either; X Monitoring System Set-up X Alarm History Report Yes No NA All monitoring equipment is operational per manufacturer’s specifications? ☐ X Secondary containment systems are free of damage, debris, or liquid? X ☐ Are the audible and visual alarms operational? X ☐ All sensors have been: 1) visually inspected for wiring kinks, breaks and residual buildup on floats; and 2) tested for functionality and confirmed operational? ☐ X ☐ Are all sensors installed to detect a release at the earliest opportunity in the secondary containment? X ☐ ☐ The monitoring system set-up was reviewed, and proper settings confirmed? X ☐ ☐ Was the monitoring control panel’s backup battery visually inspected, functionally tested, and confirmed operational? X ☐ ☐ Does the flow of fuel stop at the dispenser if a release is detected in the under-dispenser containment? X ☐ ☐ Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically disconnected? X ☐ ☐ 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) X Sump X UDC X ☐ ☐ If monitoring system alarms are relayed to a remote monitoring center, is all communication equipment operational? ☐ ☐ X 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 5 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 L-1 794380-208 87 STP Sump X ☐ L-2 794380-208 91 STP Sump X ☐ L-3 794380-208 Diesel STP Sump X ☐ L-4 794380-208 87 Fill Sump X ☐ L-5 794380-208 91 Fill Sump X ☐ L-6 794380-208 Diesel Fill Sump X ☐ L-7 794390-420 87 Tank Annular X ☐ L-8 794390-409 91-Diesel Tank Annular X ☐ UDC 1-2 330212-001 UDC 1-2 X ☐ UDC 3-4 330212-001 UDC 3-4 X ☐ UDC 5-6 330212-001 UDC 5-6 X ☐ UDC 7-8 330212-001 UDC 7-8 ☐ X ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ 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 5 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.) X 3 GPH ☐ 0.1 GPH ☐ 0.2 GPH Yes No NA Has the testing apparatus been properly calibrated? X ☐ ☐ For emergency generator tank systems, does the LLD create an audible and visual alarm when a leak is detected? ☐ ☐ X For mechanical LLDs, does the LLD restrict the flow through the pipe when a release is detected? X ☐ ☐ For electronic LLDs, does the turbine automatically shut off when a release is detected? ☐ ☐ X For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ☐ ☐ X For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a tightness test? ☐ ☐ X For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? ☐ ☐ X Were all items on the equipment manufacturer’s maintenance checklist completed? X ☐ ☐ Were all LLDs confirmed operational within regulatory requirements? X ☐ ☐ LLD ID LLD Model Lines Monitored Pass Fail 1 FX-1V 87 X ☐ 2 FX-1V 91 X ☐ 3 FX-1DV Diesel X ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ 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 5 8. IN-TANK GAUGING TESTING X 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. The Veeder-Root liquid sensor in the #7-8 UDC failed testing. Advanced Compliance 4007 Brae Burn Drive Bakersfield, Ca. 93306 661-706-4321 Fax# 661-589-9329 VAPORLESS MANUFACTURING, INC. LDT-890 Leak Detector Test Record Contractor: Advanced Compliance Customer: Wilson Mobil Date: 6/30/2023 Location: 3620 Wilson Rd. Bakersfield, Ca. 93309 Product: 87 Technician: Bruce W. Hinsley Submersible Pump Identification Manufacturer: Redjacket Model No.: Serial No.: Notes: Leak Detector Identification Manufacturer: Veeder-Root Description: FX-1V Diaphragm-type: Piston-type: Tamper-proof seal installed: Other Style Leak Detector: Notes: Leak Detector in Submersible Pump Test at Dispenser Operating Pump Pressure (psi): 27 (para. 15) Gallons per hour rate: 3.0 (para. 22) Line pressure with pump shut off (psi): 20 (para. 23) Bleed-back Test with pump off (ml): 1,500 (para. 26) Step-through time to full flow (secs): 3 (para. 30) Leak detector stays in leak search position (Yes/No): Yes (para. 42) Leak Detector Test Pass / Fail Notes: Pass *Complete thermal expansion test before failing leak detector Advanced Compliance 4007 Brae Burn Drive Bakersfield, Ca. 93306 661-706-4321 Fax# 661-589-9329 VAPORLESS MANUFACTURING, INC. LDT-890 Leak Detector Test Record Contractor: Advanced Compliance Customer: Wilson Mobil Date: 6/30/2023 Location: 3620 Wilson Rd. Bakersfield, Ca. 93309 Product: 91 Technician: Bruce W. Hinsley Submersible Pump Identification Manufacturer: Redjacket Model No.: Serial No.: Notes: Leak Detector Identification Manufacturer: Veeder-Root Description: FX-1V Diaphragm-type: Piston-type: Tamper-proof seal installed: Other Style Leak Detector: Notes: Leak Detector in Submersible Pump Test at Dispenser Operating Pump Pressure (psi): 26 (para. 15) Gallons per hour rate: 3.0 (para. 22) Line pressure with pump shut off (psi): 21 (para. 23) Bleed-back Test with pump off (ml): 1,800 (para. 26) Step-through time to full flow (secs): 3 (para. 30) Leak detector stays in leak search position (Yes/No): Yes (para. 42) Leak Detector Test Pass / Fail Notes: Pass *Complete thermal expansion test before failing leak detector Advanced Compliance 4007 Brae Burn Drive Bakersfield, Ca. 93306 661-706-4321 Fax# 661-589-9329 VAPORLESS MANUFACTURING, INC. LDT-890 Leak Detector Test Record Contractor: Advanced Compliance Customer: Wilson Mobil Date: 6/30/2023 Location: 3620 Wilson Rd. Bakersfield, Ca. 93309 Product: Diesel Technician: Bruce W. Hinsley Submersible Pump Identification Manufacturer: Redjacket Model No.: Serial No.: Notes: Leak Detector Identification Manufacturer: Veeder-Root Description: FX-1DV Diaphragm-type: Piston-type: Tamper-proof seal installed: Other Style Leak Detector: Notes: Leak Detector in Submersible Pump Test at Dispenser Operating Pump Pressure (psi): 29 (para. 15) Gallons per hour rate: 3.0 (para. 22) Line pressure with pump shut off (psi): 21 (para. 23) Bleed-back Test with pump off (ml): 150 (para. 26) Step-through time to full flow (secs): 3 (para. 30) Leak detector stays in leak search position (Yes/No): Yes (para. 42) Leak Detector Test Pass / Fail Notes: Pass *Complete thermal expansion test before failing leak detector Ver. 1.5 – 08.20.14 Shear Valve Operation Test CERS ID: 10130596 Test Company: Advanced Compliance Site Name: Wilson Mobil Technician: Bruce W. Hinsley Site Address: 3620 Wilson Rd. Certification Number Expiration Date City: Bakersfield Zip: 93309 ICC (SERVICE TECH): 8032698 6/25/2025 Date/Time of Test: 6/30/2023 09:00 Product Grade Dispenser Number 1.Shear Valve Type (Product or Vapor) 2. Is the shear valve properly anchored? 3. Is the shear valve within ½ in of dispenser island? 4. Is the lever arm free moving? 5. Does the lever arm close poppet valve? 6. Can you Dispense with shear valve in closed position? Pass / Fail 87 1-2 P Y Y Y Y No Pass 91 1-2 P Y Y Y Y No Pass 87 3-3 P Y Y Y Y No Pass 91 3-4 P Y Y Y Y No Pass 87 5-6 P Y Y Y Y No Pass 91 5-6 P Y Y Y Y No Pass 87 7-8 P Y Y Y Y No Pass 91 7-8 P Y Y Y Y No Pass Diesel 7-8 P Y Y Y Y No Pass . Signature of Technician: ___________________________ Date: 6/30/2023 CERS = California Environmental Reporting System, ID = Identification, UST = Underground storage tank, ICC = International Code Council UNDERGROUND STORAGE TANK SPILL CONTAINER TESTING REPORT FORM (Page 1 of 1) Type of Action Installation Test Repair Test 12 Month Test I. FACILITY INFORMATION CERS ID 10130596 Date of Spill Container Test 6/30/2023 Business Name (Same as Facility Name or DBA-Doing Business As.) Wilson Mobil Business Site Address 3620 Wilson Rd. City Bakersfield ZIP Code 93309 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification.) Bruce W. Hinsley Phone # (661) 706 - 4321 Ext. Contractor/Tank Tester License # 971259 ICC Certification # 8032698 ICC Certification Expiration Date 6/25/2025 Spill Container Testing Training and Certifications (List applicable certifications.) III. SPILL CONTAINER TESTING INFORMATION Test Method Used: Manufacturer Guidelines: (Specify) Industry Code or Engineering Standard: (Specify) Industry Standard Engineered Method: (Specify) Attach the testing procedures and all documentation required to determine the results. # of Attached Pages Tank ID: (By tank number, stored product, etc.) 87 91 Diesel Spill Container Manufacturer: Phil-Tite Phil-Tite Phil-Tite Method of Cathodic Protection Non-Metallic Non-Metallic Non-Metallic Non-Metallic Isolation Isolation Isolation Isolation Other (Specify in section V.) Other (Specify in section V.) Other (Specify in section V.) Other (Specify in section V.) Inside Diameter of Spill Container: (Inches) 15" 15" 15" Depth of Spill Container: (Inches) 20" 20" 20" Does the spill container have a 5 gallon capacity? Yes No Yes No Yes No Yes No Method to Keep Spill Container Empty Drain Valve Drain Valve Drain Valve Drain Valve Onsite Pump Onsite Pump Onsite Pump Onsite Pump Other (Specify in section V.) Other (Specify in section V.) Other (Specify in section V.) Other (Specify in section V.) IV. SUMMARY OF TESTING RESULTS Spill Container Test Results Pass Fail Pass Fail Pass Fail Pass Fail V. COMMENTS All items marked “Fail” above must be explained in this section. Any additional comments may also be provided here. The drain valve in the 87 fill bucket is leaking into the tank. VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the spill containers were tested in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637.1 and all the information contained herein is accurate. UST Service Technician Signature If the facility has more components than this form accommodates, additional copies of this page may be attached.