The URL can be used to link to this page

Home My WebLink AboutFMC 2024 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 6 TYPE OF ACTION ☐ Installation ☐ Repair ☒ 12 Month 1. FACILITY INFORMATION CERS ID 10022950 Certification Date 8/30/2024 Facility Name Ming ARCO AM/PM Facility Address 4203 Ming Ave. 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 6/26/2025 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date Veeder-Root 4/21/2026 Redjacket LLD 1/4/2026 VMI 1/4/2026 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 8/30/2024 Total # of Pages 5. MONITORING SYSTEM AND PROGRAMMING 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 336.01 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 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 794390-409 87 T1 Tank Annular X ☐ L-2 794380-208 87 T1 STP Sump X ☐ L-3 794380-208 87 T1 Fill Sump X ☐ L-4 794390-409 87 T2 Tank Annular X ☐ L-5 794380-208 87 T2 STP Sump X ☐ L-6 794380-208 87 T2 Fill Sump X ☐ L-7 794390-409 87 T3 Tank Annular X ☐ L-8 794380-208 87 T3 STP Sump X ☐ L-9 794380-208 87 T3 Fill Sump X ☐ L-10 794390-409 91 Tank Annular X ☐ L-11 794380-208 91 Fill Sump X ☐ L-12 794380-208 91 STP Sump X ☐ L-13 794380-208 UDC 1-2 X ☐ L-14 794380-208 UDC 3-4 X ☐ L-15 794380-208 UDC 5-6 X ☐ L-16 794380-208 UDC 7-8 X ☐ L-17 794380-208 UDC 9-10 X ☐ L-18 794380-208 UDC 11-12 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 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 87 PLLD 87 X ☐ 91 PLLD 91 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 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. Tank #2 & #3 spill containers fail testing due to leaking drain valves. Ver. 1.5 – 08.20.14 Shear Valve Operation Test CERS ID: 10022950 Test Company: Advanced Compliance Site Name: Ming ARCO AM/PM Technician: Bruce W. Hinsley Site Address: 4203 Ming Ave. Certification Number Expiration Date City: Bakersfield Zip: 93309 ICC (SERVICE TECH): 8032698 6/25/2025 Date/Time of Test: 8/2/30024 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 87 9-10 P Y Y Y Y No Pass 91 9-10 P Y Y Y Y No Pass 87 11-12 P Y Y Y Y No Pass 91 11-12 P Y Y Y Y No Pass . Signature of Technician: ___________________________ Date: 8/30/2024 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: ARCO AMPM Date: 8/30/2024 Location: 4302 Ming Ave. Bakersfield, Ca. Product: 87 UL Technician: Bruce W. Hinsley Submersible Pump Identification Manufacturer: Redjacket Model No.: Serial No.: Notes: Leak Detector Identification Manufacturer: Veeder-Root Description: PLLD Diaphragm-type: Piston-type: Tamper-proof seal installed: Other Style Leak Detector: Electronic 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): 100 (para. 26) Step-through time to full flow (secs): N/A (para. 30) Leak detector stays in leak search position (Yes/No): N/A (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: ARCO AMPM Date: 8/30/2024 Location: 4302 Ming Ave. Bakersfield, Ca. Product: 91 UL Technician: Bruce W. Hinsley Submersible Pump Identification Manufacturer: Redjacket Model No.: Serial No.: Notes: Leak Detector Identification Manufacturer: Veeder-Root Description: PLLD Diaphragm-type: Piston-type: Tamper-proof seal installed: Other Style Leak Detector: Electronic Notes: Leak Detector in Submersible Pump Test at Dispenser Operating Pump Pressure (psi): 28 (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): 95 (para. 26) Step-through time to full flow (secs): N/A (para. 30) Leak detector stays in leak search position (Yes/No): N/A (para. 42) Leak Detector Test Pass / Fail Notes: Pass *Complete thermal expansion test before failing leak detector 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 10022950 Date of Spill Container Test 8/30/2024 Business Name (Same as Facility Name or DBA-Doing Business As.) Ming ARCO AM/PM Business Site Address 4203 Ming Ave. 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.) T1 87 T2 87 T3 87 T4 91 Spill Container Manufacturer: OPW OPW OPW OPW 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" 15" Depth of Spill Container: (Inches) 20" 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. Tank #2 & #3 spill containers fail testing due to leaking drain valves. 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.