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Home My WebLink AboutFMC 2024CERS = 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 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 Page 2 of 6 5. MONITORING SYSTEM AND PROGRAMMING A separate Monitoring System Certification Form must be prepared for each control panel. Make of Monitoring System Control Panel Model of Monitoring System Control Panel Software Version Installed Attach the post-certification reports if the monitoring system is capable of generating either;Monitoring System Set-up Alarm History Report Yes No NA All monitoring equipment is operational per manufacturer’s specifications? Secondary containment systems are free of damage, debris, or liquid? Are the audible and visual alarms operational? All sensors have been: 1) visually inspected for wiring kinks, breaks and residual buildup on floats; and 2) tested for functionality and confirmed operational? Are all sensors installed to detect a release at the earliest opportunity in the secondary containment? The monitoring system set-up was reviewed, and proper settings confirmed? Was the monitoring control panel’s backup battery visually inspected, functionally tested, and confirmed operational? Does the flow of fuel stop at the dispenser if a release is detected in the under- dispenser containment? Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically disconnected? 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)Sump UDC If monitoring system alarms are relayed to a remote monitoring center, is all communication equipment operational? Describe all answers marked “No” or “Fail” and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 3 of 6 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 Describe all answers marked “No” or “Fail” and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 4 of 6 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.) 3 GPH 0.1 GPH 0.2 GPH Yes No NA Has the testing apparatus been properly calibrated? For emergency generator tank systems, does the LLD create an audible and visual alarm when a leak is detected? For mechanical LLDs, does the LLD restrict the flow through the pipe when a release is detected? For electronic LLDs, does the turbine automatically shut off when a release is detected? For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a tightness test? For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? Were all items on the equipment manufacturer’s maintenance checklist completed? Were all LLDs confirmed operational within regulatory requirements? LLD ID LLD Model Lines Monitored Pass Fail Describe all answers marked “No” or “Fail” and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 5 of 6 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 9. COMMENTS Describe all answers marked “No” or “Fail” and proposed remedy. List all monitoring equipment either replaced or repaired. SHEAR VALVE OPERATION INSPECTION Facility Name: Owner Address: Address City, State, Zip Code: City, State, Zip Code: Facility I.D. #:e #: Testing Company: Phone #: This data sheet is for inspecting shear valves located inside dispensers. See PEI/RP1200 Section 10 for the inspection procedure. Product Grade Dispenser ID# Shear ValveType (Product/Vapor) 1. Is the shear valve rigidly anchored to the dispenser box frame or dispenser island? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No 2. Is the shear section posi- tioned between ½ inch above or below the top surface of the dispenser island? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No 3. Is the lever arm free to move? Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA 4. Does the lever arm snap the poppet valve ? Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA 5. Can any product be dispensed when the product shear valve is closed? Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA - Test Results Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Comments: Name (print)Signature < I10100 OCT 22, 2024 1:53 PM CIRCLE K 2708606 1030 OAK ST 661-861-8048 BAKERSFIELD,CA.93304 SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL > < I20100 OCT 22, 2024 1:53 PM CIRCLE K 2708606 1030 OAK ST 661-861-8048 BAKERSFIELD,CA.93304 IN-TANK INVENTORY TANK PRODUCT VOLUME TC VOLUME ULLAGE HEIGHT WATER TEMP 1 UNL Regular 7490 7364 2206 65.54 0.00 84.02 2 UNL Premium 3290 3224 6406 34.01 0.00 88.26 3 UNL Plus NoBlend 2982 2931 6714 31.66 0.00 83.94 > < I51700 OCT 22, 2024 1:53 PM SYSTEM TYPE AND LANGUAGE FLAG SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYYY HH:MM:SS xM > < I50F00 OCT 22, 2024 1:53 PM MON DD YYYY HH:MM:SS xM > < I60100 OCT 22, 2024 1:53 PM TANK CONFIGURATION DEVICE LABEL CONFIGURED 1 UNL Regular ON 2 UNL Premium ON 3 UNL Plus NoBlend ON 4 OFF > < I60200 OCT 22, 2024 1:53 PM TANK PRODUCT LABEL TANK PRODUCT LABEL 1 UNL Regular 2 UNL Premium 3 UNL Plus NoBlend 4 > < I60300 OCT 22, 2024 1:53 PM TANK PRODUCT CODE TANK PRODUCT LABEL 1 UNL Regular A 2 UNL Premium C 3 UNL Plus NoBlend B 4 4 > < I60400 OCT 22, 2024 1:53 PM TANK FULL VOLUME TANK PRODUCT LABEL GALLONS 1 UNL Regular 9696 2 UNL Premium 9696 3 UNL Plus NoBlend 9696 4 0 > < I60700 OCT 22, 2024 1:54 PM TANK DIAMETER TANK PRODUCT LABEL INCHES 1 UNL Regular 91.75 2 UNL Premium 91.75 3 UNL Plus NoBlend 91.75 4 0.00 > < I60900 OCT 22, 2024 1:54 PM TANK THERMAL COEFFICIENT TANK PRODUCT LABEL 1 UNL Regular 0.000700 2 UNL Premium 0.000700 3 UNL Plus NoBlend 0.000700 4 0.000000 > < I61200 OCT 22, 2024 1:54 PM TANK MANIFOLDED PARTNERS TANK PRODUCT LABEL SIPHON MANIFOLDED TANKS LINE MANIFOLDED TANKS 1 UNL Regular NONE NONE 2 UNL Premium NONE NONE 3 UNL Plus NoBlend NONE NONE 4 NONE NONE > < I62100 OCT 22, 2024 1:54 PM TANK LOW PRODUCT LIMIT TANK PRODUCT LABEL GALLONS 1 UNL Regular 1000 2 UNL Premium 1000 3 UNL Plus NoBlend 490 4 0 > < I62200 OCT 22, 2024 1:54 PM TANK HIGH PRODUCT LIMIT TANK PRODUCT LABEL GALLONS 1 UNL Regular 9211 2 UNL Premium 9211 3 UNL Plus NoBlend 9211 4 0 > < I62300 OCT 22, 2024 1:54 PM TANK OVERFILL LEVEL LIMIT TANK PRODUCT LABEL GALLONS 1 UNL Regular 8726 2 UNL Premium 8726 3 UNL Plus NoBlend 8726 4 0 > < I62400 OCT 22, 2024 1:54 PM TANK HIGH WATER LEVEL LIMIT TANK PRODUCT LABEL INCHES 1 UNL Regular 3.0 2 UNL Premium 3.0 3 UNL Plus NoBlend 3.0 > < I62900 OCT 22, 2024 1:54 PM TANK DELIVERY REQUIRED LIMIT TANK PRODUCT LABEL GALLONS 1 UNL Regular 491 2 UNL Premium 491 3 UNL Plus NoBlend 491 4 0 > < I70300 OCT 22, 2024 1:54 PM LIQUID TYPE SENSOR LOCATION TYPE 1 87 ANNULAR TRI-STATE (SINGLE FLOAT) 2 91 ANNULAR TRI-STATE (SINGLE FLOAT) 3 89 ANNULAR TRI-STATE (SINGLE FLOAT) 4 TRI-STATE (SINGLE FLOAT) 5 TRI-STATE (SINGLE FLOAT) 6 TRI-STATE (SINGLE FLOAT) 7 87 FILL TRI-STATE (SINGLE FLOAT) 8 91 FILL TRI-STATE (SINGLE FLOAT) 9 89 FILL TRI-STATE (SINGLE FLOAT) 10 TRI-STATE (SINGLE FLOAT) 11 TRI-STATE (SINGLE FLOAT) 12 TRI-STATE (SINGLE FLOAT) 13 TRI-STATE (SINGLE FLOAT) 14 TRI-STATE (SINGLE FLOAT) 15 TRI-STATE (SINGLE FLOAT) 16 TRI-STATE (SINGLE FLOAT) > < I20600 OCT 22, 2024 1:54 PM CIRCLE K 2708606 1030 OAK ST 661-861-8048 BAKERSFIELD,CA.93304 TANK ALARM HISTORY TANK 1 UNL Regular LEAK ALARM NOV 17, 2022 12:24 PM OVERFILL ALARM SEP 5, 2023 10:13 AM NOV 3, 2022 11:16 PM LOW PRODUCT ALARM JUN 3, 2024 8:01 PM MAY 24, 2023 11:59 AM APR 26, 2023 8:46 PM SUDDEN LOSS ALARM NOV 17, 2022 4:23 PM PROBE OUT JUL 18, 2022 1:05 PM TANK 2 UNL Premium LEAK ALARM NOV 17, 2022 9:24 PM LOW PRODUCT ALARM JUN 21, 2024 9:43 AM PROBE OUT JUL 18, 2022 1:05 PM TANK 3 UNL Plus NoBlend PROBE OUT JUL 18, 2022 1:06 PM TANK 5 TANK 6 TANK 7 TANK 8 TANK 9 TANK 10 TANK 11 TANK 12 TANK 13 TANK 14 TANK 15 TANK 16 > < I30200 OCT 22, 2024 1:58 PM CIRCLE K 2708606 1030 OAK ST 661-861-8048 BAKERSFIELD,CA.93304 LIQUID ALARM HISTORY REPORT SENSOR LOCATION 1 87 ANNULAR OCT 22, 2024 10:14 AM FUEL ALARM OCT 22, 2024 10:14 AM FUEL ALARM OCT 22, 2024 8:42 AM SENSOR OUT ALARM 2 91 ANNULAR OCT 22, 2024 8:42 AM SENSOR OUT ALARM OCT 22, 2024 8:37 AM FUEL ALARM OCT 22, 2024 8:32 AM FUEL ALARM 3 89 ANNULAR OCT 22, 2024 8:42 AM SENSOR OUT ALARM OCT 22, 2024 8:19 AM FUEL ALARM OCT 22, 2024 8:16 AM FUEL ALARM 7 87 FILL OCT 22, 2024 8:42 AM SENSOR OUT ALARM OCT 22, 2024 8:41 AM FUEL ALARM OCT 5, 2023 10:19 AM SENSOR OUT ALARM 8 91 FILL OCT 22, 2024 8:42 AM SENSOR OUT ALARM OCT 22, 2024 8:37 AM FUEL ALARM OCT 5, 2023 10:19 AM SENSOR OUT ALARM 9 89 FILL OCT 22, 2024 8:42 AM SENSOR OUT ALARM OCT 22, 2024 8:19 AM FUEL ALARM OCT 5, 2023 10:19 AM SENSOR OUT ALARM > <9999FF1B> < I34200 OCT 22, 2024 1:58 PM > < I34700 OCT 22, 2024 1:58 PM > < I10100 OCT 22, 2024 1:58 PM CIRCLE K 2708606 1030 OAK ST 661-861-8048 BAKERSFIELD,CA.93304 SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL > < I90200 OCT 22, 2024 1:58 PM SOFTWARE REVISION LEVEL VERSION 336.02 SOFTWARE# 346336-100-C CREATED - 21.02.13.11.53 S-MODULE# 330160-004-a SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS ISD/APM >