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Home My WebLink AboutEMC 2025 (VEEDER ROOT UPGRADE)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 10117291 Certification Date 03/5/2025 Facility Name PENSKE CA-604 Facility Address 2929 E BRUNDAGE City BAKERSFIELD ZIP Code 93307 2. SERVICE TECHNICIAN INFORMATION Company Performing the Certification WESTERN PUMP, INC. Phone 619-239-9988 Mailing Address 3235 F. STREET, SAN DIEGO CA 92102 Service Technician Performing Test CHRIS MIZICKO Contractor/Tank Tester License Number 673853 ICC Number 8276846 ICC Expiration Date 12/16/2026 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date ICC #8276846 12/16/2026 VEEDER ROOT #B37435 01/06/2027 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 03/5/2025 Total # of Pages ce Technician Sign 11 Underground Storage Tank Monitoring System Certification Form 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 VEEDER ROOT Model of Monitoring System Control Panel TLS 450 PLUS Software Version Installed 10.P.233.58 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 Underground Storage Tank Monitoring System Certification Form 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 L1 794380-301 DIESEL T1 ANNULAR ܈܈ ܆܆ L2 794380-323 DIESEL FILL SUMP ܈܈ ܆܆ L3 794380-323 DIESEL STP SUMP ܈܈ ܆܆ L4 794390-409 DEF ANNULAR ܈܈ ܆܆ L5 794380-323 DEF STP ܈܈ ܆܆ L6 794380-304 DIESEL FILL BRINE ܈܈ ܆܆ L7 794380-304 DIESEL STP BRINE ܈܈ ܆܆ L8 794380-304 DEF STP BRINE ܈܈ ܆܆ L9 794380-323 UDC 1 ܈܈ ܆܆ L10 794380-323 UDC 2 ܈܈ ܆܆ L11 794380-323 UDC 3 ܈܈ ܆܆ L12 794380-304 UDC 1 ANNULAR ܈܈ ܆܆ L13 794380-304 UDC 2 ANNULAR ܈܈ ܆܆ L14 794380-304 UDC 3 ANNULAR ܈܈ ܆܆ L15 794380-323 VENT SUMP ܈܈ ܆܆ L16 794380-304 VENT SUMP BRINE ܈܈ ܆܆ VS 1 857280-100 DIESEL ALL LINES VAC ܈܈ ܆܆ VS 2 857280-100 DEF ALL LINES VAC ܈܈ ܆܆ ܆܆ ܆܆ ܆܆ ܆܆ ܆܆ ܆܆ ܆܆ ܆܆ ܆܆ ܆܆ ܆܆ ܆܆ 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 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.