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HomeMy WebLinkAboutAST- MON. TEST 8/8/2003 MONITI klNG SYSTEM CERTIFI(_ ION For Use By All Jurisdictions Within the State of CaliJbrnia Authority Cited: Chapler 6. 7, Health and.Safety Code; Chapter 16, Division 3, Title 23, Cal~;rnia Code of Regulations This form must ~ used to d~ument testing and servicing of monitoring equipmmt. A separate ce~ification or repo~ must ~ prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must ~ provided to the tank system om~/operator. '~e omer/op~ator must submit a copy of this form to the I~al agency regulating UST systems within 30 days of test date. A. General Information FaciliW Name: MCI Bldg. No.: St. Site Address: 4901 Commerce ~. CiW: Bakersfield, CA Zip: Faciliw Contact Person: Contact Phone No.: Mak~M~el of Monitoring System: EBW Aut~Stik II Date of Testin~S~vicing: 08/08/03 B. Invento~ of Equipment Tested/Ce~ified Check the approp~ate ~xes to indicate s~cific equipment ins~cte~iced: ~nk ID: Di~el Back-I In Gen. Tank Tank ID: ~ ~-T~k Gau~na Pro~. M~el: EBW ~ ~-T~ Oau~na Pro~. M~el: ~ ~ul~ Soa~ or Vault Sensor. M~el: EBW ~ ~nul~ Soa~ or Vault Sensor. M~el: H Pioina Sumo / Trench Sensorfs~. M~ei: ~ Pioina S~o / Trench Sensogs~. M~el: ~ Fill Sumo Sensor~s~. M~el: ~ Fill Sumo Sea,gsa. M~el: ~ M¢ch~i~l Line ~ Deteaor. M~el: ~ M~h~i~l Line ~ ~teaor. M~ei: ~ Elearonic Line ~& ~t~or. M~el: ~ Elearoni¢ Line ~ Deteaor. M~el: ~ T~ Ov~fill / Hi~-~vel S~sor. M~el: ~ T~ Overfill / ~-~vel Sensor. M~el: ~ ~her (s~ equipment ~ ~d m~el in Seaion E on P~ 2). U ~her (s~ci~ equipment ~ ~d m~el in Se~ion E on P~e 2). T~k ID: I Tank ID: ~ ln-T~ Gau~na Probe. M~el: ~ ~-T~k Gau~na Pro~. M~el: ~ ~nul~ Soa~ or Vault Sensor. M~el: ~ ~ul~ Soa~ or Vault Sensor. M~el: ~ Pi~e S~ / Trench Sensor(s). M~el: ~ Pi~ine S~ / Trench Sen~r(s). M~eI: ~ Fill S~ Sen~r(s). M~el: ~ Fill Sm~ Sensor(sl. M~el: ~ M~h~i~ Line ~ ~teaor. M~el: ~ Mech~i~l Line ~ Deteaor. M~el: ~ Elearonic Line ~& Dete~or. M~el: D Elearonic Line ~ Deteaor. M~el: ~ T~ Overfill / Hi~-~vel Sensor. M~el: ~ T~ Overfill / Hi~-~vel Sensor. M~el: ~ ~her (s~ci~ eaui~ment ~ ~d m~el in Se~ion E on Pa~e 2). D ~her (s~d~ eauinm~t t~ ~d m~el in Se~ion E on Pane 2). ~ ~ Dis~nser Containment Sensor(s). M~el: ~ Dis~nser Contaiment Sensor(s). M~el: H Dis~nser Containment Float(s) ~d Chain(s). H Dis~nser Containment Float(s) ~d Chain(s). Dispenser Dispenser ID: ~ Dispenser Containment Sensor(s). M~el: ~ Dis~nser Contai~ent Sensor(s). M~el: m Shear Vah,e(s). ~ Shear Valve(s). U Dis~nser Contai~ent Float(s) and Chain(s). ~ Dispenser ~ntai~ent Float(s) and Chain(s). Dispenser Dispenser ID: ~ Dispenser Containment Sensor(s). M~eI: ~ Dis~nser Contai~ent Sensor(s). M~eI: ri Shear Valve/s). ~ She~ Valveis). [-1 Disvenser Contai~ent Float(s) ~d Chain(s). FI Dis~nser Containment Float(s) ~d Chain(s). *If the facility ~ntains more t~ks or dispensers, ~py this fo~. Include information for every tank and dispenser at the lhcility. C. Ce~ification - I ce~ify that the equipment identified in this d~ument was inspected/se~iced in accordance with the manufacturers' guidelines. Aaached to this Ce~[fication is infomation (e.g. maaufacture~' chec~ists) necessa~ to verify that this information is correct and a Plot Plan sho~ng the layout of monito~ng equipment. For any equipment capable of generating such repo~s, I have also a~ached a copy of the repo~; (c~ecg all that apply): . System set-up ' ~ Alarm histo~ repo~ _~ Technician Name (print): David Walker ~ ~~~nature: Certification No.: 006-05-0173 . u.s.r [ o.: 745065 A,B-HAZ Testing Company Name: Tank orC .ro .ia d'{ '~~'~'" }P~,~ No. (909)273-0900 Site Address: 1379 Pi~ St. Suite 103 Corona. CA ~', )" : ~ / '/3v g~ Date of Testing/Servicing: 08/08/03 Monitoring System Certification tge ~P~>' "~ 03/Or F. In-Tank Gauging / SIR Equil [] Check this box if tank is used only for inventory control. 121 Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: ~ [] No* Has all input wiring been inspected [or proper entry and termination, including testing for ground l~aults? ~ [] No* Were all tank gauging probes visually inspected for damage and residue buildup? [l~ [] No* Was accuracy of system product level readings tested? ~ [] No* Was accuracy of system water level readings tested? ~ [] No* Were all probes reinstalled properly? ~ [] No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be eorrected. G. Line Leak Detectors (LLD): ~~ i: ~ ~ i_ 2. Complete. the following checklist: [] Y~ [] No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ~ (Check all that apply) Simulated leak rate: [] 3 g.p.h.; i-I 0.1 g.p.h; [] 0.2 g.p.h. [] Yes [] No* Were all LLDs confirmed operational and accurate within regulatory requirements? [] Yes [] No* Was the testing apparatus properly calibrated? [] Yes [] No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? [] N/A [21 Yes O No* For electronic LLDs, does the turbine automatically shut offifthe LLD detects a leak? I-I N/A f~ Yes [] No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled I~! N/A or disconnected? I~1 Yes I~l No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system [] N/A malfunctions or fails a test? [] Yes I~l No* For electronic LLDs, have all accessible wiring connections been visually inspected? I~! N/A I~l Yes [] No* Were all items on the equipment manufacturer's maintenance checklist completed? · In the Section H, below, describe how and when these deficiencies were or will be corrected. Ho Comments: !). Results of Testing/Servicing Software Version Installed: Complete the following checklist: ~i~ ~! No* Is the audible alarm operational? ~.i!~ [] No* Is the visual alarm operational? __ ~:i~ [] No* Were all sensors visually inspected, functionally tested, and confirmed operational? l~i.;~ ~ [] No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? [] Yes [] No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) ~ operational? [] Yes [] No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ~ monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) FI Sump/Trench Sensors; [] Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? I-I Yes; FI No. [] Yes [] No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ~ mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? % Fl Yes* ~ Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. [] Yes* ~ Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) [] Product; l-I Water. If yes, describe causes in Section E, below. ~ Fl No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable ~ [] No* Is all monitoring equipment operational per manufacturer's specifications?. · In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 113/111 UST Monitoring Site Plan Site location: fv~ C I INSTRUCTIONS lfyot already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring :m Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if instal[ed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Tank Specialists of California (888) 606-TANK.t t ( #745065 A,B-HAZ ) Page __~ of SWRC~iB, January 2002 Page of__ Secondary Containment Testing Report Form This f~rm is intended f~r use by c~ntract~rs perf~rming peri~dic testing ~f U$T sec~ndary c~ntainment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the faciliO~ owner~operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: AT&T I Date of Testing: 8/20/03 Facility Address: 1520 20~ street. Bakersfield Ca. Contact: Ken Smith [ Phone: 1(217)747-9336 Facility Date Local Agency Was Notified of Testing Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORiVL~.TION Company Tank Specialists of California Technician Conducting Test: Quentin Fonteno Credentials: x CSLB Licensed Contractor SWRCB Licensed Tank Tester License Type:~A-B, HAZ _ n~,,u._~LLicense Numbe~r: 74506~ 5~ ......... Manufacturer Training Manufacturer ' Component(s) Date Training Expires Incon Incon Sump Testing Monitor System 7-25.05 3. SUMMARY OF TEST RESULTS Not Repairs l Component Pass Fail Tested Not Repairs Made Component Pass Fail Tested Made 2 Secondary lines x [] [] [] [] [] [] [] .0 [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] 0 [] 0 [] [] 0 0 [] [] [] [] [] [] [] [] [] [] [] 0 [] [] [] [] [] [] [] [] 0 [] [] [] [] [] [] [] 0 [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPON~E FOR CO~ING THIS TESTING To the best of my knowledge, the f..acts stated in this cument mpliance with legal requirements Technician's Sie:nature: ~a ~ ~Date: ~,.~ - ~j/_'). C~,'~ SNVRC~B, January 2002 Page of 5. SECONDARY PIPE TESTING Test Method Developed By: [] Piping Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) SWCRB Test Method Used: ~ Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used:O-15 PSI GAUGE Equipment Resolution: [~m~nln~mSll~ Piping Run # 1 Piping Run # 2 Piping Run # I Piping Run # Piping Material: Steel/fiberglass Steel/fiberglass Piping Manufacturer: Piping Diameter: 2 in 2 in Length of Piping Run: 40 - 50 ft 40 - 50 fi Product Stored: Diesel Diesel Method and location of piping-nm isolation: Underg::om:d Undergl'ound Wait time between applying pressure/vacuum/water and 30 Minutes 30 Minutes 30 Minutes 30 Minutes starting test: Test Start Time: 1200 1300 Initial Reading (PO: 5 psi 5 psi Test End Time: 1300 1400 Final Reading (RF): 5 psi 5 psai Test Duration: 60 Minutes 60. Minutes 60 Minutes 60 Minutes Change in Reading (Rr-RO: None None 0 0 Pass/Fail Threshold or Criteria: 5 psi 5 psi Test Result: X Pass [] Fail x Pass [] Fail [] Pass [] Fail [] Pass [] Fail Comments - (include information on repairs made prior to testin~ and recommended follow-up for failed tests) CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-:5979 APPLICATION TO INSTALL AND/OR REMOVE ABOVE GROUND STORAGE TANK(S) In conformity with provisions of pertinent ordinances, codes and/or regulations, permission is hereby granted to: 40,-/ Name of Company Address ~'6~'~ Z-~ to display, store, install, use, operate, sell or handle materials or process involving or creating conditions deemed hazardous to life or property as follows: q~ol Co/~2///e-~-~r' Ir'J~;~e il/o~fd- /~/~sT' o.,~ /3/~.3 ~eoo ?~ subject to the provisions and/or limitations as provided. Violation of pertinent ordinances, codes and/or regulations shall void this permit. Permit Denied ¢' g/-~' Date Applicant Name (print) Applicant Signature THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FRTTEN POt~ S¥STEHS $30-530-17~? ~o~ , '~EP. 18. 2000 2'00?M NO. ¢863 P. 2 ~ove referenced ~42 require~e~. Cur ~ file numar is F~t6747. Th~ sp~ci~c t~ ~.~ber u~d for t~ p~cular u~t ~ ~g95160. ?~?~:: ,::: , ..... ~ ..... ,F'Vff, ............. , i::' ,i,ri"i: ,,::::::::,, Mail a copy of the completed form to: CUPA Inspector: California Regional Water Quali, ConSol B°ard Phone: ( Date: ~ / O0 / a~ The following facility is storing "petroleum" in a single storage tank greater than 660 gallons or in multiple storage tanks with a cumulative storage capacity greater than 1,320 gallons. "Petroleum" means crude oil, or any fraction thereof, which is liquid at 60 degrees Fahrenheit temperature and 14.7 pounds per square inch absolute pressure. This includes petroleum based substances comprised of a complex blend of hydrocarbons, such as gasoline, diesel, jet fuels, residual fuel oils, lubricants, some petroleum solvents, and used oils. An example of a substance that is not "petroleum" is liquid propane gas (LPG). Note: The backside of this form identifies storage tanks and facilities exempt from the state Aboveground Petroleum Storage Act SPCC requirement. ~-~ ~_~ Facility Name: /~i C.. ~ ~(~ Contact: ed T. R&{ Phone:( ) ~ ::;~ : ::.~::: ~'T~e;~Ed~ili~YS i~ :~o~iidnee ~With:H&SC ~ection 25270:~5(c)¢ th~ prep~ration'~an I~::';~ :.A~:~°mP!~' 0[ihe:.facility~s SPCC Pian¢ cerafied by a. Re~st~red :Professional: Engin~, ] :::.:: ::~.:::::.] 'mot ~ttendedat]east::8:hours per dayl.the. SPC~ plan is maintained~at.~thenearest::field.offiC~ ;~::~: :: ~: ]:,. Th~ facili~ if no~ ih complianee~:~i{O: m SCS~{~o,:? :~h~::Sw~e~]::~or~:operatpr;~as:g~are:pf ~he:~bo~eg[o~nd Pe~ro!e~m~S~or~ge]~:A~t~ ~.co~y]~f ~ ~State:~at~r~:ResOdt~s'Cont~01 Board; AboVegroUnd yank program br0chU~e' cc: Carol Julian State Water Resources Control Board Division of Clean Water Programs P.O. Box 944212 Sacramento, CA 94244-2120 : SWRCB, C.WP Form AGT-1 (06,/28/99) STORAGE TANKS AND FACILITIES EXEMPT FROM THE STATE SPCC REQUIREMENT The Aboveground Petroleum Storage Act (APSA), Health and Safety Code (H&SC), Section 25270.2(k), defines "storage tank" as any aboveground tank or container used for the storage of petroleum. "Storage tank" does not include any of the following: (1) A pressure vessel or boiler which is subject to Part 6 of Division 5 of the Labor Code. (2) A storage tank containing hazardous waste, as defined in subdivision (g) of Section 25316, if the person owning or operating the storage tank has been issued a hazardous waste facilities permit for the storage tank by the Department of Toxic Substances Control. (3) An aboveground oil production tank which is subject to Section 3106 of the Public Resources Code (Division of Oil and Gas). [] (4) Oil-filled electrical equipment, including, but not limited to, transformers, circuit breakers, or capacitors, if the oil-filled electrical equipment meets either of the following conditions: (A) The equipment contains less than 10,000 gallons of dielectric fluid, or (B) The equipment contains 10,000 gallons or more of dielectric fluid with PCB levels less than 50 ppm. The appropriate containment or diversionary structures or equipment are employed to prevent discharged oil from reaching a navigable water course, and the electrical equipment is visually inspected in' accordance with the usual routine maintenance procedures of the owner or operator. If you checked any one of the four boxes above, then the facility is not subject to the state APSA registration, fee or SPCC plan requirements. Additionally, H&SC Section 25270.5(d) specifically does not require an SPCC plan for the following facilities: [] Farms, nurseries, and construction sites, which do not have tank logging or a single exceeding 20,000 gallons and which have a cumulative storage capacity no greater than 100,000 gallons. However, these facilities are still required to pay a fee and register their tank(s) with the State Water Resources Control Board.