HomeMy WebLinkAboutUST-MONIT. SYSTEM 10/12/2004
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MONITOR SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of California
Authority Cited'.,Chapter 6,7, Health and Safety COde; Chapter 16, Division 3, Title 23, California COde of Regulations
This form must be used to document testinQ and servicin¡¡ of monitorinQ equipment ¡>'.§§I1J![j~ǧ(ji!i,,ªI!OJ1...9Uj!J1Qr1Jn!ðLQo.JH~
_ for,each.monitorina svstem control ~ by. the technicien Who performs the wont A copy of this form'must be provi,ded, to the tank
system owner/ciperåtor. The owner/operator must submit a copy of this form to the local agencY· regulating UST' systems within 30
;~day~, of teai'date, .., - , . ,;,.. '
,A. General Information
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Facility Name: Yoo'a 34th Street Mobil
Site Addrass: 600 34th Street
Facility Contael Peraon: Lena
Make/Model of Monitorina SYltem:
City
Bldg. No,
Bakersf,ald
Contact Phone No. (661)
Date of Teltin¡¡/Servicina:
SIN 80747179805003
G,lbarco
B. In"entory of Equipment T"tedlCertllled
Check the a ro riate boxes to Indicate
Tank ID: # 1 Pramium
x In-Tank Gauging Probe.
x Annular Space or Vault Sensor
x Piping SumprTrench Sensor(s).
Fill Sump Sensor(s)
Mechanical Line Leak Detector.
Electronic Line Leak Detector.
Tank O"erlill/.High-Level Sensor.
Dispenser Containment Sensor(s).
Shear Valve(s).
Dispenser Containment Float(s) and Chain(s).
Other s c; ui ment t and mOdel in Section E on Pa
Tenk 10: II 3 Unleaded R ular
x In-Tank Gauging Probe. Model'
x Annular Space or Vault Sensor. Model:
x Piping SumprTrench Sansor(s). MOdel:
Fill Sump Sensor(s), ' MOdel:
Mechanical Line Leak Detector. Model'
Electronic Line Leak,Detector. Model:
Tânk Overfill I High-Level Sensor. Model: OPW
Dispensar Containment Sensor(s). MOdel:
\ Sh~ar Va!ye(s)
Dispenser ço~ta;nme!1t, Float(s) af'd Cl1a,n(s).
Other "'. , .' ui ' ntt ., and mOdel In Section E on P
ted/serviced:
..
Zip: 93301
330-7686
10112/04
Tank 10 /I 2 Plus
x In- Tank 'Gauging Proba
Annuler Spttee 0( Vault Sensor
Piping SumprTrench Sensor(s).
Fin Sump Sensor(s).
Mechanical Line Leak Deteelor.
Electronic Line Leak Detector.
Tank Overfill I High-Level Sensor,
Dispenser Containment Sensor(s).
Shear Valve(s).
Dispanser Containmant Float(s) and Chain(s).
Other s ec; ui ment and model in Section E on Pa
Tank 10·
In- Tank Gaugi"\ Probe.
Annular Space or Vault Sensor
Piping SumprT rench Sensor( s)
Fill Sump Sensor{s).
Mechanicel Line Leak Delector.
Electronic Line Leak Detector.
Tank Overfill I H'gh-Level Sensor.
Dispenser Containment Sensor(s).
Shear Valve(s).
Dispenser Containment Float(s) and Chain(s).
Dthèr .. u, ment I and mOdel in Section E on Pa
Model
MOdel:
Model'
Model:
MOdel:
Model:
Model:
Model:
Gllbareo
Tri Stete
Tri State
OPW
Gilbarco
Tri Slate
Tri State
. ... .... .~,"
Model'
Model
Model:
Gilbareo
Tri Stete
Tri State
Mode!"
Model:
Model:
Model:
Model:
OPW
e2
Model'
Model:
Model'
Model:
Model'
Model:
Model:
Model:
e2
C. Certification - I certify that the equipment identified in this document was inspected/serviced in aCCOf'danœ with the manufacturer's gUidelines
Ahached to this Certdicetion is informal ion (e.g. manufecturers' checklists) necessary to verify that this information is correct and a PIOI Plan
showing the layout of monitoring equipment For any equipment capable of generating such reports, I have also ahached a copy of the raport;
(check all thet apply) :' 0 System set-up
o Alarm hi&tory report
Technician Name (print): Michael Moore
CertlLic. No.
562060899
Testing Company Name: Redwine Testing Services, Inc.
Phone No (800) 582-6368
Pa~1~3
Signature:
--1Y14ot~..t.U vM.~,,-
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Monitor System Certlflc:ation
Site Address: 800 34th Street. Bakersfield, CA 93301
D. Results of T Hting/SerYtcing
Software Version Installed: Gilbarco SIN 80247179805003
Dale of Testing/Servicing:
10/12/04
Is the audible alarm ° rational? N/A
Is Ihe visual alarm ° eralional?
Were all $en~$ "i$UðttY...!Q~~J~nctio~~~_jLtl!~-,-~d coD!!!!T'ed o~_~_tj"9Q~!?..____ "__ ~.
Were all sensors ,nstalled at lowest point 01 secondary containment and positioned so that othttr equlpmenl w,lI not
interfere with their ro r 0 ration?
No' If alarms are relayed 10 a remole monitoring slat'on. is all communlcalions equ'pment (e.g. modem) operational?
N/A
No'
N/A
-------. ----~
licable
e. Comments;
Category
Form
Serial/l
Super
Tri State Piping Sump
Tn State Annular
0794380-208
0794390-409
247986
247018
Regular
Tri State Piping Sump
Tn State Annular
0794380-208
0794390-409
498759
424649
Plus
Tri Stale Piping Sump
T ri State Annular
0794380-208
0794390-409
248172
347016
Peve 2 01 3
03101
:"
Monitoring System CertlflcIUon
Sile AOdress: 600 34lh Slreel, BakerslielO, CA 93301
Dala 01 T estinQIS8Nk;;ng
10112104
F. In-Tlnk Gauging I SIR Equipment:
o Check this box if tank gauging is used only lor inventory control.
o Check this box if no tank gauging or SIR equipment is installed,
Thla aection must be completed If in-tenk geuging equipment is used to perform leek detection monitoring.
Complete the followlna checklist:
x Yes No' Has all input wiring bOOn inspected for orooer ent" and termination. Including testing for ground faults? . Where visible
x Yes No' Were all tank oauaina orObes vlsuall Insoected for damaoe and residue bUildup?
x Yes No' Was accuracv of svstem pradud level readlno s tested?
x Yes No' Was accuracv of svstam water level readinas lested?
x Yes No' Were all orObes reinstalled orooerlv?
x Yes No' Were all items on the eQuipment manufacturers maintenance Checklist completed?
. In the SecUon H, below, describe how Ind when theM deficiencies we... or will be corrected,
G. line Leak DelecloTtl (llD):
fKJ Check this box if LLDs are not installed
o
NIA
No'
No'
No'
NIA
No' For electronic LLDs, does the turbine automatically shut off if the LLD delects a leak?
NIA
No'
NIA
No'
NIA
No'
NIA
Yes No' Were all items on the ui ment manufacturers maintenance Checklist com leted?
. In the Section H, below, deecribe hOw Ind when theM deficiencies were or will be correcled.
po ormance
For electronic LLDs, does the turbine automatically shul off if any portion of the monitoring system is disabled
or disconnected?
F or electronic LLD~,
or fails a test?
For electronic LLDs,
does the turbine automatically $hut off if any portion at the monitoring system malfunctions
have all accessible wiring connections bOOn visually inspected?
H. Comments:
Page 3 of 3
03101
~
UST Monitoring Site Plan
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i~r,: InstnJdioas
, 'I!~ ,'~ already b&~ . djagram that show. aU required information. you may intlude it, rather than this page. witb
':f :óor Monitoring System CertificaÜon, On your site plan., show the general layout of tanks and piJ)ÍnB, Clev1y
'; :.,,'.., . locatioDJ of the foUowing cqwpment. if installed: monitoring system CoQt.rol pb.nels; ~SOrl moaitoring
£Ifp)c annular space$. swnps, dispen.ter p&n.I, spilJ containers, or other secondary cont~t are.u~ medw.aical or
~ '~~nic tiDe I~ ,detectors; and in-tanJc IiqWd I~ probes (if use<! for leak detection), In the spa.ce provided.
.~~ tbe date thiJ Srte Plan was prepared, '
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10/7/2004 10:29 PAGE 001/001 Fax Server
10/87/2084 88:45 6618363177
RED.oIIt€ TESTING svæ
PAGE e2/B2
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CITY OF BAKERSFIELD
OFFICE OF ENVIR,ONMENTAL SERVICES
171S Chester A ve" Bakersfield, CA (661) 326-3979
APPLICA TION TO PERFORM
FUEL MONITORING CERTIFICATION
FACILITy _ Y lit} ts 3t1-.. ~ ~ mo hi /
ADD~S-Jpo ~~ 3+Tw, ~~-\"'u~~Itl) r-A t.t3~ol
OPERATORS ~AME ' Lf.ft&.
OW'NBRS NAMB' M(" ¥blj
NAMEOP MONITOR MANtJ'FAC'TURBR (;. }b&,.c~
DOES PACIL.rrV ~ VB DISPENSER PANS? ¥BS_ NO_
TANK , VOLUMB CONTBNTS
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NAMBOFTESTINOCOMPANY~II\L '~-6~ r~¡J&l'U, +I'\L.
CONTRAcrORS UCENSB. .._~~~R1" A ~"%,
NAME '" PHONE NUMBER OF CONTACT PERSON ~ J ~f'r (,l,~.34. ,q\:1
DATE & TIME TBST IS TO BE COND UCTED o· IØl ~ ,n; ()/J l}rt\
APPROVED BY
10-1"0 .¡
DATE
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IONA n1R.B OF APPUCANT
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