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Home My WebLink AboutUNDERGROUND TANK ~~v , -. From: Patricia Glngg To: Steve Underwood Date: 7/30/2004 Time: 10:56:36 PM Page 2 of 5 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State ofCalifomia Authority Cited: - Chapter 6. 7, Health and Sqfety Code; Chapter 16, Division 3. Title 23. California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each monitoring system control panel by the technician who perfonns the work. A copy of this fonn must be provided to the tank system owner/operator. The owner/operator must submit a copy of this fonn to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: Pepsi #4985 Site Address: 215 E. 21st Street Facility Contact Person: Mike Morgantini Make/Model of Monitoring System: Veeder root! simplicity Bldg. No: City: Bakersfield Zip: 93305 Contact Phone No.: 661-635-1190 Date ofTesting/Servicing: 7/22/2004 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to Indicate specInc equipment inspected/serviced Tank ID: diesel Tank ID: N/A ,,] In-Tank Gauging Probe. Model: 847390-109 o In-Tank Gauging Probe Model: "1 Annular Space or Vault Sensor Model: 794380-407 Aru1ular Space or Vault Sensor. Model: o Piping Sump I Trench Sensor(s). Model: 794380-352 Piping Sump I Trench Sensor(s) Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: " Mechanical Line Leak Detector Model: VMI-LD-2000 Mechanical Line Leak Detector Model: Electronic Line Leak Detector Model: Electronic Line Leak Detector Model: " Tank Overfill/High-Level Sensor Model: ebw flapper Tank Overfùl / High-Level Sensor Model: o Other (specify equipment type and model in Section E on Page 2). Other (specify eQuipment type and model in Section E on Page 2). Tank ID: N/A Tank ID: N/A In-Tank Gauging Probc. Model: In-Tank Gauging Probe Model: Annular Space or V aul t Sensor Model: Aru1ular Space or Vault Sensor. Model: Piping Sump I Trench Sensor(s). Model: Piping Sump I Trench Sensor(s) Model: Fill SurnpSensor(s). Model: Fill S1U11P Sensor(s). Model: Mechanical Line Leak Detector Model: Mechanical Line Leak Detector Model: Electronic Line Leak Detector Model: Electronic Line Leak Detector Model: Tank Overfill / High-Level Sensor Model: Tank Overfill / High-Level Sensor Model: Other (specify equipment type and model in Section E on Page 2). Other (specify eQuipment type and model in Section E on Page 2). Dispenser ID: 1 Dispenser ID: N/A o Dispenser Containment Sensor(s). Model: bravo o Dispenser Containment Sensor(s). Model: ~Shear Valve(s). o SheaI Valve(s). ~ Dispenser Containment Float(s) and Chain(s). o Dispenser Containment Float(s) and Chain(s). Dispenser ID: N/A Dispenser ID: N/A o Dispenser Containment Sensor(s). Model: o Dispenser Containment Sensor(s). Model: o Shear Valve(s). o Shear Valve(s). o Dispenser Containment Float(s) and Chain(s). o Dispenser Containment Float(s) and Chain(s). Dispenser ID: N/A Dispenser ID: N/A o Dispenser Containment Sensor(s). Model: o Dispenser Contairunent Sensor(s). Model: o Shear Valve(s). o SheaI Valve(s). 10 Dispenser Contairunent Float(s) and Chain(s). o Dispenser Contaimnent Float(s) and Chain(s). If the facility contains more tanks or dispensers, copy this form. Include infonnation for every tank and dispenser at the facility. C. Certification I certifY that the equipment Identlfled In this document was Inspected/serviced In accordance with the manufacturers' guidelines, Attached to this Certlncatlon Is Information (e.g. manufacturers' checklists) necessary to verilY that this Information Is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, 1 have also attached a copy of the report; (check all that apply): ~ System Setup ø Alarm History Report Technician Name(print): Todd M. Rex Signature: T~ 11, ~u Certification No: 6666 License. No: Testing Company Name: Clean Fuels Phone No: 626-447-7000 Site Address: 215 E. 21st s1. Bakersfield CA 93305 Date of Testing/Servicing: 7/22/2004 Monitoring System Certification Page 1 of3 EM 785952 D. Results of Testing/Servicing '; (, From: Patricia Gingg To: Steve Underwood Date: 7/30/2004 Time: 10:56:36 PM Page 3 of 5 Software Version Installed: 119.05 C h ~ II h kl omplete t e 0 OWIß~ C ec ¡st: " Yes .... No'" Is the audible alann operational? " Yes No'" Is the visual alarm operational? " Yes No'" Were all sensors visually inspected, functionally tested, and conflffiled operational? " Yes .... 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. modern) N/A operational? "J Yes No'" For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: -which sensors initiate positive shut-down? (CheckaJlthaJ apply) o Smnpffrench Sensors; o Dispenser Contairunent Sensors. Did you confinn positive shut-down due to leaks and sensor failure/disconnection? ~ Yes 0 No UYes [ No'" For tank systems that utilize the monitoring system as the prÌrna¡y tank overfill warning device (i.e. no [" N/A 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 alann trigger? % ] Yes* RlNo 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. o Yes* ¡;,] No Was liquid found inside any secondary containment systems designed as dry systems? (C1reck all that apply) o Product 0 Water If yes describe causes in Section E, below. ,,] Yes []No'" Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports.. if applicable bd Yes DNo'" 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: Agency: Bakersfield city fd Spill bucket was tested electromcly results will be attached Line was tested results will be attached Pass pass Page 2 of3 F. In-Tank Gauging I SIR Equipment: ~ Check this box if tank gauging is used only for inventory control o 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 perfonn leak detection monitoring. .1\ From: Patricia Gingg To: Steve Underwood Date: 7/3012004 Time: 10:56:36 PM Page 4 of 5 c Itth~1I h kr t omple e e 0 oWmR c ec IS: Yes No'" Has all input wiring been inspected for proper entry and temlination, including testing for ground faults? Yes No'" Were all tank gauging probes visuallv inspected for damage and residue buildup? Yes No'" Was accuracy of system product level readings tested? Yes No'" Was accuracy of system water level readings tested? Yes No'" Were all probes reinstalled properly? 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. G. Line Leak Detectors (LLD): o Check tlùs box if LLDs are not installed Complete the following checklist: v'] Yes No'" For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? N/A (Check all that apply) Simulated leak rate: ~ 3g.p.h.; [] 0.1 g.p.h; [J 0.2 g.p.h. øYes No'" Were all LLDs confirmed operational and accurate witlùn regulatory requirements? "J Yes No>l< Was the testing apparatus properly calibrated? ¡6IJ Yes Noll< For mechanical LLDs, does the LLD restrict product flow if it detects a leak? N/A ] Yes Noll< For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? v' N/A ¡[] Yes Nolle F or electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled v' N/A or disconnected? J Yes No>l< For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system v' N/A malfunctions or fails a test? I[] Yes No>l< For electronic LLDs, have all accessible wiring connections been visually inspected? ., N/A ¡øYes No>l< 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, H. Comments: Page 3 013 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3911 FAX (661) 852-2170 SUPPRESSION SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 852-2170 PREVENTION SERVICES FIRE SAFETY SERVICES' ENVIRONMENTAL SERVICES 900 Truxtun Ave.. Suite 210 Bakersfield. CA 93301 VOICE (661) 326-3979 FAX (661) 852-2171 FIRE INVESTIGATION 1715 Chester Ave.. 3,d Floor Bakersfield. CA 93301 VOICE (661) 326-3951 FAX (661 852-2172 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 December 10, 2004 Pepsi Cola 215 E. 21st Street Bakersfield, CA 93305 REMINDER NOTICE Re: Necessary Compliance Deadlines for UST Owners/Operators Dear Valued Customer: The purpose of this letter is to remind you about three compliance deadlines for UST Owners/Operators. These are as follows: J) January 1,2005 deadline for submitting declaration statement designating: (a) Owner/Operator understands and is in compliance with all applicable UST requirements, and (b) Owner identifies the designated UST Operator for each facility owned, (c) Owner/Operator passes and submits proof of International Code Council Test. 2) EVR upgrade requirements on spill buckets are due April 1,2005, 3) Secondary Containment Testing on all secondary systems. Code requires re-testing 36 months from date of last test which was in 2002. Should you have questions regarding these compliance deadlines, please feel free to call me at 661 - 326-3190. Sincerely, ¡; - 1'1 / )tiz. UtMuC Steve Underwood Fire Prevention Officer SU:db {{~~PIIÙ~r¡ (h(! 9f;;NINnl.l'll(,~!I @(N( :? l!o.tte cj//uul Qr;( Y¡;::"Itál//l1j JJ i' ." a ;:! '1J ~ õ' i" GI :, Ie Ie ~ ø ~ c :J a. 11> ~ o o a. 7/16/2003 Bakersfield Date: Location vent a OJ ~ ~ ¡;; ~ '" 8 .... -i 3' ~ .... o ¡;, 01 ¡;, 01 '1J s: o. ~ LJ fi ci o alarm panel '1J OJ Ie 11> U\ g, U\ ¡bUilding I ~opanetank annular /fence