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Home My WebLink AboutUST-REPORT 10/7/2004 10/07/2004 08:45 6618363177 REDWINE TESTING SVCS PAGE 02/02 -' CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICA TION TO PERFORM FUEL MONITORING CERTIFICATION FACILITY_ Yðð·S 3tl..u... ~ mob. I ADDRSSS-Îöo ~~ -3+T W,' 'Rea. \c.~I-~.ÇJ It;.Y ~ t!.A lf330 I OPERATORS NAME . J.....~I':)"- OWNERs NAME~ me YM NAME OF MONITOR MANUFACTURER (;. Jba.~l'..ð DOES FACfi.JTY HA VB DISPENSER PANS? YBS_ NO_ TANK # VOLUME I JO~ .'-..,/ ..2 lOr<::.. -3 51' CONTENTs ,1. Un \9 1i''' PI v..~ "U±e.n-. NAME OF TESTING COMPANY 'ReJWIt\L 'e.Ja±J'j ~~YUll' ~J Irv.... CONTRACfORS UCENSE # 5'3.:J.3'Jí' A N-A.'Z.. _ NAME & PHONE NUMBER OF CONTACT PERSON ~ T t.U"l\f'r løl.l.. (.34-,- r:,q'!.S DATE & TIlvŒ TEST IS TO BE CONDUCTED '0· (.;l.~" ID](J{J t:}rt\ J(d'~ APPROVED BY 10-1--01 DATE ~7~ IONA TURE OF AP~UCANT J - it --\- -. ... ¡:;'v j '\V '",,,\ ;7 ~/ 'x. /' '\ ~ ~ , ~ ' MONITOR SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of Califomie Authority Cited:.Chepter 6,7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document test in¡¡ and S9rvicin¡¡ of monitorinQ equipment ð.i§I1WIILÇ§!j!fi.Ç!!i-9r:l.9~P.2.r:1.Jn_J,¡§UIUlr~ .foreach·monitorina svstemcontrol~ by the technician who performs the won< A copy 01 this form must be provided to the tank system owner/operator. The owrier/operator must submit a copy of this form to the' local agencý·reOulating UST'sYSlemS within 30 _day~ oftesl' date .. - . . . '.' A. Ganeral Information Facility Name: Yea's 34th Street Mobil Site Address; 600 34th Street Facility Contact Person: Lena M....e/Model of Monitorir\Ç Sy.tem: Bldg. No Bakersfield Contact Phone No. (661) Dete of Tutir\\llServicir\Ç: City: SIN 60747179605003 Gllbarco B. Inventory of Equipment T..tedlCertlfled Check the a '0 riate box.. to Indicate Tank ID. II 1 Premium x In-Tank Gauging Probe. Model Gilbarco x Annuler Space or Vault Sensor Model T rl St.t. x Piping SumplTrench Sensor(s). Model' Tri State Fill Sump Sensor(s). Model' Mechanical Une Leak Detector ModeL Electronic Une Leak Delector. Model: Tank Overfill/.High-level Sensor Model: OPW Dispenser Contáinment Sensor(s). Model: Shear Valve(s). Dispenser Containment Float(s) and Chain(s) Other s i ui ment t and model in Section E on Pa e 2 T enk ID: II 3 Unleeded R ular x In-Tank Gauging Probe. Model: Gilbarco Annular Spaca or Vault Sensor. Model: Tri Stale Piping SumplTrench Sensor(s). Model Tri State Fill Sump Sensor(s). . ModeL Mechanical Line Leak Detector, Model' Electronic Line Leak Detector. Model Tank Overfill I High-Level Sensor. Model: OPW Dispenser Containment Sensor(s). Model' , Sh~ar Valve(s). ()isponser ~o(1ta!nme!1t. Float(s) a~ C~aln(s) Other 5 . '. . . ui nt t .. and mOdel in Section E on P e 2 Zip 93301 330-7686 10/12/04 Tank ID' II 2 Plus In- Tank Gauging Probe. Annular Spece or Vault Senoor. Piping SumplTrench Sensor(s). FiU Swnp Sen~or(5). Mechanical Line Leak Detector, Electronic Line Leak Detector. Tank Overfill I High-Level Sensor. Dispenser Conteinment Sensor(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s) Other s ci ui ment t and model in Section E on Pe e 2 Tank ID In- Tank Gauging Probe. Annular Spaœ or Vaull Sensor Piping SumplTrench Sensor(s). Fill Sump Sensor(s). Mechanical Line Leak Detector. Electronic Line Leak Detector. Tank Overfill I Hlgh·Level Sensor. Dispenser Comeinmem Sensor(s). Shear Valve(s) Dispen&er Containment Floet(s) and Chain(s) Other s ui men, t and model in Section E on Pa e 2 Model: Model' Model: Gilbarco Tri State Tn State ~.1ode!: Modal: Model: Model: Model: OPW Model: ModeL Model' Model: Model: Model Model: Model C. Certlflclltion - I œrtify that the equipment identified In this dOCUment was inspectedl.erviœd in eCCOt'denœ with the manufecture(s gUideline. Aheched to this Certjficatl~n is information (e.g. manufacturers' checklists) necessary 10 verify that this intormetion is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating .uch reports, I have el.o ehached a copy of the report; (check all that apply) :' 0 Sy.tem set-up o Alarm history report Technician Name (print): Michael MoQre Cert.lUc No 562060899 Testing Company Name: Redwine Testing Serviœs, Inc. PhOne No _ ( 600) 582 -6368 Pa;;<l~"D Signature: --1Y\~~u VlVljllartY -;; 7 Monitor System Certfflcatlon Site Address: 600 34th Street, Bakersfield, CA 93301 Date of TestinglS8f\'icìng: 10/12/04 D, Results of Teatlng/Servlclng Software Version Installed: Gilbarco SIN 80247179B05003 No' N/A No' For pressurized piping sy.tems, does the turbine eutomatically shut down d the piping secondary conteinment N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) D SumpfTrench Sensors: 0 Dispenser Conteinment Sensors. Old ou confirm sitive shut-down due 10 leaks n sensor failure/disconnection? DYes' 0 No For tenk systems that utilize the monitoring system as the primary tank overfill warning device (Le no mechanical overti\\ prevention ....alve is ¡n~t8I1ed). is the overtill werning alarm vl,ible end audible al the tank fill point(') and o ratin ro rl? ff so at what rœnt of tank ca aClt does the alarm tri eO 90 % Was any monitoring equipment replaced? If yes, identify SpecifiC sensors, probes. or other equipment replaced and list the manufacturer name end model for all re laœment arts In Section E below No· \ß,Ja~ I¡q~id found ins;dð any ~&"...cndai)" coolairllnünt Systêfn:) d~sjgned a~ dry systems? (Cnecj( all tnBt apply) D' Product: 0 Water. ff es describe cau~. in Section E, below Yes No' Was monitonn . .tem sel-u reviewed 10 ensure ro r se«in s? A«ech sel u Yes No· Is all monitorin ui ent 0 rational manufacturer's s iflcallons? . In Section E below, dncribe how and when these deflclencl.. were or will be corrected. Is the audible alarm 0 rational? Is the visual alarm 0 rational? Were a\\ )en"Of' vi,u&\\),J.!:!~~~J~f)C\i~~~\),__\~~-,-~2...~..!!!!T'ed ~.~~9!}~1'1.____ "_ _. _ __. __0 _. .___~_ 0.__ _ _ n _ _ Were all sensors Instelled at lowest point of secondary containment and positioned so the! 01 tier equlpmenl will not interfere wilh their r r 0 ration? _ If alarms are relayed 10 a remote monltonng stet ion, is all communications equipment (e.g. modem) operational? N/A U__'__ ___0______ e, Comments: Category Form Serial # Super Tri State Piping Sump 0794380-208 247986 Tri State Annular 0794390-409 247018 R9Qular Tri State Piping Sump 0794380-208 498759 Tri State Annular 0794390-409 424649 Plus Tri State Piping Sump 0794380-208 248172 Tri State Annular 0794390-409 347016 Page 2 of 3 03101 .. Monitoring System Cer1lflcation Site AddreSs: 600 34th Street. Bakersfield. CA 93301 Date ot T estinQ/5eNiCino 10 1 121 04 F. In· Tank Gauging I SIR Equipment: o Check this box ~ tank gauging is used only for inventory control. o Check this box ~ no tank gauging or SIR equipment is installed. Thi. oection mu.t be completed if in-tank ¡¡auginç¡ equipment i. used to perform leak detection monitorin¡¡. Complete the rollowlng checklist: x Yes No' Has all ¡nout wirina been jnsoected for Droper entry and termination, includIng testjnQ for Qrown" faults? . Where "isible x Yes No' Were all tank oauaina orobes Vlsuallv Insoected for damaae and reSidue bUllduo? x Yes No' Wes eccuracv of svstem product level readino s tested? x Yes No' Was accuracv of svstem water level readinas tested? x Yes No' Were all crobes reinstalled orooerlv? x Yes No' Were all items on the eauioment manufacture(s maintenance checklist comoleted? . In the Section H, below, describe how and when theM deliciencln were or will be corrected. G. Line Leak Oetectol1l (LLO): IÐ Check this box ~ LLDs are not installed lete the followln checklist: e~ 0 or eqUlpmem start-up or annUð eqUIpment con lcatlon. was a ell 51mu at N/A (Check all that apply) Simulated leak rate' 0 3 g.p.h.; Do, g.p.h., No' Were all LLDs confirmed retional and accurate within r ulat No' Was the tesling apparatus properly calibrated? No' For mechanical LLDs, does the LLD restrict product flow ~ it detec'.s a leek? N/A No' For electronic LLDs. does the turbine automatically shut off ~ the LLD detects e leak? NJA No' For electronic LLDs, does the turbine automatically shut off ~ any portion of the monitoring system is disabled N/A or disconnected? No' F cr eleCIr<>nic LLDs. does the turbine automalically shut off ~ any portion of the monitoring system ma~unctions N/A or fails e test? No' For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Yes No' Were all items on the ui ment manufacture(s melntenance checklist com leted? . In the Section H, below, describe how and when theM deliclencln were or will be corrected. H. Commenta: Page 3 of 3 03101 UST Monitoring Site Plan '<00'-> \~0\:~ \~c-.\..<vs~,~~ , . t~ ~~30 I. ......\V', '\\~" ~ ,,' . . ~ . , . , . . . . . . . . ",.... .¡ . '/f'ø," . , ~~~: .-. ~ --.-..... . '. . . , . . ~.., .«; . . \! '~,. '. .. .. .. .. , . . \M~~l\ . ~\~~ ' . .'. . , .. ,.. . .~~' . . . . , .. . , .-, 1"- ,(::-ni:::¡¿? ' oJ....; ~ . , . , ~ · ..: .... ~." ......... ~"'6·· ...'"....; :,. ,....-. v~" . · ~', ;~\."::<2)? O· , '~í.J/t:,;. . 0,' , {., "7:' c. . ,:\ .~...~. , 7i..' \~~ . . ., . \,. ~'.:" ,.. . , , , . , . . . . . , . . . , &;\ ~,.:', Ie -':,' . , , . ;..~~' , ". . . ,~1 . ~~ "':.;?Ø1P' v' t: ' ; "Ov T' ~~":.' -%' ct· ·efjt;(Çv ,. f'.....·' · .Î c........ " ,..,. .r~.,.,... . -:; '..... ; ¡ i\:' . , 'O~_:~ . . . ·0" . \~. '\)' , , .('-' . . . .. " ",~ /..." C). ~ ,CL,', .PLv,s.,. '. . . \. ..' . ...ø."l..........-: .. ., 0 /'" :~, ;).'.., , , . '... ' .:1" . tr..~. ~il;:'f!>· \~~;~.. " f4;;i;~:- , ' r~l..' · ·fif,YÓU already ha~ I wagrara that shoWI aU required information, you may include it, rather than this page. with ,~ :ów- Monitoring System CertitiC4tkm, On your site plan, show the general layout of tanks and piping. Cla.rly '; ~:.,'. ' locations of the foUowing equipment, if installed: monhoring system control pttntJs; seD90T1 monitoring ~fp)c annular space1, 5WI1pJ, dispcoser pan.t, spill containers, or other secondary oont~t areu; It*~cal or ~ .~~...'. oiç line l~ .de«ectors; and in-tw hquid levcl probes (if used for leak detect10n). In the space provided. A~ the date thiJ Srte Plan was prq>&red. . ~'-:). ' "~)':".." \ ;:\:. ~f~. '" .. :.tr:~í: :' ~"~~. · :~~.<. Ii! 1'..1··.. .:~f...~·-.; ,p,!,:' . it-rw.:,. 'a--; . ~. :q (¡-, . r----t. .~, ...., , '. 'N' . ...c;, . -.r---r , .L-.J t=! , . , , .. IN . . , . Dee ~ ~ ~; JA! .xL1.2::J-. Instnlctions .. . " .--.,.. --' . - -- '.. . :0 . -R·ìghtFax 10/7/2004 10:29 PAGE 001/001 Fax Server 10/87/2884 08:45 6618363117 RE1),tIt£ TESTING SVCS PÞŒ. 82/02 -' CITY OF BAKERSFIELD OFFICE OF ENVIR.ONMENTAL SERVICES 171S Chester Ave.. Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION PACIurY Yað'~ ?,tJ.-.~ ~ mob,' AI)D~S~ ~~ ~y-+) ~k.er~.f'l~ltl) Ç..A £t3301 OPBRATORS NAME . L-.. OWNBRS NAME ' Mr Vðð NAMBOP MONrrOR MANUFACTtJ1lER b, I~,.(~ DOSS PAcn.rrV HA VB DISPENSER PANS? ¥6S_ v NO_ TANX , VOLl1ME CONTBNTS I JO~ --- ~ .. ' 0 .::.. :r3-Pl~~ .3 ... S~ ~ NAMBOPTBSTlNOCOMPANY~~l... \n-b~ t~û\t'Q) +I\L. CONTRACTORS UCENSB, ._~~r!2J7P A ij..A-z, NAME &. PHONE NUMBER OF CONTACT PERSON ~ -r lU'I\,r f.4,1· 6..J4.~~ DATE&TIMBT5ST IS TO BE CONDUCTED 10'" t.a.p"l- In;OD~ .J, [~M£) APPROVED BY 10-'-0'¡ DATE é 7VVl IONA nJR.B OF APPUCANT ../