HomeMy WebLinkAboutBUSINESS PLAN 10/21/2004
.Oct .El 04 02:51p
I \ ~ OÇT/ 21 ~ 20~3 13:29
~. ;
V'. ._ .. -..,.. . i .
\ .. ~
BKSFLD FIRE -eR~VE"TIOn
(661)852-2172
p. 1
p.2
, i
", ,'..'
(
" ,
, I
,¡ .
! ;~' .
~ ; /' ~ .,.
" ~ .;
.'"¥'
. ¡
. ;.. ~.
,
mY OF BJ\ICR1tSFIUI..D
OJFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., BabrsfieJd~ CA (661) 326-3979
. Q3301
: ,.
APPLICATION TO PERJi'ORM
FUEL MONITORING CERTIFICATION:
. · =~:;~ÇL7:r*:;¡('Ic.
, ,
i ~Tc>1tS~ .,U5 ç 1St'.> ft.A4.(
'O~~«. :L-tJ í- ,B~3foÑ: .
NAME~~'MoNlTORMANDPACTURER ,'Lt'_tAk/-I-
OOEsFÁCo:.rryBAVE~PÅNs? 'YBs~ NOL ~
....
, ,.
, . .'." .: J
TAMx. '
t
.,"J.'
vm.vMB
CONTBNTS '
I); éJc(
, .
, '
.-. .
:: 'I,
',:
"~~~~~MiY16-~*~ t:,</'MP,£~f.-Î
CQNI'RACTORSLICBNSB# ,. ¡t} /} ~·gOV} '- .
NAMB.PBONBNUMBEROFCONTACTPERSON 1)iM1 '¡'¡4.y'k-c../~ f't)f~ /(7) -7//</
DATB,& mœ TSST IS TO'BE CONDUC1P.D--.£2d: ;( ~ J..ò/.J·'1 í Ò r11r)
~<;f~~VL/b.~( ID/d;t-<I'1. ~~~
APPROVED BY DATE SlGNATURBOP APPUCANT
,
" :1
S13l1 ~9~'1 A- .~ jt)t/L fh Ii
, .
/ j . {i P'A. /¿c.t1 "'''-C
. . Ii [S -rr....¡r.
ùVtÎ.. ~ d 1I:..u"..
~
·f
I
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the SIale ofCa/ifomia
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 testing and servicing of monitoring equipment. A separate certification or report must be preparec
for each monitorinl! system control panel by the technician who performs the work. A copy of this form must be provided to the tanJ.
system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 3C
qays of test date.
A. General Information
Facility Name: lJ~ ~~..A-j
Site Address: 4ðtol l..,l~~ MA-f\e ~
Facility Contact Person: B. \~ L-ovt~
MakelModel of Monitoring System: ~~brlNwJ.
Bldg. No.:
City: gAW~'~ (r! Zip: ~3\3
Conµct Phone No.: (~v I ) ~~- 1;nDJ.
~ .(-c~iD ...IIi Date of Testing/Servicing: J.QJ Z2-/ P4-
B. Inventòry of Equipment Tested/Certified
Check the a ro riate boxes to iDdicate s 'fie e ui meut ius ectedls.:rvÍced:
Tank ID:
o In-Tank Gauging Probe. Model:"
o Annular Space or Vault Sensor. Model:
o Piping Sump / Trench Sensor(s). Madej:
o Fill Sump Sensor(s). Model:
o Mechanical Line Leak Detector. Mode!:
o Electronic Line Leak Detector. Model:
o Tank Overfill / High-Level Sensor. Model:
o Other s eci ui ment e and model in Section E on Pa e 2).
Tank ID:
o In-Tank Gauging Probe. Model:
o Annular Space or Vault Sensor. Model:
o Piping Sump / Trench Sensor(s). Model:
o Fill Sump Sensor(s). Model:
o Mechanical Line Leak Detector. Model:
o Electronic Line Leak Detector. Model:
o Tank Overfill / High-Level Sensor. Model:
o Other sec' e ui ment e and model in Section E on Pa e 2 .
TankID: C>I~
~ In-Tank Gauging Probe. Model: M~
o Annular Space or Vault Sensor. Model:
o Piping Sump / Trench Sensor(s). Model:
o Fill Sump Sensor(s). Model:
o Mechanical Line Leak Detector. Model:
o Electronic Line Leak Detector. Model:
o T~ Overfill / High-Level Sensor. Model:
o er sec' e ui ment e and model in Section E an Pa e 2.
TaQk ID:
o In-Tank Gauging Probe. Model:
o Annular Space or Vault Sensor. Model:
o Piping Sump / Trench Sensor(s). Model:
q Fill Sump Sc:nsor(s). Model:
o Mechanical Line Leak Detector. Model:
o Electronic Line Leak Detector. Model:
o Tank Overfill / High-Level Sensor. Model:
o Otber sec' e ui ment e and model in Section Eon P e 2.
Dispenser ill:.
o Dispenser Containment Sensor(s). Model:
o Shear Valve(s).
o Di ensc:r Containment Flo s and Chain s .
Dispenser ID:
Q Dispenser Containment Sensor(s). Model:
o Shear Valve(s).
o Dis cnser Containment Float s and Chain s .
Dispenser ID:
o Dispenser ContAinment Sensor(s). Model:
o Shear Valve(s).
DDis enser Containment Flo s and s .
-If the facility contains more tanks or dispensers, copy tbis form.
Dispenser ID:
o Dispenser Containment Scnsor(s). Model:
o Shear Valve(s).
o D' enser Containment Floa s and Chain(s).
Dispenser ID:
o Dispenser Containment Sensor(s). Model:
o ShearValve(s).
o Di enser Containment Flo s) and Chain s).
Dispenser ID:
o Dispenser Containment Sensor(s). Model:
o Shear Valve(s).
o Dis ensc:r Containment Flo s 'and Chain(s).
lncludc.information for every tank and dispenser at tbe facility.
C. Certification - I certify that the equipment identified in this document was inspected/servi e
guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) c
correct and a Plot Plan showing the layout of monitoring equipment. For any equi
attached a copy ofthe report; (check an tha! apply): 0 System set-up 0 A a
Technician Name (print): _Ed McKee Signature:
..-
Certification No.:
License. No.:
A738065
Phone No.:C760_)_956-0024
Date of Testing/Servicing: ,) 0/ [;2../0+-
")
Testing Company Name: _Tri-State Environmental
Site AddreSs: ~pl¿""l$Þr-' 'Mo,.,('\.t--a
Page 1 0(3
03/01
Monitoring System Certification
D~ Results of Testing/Servicing
Software Version Installed:
-----
Com lete the folIowin checklist:
. Yes D No· Is the audible alarm 0 erational?
Yes D No· Is the visual alarm 0 erational?
t8 Yes D No· Were all sensors visuall ins ected, functionall tested, and confmned 0 erational? I
m Yes a No'" Were all sensors installed at lowest point of secondary containment and positioned so that other equipment wi]]
not interfere with their ro er 0 eration?
a Yes D No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem)
œa N/ A operational?
a Yes a No* For pressurized piping systems, does the turbine automatica]]y shut down if the piping secondary containment
o 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) a Swnp/Trench Sensors; 0 Dispenser Containment Sensors.
Did ou confmn ositive shut-down due to leaks and sensor failure/disconnection? 0 Yes; a No.
DYes D No· For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no
œ N/ A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank
fill oint(s and 0 eratin ro erl ? If so, at what ercent of tank ca aci does the alarm tri aer? %
o Yes· III No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced
and list the manufacturer name and model for all re lacement arts in Section E, below.
o Yes· III No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) 0
Product; 0 Water. If es, describe causes in Section E, below.
II Yes D No· Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u
18 Yes 0 No· Is all monitorin e ui ment erational er manufacturer's s ecifications?
* In Section E below, describe how and when these deficiencies were or will be corrected.
E. Comments:
+'
fr',,,,,kr
\~ Y\O;-
lI\)()r~ \'\'J
Page 2 of3
()3/() 1
F. In-Tank Gauging / SIR Equipment:
a Check this box if tank gauging is used only for inventory control.
a 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.
c
b t: II
b !d'
I~
I
I
ompJete t e 0 owme: c ec 1St:
8 Yes 0 No· Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
r.a Yes a No· Were all tank gauging probes visually inspected for damage and residue buildup?
a Yes 4iI No· W'a}) accuracy of system product level readings tested?
DYes . No· Was accuracy of system water I~vel reap.ings tested? .
. Yes a No· Were all probes reinstalled properly?
..
II Yes a 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 this box if LLDs are not installed.
c
b f, 11
kl
omPlete t e 0 owme: chec ist:
DYes 0 No· For equipment start-up or annual equipment certification, was a leak simulated to verifY LLD performance?
a N/A (Check all that apply) Simulated leak rate: 03 g.p.h.; 0 0.1 g.p.h; 0 0.2 g.p.h.
DYes a No· Were all LLDs confmned operational and accurate within regulatory requirements?
a Yes a No· Was the testing apparatus properly calibrated?
DYes a No· For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
a N/A
I:) Yes I:) No· F or electronic LLDs, does the turbine automaticaIly shut off if the LLD detects· a leak?
o N/A
DYes a No· For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
o N/A or disconnected?
a Yes a No'" For electronic LLDs, does the turbine automaticaIly shut off if any portion of the monitoring system malfunctions
o N/A or fails a test?
I:) Yes o No'" For electronic LLDs, have all accessible wiring connections been visuaIly inspected?
a N/A
a Yes a No· Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe bow and when these deficiencies were or will be corrected.
H. Comments:
~ I _ .f?vb l6 '\'\0 t- I¡\JOr\vl\tl~ - ~'Ò'I\{V"'€.AAl ('<:f>(~"'lj
~~. tÝ tvv· ~~ ~~ ~e- +~4-+- l<'.
û· ~..lÞ- ,( 7Vl'~· V\.V~ ( Ù'r':.~~~· \ ~ v Scz.- )
Page 3 o{3
03/01
MONITORING 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 fonn must be used to document testing and servicing of monitoring equipment. A separate certification or report must be preparec
for each monitoring system control panel by the technician who perfonns the work. A copy of this fonn must be provided to the tan].
system owner/operator. The owner/operator must submit a copy of this fonn to the local agency regulating UST systems within 3C
qays of test date.
A. General Information (/ _ ( .
Facility Name: (j~ç , 1::>e..'>kW"~
Site Address: .410( L. \oG~ VV\Arl e C-t-.
Facility Contact Person: gc\ ÄI\ ~
MakeIModel of Monitoring System: l.£..~ Allj""+-
B. Inventory of Equipment Tested/Certified
Check the a ro riate boxes to indicatc s 'fie; e ui ment ins ec:tedfscrviccd:
Bldg. No.:
City: GÞ-\¿~r{~J. Zip: ~~S lZ
Contact Phone No.: (~( ) ~O¡~ - e¡;'1D3.
0Þr--O~ Date of Testing/Servicing: 1!Lr22 /~
Tank ill: D\~
o In-Tank Gauging Probe. Model:
It Annular Space or Vault Sensor. Model: lAH", 6
II) Piping Sump / Trench Sensor(s). Model: 8 ~+
o Fill Sump Sensor{s). Model:
. Mechanical Line Leak Detector. Model: ~ J ,,-"-r
o Electronic Line Leak Detector. Model:
o T31}k Overfill / High-Level Sensor. Model:
1:1 er s eci e ui ment e and model in Section E an P e 2 .
Tank ill:
o In-Tank Gauging Probe. Model:
o Annular Space or Vault Sensor. Model:
a Piping Sump / Trench Sensor(s). Model:
q Fill Sump Scnsor{s). Model:
o Mechanical Line Leak Detector. Model:
1:1 Electronic Line Leak Detector. Model:
o Tank Overfill / High-Level Sensor. Model:
o Other s ec' e ui ment e and model in Section E on P e 2 .
Dispenser ID: Q\ß~
. Dispenser Containment Sensor(s). Model: ~
.. Shear Valve(s).
. Di ser Containment
Dispenser ID: ~- ~.
\It Dispenser Containment Sensor{s). Model: 1"i2....t='
G Shear Valve(s).
.. Dis enser Containment
Dispenser ill:
o Dispenser ContaiIÙI1ent Sensor{s). Model:
o Shear Valve(s).
ODis enser Containment Flo s and s .
·If the facility contains more tanks or dispensers, copy this form.
Tank ill:
o In-Tank Gauging Probe. Model:"
o Annular Space or Vault Sensor. Model:
o Piping Sump / Trench Sensor{s). Model:
o Fill Sump Sensor{s). Model:
o Mechanical Line Leak: Detector. Model:
o Electronic Line Leak Detector. Model:
o Tank Overfill / High-Level Sensor. Model:
o Other s eci ui ment e and model in Section E on Pa e 2 .
Tank ID:
o In-Tank Gauging Probe. Model:
o AnnuJar Space or Vault Sensor. Model:
o Piping Sump / Trench Sensor(s). Model:
o Fill Sump Sensor(s). Model:
o Mechanical Line Leak Detector. Model:
o Electronic Line Leak Detector. ModeJ:
o Tank Overfill I High-Level Sensor. Model:
o Other s eci e ui ment e and model in Section E on Pa e 2).
Dispenser ID:
o Dispenser Containment Sensor{s). Model:
o Shear Valve(s).
o D' enser Containment Floa s) and Chain(s).
Dispenser ID:
o Dispenser Containment Sensor{s). Model:
o Shear Valve(s).
o Dis enser Containment Flo s) and Chain s .
Dispenser ill:
a Dispenser Contairunent Sensor(s). Model:
o Shear Valve(s).
o Dis enser Containment Flo s 'and Chain(s .
Include information for every tank and dis enscr at the facility.
C. Certification - I certify that the equipment identified in this document was inspededlservic
guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) ne s ry
correctand a Plot Plan sbowing the layout of monitoring equipment. For any equipm ca a Ie 0
attached a copy of the report; (check all thaJ apply): (J System set-up (J Alarm h t
Technician Name (print): _Ed McKee Signature:
Certification No.:
oz.-o gOD
Testing Company Name: _Tri-State Environmental
Site AddreSs: ~t vl~þ MJ}..[ e.
License. No.: _A738065
Phone No.:C760_)_956-0024
Date of resting/Servicing: (0 /?:ZJ ðt/-
vk-
Monitoring System Certification
Page 1 of3
03/01
3
D'. Results of T estinglServicing
Software Version installed:
..-
\
¥
Com lete the followin checklist:
. Yes D No· Is the audible alann 0 erational?
Yes D No· Is the visual alarm 0 erational?
" Yes D No" W ere all sensors visuall ms ected, functionall tested, and coníirmed 0 erational?
o Yes D No· Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their ro er 0 eration?
If alanns are relayed to a remote monitoring station, is all commw1Ìcations equipment (e.g. modem)
operational?
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 mitiate
positive shut-down? (Check all that apply) a Swnp/Trench Sensors; IIJ Dispenser Containment Sensors.
Did au confmn ositive shut-down due to leaks and sensor failure/disconnection? Ell Yes; D No.
D No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no
ç N/ A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank
till oint s and 0 eratin ro erl ? If so, at what ereent of tank ca aci does the alarm tri oer? %
Was any monitoring equipment replaced? If yes, identity specific sensors, probes, or otber equipment replaced
and list the manufacturer name and model for all re lacement arts in Section E, below.
Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) GI
Product; D Water. If es, describe causes in Section E, below.
it Yes D No· Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u
. Yes D No· Is all monitorin e ui ment erational er manufacturer's s ecifications?
* In Section E below, describe how and when these deficiencies were or will be corrected.
DYes
D No*
~ N/A
D No*
D N/A
. Yes
a Yes
DYes·
~ No
. Yes"
o No
J~ L-..._ _ d_1
E. Comments: ~ ~.....-oY\e./ ()/~
~'vzl~ f~ß;.~~(
ptJLJv\ 1 ll.A
~V\Ap -- 1Uw~!...L £''1
Page 2 of3
03/01
F. In-Tank Gauging / SIR Equipment:
o Check this box ¡ftank gauging is used only for inventory control.
.. 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.
c
th ~ II
h kJ' t
omp ete e 0 owm~ c ec IS :
0 Yes CJ No· Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
0 .Yes 0 No· Were all tank gauging probes visually inspected for damage and residue buildup?
0 Yes 0 No· Was accuracy of system product level readings tested?
0 Yes 0 No· Was accuracy of system water level readings tested?
0 Yes 0 No· Were all probes reinstalled properly?
-
0 Yes 0 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):
Check this box ifLLDs are not installed.
c
h f, II
h kJ'
ompJete t e 0 owml! c ec 1St:
. Yes o No· For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
o N/A (Check all that apply) Simulated leak rate: .3 g.p.h.; 0 0.1 g.p.h; 0 0.2 g.p.h.
.
.. Yes 0 No· Were all LLDs confirmed operational and accurate within regulatory requirements?
Q Yes 0 No· Was the testing apparatus properly calibrated?
@II Yes o No· For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
o N/A
0 Yes o No· For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
II N/A
0 Yes o No· For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
III N/A or disconnected?
0 Yes o No· For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions
III N/ A or fails a test?
0 Yes 0 No· For electronic LLDs, have all accessible wiring connections been visually inspected?
ill N/A
.. Yes 0 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.
H. Comments:
.(,... .;.'-- ,~".
Page 3 oC 3
03/01
~
Tri..State Environmental
Fill/Spill Bucket Test Form
DATE IO'-Þ"2--of-
Facility Name U~ p.- ~æ~~~
Address k1o! LA-SA- \M~\e- ~.A-,
City, State, Zip
~~rt~CJ~) C4- O¡~$':S
15 Min. Visual Inspection
I ! r I I I I i I
I Type i" 'll I ¡ I II ¡ ¡'
In I I' I
I I I II I I I I
I I I f--I I
I I I. II. I I I
I I I·
I I I I
L I' .
I L____ __J I L_-,-.__J
Pass/
Fail
I
Ipþ-~
1
Comments
11100 Bear Vatley Rd., PMB 320 Vietorville, Ca. 9Z39Z 1-760-956-0024
r~-----------------------~----------------------------- --1
I
I
,,"'--- '... I
I~;' "'\ :
" , I
( 'KÞ
. I I
\ / I
\ I I
" ;'~ I
'.....~____ oJ' I
I
, I
__________ ______________________~___~_______________ ___J
~;-. l'
~
bine Sump
"-_/
Dispenser
ATG
,
... !
. ,-
o·
....,... """
Annular Space
\
PS III
ßêlJl/jJUIJV
Fú/rJ y .511t-' T·CJ ¡: ¡=
Sj;N.j " ~
Fill ump
\
LA - 04
Shop .
USF Bestway
, ~v 490 Lisa Marie Ct.
'Bakersfield