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Home My WebLink AboutBUSINESS PLAN ~ - 11/22/2004 12:37 6613252529 CAL VALLEY PAGE 02 I' I;: ! . . MONITORING SystEM CERTIFICATION For Use BJ1 All Jurúdlctioit/withi" the State ofCalilornia A uthOl'iiy Cited: Chapter 6.7, Health and Sa/eo' Code; Chapter 16, Division J. Titfe' J3, CallfornlQ Code of Regu/r,uo1lS Thi~ form must be used to document testing and sçrvlelng of monitoring equipment. A·.separate certification or reDort must be prepared for each monitoring system control panel by the technician who petf'onns the work. A copy of this fonn must be provided to the tank system owner/operator. The owner/operator m~ submit a c;opy of this fonn to the local agency regulating UST systems within 30 days of test date. A. General Information Facility NóIomB: -Vt\.It.<. - (;.et..J Site Address: 2.SDo W/q.,'J..t Lh Facility Contact Penon: MóIokeIMocJel of Monitoring System: /L<.edðll' -JtOtJ r ("I..S-:15b B. Inventory of Equipment TèstedlCertified Check the Appro riaCc: hOlla to IndlClCe s~c:lfic: e lIipmenC In3pectedlsc:rvieed: ' TanlllD: I "'7 T.nk ID: 'f~ .!Iln-Tan1c. Gauging Probe. Model: htc.ø. I)ln-TBllk Qt\l,Iging Probe. Model: fHQ.~· 21 ÅPtlular Space or Vault Sensor. Model: _ Qt'Annlllar Space or Valllt'Scnsor. Model: ..rr'«cl ~.K' rt"Ir'-." ~ Piping Sump I Trench Sensor(s). Model: ..r",., f' ~~;bfl"" lit Pipin& Sump I Trench Sensor(s). Model: ~, ~L Id.'" C Fill Sump Scnsor(s). Model: 0 Fill Sump Sensor(s). Model: Q Mc:chaniçaJ Line Leak Detector. Mode:I: IJ Mec:nlll1ical Linc: Lc:ak Octcctor. Model: C Electronic: Line Leak Detççtor. Model: Q Electronic Line Leak Detector. Mode:l: Q Tank Overfill I High-Level Sensor. Model: .IJ T.nIc Overfill/ Hj¡h-Lçyçl Sm:lot. Model: C Other s ceifi c: ui mc:nt t c and mode] In Section Eon P 2). [J Other (s)eelfy ui menllypc III1d model În Seelion R (In Page 2)- TanklD: TanklD: Qlln-Tank Oauglng Probe:. Model: M4." .1:1 In-Tank Gauging Probe. Model: ~ AtlnuJar Space or Vault Sensor. Model: 5Þ.~$thr"r . IJ Annular Space or Vault Sensor. Model: ~ Piping Sump I Trench Sensor(s). Model: SWf..¡1 .:r....I.J~.,. a Piping Sump / Trcnch Sensor(s). Model: I:J pm Sump ScnBor(s). Model: a Pili Sump 5cnsot(s). Model: I:J Mechanical Lim: Leak Detector. Model: 0 McehBIIlçp Litle Le!lk '/)ctoccor, Modol: o Blççlronil; Line Lçak Dclcçtor. Model: C Elcçtroniç Line Leak DOLQÇ\or. Model: o Tank Overfill / Hi¡h-Lcvcl Scnsor. Model: IJ Tank Ovot(jlll High-Leycl Sensor. Model: C Other (specify equipment typc and model În Section E on Page 2). CJ OthGl' S Ify cqui mcnt type and modcl in SCCl.ion Eon pa.go 2). Dispenser 10: /-2- Dlspcnscr 10: "7--8'- QJ.. Dispenser Cont.,inmcnt Scn~r(s). Model: Sw.,.,' ,StR.J'oll' }II Dispenser Con1.llinrnenC SensoT(s). Model: .s"t..c4~" SelVDc, Q Shear VDlvc(s). Q Shear Vnlvc(s). ---.-.- o Dispenser Containment Ploat s and Chain s . a Dls enser Containment Float(s and Chain ; . Dbpensc:r 10: '1- V Dlspcnscr ID: ~ DispelUC/' ConlainmenrSensor(s). Model: J",,..,ø 'soCltJ'I" 0 Dispenser Containment Sçnsor(s). Model: iil Shear VaJvc(s). a Shear Valve(s). I:J Dis3enKr Conlainment Float(s) and Chain(s). a Dis enscr Conlainmcnt Float(s) and Chain s). Dispenser·ID: ~- Dispenser 10: fS Di,¡)cn$CfConlainmcnt Sc:nsor(s). Model: ,S(,...".¡i1J""',.,.. a Dispenser Containment Sensor(s). Modol: fii. Shear Valvc(JI). a Shear Valvc(s). em! sçr Containment Flœl(s) and Chain(s). a Dis e:nser Containmcnl J7loat s IInd Chain s). ·Ifthe fhclllt)' contains more lanks or dispensers, e:opy this IOm1. Inc ude information for e\lery tønk and dispenser at ( e facility. C. Certification - J terti!)' that tile equipment identified in this document was in~pcCCed/,.rvic:ed in accordance with the mlallllrac:tllrors' guidelines. Act8clu:d to tllil Certification is inform"tio" (0.1:. mqnufacturcrs' chccklists) neccssary to verify tbal thlA Inrorm~tlon Is c:orrecc IInd D Plot Plan showin!: the laYOllt of monitoring equipment. For Iny equipment capable of generating slleh reports, I have also attached a copy of th. report; (ch«lc ail thllt tlPply): Q System sct~up ÇJ Ahu·m history rcport Technician Name (print): ßY"t..L..C£_. fh'h.r It!~ ' Slgflature: ~#-.. 4- 1bJ~ Certification No.: Sb'#S""¿¡Y7f License. No.: 78''117''- AH/J'z Testing Company Name: Ca.I-~A//~1o£.o é.z:"ð!h1e~, ,; : Phone NO.:(6.:U ) 32. 7-9'J.:!t Site Address: ·2 S"Oil 14a!r1t.' li,. &k~,.rf1.t:l,lf.i ç~. Date Qf Tcstln8lServiçing/Q~flj?9.J!!!L II' ':õ: ': Ip'~~ ~ O~3 , : City: ~ e.1íJ.-!t'tM Contact Phone No.: ( ) Date ofTestingfServlclng: Æ §.j /2.5!.. Bldg. No.: Zip: r9JYo7 Monitoring System CerllncaClon 01/01 -¡; t 11/22/2004 12:37 6613252529 CAL VALLEV PAGE 03 ¡ " I I: ¡, D. R~sults of Testing/Servicing " !i Software Version Installed: Com lete the folJowing (!hccklist~ Yes C No· b the audible alarm operational? Uit Yes C No· Is the visual alann 0 nstiona 1 YI!$ C No Were al1lensors visually inspected, functionally tested, an confirmed 0 Wltiotlsl? C}iI Yes C No· Were all sensors Installed at lowest point of secondary containment and positioned so that other equipment will not ínterfere with their proper operation? If alanns are relayed to a remote monitorin¡ station, IS all communication.s equipment (e.g. modem) operational? For pressurized piping systems, docs the turbine automatically s ut own If the piping lèCondary containment monitoring system detects lit leak, fails to ope~, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Child all thaI apply) I5J.SumplTrench ~nsors: .Dispenser Containment Sensors. Did you continu ositive snut-down due to leaks and sensor failure/disconnection? .a-Yes; Q No. eYes [J No' For tank systems that uti Iz.e e monitoringsyscem OS the primary tank overfill warning device (I.e. no ßiJ N/A mechanical overfill prevention valve Is installed), is U\e overfill warning alarm visible and audible at the tank fill point(s) êlnd operating to crly? If 80, at what orc;cnt of tank capacl doeS the alarm trigger? % Was any monitoring equipment replac " I . yes, identitY specific sensors, probes, or other equipment replaced and list the manuraçturcr name Bnd mode. for all re I..cement parts in Section B, below. Was liquId foun inside any secondary contamment systems desigöcd as dry systems? (ChllCk all thDt apply) C Product; a Water. tr es, desçribe causes in Section B, below. lit. Yes 0 No'" Was monitorin stem set-u review to ensure pro er settin ? Attach'set up reports, ir applicable Yes IJ No· Is all monitoring equipment operational per manufacturer's specifications? · In Sec:tiOD E below, describe how and when these deficiencies were or wUl be corrected. No· NIA C No· C N/A [J Yes· ~ No Q Yes· tiI No E. Comments: --- :'1. , . '.' J, ~ i!· ;'~i;": : ;. !,"IBe % of 3 :: i : !; I';ï 03/01 {) .. ... 11/22/2004 12:37 6613252529 CAL VALLEY PAGE 04 F. tn-Tank Gauging I SIR Equipment: . ,; I' I." '~. ¿heck this box if tank aauging is used only for in\lentory control. a Check this box ifno tank gauging or SIR equipment is installed. " This section must be completed ifin-tank. gauging equipment is used to perfoml. leak detection monitoring. Complete tbe rol1owlng checklist: 13 Yes a No· Has all input wiring been inspected for proper entry and termination, including testing fot ground faults? ~Ye$ I;J No· Were a1l tank gauging probes visually Lnspected for damage and residue buildup? p Yes C No· Was accuracy of øysteJn product level reaóín&t tested? iii Yes a No· Was accuracy of system water level readings .tested? 12' Yos a No' Were all probes reinstalled properly? .B Yes a No· Were all Items on the equipment manl1facturer's maintenance checklist completed? .. In the Section H, below. descrIbe bow and wilen tbese detideneies were or will be corrected. G. Line Leak Detec:tors (LLD): fill ~eck this box IfLLDs are not installed. Complete the 0 owlnR checklist: : .' C Yes C No· For equipment start-up or annual equipment, certification, was ø leak simulated to verity LLD performance? [J NI A (Ched all that apply) Simulated leak tate: C 31.P.h.; C 0.1 g.p.h; C 0.2 ¡.p.h. , [J Yes C No. Were all LLDs confinned operationa1 BUeI accurate within regulatory requirements? Q Yes C No· Was the testing apparatus properly cahDn~cn a Yes a No· For mechanical LLDs, does the LLD restrict product flow ifit dctec:ts a leak? (J N/A .. eyes a No· For electronic LLDs, does the turbine ~atíClI1ly ahut off if the LLD detects a leak? [J N/A . l, I;J Yes [J No· For electronic LLDs, does the turolnc automaticillly shut off jf aT'l)' portion Df the monitoring system i. disabled a N/A or disconnected? £:I Yes [J No· For electronic LLDs, does the turbine automatically shut ofT ìf any portion of the monitoring system [J NIA malfunctions or fails a test? a Yes a No· FDr electronic LLDs, have all accenible wiring connections been visually il1specleâ? [J NI A eyes C No. Were all items on the equipment manufàçturet"s mamteDBnCe checklist completed? .. In the Section H, below. describe how and when these dcfidtDeles wore or will be corrected. H. Comments: -_..-. '.. 1__.- . . . . I ~ I pa~~~~f3"i , I¡" I 'f!: ! ! i:' : . i . ~ f -----.. 0.1101