Loading...
HomeMy WebLinkAboutBUSINESS PLAN (4) Û' d'; .. .' 'ô 12/07/2004 11:13 6613252529 CAL VALLEY PAGE 02 MONITORING SYSTEM CERTIFICA TION For Use 0)1 AII.lul"ìsdit;tlo1l!¡ Within Ihr: Stale OICo/ij"nrlfia Authority Cited: Chapter 6. ï, Health and Safety Cnde; Chapter /(" Division 3. 7ïlle 23. California Code o[ Re~ (la"'on$ This ronn must he used to document testing and $el'VicJng of monitoring equipment. A separ~lC certificatiun or te )()tt must be prepared for each monitor;ni! system control panel by the technician who performs the work. A copy oflhis form must be provided to lhe tank system owner/operator. The owner/operator must submit a copy of this forrn to the local agency regulating lJST systems within 30 days of test date. A. General Information Facility Name: -9..~~ ç" /'1-1c.vX'f,¡ Sltc Address: -~lE:. Facility Contact Pel'$on: Make/Model of Monitoring System: -11!&.bLSh(~ B. Inventory of Equipm~nt Tested/Certified Check tile approprillte be;rcs 10 indleøte specilic equípmenl ¡n,peeled/servieed: TRn~JD:---1--~ 1j In-Tank GaLlging Probe. Model:~ ~ Arlnular Space or VAult Sensor. Model: ~~~L- ~ Piping SLimp I Trench Sensor(s). Model: _fM.. S,"",f.{J... o Fill Sump 5en$0I'(s). Model: ~ Mecbanleal Line Leak Detector. Model: -.iJJJ IJ J;leclrooJc Line teak DctcclQr. Model:_ [J Tnnk Overfill / High-(..çvcl Sensor, Model: [J Other (~ecify equipment type and model in Section E on Pa.ge 2). TAnk JD: '2 «7 II In-lanl( Gaugin(t Probe. Model: ...:1J..oo GI Annular Spacc or Veult Sensor, Model; Ske' "/'ithK ~ I!jl Piping Sump / Trench SeJ1$Or(s). Model: .F/øø.r- SÛ1~t. Q Fill Slimp Scnsor(s). Model: 'It Mechanical Line Leak Detector. l\Ifodel: ~~ L 0 [J Electronic Line IJc:aJc Detector. Modol: o Tank Overfill/ I hih-Level SCD$Or, Model:_ o Othcr~ccilY equipment type altd model in Section £ on Page 2). Dispenser )1>: -.-1..: ~ Qil Dispenser Contalnmenl Sensor(s). Model: ß~~I'~"''' ¥,~ ~lo qi Shear Valvc(s). [J Dispenser Con1ainmcnl Ploal(s) and Chain(s). Dispcnser ID: _ ..2.... -. _ Oil Dispenser Con1ainmçnt Sensor(s). MOdel; Ltr.."-'r~_ ~-'- II Shear Valve(!!). C D~nset Conlainment Float(s) and Chain(s). DispcnSOf 10; ~ '___~ Ii Dispenser Conlair1ntanl Sensor(s). Model; .lJJ:s.t....dh...... .....~_" Q1 Shear Valvc(s). [Jl)ilipenscr COntainmcnl Ploags) atJd Chnin(,¡). Bldg. No.:_, _ Cil'y: -1i~~&ú£.__ Zip: _._.__ Contact Phone No.: L _)_ '- Date of Testing/Servicing; iLl 21 /Jl.Z_ - Tank 10: '__'_ [J In·Taltk Gauging Probe, Model:_ C Annular Space or VauJl Sensor. Model: _ C Piping Sump / Trench Sensor(s). Modcl: _. o Fill Sump Sensor(s). Model: ____ [J Mechanical Line Leak Dcteclor, Model: C Electronic Lint Leak Detector, Model: I:J Tank Overl111 I I-ligh-Levcl Sensor. Model; CJ Other ~ceify cquiprncnl type And model in Section E on Page 2), Tank ID: ._.__ C In-Tank Gauging ~robc, Model: __, o Annular Space Or ValJlt Sensor. Model: C Piping Sump / Ttc:nch Scn~l)r(s). Model; o FIJI Sump Sc:nsot(s). Model: C Mecllllllical Line Leak Deteçtor. Moder; o Elcctronic Line r.çaJc Detector, Model; ,,__ C Tank OverfiU I High-I,cvel Sensor. Model:__ C Other (specify equipment l}'pe and model in Section E On Page 2). Dispenser lD: _ .£:: , œ Oispenser C"ntainlTlcnt Scnsor(s). Model: 1l:~!!;~!,,~44 ti%-~'" ÿ¡ Shear Valve(s). o Dispenser ConlaJ/lmcnt Floal(s) and Chain(s). Dispenser ID:_ (J Dispenser ConlRlnmçnt Scnsor(s). Model: _ '____ [J Shear Valve(s). o Dispenser COnlainmcl1t Float(s) and Chaln(s). Ðispenser 10;. ___ C Disj'lenser Contnil1menl Scnsor(s). Model:. __ '__._ C Shoar Valvc(s), C Di~cl1SCr Containment l'loat(s) and Cllain(s), - 'lIlhe facility contains mOre tanks or dispenser!!, cory this form. Include mfol'ltlFltJon for O\'cl}' tanl; and dIspenser at the facility. C. Certification - I certif)' thAt the equipment identified in this document w:.s inspected/serviced In accordance witJl the mAnufaeturers' gUidellqos. Attached to this CertificAtion is information (e.g. ßlanuractllrers' checldlsb) neec:ssar)' to verify that this, inforraation i. correct Rlld a Plot Plan JhowinR the InyoQt of molt Îtorhll ' equipment. For any eCJulprnont capable of g8nerlltlng Jlnch reports, I hrwe also attachod a copy ortlle ropOrt; (cht!ck hi! .hal QPpl}~: 0 System set-up Q Alarm history report Technician Name (print): ß~t.u:~---'6.kfL~ Signature: ~_ """- ~~ ' Certification No.: _~~iY '.__. Lice:nse. No.: _?ffI7~H#L____ Testing Company Name: ÝJ::Jt~J/~á..~.l.t!l.t:!_Þh7' _ '_...._. Phone No.:( G "'_) :12 7-'!.J ~/ Sile Address; _l'-P!..fi 1A:c.J:uJL~~I5W£6.:.:e./ K/ ~. _,_. _, Date ofTcs1ing/Scrvicing: .!LI_2.J 1.£.,.,... Monitoring System çc:rtiOcation Pagc 1 or" 03/01 " ,~ õ' O· 12/0712004 11: 13 6613252529 CAL VALLEY PAGE 03 D. Results of Testing/Servjcin2 Software Version Installed: -.-------..- Complete the rollowlng tbeckli.~t: ~'Ycs o No. Js the audible alann oporational? IjJ Yes [J No· Is the visual alarm operational? , iii Yes I:J No. Were all sensors visually in..~pected, functionally tested, and confirmed operational? I¡i) Yes o No· Were all sensors Installed Elt lowest point of seeondary containment and positioned So that other equipment will not interfere with their proper operation? [J Yes [J No· If alanns arc relayed to a remote monitoring station, is all communicÐtions equipment (e.g. modem) iii N/A operational? (J Yes .I{' No· For preSl;urized piping systems, does the turbine ilutomatically shut down ifthe piping secondary cmuainmcnt o N/A monitoring system detects a leak, fans to operate, or is electrically disconnected? Iryes: whlçh sensors initiate positive Shut-down? (Cheç/( all thot opply) (J SumplTrench Sensors; 1:1 Dispenser Containment Sensor!!. Did you confirm ~ositivf) shut-down due to leaks and sensor failurcldisconnection? Q Yes; 0 No. Q YCs [J No· For tank systems that utilil:e the monitoring system as the primary tank overfill warning device (i.e. no Iir Nt A mechanical overfill preVention valve is installed), is the overfill warning alarm visible and audible at the tank till poin!{.~) and openning pr~erly? tf so, 8t what percent of tank capacity does the alann trjgger? % Q Yes· !XI No Was any monitoring equipment replaced? ff yes, Identify specific sensors, probes. or other cqulpmetlt replaced and list tbe manufacturer name and model for all replacement pans in Section E, below. 1:1 Yes" 1.Iit, No Was lìquid found inside any secondary containment systems designed as dry systems? (Check. all that appi)l) o Product; 0 Water_ If~es, dc.scrlbc causes in Section E, below. Ia Yes 1:1 No· Was monitoring system set·up reviewed to ensure: proper settil!i!7 Attach set ~ teports, if applicable J! Yes a No· Is all monitorit!lcquipment operational per manufacturer's specifications? .. In Sedlon E below, dcserlbe how and wbcn these defielenclu were or wllJ be corrected. E. Comments: rl..c.~h h.f .se.I-7Jï~Jio"" -Æh~. ~bJJ,tf!.j ~1vkJ.1 L~4\K déf~(h.KL -ÌJ:Lf.MePl IJ-9-~_____. '___ -"-'-- '--.- ---..-..- .-- '--'--- -------.----.-.. -.---...-- "'--- '-.-. -.- ---..--.-.--- --- 4__. .-.-- ----..-.. -'---. ----.-. '-'- -.-.--- ---- -þ-- .-.----.- ---- ---.-- ..----....-...----.--.--.---.- -._--- --', .-. .-.--'---.--.-...--- -- ----- -- ..- '-.--. --.-.-- -------- .-...---------- --'. --'-" -- --- .--..- '-'-"--'--'- - ----- --.---. -.._-- --.-...--- .,--. ..'--.-------..- - .----.---.---... .-.~---_.._-- --'-..- ..--.... ..----.------....-...-..-- PAg" l IIf J 1\3/0' '. -,.,,-;~~ ,:;~ 12/0712004 11: 13 6613252529 CAL VALLEY PAGE 04 F. 10- Tank Gauging I SIR Equipment: iii Check this box if tank gau&ing is lIsed only for inventory COI'trol. Q Check this box ¡fno tank gauging Or SIR equipment is installed. Complete the (ollowing checklist: This section must be completed ifin-tank gauging equipment is used to perform leak deteétion In()l1ilorjng. [J Yes Q No' Has all input wiring been inspected for proper entry and termination, including testi", for ground raulls? DYes 0 No' Were all tank gauging probes vi5uaIJy inspected for damage and residue buildup? CJ Yes CJ No. Was accuracy of system produet level readings tested? DYes o No' Was accuracy of system water Icvel reading.~ tested? [J Yes [J No' Wen: all probes reinstalled properly? o Yes [J No· Were all items on the equipment manuractul'er's maintenance checklist completed? · In the Section If, below, descdbc how and when these deßciencies were or wiD be corrected. G. Une Leak Detectors (LLD): o Check this box if LLDJ are not installed. Complete the COllowlng checklist: ~Ycs a No. For equipment start-up or annual equipment certification, was a leak simulated to verify LLD pcrfOmlBnce? Q N/A (Cl2fl(:1c oJ/lhol applp) Simulated leak ratc; œr 3 g.p.h.; 0 0.1 g.p,h; 0 0.2 g,p.h. .at Yes 0 No' Were all LLDs confinned operational and accurate within regulatory requirements? ~ Yes C No· Was the testing apparatus properly calibrated? Øl Yes o No· For mechanical LLDs, does the LLD restrict product now if It detects a leak? o NIA I:] Yes Q No· For electronic I..LOs, does the turbine automatically shut off if the LLD detects a leotk7 iii N/A [J Yes I:J No. For electronic J.LDs, doeR the turbine automatically shut off if any portion of the monitoring system is disabled ~ N/A or disconlJected? a Yes 1:1 No" For ~Icctronic LLDs, does the turbine automatically shut off if any portion of the monitoring system ~ N/A malfunctions or fails B test? a Yes Q No· For electronic LLCs. have all açcessible wiring connections been visually inspected? f¡II N/ A 'FYes o No. Were all items on the equipment manufacturer's maintenance checklist completed? II' In the Sedion R, helow, describe how and when these deficiencies Were or will be c:orreded. H. Comments: .-- "---.- --.--.--------.--..-... ---'-".-.-..-- -------..-.--. '--'-- .- -,- --..---.--. ----------.-.-. .--. -----.- .--. --'-"- -'-'- .-------.- '--.. --------. ----.-.- '-'-. '-..---.--. '.-.--. -'-. -...- --. ---- -._- --.-.. -- --. .-..,- -----.---..-.-.--... '---'--...---.. ..-.....-- ---.-.------.- ---"--'-"- -'--'-'.-. - -'-..- .--. ..---- Page J or J IIJJDI ..,- ",-1' .' 12/07/2004 11:13 6613252529 GAL VALLEY PAGE 05 .l\fOIlÏfol·in £ S)·~!CItl C~'I'!ilìl'll!inl1 UST Monitoring Site Pla.n Sile Address' J''p''OnYaJJ/~.&-B~ßE~.ce...,_ "- - -'--~- - - 1 . , ~ t r' ~ f~ 0 t .ft. q ~ q . 11o.rJii~( ~~: 6;~~' Ahl1n' \ , :t.; ¥ ,~ I . . 'i1. 11. Dale 11111 ) W',)s dra\VI1: .J.1J lJ../.!2.!t, Instructions If you alreH(1y hil\'~ ,I UlHgrHl11 that shows all required information, you may Include iI, Hlthcr than thi:; page, wilh you!' Monitoring Sysh:m ('cl'ti IiCí1lioll. On your site plan. show lbe general layolll c>f tanks ¡IUÙ piping. Clcarly identity locarion:; of Ihe li111( \\'il1g equipment, if installed: rnonilOI'ing system control pancls; ~en~ors monitoring lank ¡¡nnuh!l' spaces, sl.lInp¡¡, dbJ1~:l1scr P'IIlS. spill containers, or other sceoncl!1rY containmcnt areas; mcçhanictlJ or electronic line: len .; detectors: tlnd irHHl11.: liquid level probes (if used for lenk detection). In the spaee provided. nole Ihe date rJli!! She ['/1'111 was prepnrcd. .'aAI: ~_ of }{ _ II~IOII - ./ " 12/07/2004 11:13 6613252529 CAL VALLEV PAGE 06 I V APORLESS MANUFACTURING, INC. Contt'actQl LDT-890 Leak Detector Test Record Customer C'l1..l-I/a.//t.y.- ç~4.J'p;J'1el1~ Date LocatiOl! If~~ G() /)141y'Ket- - ~ JL-2.3 -011 T~hnicjan /600 J/4..hç'dlll.. ßakerxt'leJ.&(/ éA... <? 7 v¿ 15,t.c..c.~ f.hï,,~/t¡,~ , Submersible Pump Identification Model No. Seril!l1:iJ¡mbcr Manufacture,! lfeo(/e<.C.K e,- Manufacturer Leak Detector Identification DescripÛ9!J Other S~le Leak Dctcclor I( tp¿ack't,.,.. Diapbragm-typc_ Piston-type i..- Tamper·proof seal instaUed? Yes No Leak Detector in Submersible Pump Test at Dispenser 1. Operatin¡ Pump Pressurc Z r PSI (para. 15) 2. Gallons per hoW' llIte J (pans. 22) TJsi (PIU'a. 23) 3. Line pressure with pump shut ofT Jt) 4. Bleedback Test with P\JIJ)J) off---.lOS- mJ (para, 26) S. Step-through time to fun flow :3 seconds (para. 30) 6. Leak detector stays in leak search position. (pam. 42) Yesk:.. No_ LEAK DETECTOR TEST NOle: PaSt'" laic detcçtor fill ~I prDtoc:ol F.iI '" leak deteclor /it'" IÐ$C Protl)col Pass V-. Fail FOJm 890C (9-1-96) "Cornp t:te thennal expansion test before faUing leak detector. 1996 Vapor1cas Manufacturing, Inc., Prqcott Valley, AZ ...,. 12/07/2004 11:13 6613252529 CAL VALLEY PAGE 07 v APORLESS MANUF ACTIJRlNG, INC. Qw~ LDT-890 Leak Detector Test Record CustOI11S' Ca../- /,/..J/(f: £f,<,,'¡Ih1~Jff Ià1ç, LocatiOQ j/-l3-ot¡ ß'Oo-1/~I/;' Technician lfe4d..¡ 6,p /J14rkd - froduct 8.:t.k:eY..î,!;C'IR'I Ct. . 0/'/ Vi.. .6hot_" t' H,hf,Úi./ ..., Manufacturer SubDJenible Pump Identification Model No. Serial Number _ J{ft:(i4. cik'e. ï ManufacturaL- Leak Detector Jdcntificalion DescriDtioD ~r Stvle Leak De~to~ J<e.p{'H:~,CK .er Diapbragm.rype_ Piston-type ¡ __ Tamper-proofseaJ installed? Yes No Leak Defc:c:tor in Submersible Pump Test at Dispenser t. Operati~ Pump Pressure Z? psi (pUB.) 5) 2. Ga1Jons per hour fate 3 (para, 22) .3. Line pTeS5UrC with pump shut otL_L6_...,psj (para. 23) 4, Bleedbaclc: TC$t with pump ofT '10 5. Step-througb time to fun ßow-.3 ml (para. 26) seconds (para. 30) 6. Leak detector stays in leak search position. (para. 42) Yes ¡,.-- No,,==, LEAK DETECTOR TEST NOle: hit = !-Oak detector /ill lest pl'QlOccIl F.II ... Leak delac:tor rails lest protOc:ol ",. PIISS I/'" Fail Form 890C (9-1-96) ·Completc thermal expansion test before failing lea)( detector, 1996 Vaporless Manufacturing, Inc., Prescott Valley, AZ ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) TM 12/03/2004 PRODUCER (661)327-3111 FAX (661)327-1262 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wilson, Paves & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2300 Bahamas Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bakersfield, CA 93309 Suzanne Lewis INSURERS AFFORDING COVERAGE NAIC# INSURED B S S R, Inc. INSURER A: Great American Insurance Co. 6630 Rosedale Hwy. #B INSURER B: Clarendon National Ins Co Bakersfield, CA 93308 INSURER c: INSURER DI INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ¡rns-R ~~'ki TYPE OF INSURANCE POLICY NUMBER Pgl-+~~~¡;'~8~~f PgÃ!fl t'r~M/DDNYí' LIMITS LTR GENERAL LIABILITY 03GL529820 12/04/2004 12/04/2005 EACH OCCURRENCE $ 1,000,000 - X COMMERCIAL GENERAL LIABILITY PREMISES rEa occurence\ $ 100,000 I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $ A PERSONAL & ADV INJURY $ 1,000,000 - - GENERAL AGGREGATE $ 3,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 I ·nPRO- nLOC POLICY JECT AUTOMOBILE LIABILITY PA101051081 12/04/2004 12/04/2005 COMBINED SINGLE LIMIT - (Ea accident) $ ANY AUTO 1,000,000 I--- ALL OWNED AUTOS BODILY INJURY I-- $ X SCHEDULED AUTOS (Per person) B I--- ¿ HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) I--- I-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ o OCCUR o CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY LIMITS I IUdH- EMPLOYERS' LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE -. EA EMPLOYEE _$ If yes, describe under ---~~ --- - - -,--~ ------ -- -SPECIAL-PROVISIONS'below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ~ non payment of premium will result in a 10 day notice of cancellation CERTIFICATE HOLDER City of Bakersfield Fire Department Attn Steve Underwood 2101 H Street Bakersfield, CA 93301 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON T AUTHORIZED REPRE ACORD 25 (2001/08) FAX: 326-0576 ©ACORD CORPORATION 1988