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HomeMy WebLinkAboutFMC 9-13-06i it VIC'S ARCO AM/PM _ ___ ___ ___ ;' 7851 ROSEDALE HWY f _- _ FROM :BSSR,INC Fla}{ N0. :6615882786 Sep. 20 2006 10:02AM P1 ~~~ ~.t-7 d ~ BS~17, Inc. . 630 P~asedaie Hwy., # B, BakersfieEd, CA 93308 Photsa (661) 588~27771~'ax {66i) 588-2786 • 1VIt7NITURTNG SYS~'EIYI C~R,TIFICA'I`IflN This form must be used tq doauatcnt testing and servicing of monitoring; cgttipmeat. A ~~paratt certi catYOn or ren~.must preRars oLeacli tnon{to 'nr avstcm control us~el by the techriieian who p.:c~omts the work A copy of this fotm must be provided to the teak system ownedvperator. The owner/operator must submit a copfr~.atis form to the local agency regulating UST systems within 34 days of test date. A. Gene1ra114nfolt'lix Facility Namo• ~~ Site Address: f6~.1 / ~~ Facility Contact Person: Make/Modei of Monitoring System: B. X>aventoty of a~K m. ,,,,~ ~' yg2e m•Tank Gauging Probe. ' d Annular Space or Vattit Sensor. ^ Piping Sump! Trench r(s). Pltt"Sump 5ertsor(s).y'/~l~. Mechanical Lipe Leak Detector. ^ Electronic Ltne Leak Detector. ^ Tank Ovo~ u /High-Level Sensor. ^ Other s eci o ui rnent a and T ID: In-Tank Gauging P be. O Annular Space ar Vault Sensor. Cl Piping Sump ! "lhenoh~~~~•r~a Sensor(s). Mechanical Line Lea1r Detector. Electronic line Leak Detector. © Tank Ove~il./high-~vo1 Sensor. O Other isoecifl~ eauitnnent tvoe and Dispenser 173: ,~ Dispenser Cont -Shear Valve(s). Dispenser Cn: ~ Dispenser Cont Shear valve(s). Dispenser lb: _„~,1~ DispcnserContainmont ¢~ Shear Valve(s). ^ pisoenser Cnntaiemrnt 1 ~estedJCertfit~ed Model: _ __ Model: ~' ~ ---- Model: •~ Model: Model: Bldg. No.• city: •/~~ zip: D Contact ~oae No.: (~ ~^~/~" - ~ _~ bate of Testing,/Servicin$: ,~_IJ/ I y~ TanlrrlA: I~ln-Tank Gauging Probe. Model( .,,_, G7 Annular Space or• Vauic Sensor. Model: _ ^ Piping Sutttp /Trench Senso s). Model: it~it-sump Sensor(s). ~~(~. Model: Mechanical Line leak Detector. Modei• Eieetranio Line Leak Detector. Model: _ D Tank Overf+il /High-Level Sensor. ivlodel: /[J. l9''~ Teak IA: Model: ^ In-Tank Gauging Probe Model: Modr.1: _ O AnnWar Space or Vault Sensor. Model: Model; O Piping Sump /Trench Sensor(s), Model: Model: .Fill Sump Sensor(s). , Model: Model: A Mechanics] Line Leak Detoator. Model: _ _ Model: ^ Electronic Line Leak Detector. Model: Model: ©t'ank Overfill / Fligh-Level Sensor. Model: nodal in Section E on P e 2 . ^ ether s i ui ant a end model in Section E on P o Z . Dlspetiser ID: Modal: ~8'iDispenser Containment Sensor(s}. Model: • ' Shear Valve(s). Chains . ^ Dis peer Containment Floats and Chains . Dispenser YD: ~/ •• Modei: Dispenser Containmen Scnsbr(s). Modei: Shear valve(s). Chain e . ^ p' enser t;ontaiament Floa s and Chains . - _ - Distteaser lD: /• 1. contains chore tanks or dispensary; copy ~5hear Valve(s). _ O Dispenser Containrreent Frloat~s~ and Chains), .___~~ infomnation for every tank attd dispenser at the facil'sty. C. CertilYC~l3on - 1 cer#lfy that the egniptnept identified la thts document was htspeeted/serviced to accordance with the taanafaegtrera' guidelines. A,ttaehed to thta Cer4lildttiott >s int'ormation (e.g. mannPactnr,ers' e6eckltses) necessary to verify that thin ie[ortnatlon is correct and a Plot Plan showing the layout of raonitoring equl ment* For any equl meat capable of generating such reports [have also efts ed a cap of tli re ( d that apply): ~3yst set story report Technician Name (print): _ Sigtiatur Certification Nv.: ~~~"a License. No.: ~ ~~ ~~ Testing Company Name: . ~ ~ Pone No.:~~„~.~ O o y~.~,~ Site Address: /~ ~ Date ofTesting/Setvicistg: „ '~% / • _ ~~• Page t of y . ~ ~ , o3/at Monitoring System Certtacation • FROM :BSSR,INC FA}S NO. :6615882786 Sep. 20 2006 1O:O3AM P2 D. ResuEts of Tes~ing/Secviciplg . . Software Version Installed: r . ~~ ~~ !'nennlafa FMa fnlinwlno rl,anlrlictr Yes {~ No* Is the audible alarm o tioaal? Yes ^ No* Is the visual alarm o rational? .Yes ^ No* Were all sensors visual] ected functional] tested, and confirmed o erational? Yes O Noy` Were ail sensors installed at lowest point of secondary containment and positioned sq that other equipment will not interfere with their ro r ration? Q Yes d No" _ If alarms are relayed W a xeanote monitoring station, is all communications equipment (c.g. enodcm) NIA operational? Yes Q No'" For pressurized piping systems, does the turbine automatically shut dowzt if the piping secondary containment ^ NIA monitoring system detects a leak, fails to operate, or is electrically disco ected? If yes: which sensors initiate positive shut-down? Check all that apply) ~, Sumprl"rench Sensors;Dispensar Containment Sensors. Did ou confum sitive shut-down due to leaks and sensor failure/disuoruaection? 'Yes; ~ No. D Yes Na+ For tank sysfettts that utilize the rrionitoring system as tht prinnary tank overfll warning device {i.e. no NIA mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the taltk fill in s and o era ' ro erl 7 If so at what accent of tank ca act does the alarm tri er? fj Yes* No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other egtipment replaced and list the manufacturer name and model for aII r lacerrtcnt arts in Section E below. ^Yes* No Was liquid fouaxd inside any secondary containment systems designed as dry systems? (Check ail that apply) ^ ]?roduC • Q Waxer. If s describe causes in Section E below. Yes ©No* Was monito " s stem set-u reviewed to ensure ro er settin s? Attach set u re orts, if a livable . Yes ^ No* Is aII txtoaitorin tsi mart p erational er manufacturer's cifications? - En JeCUOn ~ nelOw, aesCrlDS R,/O~WJand Whe~n,rnese (~tB~tt/Ct/erlCfe$f~W~Bre pr will,.be~CO~TI'eCted. ~i. C83YlIIlBIltSi ~ //!~~ (/4~/~GC.-•• .~/'~~~L/~C -r~C Page 2 of 6~ 03101 FR(~'1 : BSSR , I NC FAX N0. :6615882786 Sep. 20 2006 10:03AM P3 F. ltin-Tank Ganging / Slut Equipment: ~ ~ ^ Check thi9 box if tank gauging is used only for inventory control. O Check this box if no tank gauging or SIR equipment is installed. This si;ction must be completed if ~n-t>ink gaugiztg equipment is used to perform leak dt;t~~tion monitoring. tiora te e me rouo wm cnecuusr: Yes ©No* Flas all input vriririg beem inspected for proper entry need termiszativn, including testing for ground faults? Yes ^ No* Were a11. teak gauging probes visually inspected far damage and residue buildup? Yes O Noy` was accuracy of system product lavel headings tested? Yes ©No* Was accuracy of systems water level readings tested? Yes D No* W«e all probes reinstalled properly? Yes ^ No* Were all items on the equipment manufaettu~er's maintenance checklist completed? * In the S ection H. below, describe how and when #hese de$elencies were or wBi be corrected. C. Line Leak Dttectors~(LI,D): ©G~eek this box if LLDs arc mat installed. Cmm~let~. tho fnllnwlna r_hprlrtiets Yas Q No* For equipraeut start-up or as~tsual aluipme ertificatian, was a leap si~aaulated to vet~ifjR LLD perfarzsasice? D N/A {Check all that aipply) Simulated leak xats: g.p.h.; ^ 0.1 g.p.h ; ^ 0.2 g.p.h. Yes Q trios Were all LLDs c~ ,a operational and acchuntn within regulatory requirealents? Ycs ~ D No* was ttsa testlzzg apparatus properly cals~brated? Yes O No* For mechanical LLUs, does flea z.z.D restrict product flow if it detects a kale? D NIA ^ Yes 0 No* Far electronic LLDs,. does the nsrbine automatically shut off if the ~ deucts a leak? ' N/A ^ Yes No* >?or electrotic ~.X.Ds, does the turbine automatically shut off if any portion of tin usonitoriug system is disabled NIA 'or disaonnccted7 D Yes No* For electronic LILDs, does t3te~ tssr>,ine automatically sksut off if ally portion of the monitoring system N/A malfunctions or fails a trst`1 ^ Ycs No* For electronic LLDs, have all accesssble wiring cormections beers visually inspected? .N/A es ^ Nos 'W'ere all iteuss.ou the ecjuipment meaufacturer's maintenance rheaklist completed? " In the Section S, below, describe how astd when these deficiencies were o~r/wfll be corrected. r Page 3 of ~ o~roi FROM :13SSR, INC FAX NO. :66152786 Sep. 20 2006 10:04AM P4 MnultAciug 3ystesm Certilicsttaeu Farm: A,dd~ far V~ Ynterrttitlal 5emeors 1i,,G X63,1, Enc. II x. Rem ar v tQ~ xt x~t~ This page should be used to document testing and servicing of vacuum and pressure intersdtial seasors. A copy of this .force must be lnctuded with tfte Monitoring System Cerlit3cadon Form, r+vhich. must be provided to the tank system owmerloperacor. fit-e owtter)aperator must submit a copy a$ the NTonitoring system Certification Form to the local agency t~sgutating UST systetns cvlthip 3U days of test date. ' 3. Comni~ts: t If the sensor suec~sfully detects s simulated vaoetam/prassnm }~ intradaeed in the interstitial space at the f12ttlteSt point from the sensar, vslCUtttn~presstu~e hay lteC4 dated to. be communicatiteg throughout the interstice. ~~ ~asi~erstIl3a1 ~ xer~ed~i Q t PaY Intxodutrd at Par End of 1~'8tit18l ~'i (~ Csau ~] Visual Tns 'oa; Other (desCrtbe iR Sac. J, below) '~aeetms was restored to eperee#eg lc~s in sll latarl .apaeasz [] was ^ No {I,Frso, deseri6c in Set. J lxlaw) FROM :BSSR,INC Monitoring System Certification FAX N0. :6615882786 Sep. 20 2006 10:05AM P5 ~S'~ ~0II~tQP1II~ ~~ilte ~~~>n Sine Address: .............. .............. i~~~:mo~t::: ' :::::::::::::::::::::::::::::: ::::::::::::::::: ~o: ,n~::::... ..... . :: ...... s...... ... ............ .. .... .. ,~' :::::::: ~`~ : ~ :::::::::.: 3 ~':::: s . .... ... ~ :: : :::::::::: ~'i~~~ ::::::::::::: ~rnt~ ....: :..:: .. .. ......... ..... ...... .......................... fem..... .... ..... ............................:....... ...... ..... :~ :. .:::::::::::~:~~::::::::::::~::::::::: ~.~I Date map was drawn: ~~~/•,~. ~tstructio~s xf you already have a diagram that shows all rakuired information, you may include it, rather than this page, with your Monitoring System Certification. Can your site plan, show tha general layout of tanks and piping. Clearly identify kocations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and iri-tank liquid level probes (if used for leak dctoction). ]Et1 the space provided, note the date this Site Plan was prepared. Page ~ o[ T o5roo FROM :BSSR,INC FAX N0. :6615882786 .Sep. 20 2006 10:05AM P6 ' SWRCl3, January 2006 • Spill Bucket 'Testiing Report ~olrm Thisform is intendedfor use 14y contractors performing wmual testing of t151"splll eonrainrrera ssrarctures. The completed farm and prtrrtouts from tests (if applicable),should be provided to the,/acility owner/operator far su6~r+ittal to the Ioeal regulatory agency. t Yr s rn _rrv trxr+n~an~r s~rrnx Facility NamC: ~ Date of Testing: " Facility Address: paclliry Con~ct: ~ phone: ]late Local Agency . as'2Jotified of Testing : ..y/' Name of Local Agency Inspector (ifprexent during eesatng): ~1tj ` TESTII~TG CONTRACTOR INFORMATI~DN Company Name: Technician Conducting Test: / Credentials': ^ CSLB Coatractor CC Service Tech. ^ SWRCS Tank Tester ^ Other (Specify) License Number(s): ~' ,. 3_ QFiLi. RIICKF.T TF,STiNG 1fNx'ORMATION Test ethod Used: drostatic ~ D Vacuum ^ Other ' Tes>: Equipment Used: Equipment Resolution: . Identify Spill Bucket (By Tank Number, Stored Product, etc. 1~ ~ ~ l 2 ~i ~ ~• ~~, ~ / / 3 Q`~J~ / 4 Bucket Installation Type: ^ Direct Bury otstained in S ^ Direct Bury ntained in Sum O Diroct Bury ontained in Sum ^ Direct Bury 0 Contained in Sum Bucket Diameter; / ~ - BUCket Depth; f ~/ •r o' ~/' , Wait.time between applying vacuum/water and start of test: ~ ~ ~+-y 'C/ Test Start Time (T~: ~~ ~ " Initial Reading (R~: Test End Time (TF), ~ ~~ i .~ Final Reading (Rg): ..(~ Test Duration (Tp - T~: ~~ ~ ( _ Change in Reading (Rr - R~; ,0 PassfFail Threshold qr Criteria: ~,~~( ~ G ~ ~~ ~~ ~~~~ //aa ~VV~f~~ 'Test Re9p1t: pass , ^ I~'ai1 Fars • • .0 Rail Pass v Fail ©Pass o Fail C:Omtll@Ctt3 ~ (include lnformatioir eut repairs made prior ~ testing; and reCOmmenf/ed.~ollmv-up for failed tests) • :::.ti=: CERTIFICt#TIUN Off' TECHNICIAN RESPO)WSIEl1E b'OR CONDUCTING THIS TESTING I hereby cerujy that a!t the lnfanaattorr co alned itt this report Ls true, accurate, acrd !a, f Irll co~rrpllaRCe with legal requlremstrts. TeChs~iGian'g Si¢~~t~re: pa~• ~~~~~~ n11iJ /T ~~, ~- ~~. c ' State laws and regulations do not currently require testing to lie performed Icy a qualified contractor. However, local requirements +..av 1tp mnrA'atrsnnw,t i