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HomeMy WebLinkAboutUST-REPORT 12/15/2005/_ '~,r(UNDERGROUND STORAGE TANKS) FILE # `BKFLD HEART HOSPITAL ~I - 3001 SILLECT AVENUE_ _ ___ _ _ .__ __ _ ~a- - -- 1 ,~ ~ti, ~~ ~ / ~1 `~~~~ FROM :BSSR,INC FAX NO. :6615882786 Dec. 30 2005 12:00PM P2 • .. ~;:. . ' Sr+ CdNDA~RY SYSTEM CERTII"iCA'~YO~v r C'ir"'ti'ri . I3A,TE ~~ ~ /~ L~3~J!' ~, ' FAG7LY't'Y ID : ~'~.~ ~ ~'~ . FACII.YTY A,DDYtF.SS~~ i (~~f`~ _ ~ - - UST Annular Space Tank 1 Tank ~ Tank 3 Tank ~ Start Time ./ip s o .'~'~" ~ p : ~ e ~" Iuitlal Pressure 'j f' .~ /6 1`,~r,9c- Fit1a[ Pressure f 6 G+ .~ `~ Certiification ~' (Sim) /L Piss /P~-s~ ~ . $eaondary ~p . Llne I ~.lne 2 ~ Line 3 ~ x,lne 4 Start Tfene ~ /e' ~d"~~ o:. ~ L(P '~ ~ ©~ ~~ 4$P . Tn,tiat Pressure ~ ~Q ~.. 3~'B5- ,.~' ~-~ . Lnd Tithe ,r~'9 ~ ~~' ~2r~ 4 •~,,.cac~ 1;Ynai Pressure l Certification "~ ,~? ~ ~ ~ ^ ~ (Signature) -s~ ' ~ ass ~~~ ~'~. ~~ v"v~ ~~g~ i a~_ _ r _ ~~ FROM :BSSR,INC FRX N0. :6615882786 Dec. 30 2005 12:01PM P3 SECpNDAR,Y SYSTEM CEETIT'ICA'~'Y~N i vE,iv, ' I '~A '~~~~ l~ ~~ ~S ~ ~ZT~ ID y rE FACII,YTY AADRESS ~ ` ' ~~ r Tank Tank Tsnk~r Tank'.- `f~ ,,~ v Start Time ~ ~,~r,~ ~~.. ~F~ ~: 2~. ~j D i Initial ~ressurn S"(Q ~lQ ~ S Qr~, End~Tinne /= ~~'''{ ~- PJ"-1 ~ stn ~ IdtT ] ~~~ ire ~~ s .~re.~ ~ i Certificatlon ~ ~ r ~ s (si~aru~) ~t~s ~~-s's p~-s~ -~:ss . Seconds Fl i W'•~'^'0t ~- svm~ .. Line 1 ~v~-( Line 2 Line 3 Line 4 Start Time e ~J ! ' ~ ° ~~ Initfsl Pregs~are S` f~~ ~`t j~ S ,~``Q.~ End Time. ~:.~ ~ p~1 2~C~1 k'inal Pressu~ ~ r~S ~. ~1Q,' ~ ~l~ - Certification (Si t ~ ~* gna ux e}. , . ~'Y f, .. ~ ~ vv r~ ~ r`~ I ~ tCJ: ~ Pa e 1 a ~`~t3t --, 2-+~~35 ~tCc~os ~~~k~ .. .. .< FROM :BSSR,INC FRX NO. :66152786 Dec. 30 2005 12:01PM P4 . - SECt3NriARY SYSTRi1s CERTIFICATION FORM ' riA1~ Iz-~~r~ oS~ . _. ' li'ACTI.ITY Y~f ~~ 2 ~ ~C~ f-f~s~- ,/~~'-~ i'A CILI i`Y~ ADDRE.riS '•' S'I ~1 ~i''1(r~'r-~ .c~ti~~ Turbine Sumps - -- ..., Sump 1 Sump 2 Sump 3 Sump 4 Start Time 2 ~ /~6 ~.:. / ~ ~- = t ~ S~ ~ t $ Initial I~eight - of V'Vater 8'~~'4 . ~. ~ S ~~ ~ : ~4'~' Time 2.: Z.L ~:(6 ~~ 'Wa t er Yieight ~ =g ~,g , ~ ~ q ~ ~. y~ ~~ 1,~~ ~Lf4rr t~~. Y~ d~ w .{-~ ~// fig I•~,~ ~Y Ws~r Height ~- ~ ~ ~- l~' ~.. Dp Time 2 =s,.~ 2 = ~ y ~..-z., ~"~ 2. 'Water Height ~•~ O 'j ~' ~`~ ~ ~ 5--~~~ Certifications ~ ~~ ~? (Sigxtature} ~ ~ S ~~S ~fS Overfiti Buckets Qverrili 1 Overfill 2 Owe~c~il~ 3 ~ Overfiil4 Start Time ~ /: ~ f ~ f 3 ~ = l~ . . Initial Y~eight ~i?wate~ ~r1~'.~" ~'. fs-~ Time ,=~~ ~=/~ ~.; ~ Water Height L~~ ~, S- o Time ~ "~' .~ ~ (`I ~ ~- = 22. Water Helgllt ~ ./ 7 ~ r~~ ` ~~ L ~~ /Certlfficatiaa lS1~fUr@~ X7'7 '~ ` /~, /(~ r . .-,LLB Wage ?of ,.,., J ~-- ~ ? ,~ FROM : BSSR, INC FAX N0. :6615882786 P5 Dec. 30 2005 12:02PM ,_,,,~.~... ,••s ~ ' . _r..... t~,nA . •-.r • r.y I cl'.~rn ~ t~(~K Tf;^cy oFrsnRY 1 • ;,?!!5~']Gi~ ~7p;Zt PN. • ~ ^•rc;T '^TY'~F2T~n ":cef• ~'~'~ ~ i 'c~ph bi=f~~21~ L~~~,,FI+'tll.. ~ r;~+trto ~,Eatt ~c-~T 2car)RT ~. ~ 'TEST STARTED 12~'15r2rn6 ?d!~t :?d r; . :s~+v~t tiTi i Fr'~ p~~r. ' ~ r>s•'irl P1 ~ , ~ ~ ..,}GTi^~ ~ . Y~4.~`` rl!EL rl~r lY t~.4. ~ 1i~g ~Ii I ' ! ~ r ; ^Cb rxl!q!Q T I,TG~ k~i ~~u , y~ • • ''ESA STARTF..t? 2:33 FPM ', ~`a7 ~?F~YF t^i:5i24~~5 L ~ 319~~' f~ ~c L. F ~ 5 '~ ?.a~2 ?t~ 5~:?GI~S ~~ <?/1 s TEST STARTS 1c1. iS120t:55 i 3E~ iN i~urEL 6.:.ciA4 IN + ' q;c t~E5Nl7!wA ~ ,j l q ~` T INGREASEI;' ~' RFaIlL 7E . OAK T?'-'•~T ~~FG•'f1~.''~' i n~VN!P ~ END TIME '?:2$ Pf4 s . . rub Rr~TE J.?,~! 5~:?$~ ~`~ I 1 ~ T~? ' END LEUELr t f,. 1531 I#~ ]] AK TNQE'aN[J„'} ~+. t~>~2 '~ V ~ .• r~~ rtr RTC t: ~~, ~~ r ' F D 1 Kf ~~~~$'~~ ~ ~ i . TEST RESULT INi:REASEU I o~ry ~cTnp , ~ :< nit ; IMr~ ' '-;-er ..._ _._...1 . ....._ -~ - -.. .... i•F~~ ~1TC' ..C ~~~ y~ ~ £N[? 1_.~ .UF~~•+ t ' A 1a. d2ti , • t 1 ~ ~, ,. , l J l FTC. ~!~r li?-illl Plgr~~D 'r~.T 12. stS T TEST aTRR,TED 2: i3 P1? ;; ' I ~~ 1 l . ?~T ST?RTFl~' •J,~.tg1~00~ BEGIN LEVEL 5.9$$6 IN, g t. °~~Iq"1'r •t'~~^D/•-'~4 { • ~~ ~~ t : ','..~ D?'~ ~ ~ ~ FHh ? I4'E~: ^: ~ PM ~ ' ~ TEt" STARTFT7 i „ „ ~ r JM1 ~ ~T ~. EhtD i~ATE i2F15/2995 ~-s~ ` Nf i:3 > ~ ".,~1 :-psis} .7~~ i ~ ~ 1 tccr ;.T~g . ~ 4~ k CI)~, ~C~I~ ~ ' ~~ ~; ;• .. ~ _~ UF.L . i 9 d d L£RK T~iRcSliQl.P 6.6fs2 IN :, x 7.2~+,~,r2G!6S 5°~., PM . '.; t S~ i " t5~'AAS i. FNn r}~~W, ~i:,a~; Tu ~ T~GT• s7F^,,,I~?„~ ~AS~ED ~ +i1~1!-~ LL.!~1K •wr:i7 ~F~'9RT ^ •.;: i ~;:v.A~ . u .F dun, n i ti'~AY HR~. br~c.: =r4 ~., 9~ ; T ".J , W~PSLfMP 7tT ~^ e } Y ' $ '11t r~ ,~ f} ; ~ N :~ 1 J: . ~r ~ , ~~T G r ,~ T~ST STARTEt~ 12f15f266` i l ~ .. M . T fi7(iRT£D t?r15F.•AC~S c I T~'' is gi_r?~a !_EUE! 5.4.S7i 't~J 'r: ' ' . ` , .u :t 4 , ~ CYI~ ! ct;`r_ 5.7C~,f~ l!~ k... ~ T ,t PFl E ~: y . EN!? TIME .5:33 Pt ~Wp '~l'tT~ 7 2 /t~ir2RL~5 ~' . Mp TIhf ~ ~tii7 t~RTt 12~iri~"I,f~f~'y7 • ' ~ , .. . END LEt•1F.L 5.456r IN ' ~ . . ° ° ET~4i? L~VF;l~, 5 7F!gr. 1M ~ ~C THk. ~Ufll ~} ~!. 5i ~1^l SFr I F ~jr{ TuiF.F.BNOLi~ @, G;4? L T~ l ~ TFSY RE'SI.Jl7 PASrFD ' • • j TEST RESI.)LT PABSEC~ i 1. .. `. ,~ FROM :BSSR,INC FAX N0. :6615882786 Sep. 28 2006 02:25PM P2 t. _-,. -.__.,- ........ . -_..__ ._... __.. _._... -- ~ ~- -. ,•r , . ;: , ... USSR, Inc. - -b63f).Roset9ale'riwy.; ~~ B, B~cersfteid, !CA 933f)S phone {661) 588-2777 Fax'(661} 588-2786 _- . -: < ~' ~ •~UN~TORIN~ SYSTEM CE~'~`~~'~CAT~ON . This form ttwst be used to document testing arsd servicing of monitoring equipment. A . ,. , to certification r~repo~ must be tsreptyed fQr each t~Q~}lpriag svstem control. pane! l,>yr the technician who perforn>.s the +work. A copy of this form must bt: provided to the tattle systerrt ownarloperator. 1'he owneF/operator must submit a copy of this form m the local agency regttlat~g UST systems within 30 days of test date. A. GeneralInf Facility Name: ~ >~ /9 S,~dg. No.: Site Address:. f~ ~ ~~~ City: .~.5:..~ Zip: -- _ Facility Contact Person: Cotrtact l?hone Na.: ~) • • ' Make/Model of Mwutoriag System: - L ~ •~ate of 7estittg/Servicing: l~l t~~ B. • Ynventolry of Egtuipme»t TestedlC trE~led Lim-~ v f~dl~~~~: ~I/!~ . a f....~~-A/....r..f ~.[. TRA Tank Gauging Probe. Mode1• O G~ Cb: r t'a ' ' t:+~ Tank Gauging Probe. Mode -~ ular Space or Vault Sensor. 'Modal: T L ' ~ular Spaco ar Vault Sensor. Model h M d l /' tag Sump /Trench Sensor(s). Model; o e : [tenc Sensor(s). ping Sump Model: ~] Fili Swnp Seytsor{s). Model: O Mechanical Line Leak Detector_ Model: D Mechanical Lino Leak Detector. Model O Eleotroaic Line Leak Detector. Modol: O Electronic Line Leak Detector. Model: ^ Tank Overt$ll ! High-Leval Sensor. Model: D Tank t7verfilt~J High-Level Sensor. Model: ^ Other i e ui t and model in Section $ on P 2 . O Other ui t e and model in Section E on Pe e 2 . Tank lp• Tank ID: _ p (n-Tank Gauging Probe. Model: ~ D to 7anlc Gauging Probe. Model: © Annular Space or Vault Satsar. Model: D Annular Space or vault Sensor. Model: O Piping Sump !Trench Sensor(s). Model: O • Piping Sump / Trench Sensor(s}. Model: O. Pill Sump Settsar(s). , Model: D Fill Sump Sensor(s). Model: O Mechanical Line Leak Detector. Model: C? Mechanical Line Leak Detector. Model: D Eteatonic Line Leak Detector. Model: ~ - - -- ----~ D Bleetronic Liae Daek beteetor. ModeF: • O Tank Ove~ft.l Nigh-Level Sonsor. Model: ~ - _ _-_ O Tank Overfill /High-Level Sensor. Model: . Q Other ci ui mcnt a and tr:odel in Section S on P e'2 . O Other s i e u' ent and mode] in Section E on P e 2 . Alspenaer ID: :' _ __-- ----.--._-- Dispenser ID: D Dispenser Containment Sensor(s). • Model: O Dispenser Containment Sensor(s). Model: .O.Shcar Valve(s). D Shear Valve(s). - O Dis ter Containment Floa s and Chaff s . ^ Di enter Containment Floats and Chains . ~iDispenser I[D: ~~ Dispenser FD: ~ ~ ' ^ bispenser Containment Sensor(s). Model:.. ~ D Dispenser Containment Sensors}. • Model: O Shear Valve(s). ©Shear V81YC(s}. Q Dis set Contairrmertt Ftoa s and t~si s . ^ Di enter Containment Float s and Chains . Dtspenser [D: ~ Dispenser fD: . D Dispenser Containment Sensor(s). Model: ©Dispenser Containment Sensor(s).. Model: _ ~ . ~ • Shear Valve(s). D Shear Valve(s). aDis nstr Containment Floa s and Chains . Cl Dis enSet Containment Floats and Chains . •lf tn¢ racmty ooata:ns mots tanxs or a:spensers, copy ws roan, moues tnrom+anon rot every rank arra aispcnscr ar urn rac,,,ry. .C. ~@ril~ll:A~411 - X cerHiy tlrat the t'gnipttteot tdentHled in gtts document was tnspectett/serviced la atcordanc: vrtth the • maauiscaFnera' gnldeltnes. Attached to tltfs CertHteation is tnfornuttlon (e.g. manufacturers' edeetclists} netxssary to verltay that thta lniormatioa i$ toYt'eCt sad a Plat 1?'lan Showing the layout pf ~naaitoring equt m For any equE gable of generating such reports, I have also a d cop~i the tie lea a t diet apply): ["System set-np ~~arm htst~ory report Technician Name (print}~~'/1 Signateire: - _ Certification No.: Testing Company Marne: y Site Address: G . ~ ` :Monttoring System Certification Fag's i of .~ Phone No.:l~/ -~~O' Date of TeatinglServiciwg: ~o3roi `~ .;ir tl w h al 0 r ~' ti 0 r d I MrySQ ~ y~ D ~ Y ~' ro ~ o' ~ o ~ ~~ D ~ ~ p , a ~ , ~ ~^ p ~! ~ . ~ i' 0 ' R ~ k ~ M 4 ~ ~ ~1 . M p 1 P QU ~ ' f Y (~'}} ~C .Ii p 7 r1 ,., n m ~ ~~ o ; ~ ~ „ ~ M~ a ~ o ~ . ~~ ! . ~p ~ .. ~~ R ~ ~. h 0 p Q 6 I ^ Q ~ F G. ~ 0 ~ ~ ~ ~, 0 bti i ~i o "y w u~ ~ ~0 ~ w ~a ao j a l'l 0 C !<f^ ~n~~ 1 ~ O 1 O Im a ~n,~ .~ ~ c ~ ~ ~ M ~a ,~ a y a ,! e J~ b 0 N m m m N A b N 0 N 0 N 3 W F ROM :BSSR,INC FAX N0. :6615882786 Sep. 28 2006 02:27PM P4 .. 14lnug SFsbem Cer~Y,esliast Farm: Admq icdr V~ Interstitial Settaars LG ~6~1, )Fatc. II ~. Rc~l~ at'Q~ iklaz~rtvring Tt~gt~ut~aa T~eg This gage shauld be need to document testing and servicing of vacuum and pressure int~etstitial sensors. A copy of this i'oran trust be included with the Monitoring System Certiffcation Form, which must be provided to ,the tank system owtter/operatar. ~'tte owner/opea~a~ar trust selbmit a Dopy of't~e Iu~Qnitoring 9ystetn Cerc~ftcatiott~Form to the local agency re~atittg YIS""}" systems within 30 days of test date. . . ~a~ r II the sensor aaceessfolly detects a siatalsted vao~ofpressmro leak. intracioced in the inte~'stik]la! space at the fiuthesE point front ttie scosor, vacuum(preastae has lteeu ~emamsgated m he ~camtntmmcatnag throughout ttYC taterstice. IIaar masitt~ret3tiat ca~oa~catt~ verf6ettz YEak Ynttioduced at Far End of Iutesstitiat ~ ~ d Crary i7isual In 'am; D Ckher (Describe in sec. 1, below) ~aeoom was e~e®ter~ed to apeeat~eg bevels to al! lnteealftisl [~ Yea Q No {Ff rem, dcsc~sbe Fa Sec. J, below) . FROM :BSSR,INC ti, FAX N0. :6615882786 Sep. 28 2006 02:28PM P5 'IVfonitori~g System Gertitlcat~n " Sire Address:V USx Mon#t4rin~ Site PiSn ., _ ~~ ~~. .,... ...... ......' ...'1...,...... ........._.. • ~ r - ~. ~ ~ . :~::::~16~ ..::: ... .. ,~ .....:::::::..~:::-... .: ::::::::::: ~ ::::~k".~U .,~,~e ::~ ::::::...:... Hate ~ was dtc°awn: ~,/c'~~/, ~n~trt u ens if you already have a diagt~am that shows all required information, you may include it, rattier than this page, with your Monitoring System Certi~cetion, On your site plan, show the general layout of tanks and piping. Clearly identify locations of the foltowin$ equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, disp~mser pans, spill containers, or other secondary containtuent areas; mectainical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection}. Tn the space provided, note the date this Site Plan was prepared. Psge ~ o[ T osroo '~FROt"i :BSSR, INC FAX N0. :5515882785 Sep. 28 2006 02:2'IBPM P6 SWRCB, January 2006 • Y Spxli Bucket Testing Report Form ?'his form is intended for tcsa by ~niroerw.s perfanntng anm~al resting of UST spill containment structures The aomplered form and printouts framlests (~'appJJc:able), should be provided to the facility owner/operator for subminal to rho loco! regulatory agency. Facitiry Name: D of Testing: Facility Address:. /fem. Facility Contact: Phone: Date Local Agency was Notified oFTestietg : Name of Local Ageney Inspector (~f present during testinP,I: d ~~~ - ~ 2_ TF.l~TYNC •CONTRACTOR INFORMATION ' Company Name• ~ ' Tecimicisa Condtteting Test: ~ Credentials': ^ CSLB Contractar C Service Tech. ^ SWRCB Tank Tester ^ Qther. e! License Number(s): - 3_ ~Pii.~. R7TC'KT.T 7T.RTiN(i•iNF(7RMATI()N Test Metlzod Used: .. 'c ^ Vacuum ^ Other . Test $quipuaeAt Used: ~ Equipment Resolution: Identify Spsll Bucket (By Tank Number. Stared Product. etc. 1/~ t/I t~~G- ~~ Z /~ fir- ~'.1~ 3 q Bucket Installation Type: ~ Bury ^ Contained in S irect Hury ^ Contaip in Sum i7 Direct Bury ^ Contained in S C Dirtct Sury ^ Contained in Sum BucketDiameter: `r Bucket Dopth: ~ ~~ Wait time between applying . v acuum/water and start oftest:~ + /~ 1 frst Start ~lme (T~: r . .,~ , Inltlal Readtsig (R~: ~`-' Test Ead Time (Tr):. . Final Reading (RF): . Test Duration (Tr -- T~: ~ Change •i~t. Reading (Rg = Ril: Pass/L?ai1'Ihreshold rn' Criteria: L~.~ . S' ~ . Test Restttt: ~ ~ - ... ss , ,^ Fail Pass D Yrall ~ ^ Pasa ^ Fail D Pass ^ Fail a..u~menis - turccuae uyarmp~ttort on repairs ~rtade prior to tastir>~and recommenr~etl follow-up for failed rests) C~RTIPTCATXON OF TLCHIIICIAN.RESPONS~LE FOR CONDUCTING THIS TESTWG I hereby eartify that eA the lnfat~Ctton raontairied in this r~part is trrtc, accurate. arrtd in, fuU cnmpllance wish tegnl requlrements. Date• f "`~~~ . ' State taws and regulations da not carrently require testing to be performed by a qualified contractor. However, total requirements mmr Fw mmw olrinnfn! ' UNDERORO~UND STORAGE TANK3~ BAKERSFIELD FIRE DEPT. ~~~~ Prevention Services Atfil f 900 Truxtun Ave., Ste. 210 APPLICATION ~ Bakersfield, CA 9330] TO PERFORM ELD I LINE TESTING Tel.: (661) 326-3979 136989 SECONDARY CONTAINMENT TESTING !TANK TIGHTNESS TEST AND TO PERFORM Fax: (661) 852-2171 FUEL MONITORING CERTIFICATION Page 1 of 1 PERMR N0. TT'- ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIC;HTNFSS TEST ~ TA PFRFARIW FI IFI IUANITnRINf; CFRTIFICATI(~N FACILITY O ; a NAME B~ONE~y~UMB~ OF ~yyl ,NTgCT PERSON f~ ADDRESS ~('1('~ ~ OWNERS NAME OPERATORS NAME , ~(„ ~ ~ _ I^. ,~ ' ~~ NUMBER OF TANKS TO BE TESTED -~- 4~ PERMIT TO OPERATE N0. E I 1 ~. ~. .: `.! :.., ~ .. '~ :.:.~~ : .....::.: .. :`~ ::TANK TESTING.COMPANY,. NAME OF TESTING COMPANY ~~~ ~~ P ON~FjIWMB R OF ONTAC P ~ySO ~7 ~b ' ~~ ` MAILING ADDRESS ~~~ ~~ ~ ~ ~~~1/ O _ ` _ _ .PHONE~.NUAAB 6L_ F 7E ER_OR.SP_ CIAL.INSP_ECTOR~ __. _ __ ~~ ._CERT,IFICATION.#:__._. ____ -. _ _ -- -~ _,_ _, - . . DATE b TIME TEST TO BE CONDUCTED ~' Q,~/ ('~ - i `/`J ICC #: I -, ~- u TEST METHOD SIGNATURE OF APPLIC T DATE j(„~ APPROVED BY DATE p~ FD 2095 (Rev. 09/05) ,