HomeMy WebLinkAboutUST-MONITORING SYSTEM CERT. 7/18/2006
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,.08/29/2005
13:57
5513252529
CAL VALLEV
PAGE
02
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdic/ions Withilt the State of California
A.uthority Cited: Ch(1pta 6.7. Health atld Safrtty OJtllt; Chapler 16, Division 3, Title 23, Califomia Code of R<!8u/a1j(ms
This form muSt be used to document tesllng and servieing of monirori1'lg equipment. A separate c;ertifiealion or N:..QQr.L!lliL~1 be ofe"p8l'ed
&r each nlOOilgrin2 system control pan!':1 by (he lcchl'lieian who perlo/'ms the work. A copy of this form mUSI be provided to rhe llmk
~ys\cm owncrfoper<l.lor. The ownerfop-:oralor mU!\l submit a copy of this form to the lOCAl lIgc;ncy reg1.lllIl.in;, UST :;%ICl11~ within 30
day~ or tesl date:.
A. Generallnfo..mation
Facilil'y N}\me: 11/, ~ C/,f'{:,...V'nl~1
SilC Addre$s; _::;};I~o J,.v/.,,")e t.J,.,.
Bldg. No,:__
_ City: /f4l.Ke,V.s:.f1'PI4' Zjp:__~,
Contact Phone No.: ( L,_._ ____
Date of Testing/Servicing: 2-1LlI t.!2fi.
f.'acility COl\tac[ Person:
MakcfModcl or Monitoring System: .JL:g~~ot" 7lS- 3So
'rllllklU: :
j!-ln.Tank Gauging Probe, Model: ....t1aCJ.Fs7.
\it Annul~r Space or Vault Sensor. Model: stc,q 1Pn~ S~
~Pipill!! 'sl)lnp IT~Reh Sensot(~). Model: Su..m.e SI;!jS",{'
a- ~i11 Sump Sensur(s). MOdel: ~''1f'''' ~
J8Mech~nic~1 Line Utile D<llector, Model: P.1-L_-__~
o Elc,'\ronic Line Lealt DeI,CC\Or. Mod!:l:
CJ TOl1k O\'crl'jlll HJgh-uvel Sen~(Ir, Model:
a Olhcl \~ eif ui menlt e Rnd model in Section E on p~ 'c 2>.
Tnnk 10: I
1ill"1n-TilRk Gauging Probe. Moclel: .-Dlt:l...!k-
tit' A!\I1t1Iar' Sp:lce Qr Vault Sensor. Model: .st:~~.C~1( .9~
l2t Pipirl~ Slimp I Trel1ch Scnsor(s). Model: S~4l!h.fPl""
ta' Fill .sump Sel1!1(lr(s). Model: ~~~
~Mcchanieal Line Lenk Detector, Model: JJt.O '_ ' '" ,
o Ekc\mnic Line Leal( Detector, Mader:
i:J Tllnk Ovc.-!i\l f High-Level Sensor, Model;
o OIlier \~ .jf e ul mel,11 :Ie lIt\d model in Section E "" POI e 2),
Dispenser ll): ---1.""<.. _
13 Dis"tms~r CQlllainmenr Sensor(s). Model: s..~, ~'W'
li!i-Shcnr Val'v~$).
CJ [)i~ ~nscr ConU,linmClllP'loill($ and Chain(s .
[)i~peME'I' 11): ;3-V
~ Dlspcnser Conlainmenl SCllsnr(~), Model: ~...LS!ttJflJ""
~ SMur V,lIv~ts).
CJ Di~ cn.~cr Containmtnl Floill(S and Chain s).
Dispc:n5er lD: .t::' -p,
Ci- Dispenser Cot1lainmcnl Sensor(s}, Modd; _~
C!r She:lr V;ll"el~},
ODis "set COlllainmenl FhIBI(S) and Chllin{s),
.lflne IHeilil)' conlnin, more rllllk.s or dispensers, copy this fOTm.
Tank ID: ',_ _,__
C In-TlIllk Onull,ing Probe. Modcl: .~
o Annular Space or Vauh Sensor, Moclel: ___,
Cl Piping Sump/Tr~nch Sensor(s). Model: _,_
o Fill Sump Scnsor(s). Model: __ ___
o Mechanical Une u:ak Ottector. Mod!:\; _ ,__.___,.
o EIt:clronic Line Leak Deb:ctor. Madel: __ __
o "lInk Overfill' High-Level Sensor, Model: _,__
CJ Other ~ if c ui ment an<! model in Section E on p, "c 21.
Tank ID: ,_
o In-Tank O~ullin.!l Probe. Mrxlel; _'_' ___
o AnnulllrSpace nr Vault Sensor, Model: ___,___
D Piping Slimp I Trench Sensor(s). Mooel: _ __
Q I<UI SUI11!, SCIUllr(S). Modc:l: __,
o Mc:chaniclll Line Leak Detector, Model:
Q Blc:;ctmnic Line l..cnk D<:teclor, Model:
o Tank Overl'illl High-Level Sensor. Model: .
o Other if ui ment I Dnd model in Sc:clhl\1 E OIl "'I~C 2 .
\)Ispellser In: ~. __,_.
a. r.>ispel'ISCr Containment ScnSOr(s), Moue-I: ~I!J!.:t....Se~
a).-ShcnI'Vnlve(s),
D Dis nscr ConlHinmcnt F10111 s) ilnd Chain(st
Dispense.. m: if'(-IO , ,__ ._
lit [)ispenser Conlainl11ent Scnsor(s), Model: s.~f' ~,_
t;it-SltcJlr Vnlve(5),
a Pis enserCOlltllinment Float ~) and Chllin s .
D!spcn~r rD: j.-, _
a-Di~penser Containment 5CnSOI'(1). Model: -~~1'~"Y _
~Shear Valvc(s).
o Oi. ense-r Conf.ainmenl Ploal(S anc;l Chain(s),
Include inl'ormation fnr ~Ycry tank ,lOd di.~pcnser Olllle lacililY.
C. CertifiC3tion - r certi(" tbat tbe equipmEnt identified in ~his document was inspected/serviced in accl.'rdance with the m~nurllctu~rs'
guidellnC$. AUlIehed tn tbis Certificlltion h InfQM_tion (e.g. ll1i1hUrnCluren;' cbcckfi$l:s) nece.....'ll!"Y to verify that rhis inliJm~llinn il;
COITl'cl "nd :;\ Pint ,Plan showi,ng t.he layout of n><mltnring eq\Iipmcnt. Fo,: any equipment capable of genernting slIch tcports.l,JjDve lIL,o
attached II copy of the rt'2!lrt; (chtlc~ aU tllat apply): a System set.up a Alarm history report
T~'X,hnidan NlIll1C (print): F:5rHC ~ fh'11:ilep. . Signature: ~.~ ~ ' _'_
Certificalion No.: ~=2S""I)7...S: License. No.: _2'i1''I17D J!f- ..._ _'_
Te"ling COl'npany Namc: J:wl-VtYletr~/...ip~~t: Phone: No,:(S-~>-.J.27-9 .J't./-__
Sit, :\cJdrc,~s: .:J3.Qf)_~p-Ke..csti'd~ t:'-G{. Dale of TCSliI1g/Servicing: _7 I.J~/ tJ~
PaIlC! 1 or ~
O~IDI
Monitoring System Certification
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6613252529
CAL VALLEV
PAGE 03
U. Re.sults of TestinglSen:icing
St,J'tware Vel'sion Installed;
Com lek the rolfowin checklist:
I!t Yes Q No" Is the audible alarm 0 crational?
Yes I:) No" IS the visual alarm 0 rational?
~ Yes 0 No" Were all Sen!:()rs visual! ins cled. functional! tested, and confinned () eralional?
a. Vel; Q No'" Were <III sensors installed at lowc:st poinl of !:econdary eonta,inment and positionoo so that l'lther equipment will
not interfere with their ro ef 0 erat;of'l?
o Yes 0 No'" If alarms are relayed to a remote monitoring station. is all communications equipment (e,g. li1Odcm)
\ill N/A operational?
~ Yc:< CJ No" For p.'essurized piping systems. does the lLIrbine automatically shut down if the piping secondal)' I.:nnlaillment
o N/A monitoring system detects II leak. fails to operate. or is electrically dl~connected7 tf ycs: which Sell!;l)r~ initial!;
positi\le sl1ut-down~ (Check all thaI apply) ,j9..SulTlp/1'r~neh Sensors: ,gl....Dispenscr ConlainlllclII ScnM.)r~.
Did ou confirm sitive shut-dowll due l,{) leaks i1nd sensor failure/disconnection? Ja-'Yes; D No:
o Yes Q No" Fnr tank !lystems that utiliz.e the monitoring system as the primary (link ovedill warning device (i.e, no
f11 N/A n'lechankal nv",rfrll prevention valve is installed), is lhe overfill wBfrJing alann vhdble and audible III Ihe tank
iii I oim s) :ltld 0 redn el'l "! If $0, at what creent of tank ea aeit does the alarm lri cr? ._ %
o Yc.:~'" ~ No Wa.$ any monitoring equipment replaced? Jr yes, identify specific sensors, probes. or other- equipmenl replaced
and lisllhe manufacturer name and model for all re lacemcnt 1I11S in Section E, below.
Ye~" 0 No Wa<;. liquid found inside any secondary containment systems designed as dry systems'? (eke('/<, flUt/wl (If)ply) CJ
Product; Water. If es. describe causes in Section E, below.
Iiit"'Ye<;. Q No'" Was rnonilorin ~ st.em se(-u teviewcd to ensure ro r setlirt s1 Attach set 1'I liClll>le
~Ye!{ 0 No* Is all Il'lonilorin ui menr. 0 eraliortal r manufacturer's s ecifica[ions?
., In Section E below, d~scribe how and when these deficiencies wena or will be corrected.
E. Comments: -LL...smp-11 ~~~O~"1::
-S~L ~ CfII.d.-,.p;11 S~P..
j.h f'h e. ~.:z-,.(.t:.~'CJtznL
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PAGE 04
F. In-Tank Gauging I SIR Equipment:
iif.,.Check this boll. if tank gat',ging is \lsed only fOf inventory comrol.
Q Check this box if no rllnl< gauging or SIR equipment js i nstalleo,
Thil' section must be completed jf in-tank gauging equipment is used to petform leak detection monitoring,
c
tJ f1 II
h kr
ompu;:te 'Ie I) OWlD2C ec 1St:
o Yes o No* Has all input wiring been inspected for propcrtmtry and terminalion. including testing for ground fault.,'~
CI Yes Q No"' Were all tank gauging probes visually inspected for damage &lid residue bllild~lp?
[J Yel: o No" Was accuracy of system producl level readi "gs tested?
Q Ycs CI No" Was accul'acy of system water level readil'gs tested?
0 Yes Q No'" Were all pf(lbc~ reinstalled properly?
Oy~ o No* Were all items on the equipment manu[aC[llrer's mainteMoce checklist comprcted?
'" In the Section H, below, describe flow and when these deficiencies were 0/' will be cl'lrreeted,
G. Line Leak D~tectors (LLT)}:
a Check (hi!; bo~ jf LLDs ~re. not inM311ed,
t.b f1 It
h k."
COI'nDlete e 0 OWirl1! ~ ec 1st:
aYe!: 0 No* For eClvipmcnt Start-tip or annual eQ1Jipmcl't certification. was l!l leak simulated to verify J~LD pcri'.)rmancc'?
0 N/A (Ched. aillhat apply) Simulated leak ratc: Q.3 g,p,h.; CI 0.1 g.p,h: 00.2 g.p,h.
~ yc;~ 0 No'" Wt!rr. 1111 ) .I.os c('lIlfilmed operational anc;!lICCurale within reg~ll..t(lry requil'cmcms?
.0" Y Cl" 0 No" Was the te:'<ling apparalUS properly calibrated?
Jill Yes o No* For mechanical LLDs. does the LLD n::stricl product flow if it detecls a leak?
o N/A
U Yes CJ No" For e1ec[ronic LLDs. docs the turbine automatically ~hut off if [he LLD delecls a leak?
QlIl N/A
Q Yes t:l No" For r::feclftlnic LLDs. does the turbine automatlcally shut off jf any pon;on or the monitoring systel'l'l is disabled
E N/A or disconnected?
Q Y\:s Q Nu" For electronic LLDs. docs the turbine automatically shut off if any pOl'li,>" or the monitol'ing sysLem mlllrunclions
9' NI ^ or fails II lesl?
0 Yes o No. Far electronic LLDs, have all acccssiblc wiring connections been visually in~pectcd'?
~N/A
2P Yes o N()* Wec'c all ilems on lhe e.quipl"l'lcnt manufacwrer's maintenance coocldillt complelad?
.. III 'he Section H. llell)w, df,lSCI'ibe how and when l;he.o;e dclidcncil$ were or will be corrected,
H. Comments:_"
Page 3 of 3
113/(11
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08/2'3/2006
13:57
661325252'3
Monitoring System Certlticatlon
Site Address:
rr' ....;.....,>r-
CAL VALLEY
PAGE 05
3~o lVh,t<Jd;.. ~J~J;}~>>~~~it~ PI.an
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Oate map was drawn: 2/ I'll 06.
Instructions
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If you already have a diagram that shows all required information, you may include it, rather than this page::, with your
Monitoring System Cenification. On your ~ite plro" show the general layout of l:anks and piping. Clearly identify
location!; of the following equipment, if installed: monitoril1g system control panels; sensors monitoring ttmk annlJlar
spaces, sumps, dispenser pans, spill containers, or other secondary containrnent areas; mechllnical 01' electronic line leak
c1etec;rors; ilnd in-rank liquid level probes (if used for leak detection). Tn the space provided, note the date this Site Plan
was prepared,
rage J:L. of Jt_
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08/2g/2006 13:57
661325252g
CAL VALLEV
PAGE 06
v APORLESS MANUFACTURING, INC.
LDT -890 Leak Detector Test Record
.QL.ot".!'~or CustQD1:T
f:j-I/all* ~:.'t::e~d 1J}d) UUH"tr]y C;:::::n
7-/(--04 33oc!A1J1k 41. &:tKet"-l+/(/~Oj..
T;cbnician
.d'V't-Uf w: Ih'H~/I!Y
ManufiletlJret
SubmersibJe Pump Identification
Modet No. ~al N1!tDber
1~A<.Ker
~Ifilcturer
Leak Detector Identification
~criDl!on
Other Style Letlk Detectm
!f.&t,ja.r..k'er
Diapbragm-typc_
Piston-type 1,/"
Tamper-proof seal installed? Yes,
No
Leak Detector in Submersible Pump
Test at DispeDseF."'
J. Operating Pu:mp Pressure :32.. pliIi (para. 15)
2. Gall()~ pa hour rate 1~o (para. 22)
3. Line pressure with pump shut off I g psi (pan. 23)
4. Blcedback Test widl pump off _ SS
5. Step-through time to fulllto\V '3
m1 (para. 26)
secoads (para. 30)
6. Leak detector sta)'tl in leak search position. (para.. 42)
Yas ...--
,-
No
LEAK DETRCTOR TEST
Nottt: Pass'" l.cBk detedOr fits cv:st prolocOl
Fail-- leak dClCCtlOr fails test protocol
Pass V
FsdI
)
Form 890C (9-1 -96)
.CQmpJete thermal expansion test before f.tiling leak detector.
1996 Vaporless Manutaeturiog, Inc., Prescott Valley, AZ
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'08/29/2006 13:57
6613252529
CAL VALLEY
PAGE 07
v APORLESS MANuFACTURING, INC.
7-1 'l-{)C
Techniei!D
-rl'V't.<.ce W. 1J:J~'/{'Il!Y
}3oe JA4"ik. 4,. &~Wf-t;f/~Ot,
LDT-890 Leak Detector Test Record
~
1J}t:1 Uf.t4t'fn1". eitel/roh
~duct
Qmtr~~
W-IIa./Il!F '!,,"t=Ch'f
Dat~ ' ca on
Je~N;,Ke""
Submersible Pump IdentificatioD
Model No. Serial Number
Manofaeturer
.efd' v.u'e~t- Diaphragm.type_
Piston~type 1./"
Leak Detector IdentIfiution
~riDWm
Other SnrJe Leak Detector
M!mUfacturer
Tamper-proof'seaJ installed? Yes No
Leak Detector in Submersible Pump
Test at Dispenser.
1. Operating Pump Pressure 3lf oai (para. 15)
2, Gallons per hour rate '3.0 (para. 22)
3. Line pressure wi,th pump shut off :2.0 Dsi (para. 23)
4. BIecdbaclc Test with pur.np off Gs _ m1 (para. 26)
5. Step.througb time to full flow '3 seconds (para. 30)
6. Leak detector stays in leak search pQsition. (para. 42)
Yes ".-
-----.
No_
LEAK DETECTOR TEST
Nob:: 'aliI"" leak dctcetor fits II:St Proloa:Jl
Fail. Leak dcu:elor faiJ!llest pn>t0C0l
Pus V
Fail
)
FOIttI 890C (9~ J -96)
.Complete thermal eKpansion test bcfufe failing leak detector.
1996 Vaporless Manufacturing, Inc.. Prescott Valley, AZ
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PAGE 08
SWRCB, January 2006
Spill Bucket Testing Report Form
'lJIisform is irrtetttkdfor use by contractors performing QMUQI testing ofusr spill containment &Jructure3. 'rhe co",pJelerilf)Tm and
pt'intatll&,/rQm tests (if applicable), .rhouldbe provided tQ the facility ownerIoperator for suh11linal to 1M local I'eguJotory agency.
I. F.4ClLlTY INFORMATION
Che
Date of Testing:
Facility Name:
Facility Address:
Facility Contact:
Date Local Agency Was Notified ofTe$ting :
Name of Local Agency Inspector (ifpresent dul'-ing testing):
Phone:
2.
yNamc: -Va.
Technician Conducdng Test:
Credentials': tif.,CSLB Contracror
License Number(s): jib
~
DIce Sl:I'Vice Tech. Cl SWRCB Tank Tester 0 Other (Speq ~
Test Method Used: 1tH ic o Vacuum o Other
Test Equipment Used: Vi:5"u .a,; Equipment Resolution;
Identify Spilt BuCket (By Tank 1 t6'7 UL 2 3 4
Number. Stored Product. erc.) O('effJ
Bucket lnstallation Type: o Direct Bury o Direct Bury o Direct BIJl'y o Direct :Bury
m-contained in SumD -'ll-Contained in Swno o Contained in Sumo o Contained in SUttlD
Bucket Diameter: la It J(J ./
Bucket Depth: /0" /0"
Wait time between applying JtJ #,;1.. I" J1.1. .....
vacuumlwater and start of test:
Test Start Time crr): 1'3:CJO n;r;Jv
Initial Reading (R.): q.tJ .- GI.b \f
Test End Time (T y)= 14:10 ''I:w
Final Reading ~): q-()" t1.n ..
Test Duration (T F - T u= It.v. I hI".
Change in Reading (R.. - Rt): ./JF. -9
PasslFail Threshold or
Criteria: -.f$' - . 2S'"
Test-~alt: ' /it- Pass OFaU J!rbs ,0 :F3i1 o I'8ss o Fail U,Pa. ' 0 Fall
3. SPILL BUCKET TESTING INFORMATION
Comments - (include i'1fonnation on reJ!!lirs made prit>r to testing, mzd recolWlfe1fded fol!.C1W-!!p fo! failed tesIs)
CERTmCATJON' OF TECIlNIClAN RESPONSmLE FOR CONDUCTING THIS TESTING
I hereby r:enJh ,"tIt tdIlhe btjimntmM totJtllhled ill this TtlpDJ'I Is true" lICCII""'e~ and in fll1l ctimpllance with leglll nquiremtmts.
Technician)s Signature: "'r>c;u~<<- 4.- ~ Oate:. 7~/8"----.o (;
I State laws and regulations do not c:urTently require testing to be performed by So quali'6ed contractor. H~ver. local requirements
may be m.ore stringent.
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08/29/2006 14:02 6613252529
CAL VALLEY
PAGE 01
CAl-VALLEY EQUIPMENT
3500 GILMORE AVE.
BAKERSFIELD, CA 93308 '
(661)327-9341 FAX: (661)325-2529
CONTRACTOR'S L1C.#784170 A HAZ
Fax ;
To: "llYn C:Lr DeAL From: !3:.~ ~~
Fax: CZ.s ~~df1/ POIIge$: d- INCLUDING COVER
Att: ~J' !/ /J{k w{}ocI Date: ~~9 (p~
r
As CC:
o Urgent 0 For Review Cl Please Gomment 0 Please Reply 0 Pie.. Recycle
Comments:
L:) ff/~
If)f 19~ s+--
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6613252529
CAL VALLEY
PAGE 02
"
CAl VALLEY EQUIPMeNT
3500 Gilmore Ave
BakBlsfield, Ca 93308
881-327-9341 Fax 861-325-2529
IMPRESSED CURRENT CATIIOOIC PROmcnON CERTfFICAnON
DATE: .~ ~ - 2--0-6 SITE:f--;-2. m" bt' L
CONTACT~ /0/ J9n..Sr
PHONE: I1a.KecsB..~/dl C~
w.B ('6t.1tt(}~'( ~Vi'cc.f
fnsIallatlon Date: MOdel" 20c05- .0<. _ SeIiaJ#:.Jl!f17l/7'7
Hours:...1I() JIltJe.:rer- f'res~VOTtage: ;?$ Amps: __Z
Adjustment:" .tZ ~a..\(1"~ COurse: c.. Fine: '/ ~
I ~ I ~f ~~1-~.t~;~l~f~~rl~:ifl~~~
I hereby certify thst the minimum syStem potential requirements for Imprnssed Current Cathodic
Protection: .
~f. HaVe t3een Met
I ~ J Have Not Been Met
for the .systems nm,renced above: taken In accordance with the minimum standan:ls of the Natlonsf
AssoctatJon of Corrosion engineers, and as done to oon'Iply with EPA end state DirectiveS
-zJ~L ~ J..h'bf1fp-.......
Technlciatl PE!ffonnJng Test
APPLICATION
TO PERFORM ELD / LINE TESTING
/ S8989 SECONDARY CONTAINMENT TESTING
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPT.
D Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
UNDERGROUND STORAGE TANKS
Page 1 of 1
PERMIT NO. I 1\ - 3,?.g
FACILITY Big Country Chevron
o LINE TESTING 0 SB-989 SECONDARY CONTAINMENT TESTING
IiJ TO PERFORM FUEL MONITORING CERTIFICATION
SITE INFORMATION
I NAME & PHONE NUMBER OF CONTACT PERSON
o ENHANCED LEAK DETECTION
o TANK TIGHTNESS TEST
ADDRESS 3300 White Lane
OWNERS NAME Sullivan's Petroleum
OPERATORS NAME Same
I PERMIT TO OPERATE NO.
IS PIPING GOING TO BE TESTED? 0 YES
VOLUME
o NO
CONTENTS
NUMBER OF TANKS TO BE TESTED
TANK #
1 87 UL
2 91 UL
TANK TESTING COMPANY
NAME OF TESTING COMPANY Cal-Valley Equipment I Bruce w. Hinsley 661-327-9341
MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308
Bruce W. Hinsley 661-327-9341
CERTIFICATION #; 006-05-1178
DATE & TIME TEST TO BE CONDUCTED July 18, 2006 12:00
SIGNATURE OF APPLl7fNT ~_ _4</ /f 1 .. /2
/). lJHt.S ADD.
APPROVED BY ~t J (,fJI'i~. pj
./
ICC#:
~ ~~ . . ~.7 -UT
DATE July 7, 2006
A
DATE "7f (of () ~
I
FD 2095 (Rev. 09/05)
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UNDERGROUND STORAGE TANKS
::.;:
,;,.':
~'.~
~;/_.
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
APPLICATION
TO PERFORM ELD I LINE TESTING
I S8989 SECONDARY CONTAINMENT TESTING
frANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
~
'~~
Page 1 of 1
LINE TESTING
rn S8-989 SECONDARY CONTAINMENT TESTING
PERMIT TO OPERATE NO.
DYES
B' NO
C NTENTS
\
CDO
'TAN)(iE;$'i1t.1~CP~RANY, ,
NAME & PHONE NUMBER OF CONTACT PERSON
~ -~~~~
MAILING ADDRESS ./J
\ 1~ ~ ~.
NAME & PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR
~ C\\C\-~~C\
DATE & TIME TEST TO BE CONDUCTED
. '5 .\IV'\.
SIGNATURE OF APP
TEST METHOD
, .-:-
APPROVED BY
FD 2095 (Rev. 09/05)
RONALD J. FRAZE
FIRE CHIEF
Gary Hutton,
Senior Deputy Chief
Administration
326-3650
Deputy Chief Dean Clason
Operationsffraining
326-3652
Deputy Chief Kirk Blair
Fire Safety/Prevention Services
326-3653
2101 "H" Street
Bakersfield, CA 93301
OFFICE: (661) 326-3941
FPlX: (661)852-2170
RALPH E. HUEY, DIRECTOR
PREVENTION SERVICES
ARESAFETYSE~S'E~RONMENTALS~CES
900 Truxtun Avenue, Suite 210
Bakersfield, CA 93301
OFFICE: (661) 326-3979
FAX: (661) 852-2171
David Weirather
Fire Plans Examiner
326-3706
Howard H. Wines, III
Hazardous Materials Specialist
326-3649
December 1, 2005
Big Country Chevron
3300 White Lane
Bakersfield, CA 93309
FINAL REMINDER NOTICE
RE: Necessary Secondary Containment Testing Requirements by
December 31,2005 of Underground Storage Tank (s) Lo~ted at
the Above Stated Address
Dear Valued Customer,
Over the last six months this office has continued to send reminder notices regarding
secondary containment testing,
Code requires that all secondary containment systems must be tested 6 months post
construction and every 36 months there after.
Senate Bill 989 became effective January 1, 2002, section 25284.1 (California
Health & Safety Code) of the new law mandates testing of secondary containment
components upon installation and every 36 months, thereafter, to insure that the
systems are capable of containing releases from the primary containment until they
are detected and removed.
Our records indicate that your facility is due prior to December 31, 2005.
Those sites that have not been tested and have not pulled a permit prior to December 31,
2005. will have their permit to operate revoked,
This office does not wish to take such action, which is why we will continue to send monthly
reminders.
Contractors are already booked several weeks in advance. I urge you to schedule your
testing date as soon as possible to avoid possible revocation of your permit to operate,
Should you have any questions, please feel free to call me at (661) 326-3190,
Sincerely,
7L 7iI:;;~Hon S~;re'
Steve Underwood
Fire Prevention Officer
SU:db
wg~~~~~..rk.~ N
;i'
"
SWRCB, January 2002
Page ~ of .:::1-
Secondary Containment Testing Report Form
This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the
appropriate pages of this form to report resultsfor all components tested. The completedform, written test procedures, and
printouts from tests (if applicable), should be provided to thefacility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: Big Country Chevron I Date of Testing: December 1, 2005
Facility Address: 3300 White Lane, Bakersfield, Ca. 93309
Facility Contact: Sullivan Petroleum I Phone: ,.~,," \ - ~ 'Z."04~J
Date Local Agency Was Notified of Testing : November 28,2005
Name of Local Agency Inspector (if present during testing):
2. TESTING CONTRACTOR INFORMATION
Company Name: Sunset Mechanical
Technician Conducting Test: Ken Brus
Credentials: M CSLB Licensed Contractor C SWRCB Licensed Tank Tester
License Type: C-36 C-IO I License Number: 589517
Manufacturer Training
Manufacturer Component(s) Date Training Expires
Incon TS-STS Inspection Equipment 1/12/08
Veeder Root Monitoring System I 6/12/06
AO Smith Secondary Piping 6/19/06
ICC Cal. UST Service Tech 12/21/06
Component Pass Fail Not Repairs Component Pass Fail Not Repairs
Tested Made Tested Made
AI>.' ',l" ... .4 C> 'S~,cc~'" \ ~ 0 n 0 ..lOt.: <<- \ ., ~ 0 0 0
L.;
AMI',) LLAQ.. Jt.;; ~ 0 0 0 :1bt."" A 3 - 't ~ 0 0 0
[J [] 0 0 (1.r.c-, # 5,-€, [!t 0 0 0
P'!=,>,Nf-;: 2..u....\ .... 1 ~ ~ LJ 0 j,n<_., _.~ B1 0 0 []
L.J
......, Q.. (J.t.)'" ? ~ 0 0 0 0 0 0 0
0 0 0 [] 1'\ t:R.<l. 4 I ~ 0 [] 0
'"",....,.- C;'l'\Ac.' ~ 0 0 0 "r:.P-.~ ~ '::J '81 0 [] 0
PH"~L1~: ~lU\'(~' io4 ~ ~ 0 0 0 0 0 0 0
0 0 0 0 ~B. ~ , ~ 0 0 0
C"'] 0 0 0 l'lI=R"" ~ ~ 0 0 0
~
0 [] 0 0 0 0 0 0
:-1 0 [J 0 0 0 C 0
3. SUMMARY OF TEST RESULTS
If hydrostatic testing was performed, describe what was done with the water after completion of tests:
,^,IAT~Q.. I=bL.,.a:;:....-:-I~tS kJR~ t>il.MP'G..D 'l1J1"6 ~,'J. ~r,OCA~!J'"TAUic:.
~~ ~eh~;;::;;: ArJr:-io~ ~i'f..:.~~A(
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best of my know/edge, the facts stated in this document are accurate and in full compliance with legal requirements
,Technician's Signature: ~~ ~
Date: D'i:<'... I - Of;
SWRCB, January 2002
Page ~ of -.::L
Test Method Used:
4. TANK ANNULAR TESTING
~ Tank Manufacturer 0 Industry Standard
o Other (Specify)
C Pressure IA1 Vacuum
o Professional Engineer
Test Method Developed By:
C Hydrostatic
Equipment Resolution: 0 -';)0 ~G
Tank # Tank #
Is Tank Exempt From Testing?1
Tank Capacity:
Tank Material:
Tank Manufacturer:
Product Stored:
Wait time between applying
pressure/vacuum/water and
startin test:
Test Start Time:
Initial Reading (R1):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading (RF-R,):
Pass/Fail Threshold or Criteria:
Test Result:
Was sensor removed for testing?
Was sensor properly replaced and
verified functional after testing?
iiNo
C Yes
CNo
DYes
DNa
<'
t () M.~ .
,$ M..... .
..., ~. - .0" IIG.
~ Pass D Fail ~ Pass D Fail D Pass D Fail D Pass D Fail
!a Y es ONo DNA aYes DNo DNA DYes DNo DNA DYes DNo DNA
~Yes CNo DNA ~Yes DNo DNA DYes CNo DNA DYes DNa DNA
Comments - (include information on repairs made prior to testing, and recommendedfollow-up for failed tests)
I Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary
containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment
testing. {California Code of Regulations, Title 23, Section 2637(a)(6)}
'i'
SWRCB, January 2002
Page ---3..- of ~
5. SECONDARY PIPE TESTING
Test Method Developed By:
Test Method Used:
2I'Piping Manufacturer
o Other (SpecifY)
~Pressure
o Industry Standard
o Professional Engineer
o Vacuum
o Hydrostatic
[] Other (Specify)
Test Equipment Used: l..J., GS~ F/u..E 0 NE lSf; r:.RuG~ CoJ/(',.k..
Equipment Resolution:
Piping Run #
Piping Run #
Piping Run #
Piping Run #
Piping Material:
Piping Manufacturer:
Piping Diameter:
Length of Piping Run:
Product Stored:
Method and location of
i in -run isolation:
Wait time between applying
pressure/vacuum/water and
start in test:
Test Start Time:
Initial Reading (R,):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading (RF-R,):
Pass/Fail Threshold or
Criteria:
Test Result:
TEST ~oT
S.
IS Mt ~ .
tS M't\J ,
j I ~ CO A .-...,.
~.:L:.
H :OO~~
c::. P~'.:L
l~.:, ~ FM
5 PS:t:.
60 ""It..:>
l''''Z.:C'l>c.P.......
ps-z
60 I 'IV...,.
-{;I
-'~
~ Pass D Fail
D Pass D Fail
D Pass D Fail
~ Pass D Fail
Comments - (include information on repairs made prior to testing, and recommendedfollow-up for failed tests)
SWRCB, January 2002
Test Method Developed By:
Test Method Used:
6. PIPING SUMP TESTING
~ Sump Manufacturer
D Other (Specify)
D Pressure
D Other (Specify)
Test Equipment Used: ::tklCoA.> l~ ~ ~IS
D Industry Standard
D Vacuum
Sump Diameter:
Sump Depth:
Sump Material:
Height from Tank Top to Top of
Highest Pi in Penetration:
Height from Tank Top to Lowest
Electrical Penetration:
Condition of sump prior to testing:
Portion of Sump Tested I
Does turbine shut down when
sump sensor detects liquid (both
roduct and water)?'
Turbine shutdown response time
Is system programmed for fail-safe
shutdown?'
Was fail-safe verified to be
o erational?'
Wait time between applying
pressure/vacuum/water and starting
test:
Test Start Time:
Initial Reading (R1):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading (RF-R,):
Pass/Fail Threshold or Criteria:
Test Result:
Was sensor removed for testing?
Was sensor properly replaced and
verified functional after testing?
t S 6"
"
~Yes DNa DNA
-'0 St:;.<:..
SYes DNa DNA
~Yes DNo DNA
30 ,....,....,.
PIO'\
'5 -..
i7 -~
-t 7-4 '4
~es DNo DNA
o 'i) t,.<:... .
iX.Yes DNo DNA
)dYes DNo DNA
6<::" 3'" '\N "
. l
IS lVt,tV.
+ 002.-'
~ Pass D Fail
~Yes DNo DNA
~Yes DNo DNA
Page~of~
D Professional Engineer
IK Hydrostatic
Equipment Resolution: .:t . OC?_ '.
Sump #
DYes DNo DNA
DYes DNo DNA
DYes DNo DNA
D Pass 0 Fail
DYes DNo DNA
DYes DNo DNA
Sump #
DYes DNo DNA
DYes DNo DNA
DYes DNo DNA
o Pass 0 Fail
DYes DNo DNA
DYes DNo DNA
Comments - (include information on repairs made prior to testing, and recommendedfollow-up for failed tests)
I'Z..:\;"- p-
c\ r- .....
I
-, .0004 "
+ . O~2 . ,#
~ Pass 0 Fail
~Yes DNo DNA
~Yes DNo DNA
I If the entire depth of the sump is not tested, specify how much was tested, If the answer to ill!Y afthe questions indicated with an
asterisk (*) is "NO" or "NA", the entire sump must be tested, (See SWRCB LG-160)
"
SWRCB, January 2002
Page~of~
7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING
Test Method Developed By: ~ UDC Manufacturer D Industry Standard D Professional Engineer
o Other (Speci/y)
Test Method Used: o Pressure D Vacuum iil Hydrostatic
D Other (Specify)
Test Equipment Used: t..)(' l~.. - f'...., Equipment Resolution: ~ . 00"2.. ~,
UDC # l~'2- UDC # ~-, (.I UDC #5-<; -I' <6 UDC # 9 . 1 l::) it./2
UDC Manufacturer: -r'OTA t. (~B"T'", ('n"iT Tt't1'"'R L C'6 U., -rO-r~l (' 1"'}f',,)"'T .
UDC Material: ~ I 0 .. to L1 , L\ 1"...c. r:: l~'" n 1!!1 ,.. ,:::~ ~,~~<.; .A<.c;:. I:::,C... c ~, ..o.~<"
UDC Depth: 'R 2) ~- "'1\,-1'\ ...., ~~ ..., ,~O ", 30 .:, i\c ,~.
Height from UDC Bottom to Top q. q q "
of Highest Piping Penetration: - . q " q" q ,
Height from UDC Bottom to
Lowest Electrical Penetration: 7 - , .., '. '7 -, -,-. '7 " "7 -.
Condition of UDC prior to
testing: GoOOO Goo~ 6oCt::l bcOC ~CD CO~
Portion ofUDC Tested + itS ~, 4- IS .~ -+ IS':' +15" + IS -, + 15. "
Does turbine shut down when
UDC sensor detects liquid (both ~ Yes DNo CJ NA Ki Yes DNo DNA iYes DNo DNA jj. Yes DNo DNA
product and water)?'
Turbine shutdown response time - 30 6<=.<., -3.Z\ '3, <- - ~O "~CL.I-;'k\~,o.t', "i\b (;cr_J -,~ 'd,
Is system programmed for fail- t1l Yes DNo DNA ijQYes DNo DNA ~Yes DNo DNA ~Yes DNo DNA
safe shutdown?'
Was fail-safe verified to be ~Yes DNo DNA IlYes DNo DNA ~Yes DNo DNA ~Yes DNo DNA
operational?'
Wait time between applying ,
pressure/vacuum/water and 15 M,IU. is M,w\t . 1'$ M If". IS M,N is' >>vi IN l~ i'\1.....
starting test
Test Start Time: It: I ~ A..... II ~ f <jif It> ,-"" II 'I~A" ',:11;1\,... I. '. .., 't ,.." " :<{4 liS;
Initial Reading (R,): 5,'2.<1',- '. S ' 'iiCl I, " b. -=u..~'=\' 4.9&*30' 4.Z6t.f7'. Z,'it~"'2'
Test End Time: II :~~ 11M II'.~~ ~,\.oo " ., ~~ ~. · It : 'is?. ,. r. II ~~q "u, II' Sc~^ '1
Final Reading (RF): ~, ~q,,,,,", ~ 4015f '. l~ qf, 4 J . .:; q rt'2;l . 4.. '7(..'46, . 2,~iq
Test Duration: I _'(' i1A, t'\.I , , 5 w. "" '"' Il.o ,... l~ ,... ,W\I /{' "",t<<; . I~M,....
Change in Reading (RF-R,): fl{ -+ . non j -, 1+ "~o...."'7.." -' .iI"'>,","" J ., - . (J('V'o.J ., -r.
Pass/Fail Threshold or Criteria: -:!' ' l"JrJ L_ <,' + .n~.., - , ..:1. oo'"!. '. +.00-' lj ~ . CY'\2 " f .CC'2. "
Test Result: ~ Pass D Fail Is: Pass D Fail ~ Pass D Fail B Pass D Fail
Was sensor removed for testing? .fIl Yes DNa DNA ~Yes DNa DNA ~Yes DNa DNA 8Yes DNa DNA
Was sensor properly replaced and ~Yes [1 No DNA !j Yes ONo DNA I;t Yes DNo DNA a'! Yes DNo DNA
verified functional after testing?
Comments - (include information on repairs made prior to testing, and recommendedfollow-upfor failed tests)
12e.PlA CE: 1l ~H' ~A~,")t;;-R.. 'VAl..v.i:.:.<i :I::N "'TE:~T' R~"'\"'S '
I If the entire depth of the UDC is not tested, specify how much was tested, If the answer to ill1Y of the questions indicated with an
asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160)
SWRCB, January 2002
Page~of~
8. FILL RISER CONTAINMENT SUMP TESTING
Facility is Not Equipped With Fill Riser Containment Sumps D
Fill Riser Containment Sumps are Present, but were Not Tested D
Test Method Developed By: It1 Sump Manufacturer D Industry Standard
D Other (SpecifY)
Test Method Used: ::::: Pressure 0 Vacuum
D Other (SpecifY)
, Test Equipment Used: -:r N G 0 l\) .,.~-; - ~TS
D Professional Engineer
~ Hydrostatic
Equipment Resolution: :t, 007. "
(
Fill Sump #
~~ '.
4'
1'7 h
Fill Sump #
Fill Sump #
Sump Diameter:
Sump Depth:
Height from Tank Top to Top of
Hi hest Pi irig Penetration:
Height from Tank Top to Lowest
Electrical Penetration:
Condition of sump prior to
testin :
Portion of Sum Tested
Sump Material:
Wait time between applying
pressure/vacuum/water and
startin test:
Test Start Time:
Initial Reading (R,):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading (RF-R1):
Pass/Fail Threshold or Criteria:
Test Result:
Is there a sensor in the sump?
Does the sensor alarm when
either product or water is
detected?
Was sensor removed for testing?
Was sensor properly replaced and
verified functional after testing?
''7 "
f
\8'.
is jVfl~ ,
~s :.., ~,
.,
,N.
- .o~o +.0<:'\0<... ..
-t . 0 o~ '. r ,007 "
Pass o Fail ~ Pass D Fail o Pass o Fail D Pass D Fail
~Yes uNo ~Yes DNo o Yes uNo DYes DNo
l\!Yes DNo DNA !!!.Yes DNo DNA DYes DNo DNA DYes DNo DNA
Yes DNo DNA Ii Y es DNo DNA DYes DNo DNA DYes DNo DNA
!iIII Yes DNo DNA ~Yes DNo DNA DYes DNo DNA DYes DNo DNA
Comments - (include information on repairs made prior to testing, and recommendedfollow-up for failed tests)
..
SWRCB, January 2002
Page -.2 of ~
9. SPILL/OVERFILL CONTAINMENT BOXES
Facility is Not Equipped With Spill/Overfill Containment Boxes 0
Spill/Overfill Containment Boxes are Present, but were Not Tested 0
Test Method Developed By: 2S.Spill Bucket Manufacturer 0 Industry Standard
o Other (Specffj;)
Test Method Used:
u Pressure
o Other (Specify)
Bucket Diameter:
Bucket Depth:
Wait time between applying
pressure/vacuum/water and
startin test:
Test Start Time:
Initial Reading (R1):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading (RF-R,):
Pass/Fail Threshold or
Criteria:
Test Result:
- "
IS ""t~.
~ Pass 0 Fail
o Professional Engineer
o Vacuum
~Hydrostatic
Equipment Resolution: :!. OO"L -.,
Spill Box # '2..
11- ~
, 't. ".
Spill Box #
Spill Box #
\s j\A 1 '" '
'.
+ .600 ; .,.
:t . D02. -...
I!t. Pass 0 Fail
o Pass 0 Fail
o Pass 0 Fail
Comments - (include information on repairs made prior to testing, and recommendedfollow-up for failed tests)
~
,~
::~:;.~)Ui~.rr~:11'! C;HCUI~ClJ"~
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TEST STARTED
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END DATE
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TEST RESULT
~;;~~~l;l~l~~i~!:~
TEST :;:;TART(D
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BEG It", L.EI.IEL.
~].,jl) 7: !1E
END DATE
1. ;>'''(1 ':, /'2~j0:J
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TEST STARTED
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END T!~iE
::~J'~f) C)r::! TE
a,!D LEl.JE:'"
~.._:::f4i< T~-!~~ESHOL..0
TEST RESUL..';
a. a~i2 I~~
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'i :44 I1r";
~,2;01>2005
. ,:. 8~'::?2 I t~
"'": , .-",';3 Ht"
i ~:":~~;i~3~:~'
0. 002 I ~.~
[;)A~;::;[D
TEST STARTED
T!::ST ;~:;7HRTED
SEOUl L.El.JEL
:=:~~D -:- J". ME
am DATE
:-:,["rl ; ;:-;j[!
LE.A:< -THRESHOL[)
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12: 3(1 pr~
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6" 8505 I~.;
,j. 002 Ir~
PASSED
;:'::;-2
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:,2/(,1/2005
G" '1755 It~
12: 36 ?r1
i2/ttl/2005
:s. J.752 IN
o It ~::1!3~:~ I t.~
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12:21 r't'1
12/131/213[15
3. t.804 IN
12:36 Pt')
12/01/21305
3.6803 F;
0.002 IN
PASSED
12:21 Ptl\
: 2/01/20135
3.6205 IN
12: 36 Pf1
12/01/2005
3.6206 Ir-l
0.002 Ii',
PASSED
GIG C8UN7~Y CHEURON
33~1t2; ~)H I.it: i...AI'~E
3f1;<;::~:S;= I r:lj) GA. ':;33~19
1-(:~6l-827 -0487
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12/121 ; ,."20\:1:5
~ 1 ~ 33
f,r,~
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TEf;T STARTED
. r':.''''J.,''' )..E:UE:"
END TIflE
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STARTED
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BEGH.i LEl.JEL
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D-lC, CI11 TE
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LEAK THRESHOLD
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U[)C~j-t.
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TEST STARTED
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U~i) TIME
::::..~[; ;)(1'i'"E
Et'~D LEt..JEL.
:_~~!1K -r;-;RESHOLD
!'EST RESULT
:,~:DC7-~::;
:i, : ~ 1 :~; (1111
12/01.....2fH2l~~
5. 2916 i~'~
:, 1 ; 33 fit"
~_ 2/0 1. /20iZ15
5. 21316 I~~
~3.[l02 Ii~
?ASSED
i1: 1:3 fW';
12,/01./2005
5.4017 I f~
11 ~ 3~:; A~1
12/0,/2005
5. 4018 It~
(1. 002 H,;
:"'rlSSED
11~1::; Ar1
12/01/2005
6.. S~6:::;9 IN
11 : 33 Hr',
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