HomeMy WebLinkAboutFMC RESULTS 2/25/2008~'~{` MONITORING SYSTEM CERTIFICATION
For Use By Al! Jurisdictions Within the State of Cal ifornia
Authority Cited.• Chapter 6. 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regedations
'ibis form must be used to document testing and servicing of monitoring equipment. A separate certification or reaort must be
prepared for each monitorin~ svstem control panel by the technician who performs the work. A copy of this form must be provided
to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems
within 30 days of this date.
A. General Information
Faciliry Name: White Water Car Wash
Site Address: 2301 H Street
Bldg. No.:
Zip: 93301
Faciliry Contact Person: Julio (Manager) Contact Phone No.: 661-343-1706
Make/Mode) of Monitoring System: EBW
B. Inventory of Ec~uipment Tested/Certified
Check the ~yyropri~h bosa lo io aa ~peeilie eqdpmeut bupectedherviad:
Tank ID: Regular
[x] In-Tank Gauging Probe. Model:8463so-1o7
[z] Annular Space or Vault Probe. Model:~acuum
[z] Piping Sump / Trench Sensor(s). Model:Ronan
[J Fill Sump Sensor(s) Model:
(x] Mechanical Line Leak Detector. Model: Fx-~v
^ Electronic Line Leak Detector. Model:
U Tank Overfill / High Level Sensor. Model: OPw 6~-SO
^ Other (specify equip. type and model in Sec. E on Pg. 2)
TaaklD: Super
[X] In-Tank Gauging Probe. Model:~380-107
(X] Annular Space or Vault Sensor. Model ~acuum
[~ Piping Sump / Trench Sensor(s). Model:Ronan
[] Fill Sump Sensors(s). Model:
[1 Mechanica) Line Leak Decector. Model:FX-1V
^ Electronic Line Leak Detector. Model:
U Tank Overfill / High Level Sensor. Model:oPW s~-so
^ Other (specify equip. type and model in Sec. E on Pg. 2)
Dispeaser ID: ~ ~ 2
n Dispenser Containment Sensor(s). Model: ~udreau aos
[X] Shear Valve(s).
^ Dispenser Containment Float(s) and Chain(s).
Dispenser ID:
~ Dispenser Containment Sensor(s). Model: _
^ Shear Valve(s).
~ Dispenser Containment Float(s) and Chains(s).
Tank ID: ~ P~us
[z] In-Tank Gauging Probe. Model: ~~-~o~
U Annulaz Space or Vault Sensor. Model: ~cuum
(x] Piping Sump / Trench Sensor(s). Model: Ronan
U Fill Sump Sensor(s). ModeL•
[X] Mechanical Line Leak Detector. Model: FX-1V
^ Electronic Line Leak Detector. Model:
U Tank Overfill / High Leval Sensor. Model: OPW 61~0
^ Other (soecifv eauio. tvce and model in Sec. E on P¢. 21
Tank ID:
^ In-Tank Gauging Probe. Model:
^ Annular Space or Vault Sensor. Model:
^ Piping Sump / Trench Sensor(s). Model:
^ Fill Sump Sensor(s). Model:
^ Mechanical Line Leak Detector. Model:
^ Electronic Line Leak Detector. Model:
~ Tank Overfill / High Level Sensor. Model,
^ Other (specify equip. typs and model in Sec. E on Pg. 2)
Dispenser ID: 3 8~ 4
[x] Dispenser Containment Sensor(s). Model: aeaud-eau a06
U Sheaz Valve(s).
^ Dispenser Containment Float(s) and Chain(s)
Dispenser ID•
^ Dispenser Containment Sensor(s). Model: _
^ Shear Valve(s).
^ Dispenser Containment Float(s) and Chain(s).
Dispenser ID: Dispeaser ID:
^ Dispenser Containment Sensor(s). Model: ^ Dispenser Containment Sensor(s). Model:
^ Shear Valve(s). ^ Shear Valve(s).
^ Dispenser Containment Float(s) and Chain(s) ^ Dispenser Containment Float(s) and Chain(s).
more tanks or dispensers, copy this
City: Bakersfield
ation tor every
at
C. CCl'tlf C8t10~ - I certify that the equipment identified in this document was iaspected/services in accordance with the
maoufacturers' guidlines. Attached to this Certification is information (e.g. manutacturers' c6ecklist) necessary to varify t6at
this information is correct and a plot plan showing the layout of monitocing equipmeo~ For equipmeat capable of generating
such reports,l6ave attached a copy of the report; (check all that apply) ~ System t-u Alarm history report
Technician Name (print): Matthew Jennings Signatwe:
Certification No: 896~45 License No: 80a9oa
Date of Testing/Servicing: 2/25/2008
Testing Company Name: Confldence UST Servlces, Inc. Phone No: 800-338-8830
Site Address: 2801 H Street, Bakerefleld, CA. 93301 Date of Testing/Servicing: ~~D08
,D. Results of Testiog/Servicing
Software Version Installed: Unknown
Complete the tollowing checklist:
^~'es [x~ No* ~s the audible alarm operational?
x Yes No' s t e isua a arm operationa ?
x Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational?
x Yes ~ No* Were all sensors installed at the lowest point of secondary containment and positioned so that ot er
equipment wiU not interfere with their proper operation?
Yes No* ~f a arms are relayed to a remote monitoring station, is all communications equipment (e.g. modem)
x N/A operational?
x yes ~ No• For pressurized piping systems, does the turbine automatically shut down if the piping secondary
~ N/A containment monitoring system detecu a leak, fails to operate, or is electrically disconnected? If yes:
which sensors initate positive shut-down? ~ Sump/Trench Sensors0 Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? L] Yes; ^ No;
~ Yes ~ No+ For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no
[~ N/A mechanical ove~ll prevention valve is installed), is the overfill warning alarm visual and audible at
the tank fill point(s) and operating properly? If so, at what percent of tank capasity does the alarm
trigger? 90 %
Yes' ~ No W~ ~Y mon~tonng equ~pment rep aced? I Yes, ident~ spec~ ic sensors, pro es, or ot er equ~pment
replaced and list the manufacturer name and model for all replacement parts in Section E, below.
~ Yes* U No Was liquid found inside any secondary containment systems designed as dry systems?
Product; ~ Water. lf yes, describe causes in Section E, below.
x o* Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicab e.
x YeS No• Is all monitoring equipment operational per manufacturer's speciftcations?
* In Section E below, discribe how and when these deficieacies were or will be corrected.
E. Comments• The software version was not legible.
Sensors are not manufactured by the monitoring panel
The probes did not communicate with the monitor when disconnected.
SWRCB, January 2006
Spill Bucket Testing Report Form
This jorm is intended jor use by contractors performing annual testing of UST spill containment structures. The completed form and
printouls from tests (if applicable), should be provided to lhe facility owner/operator for submitta! to the local regufatory agency.
, ~. ~ir rrv nv~nuMeTinN
l. 1'Al.iLai i ai~a v
Facility Name: White Water Caz Wash Date of Testing: 2/25/O8
Facility Address: 2301 H Street
FacilityContact: Julio(Manager) Phone: (661)343-1706
Date Local Agency Was Notified of Testing : 2/08/O8
Name of Local Agency [nspector ('f present during ~estin~:
~ ~r,ce~rTivr_ rniv~ru A!"TnR iNF(1RMATi(1N
L. 1L' -7111~V a.va~ ai - ------- -
Company Name: Confidence UST Services INC.
Technician Conducting Test: Matthew Jennings
Credentials~: ^ CSLB Contractor x ICC Service Tech. ^ SWRCB Tank Tester 0 Other (Spec~)
License Number(s): 5302760-UT
2 CDii i n~T~u~T T~cTnvr_ nvFnRMATinN
J. -71 aLaJ alvva~aJ -- -----
Test Method Used: x Hydrostatic ^ Vacuum ~ Other
Test Equipment Used: Equipment Resolution:
Identify Spill Bucket (By Tank
Number, Stored Product, etc. 1 Regular 2 Ptus 3 Super 4
Bucket Installation Type: x Direct Bury
p Contained in Sum x Direct Bury
^ Contained in Sump x Direct Bury
^ Contained in Sump ^ Direct Bury
^ Contained in Sum
Bucket Diameter: 12.00" 12.00" 12.00"
Bucket Depth: 13.25" 13.00" 13.25"
Wait time between applying
vacuum/water and start of test: I S min. 15 min. 15 min.
Test Start Time (Ti): 9:30 AM 9:30 AM 9:30 AM
lnitial Reading (R,): 8.00" 8.25" 8.50"
Test End Time (TF): 10:30 AM 10:30 AM 10:30 AM
Final Reading (RF): 8.00" 8.25" 8.50"
Test Duration (TF - T~): i hour 1 hour 1 hour
Change in Reading (RF- Ri): 0.0" 0.0" 0.0"
Pass/Fail Threshold or
Criteria: 0.0625 0.0625 0.0625
Test Result: X Pass ^ Fail z Pass 0 Fail x Pass ^ Fail ^ Pass D Fail
Comments (include information on repairs made prior to testing and recommended follow-up for fa~led tests) _
CERTiFICAT[ON OF TECHN[CIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
/ he~eby certijy that al/ the injormatlon contained in th/s report is lrue, accurate, and in ful/ compliance wlth lega/ requirements.
Technician's Signature:
Date: 2/25/08
~ State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.