HomeMy WebLinkAboutFMC 2010 MONITORING SYSTEM CERTIFICATION ����������������� 21
For Use By All Jurisdictions Within the State of California IE
Authority Cited: Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be
prepared for each monitoring system 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
Facility Name: Ramco Express Bldg.No.:
Site Address: 2222 F Street City: Bakersfield Zip: 93301
Facility Contact Person: Rami Contact Phone No.: 818-339-7288
Make/Model of Monitoring System: Veeder-Root TLS-350 Date of Testing/Servicing: 12/22/2010
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment Inspected/serviced:
Tank ID:_10000 gal. Regular Tank ID: 10000 gal.Plus
[X] In-Tank Gauging Probe. Model:847390-107 [] In-Tank Gauging Probe. Model:847390-107
[x] Annular Space or Vault Probe. Model:794390-420 ❑ Annular Space or Vault Sensor. Model:
[x] Piping Sump/Trench Sensor(s). Model:794380-208 r] Piping Sump/Trench Sensor(s). Model: 784380-208
❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s). Model:
[J Mechanical Line Leak Detector. Model:FX1V [x] Mechanical Line Leak Detector. Model: FX1V
❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model:
U Tank Overfill/High Level Sensor. Model:847390-107 Tank Overfill/High Leval Sensor. Model: 847390-107
❑ Other(specify equip.type and model in Sec.E on Pg.2) ❑ Other(specify equip.type and model in Sec. E on Pg.2)
Tank ID: 10000 gal.Super Tank ID:
❑ In-Tank Gauging Probe. Model: ❑ In-Tank Gauging Probe. Model:
❑ Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. 'Model:
❑ Piping Sump/Trench Sensor(s). Model: ❑ Piping Sump/Trench Sensor(s). Model:
❑ Fill Sump Sensors(s). Model: ❑ Fill Sump Sensor(s). Model:
❑ Mechanical Line Leak Detector. Model: ❑ Mechanical Line Leak Detector. Model:
❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model:
❑ Tank Overfill/High Level Sensor. Model: ❑ Tank Overfill/High Level Sensor.Model:
❑ Other(specify equip.type and model in Sec.E on Pg.2) ❑ Other(specify equip.typs and model in Sec. E on Pg.2)
Dispenser ID: Dispenser 112 Dispenser ID: Dispenser 314
❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s).Model:
[X] Shear Valve(s). [x] Shear Valve(s).
Lx] Dispenser Containment Float(s)and Chain(s). [X] Dispenser Containment Float(s)and Chain(s)
Dispenser ID: Dispenser ID:
❑ Dispenser Containment Sensor(s). Model: ❑ Dispenser Containment Sensor(s).Model:
❑ Shear Valve(s). ❑ Shear Valve(s).
❑ Dispenser Containment Float(s)and Chains(s). ❑ Dispenser Containment Float(s)and Chain(s).
Dispenser iD: Dispenser 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).
*if the facility contains more tanks or dispensers,copy this form. Include information for every tank and dispenser at the facility.
C. Certification -i certify that the equipment identified in this document was inspected/services in accord4nce with the
manufacturers' guidlines.Attached to this Certification is information(e.g.manufacturers'checklist)necessary to varify that
this information is correct and a plot plan showing the layout of monitoring equipment.For equipment capable of generating
such reports,1 have attached a copy of the report; (check all that apply) x❑System Set-up Lx]Alarm history report
Technician Name(print): Kristopher Karns Signature: " C(At.,,
Certification No: 834108 License No:804904
Testing Company Name: Confidence/1ST Services,Inc. Phone No: 800-339-9930
Site Address: 2222 F Street,Bakersfield,CA 93301 I 11111111111 22 -Date of Testing/Servicing: 12/2212010
1 E
D. Results of Testing/Servicing
Software Version Installed: 16.02
Complete the following checklist:
Lx] Yes ❑ No* Is the audible alarm operational?
x Yes No* Is the Visual alarm operational?
x Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational?
x I Yes ❑ No* Were all sensors installed at the lowest point of secondary containment and positioned so that other
equipment will not interfere with their proper operation?
Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment(e.g.modem)
Hx 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 detects a leak,fails to operate,or is electrically disconnected?If yes:
which sensors initate positive shut-down? E Sump/Trench Sensors[x]Dispenser Containment Sensors
Did you confirm positive shut-down due to leaks and sensor failure/disconnected? N Yes; ❑ No;
F-1 Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no
U N/A mechanical overfill 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? 9p
❑ Yes* U No Was any monitoring equipment replaced?If Yes, identify specific sensors,probes,or other equipment
replaced and list the manufacturer name and model for all replacement parts in Section E,below.
❑ Yes* E No Was liquid found inside any secondary containment systems designed as dry systems?
❑ Product; ❑ Water. If yes,describe causes in Section E,below.
Tx 17 No* Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports, if applicable.
x Yes No* Is all monitoring equipment operational per manufacturer's specifications?
* In Section E below,discribe how and when these deficiencies were or will be corrected.
E. Comments:
F. In-Tank Guaging/SIR Equipment: U Check this box if tank guaging is used only for inventory control.
[:1 Check this box if tank guaging or SIR equipment is installed.
This section must be completed if in-tank guaging equipment is used to perform leak detection monitoring.
Complete the following checklist:
[X] Yes ❑ No* Has all input wiring been inspected for proper enter and termination,including testing for ground faults?
x Yes No* Were all tank guaging probes visually inspected for damage and residue buildup?
x Yes No* Was accuracy of system product level readings tested?
[xj Yes E No* Was accuracy of system water level readings tested?
x Yes No* Were all probes reinstalled properly?
Lx] Yes ❑ No*I Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H,below,describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD): ❑Check this box if LLD's are not installed.
Complete the following checklist:
L] Yes ❑ No* For equip. start-up or annual equipment certification,was a leak simulated to varify LLD performance?
(Check all that apply) Simulated leak rate: [X]3 g.p.h.: 00.1 g.p.h.; 00.2 g.p.h.;
[X] Yes No* Were all LLD's confirmed operational and accurate within regulatory requirments?
x Yes No* Was the testing apparatus properly calibrated?
rx] Yes No* For machanica LLD's, does t e LLD restrict product flow if it detects a leak?
N/A
❑ Yes No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak?
Lx] N/A
❑ Yes 7 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is
[x] N/A disabled or disconnected?
F-] Yes No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system
[X] N/A malfunction or fails a test?
❑ Yes No* For electronic LLD's,have all accessible wiring connections been visually inspected?
[X] N/A
x Yes No Were all items on the equipment manufacturer's maintenance checklist completed?
* In the section H,below,describe how and when these deficiencies were or will be corrected.
H. Comments:
RAMCO EXPRESS —"� -SYSTEM SETUP COMMUNICATIONS SETUP
2222 F STREET - - -
BAKERSFIELD CA 93301 12-22-10 8:52 -
661-324-1758
12-22-10 8:52 1
1 PORT SETTINGS:
SYSTEM SYSTEM LANGUAGE COMM
BAU HOARD : I .:ERS-232)
U.S. BAUD RATE 9600
<-PARITY- -~ i° ODD
S�,�STEIh STATUS REPORT ENGLISH ( i STOP BIT 1 STOP
ALL FUNCTIONS NORMAL SYSTEM YDA E/TIMESFORMAT DATA LENGTH," 7 DATA_.
INVENTORY REPORT k COMM BOARD 2 (RS-232)
RAMCO EXPRESS BAUD RATE 1200
2222 F :STREET PARITY ODD
T 1 :PLUS BAKERSFIELD-CA.93301 STOP BIT 1 STOP
VOLUME = 661-324-1758 DATA LENGTH:. 7 DATA
ULLAGE 1620 GALS
8064 GALS SHIFT TIME 1. 6:00 AM
90% ULLAGE= 7095 GALS SHIFT TIME" 2 DISABLED AUTO TRANSMIT SETTINGS:
TC VOLUME 1607 GALS SHIFT TIME 3 DISABLED
HEIGHT = 19.89 INCHES SHIFT TIME 4 :: DISABLED AUTO LEAK ALARM LIMIT
WATER VOL 0 GALS DISABLED
WATER = 0.00 INCHES TANK PERIODIC WARNINGS AUTO HIGH WATER LIMIT
TEMP 70.5 DEG F DISABLED "` ! DISABLED
TANK ANNUAL WARNINGS AUTO OVERFILL LIMIT
T 2:REG DISABLED DISABLED
VOLUME _ LINE PERIODIC WARNINGS AUTO LOW PRODUCT
a
ULLAGE 5054 GALS DISABLED DISABLED
4630 GALS LINE ANNUAL WARNINGS AUTO THEFT LIMIT
90% ULLAGE= 3661 GALS DISABLED DISABLED
TC VOLUME = 5035 GALS AUTO DELIVERY START
WATERTVOL 45'58 INCHES PRINT TC VOLUMES DISABLED
WATER _ 0 GALS ENABLED AUTO- DELIVERY END
TEMP O.UO INCHES DISABLED
= 65.2 DEG F TEMP COMPENSATION AUTO EXTERNAL INPUT ON
VALUE (DEG F ) : 6.0.0 DISABLED"
T 3:pREM STICK HEIGHT OFFSET AUTO EXTERNAL INPUT OFF
VOLUME 1889 GALS DISABLED S DISABLED
ULLAGE = 7795 GALS H-PROTOCOL DATA FORMAT AUTO SENSOR FUEL ALARM
TO%VULUNIEE= 6826 GALS HEIGHT DISABLED
AUTO SENSOR WATER ALARM
HEIGHT 1875 GALS PRECISION TEST DURATION DISABLED
22. 17 INCHES HOURS: 12 AUTO SENSOR OUT ALARM
WATER VOL = 13 GALS DAYLIGHT SAVING TIME DISABLED
WATER = 0.77 INCHES ENABLED
TEMP = 69.9 DEG-.F START DATE:. .
MAR WEEK 2 SUN
* # E ND START TIME
2:00 AM
END DATE RS-232 SECURITY
NOV WEEK 1 SUN CODE :. 000000
END TIME
2:00 AM
R£-DIRECT LOCAL PRINTOUT
DISABLED
RS-232 END OF MESSAGE
DISABLED
IN—TANK SETUP PRODUCT CODE 2 —i T 3:PREM 3
THERMAL COEFF : .000700 PRODUCT CODE 000700
T 1 :PLUS TANK DIAMETER 89.00 THERMAL COEFF : 89,00
PRODUCT CODE 1 TANK PROFILE 4 PTS TANK DIAMETER 4 PTS
THERMAL COEFF : .000700 FULL VOL 9684• TANK PROFILE 9684
! TANK DIAMETER 89,00 66.8 INCH VOL 7861' FULL VOL • 7861
TANK PROFILE 4 PTS 44.5 INCH VOL 4904 66.8 INCH VOL
FULL VOL 9684 22.3-lNCH. VOL, ..18-98. I 44.5 INCH VOL 4898
66.8 INCH VOL 7861
22.3 INCH VOL :'
44.5 INCH VOL 4904 FLOAT SIZE:- 4.0 IN. 8496 _
22.3 INCH VOL 1898 FLOAT SIZE: 4.0 IN. 8496
WATER WARNING 2.0 2.0
FLOAT SIZE: 4.0 IN. 8496 HIGH WATER.LIMIT: 3.0 HRWATENILIMIT: 3.0
MAX OR LABEL VOL: 9684 I MAX OR LABEL VOL: 9684
WATER WARNING 2.0 OVERFILL LIMIT '90% 90%
HI^H WATER LINIIT: 3.0 8715 OVERFILL LIMIT 8715
MAX OR LABEL VOL: 9684 HIGH PRODUCT. 95% i g5%
9199 HIGH PRODUCT 9199
5%
OVERFILL LIMIT 715 DELIVERY LIMIT IO% 10%
8715 gig DELIVERY LIMIT 968
HIGH PRODUCT 95%
DELIVERY LIMIT X10% LOW PRODUCT 675 675
LOW PRODUCT
968 LEAK ALARM LIMIT: 99 99
SUDDEN LOSS LIMIT: 50 LEAK ALARM LIMIT: 50
LOW PRODUCT 675 TANK TILT 2.74 SUDDEN LOSS LIMIT 2,60
TANK TILT
LEAK ALARM LIMIT: 99 MANIFOLDED TANKS
SUDDEN LOSS LIMIT: 50 T#: NONE MANIFOLDED TANKS
TANK TILT 3.02 T#: NONE
MANIFOLDED TANKS LEAK MIN PERIODIC: 10% 10%
T#: NONE 968 LEAK MIN PERIODIC:
968
LEAK MIN PERIODIC: p�; LEAK MIN ANNUAL 1O% MIN ANNUAL : IO%
966 LEAK 68
9
LEAK MIN ANNUAL 0% PERIODIC TEST TYPE
0 STANDARD ! PERIODIC TEST TYPE
STANDARD
PERIODIC TEST TYPE ANNUAL TEST FAIL
ALARM DISABLED ANNUAL TEST FAIL
STANDARD ALARM DISABLED
ANNUAL TEST FAIL PERIODIC TEST. FAIL s
ALARM DISABLED ALARM DISABLED PERIODIC,TEST ALARM DISABLED
PERIODIC TEST FAIL GROSS TEST FAIL
ALARM DISABLED ALARM DISABLED GROSS TEST ALARM DISABLED
GROSS TEST FAIL ANN TEST AVERAGING: OFF
ALARM DISABLED PER TEST AVERAGING: OFF PER TEST, AV RAGING: OFF
ANN TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TANK TEST NOTIFY: OFF
PER TEST AVERAGING: OFF TNK TST SIPHON BREAK:OFF I, TNK TST SIPHON BREAK:OFF
TANK TEST NOTIFY: OFF DELIVERY DELAY : 15 MIN DELIVERY DELAY 15 MIN
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY 15 MIN
SWRCB,January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and
printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: Ramco Express Date of Testing: 12/22/2010
Facility Address: 2222 F Street Bakersfield,CA 93301
Facility Contact: Rami I Phone: 818-339-7288
Date Local Agency Was Notified of Testing: 12/10/10
Name of Local Agency Inspector(if present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services
Technician Conducting Test: Kristopher Karns
Credentials': nx CSLB Contractor ❑x ICC Service Tech. ❑x SWRCB Tank Tester ❑Other(Spec)
License Number(s): CSLB# 804904 ICC# 5264406-UT TT# 09-1743
1 SPILL BUCKET TESTING INFORMATION
Test Method Used: Lake 0 Hydrostatic ❑Vacuum ❑Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket(By Tank I Regular 2 Plus 3 Super 4
Number, Stored Product, etc.)
Bucket Installation Type: 9 Direct Bury 9 Direct Bury ❑x Direct Bury ❑Direct Bury
❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum
Bucket Diameter: 12.00" 12.00" 12.00"
Bucket Depth: 10.75" 11.25" 11.25"
Wait time between applying 5min. 5min. 5min.
vacuum/water and start of test:
Test Start Time(Ti): 9:00am 9:00am 9:00am
Initial Reading(Rj): 9.00" 9.50" 9.50"
Test End Time(TF): 10:00am 10:00am 10:00am
Final Reading(RF): 9.00" 9.50" 9.50"
Test Duration (TF—Tj): 1 hour 1 hour l hour
Change in Reading(RF-Ri): 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625"
Criteria:
Test Result: 0 Pass ❑Fail, 0 Pass ❑Fail 21-.Pass ❑Fail : . ❑ Pass 0 Fail.
Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements.
Technician's Signature: _ Date: 12/22/2010
' State laws and regulations do not currently require testing to be performed by a qualified contractor. However,local
requirements may be more stringent.
1=Veeder-Root Panel 1
2=ES4 SvAtch Ramco Express
3=208 Sinsov 2222 F Street
4=409 sensor Bakersfield,CA 93301
5=PLLD
5=ATG
7=Bravo Box 12/22/2010
2
Dispenser
Plus STP Sump 1/2 South
3•`'•D ® 1 2
7
Ragular STP Sump
Dispenser
O 3/4
3,5,0
O 3 4
7
Super STP Sump
O 3,5,a 0
0
F Street