HomeMy WebLinkAbout2010 RESULTS 111#3 as MONITORING SYSTEM CERTIFICATION Piss
IE For Use dy All Jurisdictions Within the State of Califnrniu
.4uthority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Tille 2:3, CuliJbrniu Code of ReAufation.v
I'his form must tx; used.to document,tilting,and servicing of-monitoring equipment. A separate eertilication or report Must bC prcrarcd lur catch
monitoring system control nanel'b},fhc technician who performs the work. "A.4 iopylo This form.must he pravided lo-file iank system O ner/opmoor.
I'ln Owner/operator niust submit acopy of tt isform toahe local,agency. regulating US]'systems within 30 days ol'.te.4 daitc..
A: General information
Facility Name: ORANGE BELT STAGES i 1 :No.:
Site Address: 3646 SILLECT`AVE City: BAKERSFIELD Zip:. 93308_
Facility Contact Person: MATT Contact Phone No.:
MakeiModel of Monitoring System:,TLS-350 INSP..ERNIE MEDINA: Date of TestinrlScr.vic±nb; 64812010
B. inventory of Equipment Tested/Certified.
Check the a "ro riateboxes to indicates ecific ui meat ins ected/wrvie..
Tank ID: DIESEL Tank I1):
In=rank-Gaup ing Pridx. Model- MAGI C1 In-Tank,Gaugmg.:Probe. Model: ..
®:Annular Spacc,or Vault Sensor. Mod& TRANSDUCER Q Annular Space or Vault Sensor; Model:
:0-Piping-Sump/Trench Scno y Model. 208' Q Piping Sump(Trcnch_Sensar(s). Modcl`.
Q:MIUSunip Sensiir(s). Model: Q Fill.Sump Scnsor(s). Model:
'.?Mechanical Line Lek-Detector. Model:.F)00V Q Mechanical Linca,eak Defector.- Mcidcl '..
❑f.lcotrimisa.inc.i:eak.1)cti ctor. Model: Q Electronic"Line Leal;b0cetor. Model:.
Q°l enk OvcrliR/'l lig)r laud Sensor. Model:, Q Tank Overfill/:I ligh-level Sensor. Model:
Q•.Other(specify equipment type and.model in Section I:.on Page 2). Q Chher(specify equipment type and mi d6hii Si u'et>ir,F on•Page 2).
Tank i:D: Tank:ID:
Q Iri=rank Gauging Pmtx: Model: Q"In--tank Gauging Probe. Mudnl;'
Q Annular Spau aw Vault Sensor: Model:. Q:lnnutar Spacc or Vault Sensor., model:
Piping Sump!'1'runch Sensor(s). MWO: Q Piping Sump!Treneh Scnsor(.iI Mt 1: .
❑fiii:Sump Sensor(s): Model:. Q'Fill Sump ensor(s). . model:
Q Mechanical Line Leak Doke lor. Model: 0,'Mechanical Line 1..cak.1)eiecux. Moili L ..
Q Islectrnnic I.ineI utk Ixteclor. Model: Q'Llectronic line Leak,Doectiw: MtOcl:
Q.'.I'ank_.0veriill.I l Iigh-t.cwl Sensor. Model: Q Tank(Verrill ,I ligh-l,erci:Scntior. `to k;1: .
❑Other(specify oquipmcnttypc.and.trn)dcl in Section E:on Page 2): []Other(specify equipmenttyprand niodel in.Scction I on,}'are"2j
Dispenser ID: 1 Dispenser.ID:
®i)ist+cnurC'pntainincntScnsor(s). .Medci: 001 Q Dispenser,Containmcnt Scnsor(s). Model:
®SIx arValyc(s). ❑Shear Valve(s).
Q`1)tspenser Contaitnncnt Floai(�.)'and:C;hai.n(s). Q Dispenser Containment Float(s)'and Chain(s).:
;I)ispepser 1p;" Dispenser ID:
❑I)ispsnscr C'cx►tainiiiciit Scnscir(s) Model. [1 U:9penscr ContuinmentSensnr(s}. Nlndcl:.
Q,Shcar YAW,). Q Shear V,aNc(s)
�t tspensci•Ccmtaariiiient.11ciat{s)end.Chain(s). 06ispbnscr C:ontainmenc.Flaa1(s}:and Cheiit(s}
i
B Drspettser ID... Dispenser 1D:
a ,Q I>ispcamr,Containmcnt S654(s). Modd:. El Drspcnser ContainmentSensor(s). Motel:
El Shear Valve(s). ❑Sheaf-Valve(s). -
Q t)is,pPnser 0mainmcw Flnat(s)and:C°hain(0. Q:I)ispenser Containment Ploags}and'C hain(v).
"lf the tacility contains more.tanks or:dispcnsers,copy this form.. Include information for;evcry 1ank,and di's0.%,r at the facility.
C. Certification -icertify thataheequipmentidentified in_this.documentwas inspected/serviced in accordance with.the man.ufaciurers'
guidelines. Attached to this Certification Is information.(e.g..manufacturers` checklists) necessary to verify that this Information is
correct and a Plot Plan showing the layout of,monitoring equipment. For any,.equipment.capable_of generating such reports,I have also
attached s copy of the report;(&hecA-ad that apply):. ®System,Set-up Alarm history report
Technician Name(print): . STEVEN OB.ERT Signature:_c
Certification No:: A28531 .1..8029980-UT License-No 0611 D40 809850
1`esting:C o.Inpiiny Name- .RiCtl Environmental Phone N6.;(.661)'192 68687 � T
Testing Company Address: 5643 B90OKS CT.BAKERSFIELD, CA-93308, Date.of TestinglServicin-_i 6/2912010
'Page 1 of 5.
UN,036-1J4 w%w.unidocs:org 44 Rcv.6.1/1 7 10$
IE
Monitoring System Certification
!). Results of Testing/$jmvicing
Stiitwarc.Vorsion Installed:. 6,01,
:coin, aMe'the,follow.in ;checklist:
® Yes. O,No* ls,Ahe audible alarm operational?
---1.
Yes. [I..No* Is the visual alarm operational?
® Y'es _p. :No* Wgle.all sensors visually nspected,functionally tested;Ahd confirm ed.operational?
N Yes 0 No* Were"gall sensors installed at lowest point of secondary containment and positioned,sorthtit other equipment will
not,interfere with their proper operation?
O 'Yes 0 No* If alarms are relayed to a remora monitoring station, is all. .communications egUi.p1.11011 .(e.`,.. modem)
N N/A op&.ationaV _
N Yes p No's For pressurised piping system , does the turbine automatically shut down if thc`piping:secondary containment
0 N/A monitoring system detects a'leak,fails to operate,or is electrically disconnected? If yes:which sensors initiate
positive.shut=down? (Check ll:that:app'ly) ®Sumprrrench Sensors; -JD DispcnscrContdinnient Sensors.
Did you confirm positive shut-down.due to leaks and sensor failureldisconnection2 N Yes; 0.No.
01 Yes O No* For,tank systems that of llze the'•'monitoring system as the, primary tank, pvcrfi)! Warning, device (i.e., no
N/A Meehan tcal:overfill prevention valv&Js installed), is:the'z overfill:warning alarm yisibl"c and.audiW at the tank
fill.- int(s)Aand o ratin property?'if so;at what . scent bftankcapacity does'lhc:alarin trigger? °iii
p Yes* ® No Was any monitoring equipment replaced? If yes, identify specific sensors,probes, or other equiptni nt replaced
and list the manufacturer name'and model for:all replacement.parts:in Section+',below.
.
[] Yes* [D :No Was liquid found inside any secondary containment:systems designed as dry: ystems� lhui'cippl}°j
p Product; ❑Water. If yes,describe causes in:Section E,:below.
9 Yes ❑ No* Was mortitorino system set-up reviewed,to ensure proper settings? Attach set:.up reports;;ifap livable
Yee 0 Noy`. Is all dionitoring equipment operational per manufacturer's specifications`?
jn'Sectil6ri"F below,describe how and whenahese.deficiencies were!.or will be corrected.
i
E. ;Comments:
Page 2 of .5
t N-036—2!4 www.unid,66.irg Rev.01/1?109
M,qhitoring'System Certification
F. lii=TankCauging/ StR-Equipment:
9 Check this:.box if tanksau-ingis:u.sed only for Inventory control.
❑ Chdck this box if no tank,gaugibg or SIR equipmencis Instaile(L
This section must be completed if in-tank gaugingg.:equipment is used to perforrii leak'dclt cti6n,.moniioring.
Complete the following.checklist;
El Yes ❑ No* Has all input wiring been inspected for proper entry and term ination,:including te sting for i),round faults?
,
❑ Yes ❑ No* Were all tank gauging g probes visually inspected f6r,dabiage and residue buildup?
Yes' ❑ No*- 'Alas accuracy of system product level readings tested?
Yes ❑ No* Wastaccuracy of systein water-,leVel readirip.tested?
Yes El No'l -1 Were all probes reinstalled properly!
Yo No*_1 Were all items on the:equipment manufacturer's maintenance:checklist.completed').
in Section.,H below,describe. MW and*-,!ied'tbese
deficiencies were or wilibHe corrected:
❑ Check this box if LLDs are not.in
stalled.
1,6rnpietelhO foil... inp
:checkfist:
0 Y&; No* For equipment -up or.aririuAleqU equipment certification, was :a leak simulated to verif�� 1.1.4) ,per-tormance'.1
-pment�zstart
❑ N/A (Check,all that aPPI Simulated leak rate: 10 3 g p:h:, 00.1 gwp.h, El 6.2-g.p h.
jZ Yes ❑ No* Were all LLDs-confirmed Qp ry erational.and accurate within regu ato requirements`.'
0 Yes ❑ No* Was the testing apparatus propefly::calibrat6d?
Z Yes ❑ No* For mechanical L.I-Ds,does the LLD restrict product flow,if it:detects a leak?
❑ N/A
❑ Yes 0 No* For electronic LLDs,does the turbine automatically shut off if the LL Udetects a leak.?
El Yes ❑ NO For electronic!LLDs &es the turbine automatically shut-off if any portion of the mobit ringsystem is jlsablcd
y 0
0 N/A or disconnected?
'For turbine automatically shutbff-if any portion of the monitoring system malfunctions
❑ Y�es� E3,No* electronic LLDs,dotsthe t r .0 g
N or'fails a test?
Ci8es J_: 3 :No* de-electrbniq LLDs,have-all accessible wiring connections been visually inspected?'.
19 -N/A
Yes wo :No-� Wereall itens..on the e qu ip m ent manufacturer's maintenance checklist-completed?
(i4�$e-etibn below,describe how and when.theSe, iencies-mere or will betorrected.
H.. Comineftts*,
Page 3 of
UINA34-314. Wwwmnidws.org
L %-w, C. I
Monitoring. Vai�uuip/Prmtire interstitial System Certification Form: AdMiduni for, a ,
L esults Of Vacuum/.Pressurt,Monitoring,Equipment.Testing g
This pAge,shbuldbe:iised to document testing,.and servicing i_ a
of v cuum-drid.pressure interstitial sensor~: A copy ol'
.this form must:N included With theMonitoring-System CertifkAtidn Form, which must be provided. to the tank
s,ystettiowner/operator. The ownertooerdtdr must submit,a copy of the:.Monitorina System CO%rtification Form to thc
Focal agency.regulating UST:-�Ystejhs within 3'O&ys oftest:dAte.
Manufacturer:.MORRISON BROS Model-;TRANSDUCER ER System Type' ❑ P.rqssulv! 9 VEICLIUM
Sensor If
Component(s) Monitored by this Sensor: DIESEL ANNULAR
L:2
Sensor Functionality Test Result: Pass; D.FaR Interstitial Communication Les[Result.:Kpa"S.-, ❑ Fail
Component(s) Monitored by this-Sensor:
Sensor iFtinctiona Iity'Fesf.Result:❑ Pass; Fail Interstitial Communication'lest Resull.-"Ej.Pass; ❑ ail
Component(s) Monitored by.th.6-Sensor:.
Sensor.Functionality TestResult: El Pass,, [I Fail Interstitial Communication 1'e st,gesult. El Patss 'ail
Com.ponent(s)IMbriftored by tkis-Seqsor:,
Sensor Functionality test Result:[3,Pass;- E] fail ":)Morstilial Communication:restR csu It: pwssj Ej I"ad
Component(s)Monitored by 1his!§Sensor:
Sensor,Functionality Test Fail interstitial,CQm.murucat'on TestResu
It: Naas;
toComponents) Monitored'by,thi..s
Sensor..
Sensor Functiohalit I Test,R4tilt-,❑ Pass;� Ej, Fall: Interstitial Communication Test.Result:. Pass;. Fail
y
Com-ponent(s Monitored:by this,Sedwr:
qcnsor Functionality Test_Result: El:Pass- ❑ Fail Interstitial Co rimunlcation 1"est,Rest,lt::E]:Paqs; ❑ Fail .
Cornponent(s) Monitored:by this,Sensor
Scnsor'Funcfionality,-I est,,Rtsult- ❑pass; '[j Fail Interstitial CorrinfunidAtionTesi Result:,❑ Vass; ❑ Fail
Component(s)Monitored by this.Sins,or:.
Sensor Functionality Test Result: ❑ Pass, ❑ Fail ,Iniersiitial,CommOtiicatiori Test Rd,SLilt'.,❑ Pass; El, Fail
omponen't(s) Monitored by this Sensor:
Sensor Functionality Test Result: ❑ PAS"; ❑ Fail ;Interstitial Communication Test'Resull:❑ Pass: ❑ Fail
How was interstitial'.communication verified?
e, Inspeption- ❑ Oiher,(P�=r.*�inSea .1, hehllw)
❑ I-eak,Introduced at Far End of InwTstitial'Space.,' ❑ Gau- 'Visual
Was vacuunt/Pressurerestored t1o:opera ting levels,in all interstitial spaces? Z Yes EjNo.(ff no,,davcrihe:im54c:,J, belotv)
J. Comments:
'Page 4 of .5
If the sensor successfully detects a si-mutated vacuum/pressure leak introduced in the-interstitial;spdce at the furthest point from the
sensor,vacuum/pressure has been.demonstrated to be:comn)UPicati n-g throughout the interstice..
(:N4136A-1/1 .WWw'.unidomorg Rev.01/20/06
v c v
Monitdrieig,System Certitication
UST Monitoring Site Plan
Site Address: 3640 SILL ECT AVE BAORSFIELD;,CA 93308
t,-Vo.IL.- u-kX'. .. . .
tNCcrVft}�' . . . .
_ .. . ..
- .. .. -�
. .. . ^r
' . .: .
Date map was drawn;;6/28/2010.
Instructions
if you already'have a diagram that shoo' ws,alt required information, you may include it, rather a6an this;page: with your:'4ioniiori.ng
System Certification. On your site plan; show tile'general:layout of'.tanks and piping. Clearly identify locations of the folloeving.
cyuipment, if installed: ronitoring,system, control panes; sensors monitoring tank.annular spaces, sumps:. dispenser pans, spill
containers, or other secondary containment•areas-,mechanical or e1ectronic1ine IeA detectors; and in-tank. liquid ledcl'probes (if used
1b.r Icak detection). In the space,provided-noie the date ails Site Plan.was prepared.
Page S of 5
.l'N 036- '/J "W.Unidocs.org: Re.v:.01'!1.7/08
a
RICH ENVIRONMENTAL..
3305 BRITTAN:ST BAKERSFIFI D,:CA. 93308
OFF 1CF:,(66t)326-8402 t AX (66:1)326-8934
PRODUCT LINE.LEAK DETECTOR TEST
WORK SHEET
W/O#.
FACILITY NAME: ORANGE BELT'STAGES .
FACILITY ADMESS': 3640'SILLECT AVEN.UE, .BAKERSFIELD, CA
PRODUCT`LINE TYPE: PRESSURE
PRODUCT 1EAK;DETECT0R TYPE TEST TRIP PASS'
BELOW P.S.I. OR
SERIAL NUMBER 3 G.P.H. FAII,
DIESEL L/D TYPE : RED JACKET...
YES 10 P,S.I. PASS'
SERIAL#,. 6857
L/D TYPE:; PASS
YES
SERIAL# FAIL
L/D:TYPF':' .' PASS
YES
SERIAL#... FAIL
L/D TYPE: PASS,
YES:
FAIL
'I CERTIFY THE ABOVE TESTSVERE CON DUCTED ON THIS DATE ACCORDIN(:TO RFI)
_JACKET PUMPS FIELD-TEST APPARATUS TESTING PROCEDURE AND LIMITATIONS.
THE MECHANICAL LEAK DETECTOR TESTYASS I FAIL[S-DETERMINED BY USIN( A
.LOW FLOW THRESHOLD.TRIP:RATE O1'.3 GALLONS PIER HOUR OR.LESS AT 10 P.S.I.1
ACKNOWLEDGE THAT ALL DATA COLLECTED 1S TRUE AND CORRECT"TO THE BEST
OFMY KNOWLEDGE.
TECHNICIAN: STEVEN OBERT.
SIGNATURE:_� > DATE: 628/10
SWRC1.3,hnuary 2006
Spill Bucket Testing Report Form
T his fiwM is into nded fbr use hy.conlractors lierforming annual;lesling:of UST spill containment slrucluhr i,the compl.eied form unil
prinfoufs from fes'ts(!f upr(lcahle), should he-provided to the;facility,owherl�iperci or°for.su6+rrittdl it)_lhit toga!regillafilrY agengi
1:: FACILITY INFORMATION
Facility Name: ORANGE"BELT STAGES, ,,. Date of`I esiing: 612,5%10
facility Address: 3640 SILL!'CT AVE,8AICERSFl�LD CA, —
F•acility Contact: MATT Phone.
bate,I:ocal:Agency Was.Notified dtesting 6128/10
Name.of Local Agency Inspector(if present during testinf): 'ERN IE MEUINA
1. TESTING CONTRACTORINFORMAT16N
Company Name: RICH..ENVIRONNIENTAL
Technician Conducting Test: STEVEN OBERT
Credentials'-- 1:I.CSLB Contractor X.ICC Service Tech. [ SWRCB,Tank fester 1 [Other(1n6-i ) _
License Number(s)` 8029480-UT
3. SPILL BUCKET'TESTINC.INFORMATION
Test Method.Used: X Hydrostatic .I Vacuum I Other _-
`Pest Equipment Used: VISUAL Equipment';Resal ition'.0
Identify Spill Bucket(t3y Tank 1 2 3 4
r finiher, Stored Producl, etc. DIESEL
Bucket Insiallation:Type: X Direct Bury. l :Direct Bury Dieect'Bury, !Direci Bur ry
i. I Contained in Sump, r 1 Contained in Sump t,i Contained in .Uni i.Contained in Sump,
Bucket Diameter: 12"
Bucket Depth: 14"
Wait-time between applying
vacuum/water and start of test: 30:MIN
Tesi.Start Time(Ti); 09.04
Initial Readrng,(it;). 12".
I' End Time(Ti:.) ;1:000
Final Reading(;Ri_),. t2" --
Pest Duration Cf`f—T;): 1-140A
(Change n Reading(R,:_Rr)-- 0:
—�
'PassfFail Threshold.or
Criteria:
Test Result: X Pas&. . L!°1~&1i1 f,�:FMS ;':(�Fair .. k1 Pass, �.i Fail Pass 1"1.Fail
Comments (include information on repairs made priur to lesting and rec2mmended full<�w�upf{ir faelcd>te;}L�j
CERTI FICATI ON,OF TECH NICAN RESPONSIBLE FOR CONDUCTING THIS TESTING
1 here6y certify that-i ll the hiformation contained In this report-u true,'accurate,and to full=compliance with legpl requirements;.
Technician's Signature; — Cute:^_-6128/10:
ti!
'State laws:and regulations-do not currcently require testing.to be petot7rred by a qualifed eantraclor:Flowever;.)ocal requirements
'may,be more Stringent.
GQMtNUNICA'TIOIVS GETUP jYJpy
I.N.-TANK SETUP -
T 1 :D I ESEL PORT SETT I ialt,�S:
PRODUCT CODE 1 ALARM HISTORY REPORT
THERMAL C,OEFF . .000450 NONE FOUND
TANX DIAMETER 95.OU -- SENSOR ALARM
TANK PROFILE . I PT: .232 SECURITY L21—DIESEL ANNULAR
FULL VOL 1 4703 CODE :, 00000.0 ANNULAR SPACE
FUEL ALARM
JUN 28. 2010 8:52 AM
FLOAT SIZE: 4:0 1 NCHEB.. =. FUEL ALARM
WATER WARNING 2.0 OCT 23. 2009 2:2I PM
HIGH WATER LliilV :3:0 RS-232—END OF DRESSAGE
<,D,I SABLED FUEL ALARM
OCT
OR LABEL VOL:: 11.783 :
m,'MAX 23:, 2Q09 2:11 PM
OVERFILL LIKIT 904 OUTPUT RELAY SETUP
1,0804 ti � -
HIGH PRODUCT 95 h:.
11193, R', ! :POSITIVE SHUTDOWN
DELIVERY LIih.IT r5% JERSION£:
a89 TANDARD
LOW.. PRODUCT`. 1000 RMALLY CLOSED
LEAK,AIARM�1 I'M I T: 99
TANKN :LOSS LIMIT: 99 QUIDs'SENSOR ALMS ALARM:;HISTORY REPORT
TANK T I LT: 0.00 1 :FUEL ALARM ;r
2..FUEL""ALARM ---- SENSOR..ALARM ---
MANI FOLDETi.
TANKS LL:SENSOR OUT ALARM L' 1 :D STP SUMP
.. � ,$
PERIODIC TEST TYPE FUEL-,ALARM
STANDARD 3UN 2a. 201fl 8.51 AM
" PERIODIC TEST`FAIL FTWARE REVISION I.EV FUEL: ALARM
ALARM DISABLED 6.0:1 ,::
OCT
123: '200`3 . 2:20 PM.
FTWAREO ;6`12760-006 s
GROSS TEST FAIL EATED - 94.02,20,15:.". FUEL ALARM
ALARM DI':SABLED SOFTWARE MODULE IA OCT 231 2009 11 --14 AM
PER TEST AVERAGING OFF
TANK. TEST NOTIFY: OFF
TNK. TST SIPHON BREA}t;OFF LEAK TEST METHOD
TEST ON DATE ALL T.
DELIVERY DELAY 1 MIN --. . - -; PEAR 30. 2006
"-'- -
START. 't.It'1E ItI6ABI:E
TEST RATE :0..20 .GAL
SYSTEM SETUP `,DURAT,;IOR: 2 . HOUR
...JUN 20.20-1 0' -g:06 AM
ZlQUID ,SENSOR SETUP
�.
SYSTEM::UTJ I TS I 1-:'DIESEL STP SUMP
U 8.. TR I,-STATE
SYSTEM LANGUAGE, CA '80ORY STP SUMP
ENGLISH
:.QRAwGZ BELT STAGES g,,2:D:I'EaEL. AiKNULAR
3640 SI:LLtCT AVE NORMALLY CLOSED
BAKERSF 1 ELD. 0,A cFaT£GORY ANNULAR
\ SHIFT TIME DISAS.LED
SHIFT TIME 2 DISABLED
SHIFT TIME 3D1;SABLEn
PER I OIx I C TEST .WARN I 1VGS
DisABLED WARNINGS
ANNUAL I TEST
b I SABLED
SYra'fEM SECURITY
CODE 000000
MONITOR CERT FAILURE REPORT
SITE.NAME ORANGE BELT STAGES DATE 6!28/10
ADDRESS: 3640-SILLECT AYENUE TECHNICIAN STEVEN OBERT
CITY : BAKERSFIELD SIGNATURE:
THE FOLLOWING COMPONENTS WERE.REPLACED/REPAIRED TO COMPLETF,
TESTING.
REPAIRS-• n
LABOR:
PAR'I'S INTALLED `` O t-1 f
N
NAME": TTTLE
SIGNATURE :
THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING
THE APPROPRIATE PARTY TO"HAVE CORRECTIVE:ACTION TAKEN TO REPAIR
THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR
ANY NEEDED RETESTING,THIS ALSO RELEASES RICH ENVIRONMENTAL OF
ANY FINES OR PENALTIES OCCURING FROM NON-COMPLIANCE..
A COPY OF THIS DOCUMENT HAS-,BEEN LEFT ON-SITE FOR YOUR
CONVIENENCE.,