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Home My WebLink About2010 FMC RESULTS IIIIIIIIIIIIIIIIIIII 37 MONITORING SYSTEM CERTIFICATION �� f I For Use By All Jurisdictions Within the State of California 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 m=mk certification"or r$oort must:be prepared for each monitoring system control Hanel 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 test date. A. General Information Facility Name: ONE STOP MOBIL Bldg.No. Site Address: 402 S.CHESTER city-.6AKERSFIELD zip: 93304 Facility Contact Person: GIL Contact Phone No.: feel) 835-8644 Make/Model of Monitoring:System: INCON - INSPONSITE'ERNIEMADINA Date.ofTesting/Servicing: 1.011212010 B. Inventory of Equipment Tested/Certified Check the a ro to boxes to indleate 5e' ai ntent Ins serviced: Tank ID; REGULAR 87 Tank ID; PREMIUM 91. ®In-Tank Gauging Probe. Model: IAAG ®In-Tank Gauging.Probe. Model: MAG ®Annular Space or'Vavh Sensor. Model: L64 ®AnntdarSpaee or Vault Sensor, ModeL.LS-3 ®Piping Sump/Trench Sensor(s). Model: L94 ®Ptping:Sump/Trench Sensor(s).. Model:.LS-3 ❑Fill Sump Sensors} Model: ❑FiliSump Sensor(s). Model: ®Mechanical Line Leak Detector.. Model: FXIV ®Mediaitical Line Leak Detector. Mo&L-.FXtV []Electronic Line Leak Detector. Model: ❑Electronic,Line Leek Detector. Model: ®Tank overfill%High-l"d Sensor. Model: FLAPPER ®Tanis.ovq ll/High-level Sensor. Model FLAPPER ❑Other(specify e(ppment t)"and model in Section E on Page 4 ❑Other(specify equipment type and model in Section E on Page 2)_ Tank lD: : Tank ID: In-Tank Gauging Probe. Model: ❑'In-Tank Gauging:Probc. Model: . ❑Annular Space or Vault Sensor. Model: []Annular Space or Vault Sensor. Model:. ❑Piping SLunp/Trench Sensor(s). Model: ❑Piping Sump/Trench Sensor(s). "Model ❑Fdi Sump.Seasot(s). Model: ❑Fill`Sump Sensors}: Model:, Q: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: t Page 2). ❑Other(specify equipment type and model in Section Eon P 2 ❑Other(specify equipment type end model in Section Eori � }. Dispenser ID: '112 Dispenser ID 314 ®Dispenser Containment Sensor(s). Model: 60i ®'.Dispenser Containment Sensor(s). Mod d. 001 ®Shear Valve(s). §�Shear valve(s). ❑Dispenser Containment Roat(s),anti Chain(s). ❑Dispenser Containment float(s)and Cham(s). Dispenser ID: Dispenser ID: Q Dispenut.Contai>iment Sensor(s). Model: ❑Dispenser Containment Sensor(s). Model: ❑Shear:Valve(s). []Shear Vilve(s), ❑Dispenser Containment Float(s)Float(s)and Chain(s). I]DWeaser Containment Float and s), Chain(s)_ Dispenser IA: Dispenser IDi: Q i 4co w`Containcrem Sensor(s). Model: [],Dispenser Containment Sensor(s). Model: 0 Shear.Valwe(s). ❑:shear Valve(s). ❑Disptnset.Contairmaent Flo*s)and Chain(s). (]:Dispenser float(s)and Chain(s). *If the%cilitycontains more tanks,or dispensers,,,copy this:form. include:iidbrniaiign fbi every tank acid dispenser sit the facility: C. Certiflcatiion-I certify that the equipment identified•in this doeurnwit w as iaspectedlservieed in accordance.with the manufacturers' guidelines. Attached to this:Certification is iatormation,`(e.g."esanufaeturers' checklists) necessary to verify,that this information.is correct and a Plot Plan•showing the.layout of monitoring nuipment For any equipment capable of generating such reports,I have also attached a copy of the report;.(check all that apply):. System Set-tip Al history report Technician Name(print): AARON.KOOPIBRANDON MASO. Certification No.: 5284880-UT License.No.: C617 D40. 80ROO Testing Company Name:. RICH ENVIRONMENTAL Phwe No.:{661) 392-8687 Testing Company.Address:.5643 BROOKS CT.BAKERSFIELD,CA$3308 Date of.Testing/Servicing: 10/12/2010 Page 1 of 6 lJN-036 l/a 1111311111111111 38 www.onidorsorg Itev.OIn7l08 I Monitoring System Certification'✓ 1 D. Results of Testing/Servieing, Software Version Installed: .99909 Conr lete the followine checklist: Yes ❑ No'` Is the audible alarm:operational? .0:Yes ❑ No* Is thevisual alarm'operational? ® Yes ❑ No' Were all sensors muallyinspeoted;functionally tested,.and:confumed operational? ®.Yes 0 No" Were all sensors;installed,at lowest point'of secondary containment and positioned so that other equipment will notimerfere,with.their proper operation? ❑ Yes ❑ No" If alarms are relayed to a rewote monitoring 'station; is all communications equipment (e g.,, modem) NIA operational? ® Yes ❑ No' For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ❑ N/A monitoring system detects a leak, f$iLS'to operate;or'is electrically disconnected? If yes:whicli.sensors:iaitiafe positive"shut..down? (Check all that apply) R Sump/Trench,5'ensors; ❑Dispenser.Contaimnent.Sensors. I Did'you confam:positive shut-down due to leaks and.sensor failure/disconnection?' ®Yes; ❑No. ❑ Yes O No* For tank systems thatrutilize the.monitoring:system as the primary tank overfill'.warning device .(i.e., no ® NIA mechenical.:ovetfill;prevention valve is installed); is:the overfill.warning alarm visible and audible at the tank operating properly? If so;at what percent of tank fill points)and capacity does the;alarm trigger? ❑ Yes' ® No Was anymonitoriug egiupment,replaced? If yes;identify,:specific sensors o or other equipment.r laced Pr ,.. . replaced acid list the manufacturer,name and model for ail replacement parts:in Section.E,below: ® Yes* ❑ No Was.liquid.found:u side.any secondary containmenrsystems designed'as dry.systems?;(Check,alkhat apply) ®Water. If yes,describe causes in Section E,below. Yes ❑ No* Was trionitoripg system,set=up.teviewed to ensure proper settings?Attach set:up reports,if applicable ® Yes 1,0 No* Is all monitoring;equipment operational,per.manufacturer',s Specifications? In-Section E below,,describe how and when.these deficiencies-were or will be-corrected.. E. Comments: Page Z of 5 UN-036-.va, w wwxuldoeLorg Rex 01117M Moeitoring System Certification`-'" F. In-Tank Gauging/'SIR Equipment: ® Check this box if tank gauging is used only for.inventory control. Cl Check this"box if no tank gauging or SIR equipment is installed. This section must be completed if inAank gauging equipment is used to perform leak detection;monitoring. Complete the following checklist: ❑ Yes ❑ No* Has all.input_wiring been inspected_for proper entry,and.termination,including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging-probes visually inspected fordamage and residue buildup? ❑ Yes 0 No* Was accuracy of system product level readings-tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes. ❑ No* Were all probes reinstalled properly?, p Yes O No* Were all items onihe equipment manufacturer's maintenance checklist completed? *Ia Section H,below,describe how.and ben these,deficiencies were or will be-corrected, G: Line Leak Detectors(LLD): ❑ Check this box if LLDs,are not;installed. Com 'lets the•followin a checklist: ® Yes O:No* For, exit start= or annual equipment up equipment:cerdfication; was a.:leak:simulated to verify LLD performance? p N/A (Checlr all thpx apply) Simulated leak.rate: ®'3 g.p:h:;,,❑0.l g ph; ❑0.2,g.p h. 14 Yes ❑ No* Were all LLDsvonfirmed:operational and.accurate within regulatory requirements? ® Yes O No' Was the testing:apparatus properly calibrated? ® Yes O No* For inechmical-LLDs„does.th,e LLD:mtrict product.,&*if it detects a leak? ❑ N/A Q Yes O N& For electronic LLDs;does the.turbmc,sutomatically shut off;if the LLD detects a leak? ® -N/A ❑'Yes D No* For electronic LLDs.,does the turbine automatically`shut.off:if any portion:of the monitoring.system is disabled R N/A or'disconnected? ❑'Yes ❑ No” Foreiectronic LLDs,does;the turbine automatically shut off if any portion of the:monitoring system;malfimctions ® N/A or'fails a test? ❑ Yes ❑ No* For elechonic,LLDs.have all'accessible,whipg.,connections been visually inspected? ® :N/A ® Yes ❑ No* Were all,items on.the equipment manufacturer's maintenance checklist completed? ;In Section H,below,describe how and,-when these deflciencies were or will be corrected. H. Comments:. Page, 3 of 5 UN-036-3/4' wwwxvidoe"g Rev.01/11/08 MQntwing SYS&M certification t1;ST 1Viotor�g Site P tau _. . ... ' — —• 1. .. .. v . 1 ' !.• f 1 •.. , 'I v Y. . .• � ., is i .. — • Y r.w._. • ♦ \ r t: •. — • .. t Y. t Vii'4 D3tdtif�Y'*to dr wA., tt yon a>re y 3�aVe a d r4 :shows`ail, i�ldorme oh: nosy iz►Cirxie;jt,rather that dg pw,;viih* 3Vloartinriii .Systeig Crttfiin. ��, tie 1g ►}s�ral iayoe o�xar�CS' nd pipug, dear(} :de $�loeia efts fbJtp �► � .:�W�i�g�5' ! 'c7"gauets, tsars oi�roitac�e$ tank s�muJer � pasts, �pitl I -joa I T�'.aa �rom�ners;or obi 'cQrrtaalta ,-mec#tacT or t1rdois;and 4at ltg Pt!©ises(if ud fWeak�}: In tte; an t� .ti�a t� �9Ei ait�ds pa+epar$d. <PR o Monitoring System;Gertification Form:Addendum for Vacaum/Pressure;IntersNtial Sensors I. Results of Vacuum/Pressure Monitoring.Equipment Testing. This page should be used to document testing'and servicing of vacuum and.pressure interstitial sensors. A copy of this form must be included with .the:Monitoring:System Certification Form; which must be,provided to the tank system owner/operator. The owner/operator must:submit a copy of the-Monitoring System Certification Form to the local agency regulating UST systems within=30 days of test date: Manufacturer: NIA Model: System Type:.[].Pressure;❑Vacuum Sensor ID Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑'Pass; ❑ Fail Interstitial Communication Test Result:❑;Pass; ❑ Fail Component(s)Monitored by tbis Sensor: Sensor.Functionality Test Result:[]'Pass; ❑ Fail Interstitial Communication Test Result:'[]Pass ,❑ Fail Components)Monitortdl,by this Sensor; Sensor Functionality Test Result:,❑Pass; ❑ Fail _ Interstitial Communication Test Results.❑Pass; ❑ Fail Components)Monitored:by this Sensor Sensor Functionality:Test Result:❑Pass;: ❑ Fail Interstitial Conmunicaaion,Test Result:.❑Pass; ❑ Fail Component(s)Monitored,by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fair Interstitial Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored;by this Sensor.:; Sensor Functionality Test Result:❑;Pass;. ❑ Fail Interstitial Communication Test Result:❑Pass, [] Fail Components)Monitored by this Sensor':. Sensor Functionality Test Result: ❑ Fail. Interstitial Communication.Test Result❑Pass; ❑ Fail. . ty ❑Pass; Components)Monitored by this Sensor. ty ❑ Fail Interstitial Communication Test Result:❑Pass;: ❑ Fail Sensor Functionality Test ❑:Pass; Component(s)Monitored by this Sensor. Sensor Functionality est Result:❑Pass; Fail. Interstitial Communication Test Result;'❑Pass;: nality ❑ .�. ❑ .Fail Component(s)Monitored by:this.Sensor.. Sensor Functionality est'Restik'❑Pass;. ❑ Fail interstitial.Communication Test.Result Pass; ty . ❑ ❑ Fail How wavinterstitial communication verified? (].Leak:lnbvduced at Far End of.Interstitial Space; ❑ Gauge;, [] Visual ion; ❑ Other,(Describe in Sec.J, below) Was vacuum/pressure restored:te operating levels`in all interstitiatspaees2 ❑.Yes ❑No of no,describe in Sec.J below) J. Continents: NONE OF THESE SENSORS ARE PRESENT AT THIS SITE, Page 4 of 5 ' if the sensorsuccessfully detects.'a simulated vacuum,pressure leak introduced in the interstitial space.at the furthest point from the sensor,vacuum/pressure has been denmo,tqrated to be communicatingthrougliout the interstice. UK-036A-1/1 www.unfdoee o'g Rev..01r16* RICHENYIRONAMNTAL 5643.BROOKS CT. BAKERSFIELD,CA.93308 OFFICE(661)392-8687 FAX(661)392-0621 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET W/0#:. FACILITY NAME:, ONE STOP MOBIL; FACILITY ADDRESS: 402 S.CHESTER BAKERSFIELD,CA. 93304 PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETEC'T'OR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL.NUMBER 3`G'.P:H. FAIL UNL$7 LID UK:. RED JACKET 'YES 10 P.S.I. PASS SERIAL#. 476:1 PREM91 LIV TYPE RED JACKET SERIAL# 7142 YES 10 P.S.I. PASS L/D TYPE,:.- PASS SERIAL# YES FAIL. VDTYPE:_ PASS SERIAL:# YES, FAIL I CERTIFY`THE--ABOVE TESTS:WERE.CONDIICTED ON THIS DATE ACCORDING TO RED JACKET PUMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMITATIONS. THE MECHANICAL.LEAK DETECTOR TEST PASS I FAIL IS DETERMINED BY USING A. IOW FLOW TIIRESHOLD..TRIP RATE.OF 3 GALLONS PER HOUR OR LESS AT 1.0'P.S.L I ACKNOWLEDGE THAT ALL,DATA COLLECTED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. TECHNICIAN:- BRANDON MASON SIGNATURE,: DATE: IOnzno SWRCB,January 2006 Spill Bucket Testing Repot 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),shoi dd�be provided to.the f acility ownerloperator for submittal"to the.local regulatory agency. 1. FACILITY INFORMATION Facility.Name:' ONE'STOP:MOBIL Date of Testing: 10/12/10 Facility Address: 402 S:CHESTER BAKERSFIELD,CA.933"04 Facili Contact OIL Phone: ty" (66I)$33=9344 Date Local Agency Was Notified'of.Testing: 07/22/10 Name of Local"Agency Inspector(tf present during testing): ERNIE MADINA 2. TESTING CONTRACTOR INFORMATION .Company Name: RICH ENVIRONMENTAL Technician Conducting Test: BRANDONMASON Credentials': 0 CSLB Contractor X ICC Service Tech. d SWRCB Tank Tester 0 Other'(Specify) License.Number(s): 5284980=UT 3. SPILL BUCKET TESTING INFORMATION Test,Method Used: X,Hydrostatic O Vacuum a Other 'Test Equipment Used:VISUAL Equipment Resolution:0 Identify Spill Bucket(By Tank 1 2 PREMH M 01l- 3 4 Number,Stored Product,eta) REGULAR`87-FILL FILL. Bucket Instaliation Type: X DirectBury X Direct ury 0 Direct Bury 0 Direct Bury ❑Contained in S ❑Contained in Sump 0 Contained hi Sum 0 Contained in•S Bucket Diameter: 12" IT! Bucket Depth: 14" 14" Wait time between applying 34 MIN 30 MIN. vacuum/water and start of test: Test Start Time(T): 0900 0900. Initial Reading W: 10" 10" Test End Time(TF): 1000 100.0 Final Reading(RF): IV i0 Test Duration(TF—T�: 1-HQT JR I=HOUR Change.in Reading(RF-'R,): 0 0 Pass/Fail Threshold or +/-0.00 +/-0.0.0 Criteria:. MINOR h Comments-(include;lnformation:on repairs made prior to.testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THISTESTING. I hereby certify that all the informadon contained in this report is&ue,:accprate,"and in fWl.compliance v�hh legal requirements c. Technician's Signature: Date: 10l12/10 State laws and re ions do not currently y require testing to be performed by aqualified-contractor.However,.local requirements may be more stringent. MONITOR CERT. FAILURE REPORT. SITE NAME: ONE STOP MOBIL DATE : 10/12/10 ADDRESS-: 402 SXHESTER: TECHNICIAN_ BRANDON MASON CITY-: BAIIERSFIELD SIGNATURE : THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS NONE LABOR: NONE PARTS INTALLED - NONE NAM . TrrLE SIGNATURE THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTYTO HAVE.CORRECTIVE ACTION TAKEN TO REPAIR, THE ABOVE LISTED PROBLEMS AND NOTOTMG,.RICH E.NVIRONMA:NTAL 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.