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Home My WebLink About5201 STOCKDALE HWY (2) ` I IIIIIII VIII III IIII 69 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California 1E 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: White Water Car Wash Bldg.No.: Site Address: 5201 Stockdale Highway City: Bakersfield zip: 93309 Facility Contact Person: Julio (Manager) Contact Phone No.: 661-343-1706 Make/Model of Monitoring System: Veeder-Root TLS-350 Date of Testing/Servicing: 01/13/09 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to in rate spe fflc equipment inspecte&senked: Tank ID: 10000 gal.Regular Tank ID: 10000 gal.Plus N In-Tank Gauging Probe. Model:847390-107 [x] In-Tank Gauging Probe. Model:847390-107 [x] Annular Space or Vault Probe. Model:794390-420 [x] Annular Space or Vault Sensor. Model: 794390-420 [x] Piping Sump/Trench Sensor(s). Model:794380-208 [x] Piping Sump/Trench Sensor(s). Model: 794380-208 ❑ Fill Sump Sensor(s) Model: ❑ Fill Sump Sensor(s). Model: [J Mechanical Line Leak Detector. Model:FXIV [X] Mechanical Line Leak Detector. Model: FX1V ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: L] Tank Overfill/High Level Sensor. Model:OPW-61-SO [x] Tank Overfill/High Leval Sensor. Model: OPw-61-SO ❑ 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: [x] In-Tank Gauging Probe. Model:847390-107 ❑ In-Tank Gauging Probe. Model: [x] Annular Space or Vault Sensor. Model:794390-420 ❑ Annular Space or Vault Sensor. Model: [X] Piping Sump/Trench Sensor(s). Model:794380-208 ❑ Piping Sump/Trench Sensor(s). Model: ❑ Fill Sump Sensors(s). Model: ❑ Fill Sump Sensor(s). Model: [xx Mechanical Line Leak Decector. Model:FX1V ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: [x] Tank Overfill/High Level Sensor. ModeI:OPW-6I-SO ❑ 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: 1 &2 Dispenser ID: 3&4 Fx] Dispenser Containment Sensor(s). Model: 330212-001 [X] Dispenser Containment Sensor(s). Model: 330212-001 [X] Shear Valve(s). [x] Shear Valve(s). ❑ Dispenser Containment Float(s)and Chain(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 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 -1 certify that the equipment identified in this document was inspected/services in accordance with the manufacturers'guidlines.Attached to this Certification is information(e.g.manufacturers'checklist)necessary to verify that this information is correct and a plot plan showing the layout of monitoring equipment.For equipment capable of generating such reports,l have attached a copy of the report; (check all that apply) Sy teen u Y�Alarm history report Technician Name(print): Matt Turner Signature: 6—1-- Certification No: 836313 License No:804904 Testing Company Name: Confidence UST Services,Inc. Phone No: 800-339-9930 Site Address: 5201 Stockdale Highway,Bakersfield C.A. 1111111111111 70 Date of Testing/Servicing: 01/13/09 D. Results of Testing/Servicing Software Version Installed: 15.04 Complete the following checklist: [xx] Yes ❑ No* Is the audible alarm operational? FXI Yes No* Is the Visual alarm operational? N 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 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? U Sump/Trench Sensors❑Dispenser Containment Sensors Did you confirm positive shut-down due to leaks and sensor failure/disconnected? LX] Yes; ❑ No; ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no UN/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? ❑ Yes* [x]I 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* ❑ No Was liquid found inside any secondary containment systems designed as dry systems? ❑ Product; ❑ Water. If yes,describe causes in Section E,below. x 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: [X] Check this box if tank guaging is used only for inventory control. ❑ 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 term ination,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? x Yes No* Was accuracy of system water level readings tested? x Yes No* Were all probes reinstalled properly? ❑ 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. G. Line Leak Detectors (LLD): ❑Check this box if LLD's are not installed. Com lete the following checklist: [X] 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: E3 g.p.h.: ❑0.1 g.p.h.; ❑0.2 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? ❑ Yes No For mac amca LLD's,does the LLD restrict product ow 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 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? ❑ 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: IN-TANK SETUP SYSTEM SETUP ; - - - - - - - - - - - ' "' . r JAN 13. 2009 3:17 PM T I :REGULAR PRODUCT CODE 1 WHITE WATER:CAR WASH THERMAL COEFF ;.000750 TANK DIAMETER 96.00 5201 S'TOCKDAL:E HWY TANK PROfiILE 1 PT BAKERSFIELD°CA SYSTEM UNITS U.S. FULL VOL 10000 iI SYSTEM LANGUAGE 1 JAN 2009 3:17 PM SENGLISDATF✓TIME FORMAT FLOAT SIZE: 4.0 IN. 8499 MON DD YYYY HH:MM:SS xM WATER WARNING 2.5 - - - - - - - WHITE WATER.CAR WASH HIGH WATER LIMIT: 3.0 SYSTEM STATUS REPORT 5201 STOCKDALE HWY BAKERSFIELD CA MAX OR LABEL VOL: 9700 ALL FUNCTIONS NORMAL, I OVERFILL LIMIT 90% k 8730 INVENTORY REPORT SHIFT TIME 1 DISABLED HIGH PRODUCT. 90% k SHIFT TIME 2 DISABLED 8730 SHIFT TIME 3 :. DISABLED DELIVERY LIMIT 10`/. VOLUME m 8124 GALS T 1 : SHIFT TIME 4 : DISABLED 1000 ' ULLAGE m 1576 GALS TANK PERIODIC WARNINGS LOW PRODUCT I000 909: ULLAGE 606 GALS DISABLED LEAK ALARM LIM.IT:• 99 TC VOLUME - 8080 GALS TANK ANNUAL WARNINGS SUDDEN LOSS, LIMIT: 99 HEIGHT - 72.69 INCHES TANK TILT 0.00 WATER VOL - 0 GALS 1 E12I r t ARW Y,i�C�9t . WATER a 0.00 INCHES Tr'I:S�IBLB> , MANIFOLDED TANKS TEMP m 67.2 DEG F TO: .NONE 1 LINE ANNUAL WARNINGS i DISABLED T 2:M I DGRADE } LEAK',M 1 N„PERIODIC: 0 VOLUME 4396 GALS PRINT TC VOLUMES 0 . ULLAGE a 5304 GALS ENABLED 9(r4 ULLAGE- 4334 S GAL ' TEMP COMPENSATION LEAK ,M A ANNU 0o t TC VOLUME 4369 GALS VALUE (DEG F ) : 60.0 -� .__`� ._-�!!�11 ;: I HEIGHT - 43.44 INCHES j STICK HEIGHT OFFSET WATER TER VOL 0 GALS DISABLED O.00 INCHES PRECISION TEST DURATION PERI,f)DIC.,TEST TYPE TEMP = 619.1'-DEG F HOURS: 12 _ STANDARD ' DAYLIGHT SAVING TIME ANNUAL TEST FAIL T 3:PR£MIUM DISABLED ALARM DISABLED VOLUME 3362' GALS i SYSTEM SECURITY ULLAGE = 6338 GALS- I CODE 000000 PERIODIC TEST FAIL 90o ULLAGE- 5368 GALSS r ALARM DISABLED TC VOLUME = 3339 GALS HEIGHT a 35.51 INCHES I GROSS TEST FAIL WATER VOL - 0 GALS 1 p ALARM DISABLED WATER - 0.00 INCHES ; TEMP 68.8 DEG F ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF END * * x * j TANK TEST NOTIFY: OFF j TNK TST SIPHON BREAK:OFF COhMUNICATION SETUP - DELIVERY DELAY 1 MIN t { ' PORT SETTINGS: I NONE FOUND 1 RS-232 SECURITY CODE : 000000 RS-232 END OF MESSAGE DISABLED LEAK TEST METHOD T 2:MIDGRADE - PRODUCT CODE 2 T 3:PREMIUM TEST ON DATE : ALL TANK THERMAL COEFF : .000750 PRODUCT CODE 3 JAN 1. 1996 TANK DIAMETER 96.00 THERMAL COEFF : .000750 START TIME . DISABLED TANK PROFILE 1 PT TANK DIAMETER 96.00 TEST RATE :0.20 GAL/HR FULL VOL 10000 TANK PROFILE 1 PT ! DURATION 2 HOURS FULL VOL 10000 FLOAT SIZE: 4.0 IN. 8499 FLOAT SIZE: 4.0 IN. 8499 I LEAK TEST REPORT FORMAT NORMAL WATER WARNING : 2.5 HIGH WATER .LIMIT: 3.0 WATER WARNING 2.5 HIGH WATER LIMIT: 3.0 I. MAX OR LABEL VOL: 9700 OVERFILL LIMIT• 908 MAX OR LABEL VOL: 9700 1- 8730 OVERFILL LIMIT 90% HIGH PRODUCT 904 8730 .x. 8730 HIGH PRODUCT 90% DELIVERY LIMIT 10% 8730 1000 DELIVERY LIMIT 10% - - - - . 1000 LOW PRODUCT 1000 " 1 LEAK ALARM LIMIT: 99 LOW PRODUCT 1000 .' SUDDEN LOSS LIMIT: 99 LEAK ALARM LIMIT: 99 LINE LirAkWCKOUT_SETUP ; TANK TILT 0.00 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 LOCKOUT 3i✓HItOULE j MANIFOLDED TANKS• I DAILY _ Tit: NONE � MANIFOLDED TANKS STARTTIM£E: DISABLED Tit: NONE ; LEAK MIN PERIODIC: 0% i 0 LEAK MIN PERIODIC: 0% 0 LEAK MIN ANNUAL 0% • 0 LEAK MIN ANNUAL 0% 0 PERIODIC TEST TYPE STANDARD 1 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED ANNUAL TEST FAIL LIQUID SENSOR-SETUP- - I ALARM DISABLED PERIODIC TEST FAIL= 1 1 :91 PI PE-ANN ALARM DISABLED PERIODIC TEST FAIL GROSS TEST FAIL ALARM DISABLED CATS ORS' CLOSE STP D SUMP ALARM DISABLED GROSS TEST FAIL ANN TEST AVERAGING: OFF ALARM DISABLED L 2:87 PIPE-ANN PER TEST AVERAGING: OFF ANN TEST AVERAGING: OFF NORMALLY CLOSED PER TEST AVERAGING: OFF CATEGORY ANNULAR SPACE TANK TEST NOTIFY: OFF t TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 1 MIN i DELIVERY DELAY 1 MIN t -----' AL-ARM HI,sT_ORY 3ZEPG'kT j x' ----- SENSOR ALARM ---- OUTPUT RELAY.SETUP r L 1 :'9'1 PIPE=ANhJ; - - - - - - - - - - STP SUMP ALARM HISTORY REPORT 1 R 1 : { FUEL ALARM --- TYPE: JAN 13, 2009 2:57 PM =- SENSOR ALARM ----- L 3:89 STANDARD sv ANNULARPSPACENN NORMALLY OPEN FUEL ,ALARM JflN 13, 2009 2:41 PM GI FUEL ALARM ° OCT 1, 2008 8:00 AM LIQUID SENSOR ALMS FUEL ALARM 09 2:41 PM FUEL ALARM ALL:FUEL ALARM JAN 13. 20 ALL:SENSOR OUT ALARM { MAY 23. 2008 6:17 AM ALL:SHORT ALARM FUEL ALARM ALL:WATER ALARM MAY 22, 2008 5:18 PM � 1 R 2: TYPE: STANDARD NORMALLY OPEN LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM ( * x x x END ALL:WATER ALARM R. 3: TYPE: STANDARD i NORMALLY OPEN r LIQUID SENSOR ALMS ; 1 ALARM HISTORY REPORT r ALL:FUEL ALARM ----- SENSOR ALARM ----- I ALL:SENSOR OUT ALARM L 2:87 PIPE-ANN ALL:SHORT ALARM ANNULAR SPACE ALARM HISTORY REPORT i ALL:WATER- ALARM FUEL ALARM _ ALARM JAN 13, 2009 2:57 PM L 4:91SSUMPR ----- FUEL ALARM STP SUMP JAN 13, 2009 2:39 PM SETUP 4DATA WARNING AM FUEL ALARM • JAN 13, 2009 2:38 PM SETUP 4DATA 2008 WARNING AM f FUEL ALARM JAN 3. 2007 12:16 PM WPLLD LINE DISABLE SETUP �; b 1 x x END { X END * x SOFTWARE REVISION LEVEL VERSION 15.04 SOFTWARE# 346015-100-E. t CREATED - 98.0.2.17.17.1.3 S-MODULEO 330160-010-A SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS PRECISION PLLD ---- - - r- _ _ -- ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 5:87 SUMP ALARM HISTORY REPORT ---- SENSOR ALARM ----- STP SUMP L 2:87 PIPE-ANN SENSOR OUT ALARM ----- SENSOR ALARM ----- ANNULAR SPACE APR 41 2008 10:15 AM L 7: FUEL ALARM OTHER SENSORS JAN 13, 2009 2:38 PM FUEL ALARM DEC 7, 2007 9:13 PM FUEL ALARM f MAR 1, 2007 11 :36 AM f 1 * * * END * * ----- SENSOR ALARM ----- L 2:87 PIPE-ANN ANNULAR SPACE FUEL ALARM 'JAN 13. 2009 2:39 PM t x * END * x ALARM HISTORY REPORT ----- SENSOR ALARM ---- { --- - SENSOR ALARM..-----' L 8: L 1 :91 PIPE-ANN, STP OTHER SENSORS I FUELSALARM ALARM HISTORY REPORT JAN 13, 2009 2:41 PM ----- SENSOR ALARM ----- L 6:89 SUMP STP SUMP SENSOR OUT ALARM APR 4, 2008 10:15 AM FUEL ALARM 1 * * * * END JAN 3, 2007 12:15 PM i � ----- SENSOR ALARM ----- FUEL ALARM , L 1 :91 PIPE-ANN DEC 27, 2004 2:56 PM STP SUMP j JAN 13, 2009 2:41 PM � r * END * * X A 1 WHITE WATER .CAR.`WASH 5201 STOCKDALE HWY BAKERSFIELD CA { JAN. 13. 2009 2:44 PM i -.SYSTEM STATUS REPORT ALL FUNCTIONS iORMAL i i ---- SENSOR ALARM ----- L 1 :91 PIPE-ANN STP SUMP v FUEL ALARM j JAN 13. 2003 2:57 PM ----- SENSOR ALARM ----- L 2:8 PIPE-ANN ( ANNULI ! SPACE- FUEL ALARM-:_ JAN 16. X009 2:57 PM . I 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: White Water Car Wash I Date of Testing: 01/13/09 Facility Address: 5201 Stockdale Highway, Bakersfield,CA 93309 Facility Contact: Julio(Manager) I Phone: 661-343-1706 Date Local Agency Was Notified of Testing : 12/29/2008 Name of Local Agency Inspector(if present during testing) Ernie Medina 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services Inc. Technician Conducting Test: Matt Turner Credentials: x CSLB Contractor x ICC Service Tech. SWRCB Tank Tester Other(Specify) License Number(s): CSLB#804904 ICC#8004564-UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used; x 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: x Direct Bury x Direct Bury x Direct Bury Direct Bury Contained in Sump Contained in Sump Contained in Sump Contained in Sum Bucket Diameter: 12" 12" 12" Bucket Depth: 14.5" H,, 11.5" Wait time between applying 5 minutes 5 minutes 5 minutes vacuum/water and start of test: Test Start Time(Ti): 1:00 pm 1:00 pm 1:00 pm Initial Reading(Rj): 8.75" 9.25" 9.00" Test End Time(TF): 2:00 pm 2:00 pm 2:00 pm Final Reading(RF): 8.75" 9.25" 9.00" Test Duration(TF—Ti): 1 hour 1 hour 1 hour Change in Reading(RF-Rj): 0 ml 0 ml 0 ml Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" Criteria: Test Result: x Pass Fail x Pass Fail x-Pass Fail Pass 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 hereby certify that all the information co awned in this report is true,accurate, and in full compliance with legal requirements. Technician's Signature: Date:_01/13/09 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.