HomeMy WebLinkAbout#725 FMC Results 7-11-13MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State of California
Authority Cited: Chapter 6. 7, /lea/th and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations
This fonn 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 torm 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: #7725 Fastrip #19 (South) Bldg. No.: ____ _
Site Address: 4901 South Union Avenue City: Bakersfield, CA Zip: 93307 -----
Facilily Contacl Person: Omero Garcia Contact Phone No.: (661) 393-7000
Make!Model of Monitoring System: Veeder-Root TLS 350 Date ofTesling/Servicing: 7/11/2013
B. Inventory of Equipment Tested/Certified
. I
"'''"'".., ~''""' 01 -'t"' "t"' '''''" '-'""~ o.u '''"'"''" ..... ..., ''t'""""'''" '-'1.""' -"'''"''' '''"' '"""""~'...,."' • '"'"''-"'
Tank ID: 12,000 gal. Regular Tank 10: 12,000 gal. sueer
C8J In-Tan!.. Gauging Probe. Model: 847390-107 C8J In-Tank Gauging Probe. Model: 847390-107
C8l Annular Space or Vault Sensor. Model: 794390-420 C8J Annular Space or Vault Sensor. Model: 794390-420
C8J Piping Sump I Trench Sensor(s). Model: 794380-208 C8J Piping Sump I Trench Scnsor(s). Model: 794380-208
0 Fill Sump Sensor(s). Model. 0 Fill Sump Sensor(s). Model:
C8J Mechanical Line Leak Detector. Model: FX-1V C8J Mechanical Line Leak Detector. Model: FX-1V
0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
C8J Tank o,erfill I lligh-Level Sensor. Model. 847390-107 C8J Tank Overfill I High-Level Sensor Model: 847390-107
0 Other (specify eqUipment type and model in Section Eon Page 2). 0 Other (specify equipment type and model in Section Eon Page 2).
Tank ID: 12,000 gal. Diesel Tank ID:
C8J In-Tank Gauging Probe. Model· 847390-107 0 In-Tank Gauging Probe. Model:
C8J Annular Space or Vault Sensor. Model: 794390-420 0 Annular Space or Vault Sensor. Model:
C8J Piping Sump I Trench Sensor(s). Model: 794380-208 0 Piping Sump I Trench Scnsor(s). Model:
0 Fill Sump Sensor(s). Model: 0 Fill Surnp Sensor(s). Model:
C8J Mechanical Line Leak Detector Model: FX-1 DV 0 Mechanical Line Leak Detector. Model:
0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
C8J Tank Overfill I lligh-Level Sensor. Model: 847390-107 0 Tank Overfill I High-Level Sensor. Model:
0 Other (specify equipment type and model in Section Eon Page 2). 0 Other (specify equipment type and model in Section Eon Page 2).
Dispenser ID: 9 & 10 Dispenser ID: 11 & 12
C8J Dispenser Containment Sensor(s). Model: 794380-208 C8J Dispenser Containment Sensor(s). Model: 794380-208
C8J Shear Valve(s). C8J Shear Valvc(s).
0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(;).
Dispenser ID: 13 & 14 DiS)Jenser ID: 15 & 16
C8J Dispenser Containment Sensor(s). Model: 794380-208 C8J Dispenser Containment Sensor(s). Model: 794380-208
C8J Shear Valve(s). C8J Shear Valvc(s).
0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s).
Dispenser ID: Dispenser ID:
0 Dispenser Containment Sensor(s). Model: 0 Dispenser Containment Sensor(s). Model:
0 Shear Valve(s). 0 Shear Valvc(s).
0 Dispenser Containment Float(s) and Chain(s). 0 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 faciltty.
c. Certification -I certify that the equipment identified in this document wns inspected/serviced in nccordnnce with the mnnufacturers'
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 a copy of the report; (clteck all that apply): ~ System set-up ~ Alarm history report
Technician Name (print): Bradley Seykora
Certification No.: B40738 =-~~---------------------------
s;g"""'., F ~
License. No.: 04904
Testing Company Name: Confidence UST Services Phone No.: (800) 339-9930
Site Address: 4901 South Union Avenue, Bakersfield, CA 93307 Date of Testing/Servicing: 7/11/2013
Page 1 of 3
Monitoring System Certification
D. Results of Testing/Servicing
Soflware Version Installed: .....::3.::.3.::.0·:..::0~2 _____________ _
c -~ ~ he foil heckr .... -.
181 Yes 0 No* Is the audible alarm operational?
181 Yes 0 No* Is the visual alarm operational?
181 Yes 0 No* Were all sensors visually inspected, functionally tested, and confirmed operational?
181 Yes 0 No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their proper operation?
0 Yes 0 No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem)
181 N/A operational?
181 Yes 0 No* For pressurized piping systems, does the turbine automatically shut down if the 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 all 1ha1 apply) 181 Sump/Trench Sensors; 181 Dispenser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? 181 Yes; 0 No.
181 Yes 0 No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no 1
0 N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank !
fill point(s) and operating properly? lf so, at what percent of tank capacity does the alarm trigger? 90%
0 Yes* 181 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.
0 Yes* 181 No Was liquid found inside any secondary containment systems designed as dry systems? (Check all thai apply)
0 Product; 0 Water. If yes, describe causes in Section E, below.
181 Yes 0 No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable
181 Yes 0 No* Is all monitoring equipment operational per manuf~ctur~r's specifications?
* In Section E below, describe how and when these deficiencies were or will be corrected.
E. Comments:
Page 2 of 3
Monitoring System Certification
F. In-Tank Gauging I SIR Equipment: 181 Check this box if tank gauging is used only for inventory control.
0 Check this box if no tank gauging or SIR equipment is installed.
This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring.
Complete the following checklist:
11181 Yes
1181 Yes
0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
0 No* Were all tank gauging probes visually inspected for damage and residue buildup?
I
181 Yes 0 No* Was accuracy of system product level readings tested?
181 Yes 0 No* Was accuracy of system water level readings tested?
181 Yes 0 No* Were all probes reinstalled properly?
181 Yes 0 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): 0 Check this box ifLLDs arc not installed.
c -~--he foil -----------heekr __ .......
181 Yes 0 No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
0 N/A (Check all that apply) Simulated leak rate: 181 3 g.p.h.; 0 0.1 g.p.h; 0 0.2 g.p.h.
181 Yes 0 No* Were all LLDs confmned operational and accurate within regulatory requirements?
181 Yes 0 No* Was the testing apparatus properly calibrated?
181 Yes 0 No* For mechanical LLDs, does the LLD restrict product tlow if it detects a leak?
0 N/A
0 Yes 0 No* For electronic LLDs, docs the turbine automatically shut off if the LLD detects a leak?
181 N/A
0 Yes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
181 N/A or disconnected?
0 Yes 0 No* For electronic LLDs, docs the turbine automatically shut off if any portion of the monitoring system malfunctions
181 N/A or fails a test?
0 Yes 0 No* For electronic LLDs, have all accessible wiring connections been visually inspected?
181 N/A
181 Yes 0 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:
Page 3 of 3
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SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors pe1jorming annual testing ofUSTspi/1 containment struclllres. The completed form and
printouts fi'om tests (if applicable), should be provided to the facility owner/operator/or submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: #7725 Fastrip # 19 1 Date ofTesting: 7/11/2013
Facility Address: 490 I South Union A venue, Bakersfield, CA 93307
Facility Contact: Omero Garcia I Phone: 661-393-7000
Date Local Agency Was Notified ofTesting: 6/17/2013
Name of Local Agency Inspector (if present during testing): Esther Duran .._
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bradley Seykora
Credentials 1: X CS LB Contractor X ICC Service Tech. U SWRCB Tank Tester 0 Other (Specifj~
License Number(s): CSLB #804904 ICC #8111231-UT
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic 0 Vacuum n Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (By Tank I Regular 2 Super 3 Diesel 4
Number, Stored Product, etc.)
Bucket Installation Type: Direct Bury 0 Direct Bury Direct Bury 0 Direct Bury
x Contained in Sump x Contained in Sump x Contained in Sump 0 Contained in Sump
Bucket Diameter: 12.00" 12.00" 12.00"
Bucket Depth: 14.50'' 13.75" 15.00"
Wait time between applying 5 min. 5 min. 5 min. vacuum/water and start of test:
Test Start Time (T1): 11:45 AM !1:45AM I 1:45AM
Initial Reading (R1): 11.75" 11.25" 11.75''
Test End Time (TF): 12:45 PM 12:45 PM 12:45 PM
Final Reading (RF): II. 75'' 11.25" 11.75"
Test Duration (T F-T1): I hour I hour I hour
Change in Reading (RF-R1): 0.00" 0.00" 0.00"
Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" Criteria:
Test Result: 1&1 Pass 0 Fail 1&1 Pass 0 Fai!_ __ 1&1 Pass 0 Fail_ 0 Pass 0 Fail
---
Comments-(include information on repairs made prior to test in~. and recommendedfollow-upforfailed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true, accurate, all{/ in full compliance with legal requirements.
Technician's Signature:. _____________________ _ Date: 7/11/2013
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
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PRODUCT SPILL CONTAINER
VAPOR SPILL CONTAINER
ANNULAR
FIRE EXTlNGUISHER
GAS METER SHUT-OFF
WATER METER SHUT-OFF
@ HEALYCAS * EVACUATlON MEETlNG POINT
#725 "L" SENSOR SETUP:
L1 87 STP
L2 87 ANNULAR
L3 91 STP
L4 91 ANNULAR
L5 DSLSTP
L6 DSL ANNULAR
L7 UDC 9-10
L8 UDC 11-12
L9 UDC 13-14
L10 UDC15-16
#775 "L" SENSOR SETUP:
L 1 87-1 STP
L2 871-1 ANNULAR
L3 87-2 STP
L4 87-2 ANNULAR
LS 91 STP
L6 91 ANNULAR
L7 DSL STP
L8 DSL ANNULAR
L9 UDC 1-2
L10 UDC 3-4
L 11 UDC 5-6
L12 UDC 7-8
L 13 N TRANS SUMP
~ ...I L 14 S TRANS SUMP
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II:
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