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HomeMy WebLinkAbout2013 RESULTSMONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State ofCal(fornia Authority Cited: Chapter 6. 7, Heaflh 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. I\ 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 test date. A. General Information Facility Name: #3366 Chevron (West) Bldg. No.: ____ _ Site Address: 8001 White Lane City: Bakersfield, CA Zip: .::..93=..:3:...:0:...:;9 __ _ Facility Contact Person: Omero Garcia Contact Phone No.: (800) 339-9930 Make/Model of Monitoring System: Veeder-Root TLS 350 Date ofTesting/Servicing: 7/16/2013 B. Inventory of Equipment Tested/Certified Check tl --~· · tc b . d" "fi t" d/scrviccd ---------------··--·-····--~-------... ···-··· ···---·- Tank ID: 12,000 gal. Regular 1 Tank 10: 12,000 gal. Regular 2 18] In-Tank Gauging Probe. Model: 847390-107 18] In-Tank Gauging Probe. Model: 847390-107 18] Annular Space or Vault Sensor. Model: 794390-420 18] Annular Space or Vault Sensor. Model: 794390-420 18] Piping Sump I Trench Scnsor(s). Model: 794380-208 18] Piping Sump I Trench Scnsor(s). Model: 794380-208 18] Fill Sump Scnsor(s). Model: 794380-208 18] Fill Sump Scnsor(s). Model: 794380-208 18] Mechanical Line Leak Detector. Model: FX-1V 18] Mechanical Line Leak Detector. Model: FX-1V 0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: 18] Tank Overfill/ High-Level Sensor. Model: 847390-107 18] Tank Overfill/ High-Level Sensor. Model: 847390-107 0 Other (specify equipment type and model in Section E on Page 2). 0 Other (specifY equipment type and model in Section Eon Page 2). Tank 10: 12,000 gal. Su~er Tank 10: 12,000 gal. Diesel 18] In-Tank Gauging Probe. Model: 847390-107 18] In-Tank Gauging Probe. Model: 847390-107 18] Annular Space or Vault Sensor. Model: 794390-420 18] Annular Space or Vault Sensor. Model: 794390-420 18] Piping Sump I Trench Scnsor(s). Model: 794380-208 18] Piping Sump I Trench Sensor(s). Model: 794380-208 18] Fill Sump Scnsor(s). Model: 794380-208 18] Fill Sump Sensor(s). Model: 794380-208 18] Mechanical Line Leak Detector. Model: FX-1V 18] Mechanical Line Leak Detector. Model: FX-1 DV 0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: 18] Tank Overfill/ High-Level Sensor. Model: 847390-107 18] Tank Overfill/ 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). Dispenser ID: 1&2 Dispenser ID: 3&4 18] Dispenser Containment Sensor(s). Model: 794380-208 18] Dispenser Containment Scnsor(s). Model: 794380-208 18] Shear Valve(s). 18] Shear Valvc(s). 0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5 & 6 Dispenser 1D: 7&8 18] Dispenser Containment Sensor(s). Model: 794380-208 18] Dispenser Containment Sensor(s). Model: 794380-208 18] Shear Valve(s). 18] Shear Valve(s). 0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s). Dispenser ID: 9 & 10 Dispenser 1D: 11 & 12 18] Dispenser Containment Sensor(s). Model: 794380-208 18] Dispenser Containment Sensor(s). Model: 794380-208 18] Shear Valve(s). 18] Shear Valve(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 lank and dispenser at the faciltty. C. Certification -I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' 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; (check all that apply): 1Zl System set-up 1Z1 Alarm history report Technician Name (print): Bradley Seykora Certification No.: =B~4-=0..:..7.::.38=--------------- Signature: ~t./2~:::;._ _____ _ License. No.: --=.8.::.04..:.;9::::.:0:...4.:..._ ____________ _ Testing Company Name: Confidence UST Services Phone No.: (800) 339-9930 Site Address: 8001 White Lane, Bakersfield, CA 93309 Date ofTesting/Servicing: 7/16/2013 Page 1 of 3 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: _..::;.3=-30.::..:·~0-=-1 _____________ _ c -he foil hecklist ~Yes 0 No* Is the audible alann operational? ~Yes 0 No* Is the visual alarm operational? ~Yes 0 No* Were all sensors visually inspected, functionally tested, and confirmed operational? ~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) ~ NIA operational? ~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 discotmected? If yes: which sensors initiate positive shut-down? (Check all that apply) ~ Sump/Trench Sensors; ~ Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ~Yes; 0 No. ~Yes 0 No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no 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? If so, at what percent of tank capacity does the alarm trigger? 90% 0 Yes* ~ 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* ~ No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) 0 Product; 0 Water. If yes, describe causes in Section E, below. ~Yes 0 No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable ~Yes 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 2 of 3 Monitoring System Certification F. In-Tank Gauging I SIR Equipment: ~ 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: - ~Yes 0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ~Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? ~Yes 0 No* Was accuracy of system product level readings tested? ~Yes 0 No* Was accuracy of system water level readings tested? ~Yes 0 No* Were all probes reinstalled properly? ~Yes 0 No* Were all items on the equipment manulacturer'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): D Check this box if LLDs are not installed. c Jete the foil -heekr ~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: ~ 3 g.p.h.: 0 0.1 g.p.h ; 0 0.2 g.p.h. ~Yes 0 No* Were all LLDs confirmed operational and accurate within regulatory requirements? ~Yes 0 No* Was the testing apparatus properly calibrated? ~Yes 0 No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? 0 N/A 0 Yes 0 No* For electronic LLDs, does the turbine automatically shut oiT if the LLD detects a leak? ~ N/A DYes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ~ N/A or disconnected? 0 Yes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system mal functions ~ N/A or fails a test? DYes 0 No* For electronic LLDs, have all accessible wiring connections been visually inspected? ~ N/A ~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 i .Fn .• n t. If· lt.i.J fiClft I ~JH I TE Lll Er-~1 :EPi':F I 1:U• ('A JUL I t',. 20 1 3 8: 5..: HII :.; .':3TE11 .:;T;.;TUS REP0RT 1~U. FUN("T 101-1:0: f·JnP.~HL II 1-'F.I :ToP.•: kEf.'·~RT T I : llf·JLE, r[•E[• VOLlll'IE • 8.:!_.!:1 t:I-I!.S UU ,:,(;£ ~ :!752 I~Lf; 90 • uLLH•.;L ~ 2552 GALS TC V•)L U11E • 8 L:? 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The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatOIJ' agency. F ACILJTY INFORMATION Facility Name: #3366 Chevron I Date ofTesting: 7/16/2013 Facility Address: 800 I White Lane. Bakersfield, CA 93309 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 Scykora Credentials 1: X CSLB Contractor X ICC Service Tech. 0 SWRCB Tank Tester U Other (S/Jecify) License Number(s): CSLB #804904 ICC #8111231-UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: x llydrostatic 0 Vacuum 0 Other Test Equipment Used: Lake Test Equipment Resolution: 0.0625" - Identify Spill Bucket (By Tank 1 Regular #I 2 Regular #2 3 Super 4 Diesel Number, Stored Product, etc.) Bucket Installation Type: Direct Bury Direct Bury 0 Direct Bury I J Direct Bury x Contained in Sump x Contained in Sump x Contained in Sun!!J. x Contained in Sump Bucket Diameter: 12.00" 12.00" 12.00'' 12.00" Bucket Depth: 14.00" 15.25" 15.00" 13.75'' Wait time between applying 5 min. 5 min. 5 min. 5 min. vacuum/water and start of test: Test Start Time (T1): 9:30AM 9:30AM 9:30AM 9:30AM Initial Reading (R1): 11.25'' 11.25" 11.25" 11.50" Test End Time (TF): 10:30 AM 10:30 AM 10:30 AM 10:30 AM Final Reading (RF): 11.25" 11.25" 11.25" 11.50" Test Duration (TF-T1): I hour I hour I hour I hour Change in Reading (RF-R1): 0.00" 0.00" 0.00" 0.00" Pass/Fail Threshold or ·- Criteria: 0.0625" 0.0625" 0.0625" 0.0625" Test Result: 1&1 Pass 0 Fail 1&1 Pass OFail 1&1 Pass D Fail 1&1 Pass 0 Fail Comments-(include if!formation on repairs made prior to testing, and recommendedfollow-upfor.failed te:.:s~·t.s:.!,) ______ _ CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING 1/tereby certify tit at alltlte information contained in litis report is true, accurate, and in full compliance witlt legal requirements. Tcch";da"'' s;gnatu .. , ~~EF-=,......--==------~~ Date: 7/16/2013 1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. I r I I I r--- I I I I J-) I I J ~ I I • I z I -... m £: I z I m I I I -----~-- #367 I 1;--l --------FIRE EXTINGUif:"ER : 13 15 : 17 ~---FlRE-6X-';INQUISHER ES~ ~~;:~ILL ""iD" . Ll.l.l FIRE ~XTINGUISHER I ----1 GAS METER/ _______j ySHUT.OfF 1~;lr2...;..;.-"'CT'GS tF~~~tH~~l? ! ~~~!,000 GALLON I l___ _ _ ___! i #366 i w 11911_ ~ I I I I II A!rlG I I I "'~~ ~ FOREHYDRANT l / •• "I~~-~I ~ • mr 4 mr mr ~ • • w I !":!"' 1r-f1 - I ' ' I Iii.. GOSFORD ROAD ...., •• Ill ~ ~ ~ ,,• --~ ... 0 n ;o...,',. ~~=og ~ ~ & .. ~ ~~o~ 2 m V>s;:-.z z: ~ ..., ·-, .. ;;;~ ~ > _6~ng 'i ...,~0.:: ~C'l S:::!:; -.,o-ux ~~)>!:: ~ ~ Z::-, -.. ""I ! I I I ~C-<~1"' r-~ -u ~~~~~ -o1·1 j 1 I . ~ ;:I #366 LEGEND L1 87-1 ANNULAR L2 87-1 FILL L3 87-1 STP L4 87·2 ANNULAR L5 87·2 FILL L6 87·2 STP #367 LEGEND L1 87·1 ANNULAR L2 87-1 STP LJ 87·1 FILL LS 87·2STP L6 81·2 ANNULAR L7 81·2 FILL L8 87-2 ANNULAR FILL L9 87·2 ANNULAR L 10 91 ANNULAR L11 91 STP L12 91 FILL L7 91 ANNULAR L8 91 FILL L9 91 STP L10 DSLANNULAR L11 DSL FILL L12 DSLSTP L13 DSLANNULAR L14 DSLSTP L15 DSLFILL L16 UOC13·14 L17 UDC15·16 L18 UDC17·18 L10 UDC10·20 L20 UDC 21 • 22 L21 UDC 23 • 24 L22 VENTBOX L13 UOC 1 ·2 L14 UOC 3-4 L15 UOC 5 ·6 L16 UDC7·8 L17 UDC 9 ·10 L 18 UDC 11 ·12 FACILilY LEGEND H HEALYCAS ESO EMERGENCY SHUT .OFF W-S WATER SHUT .OFF@ STREET W-8 WATER SHUT-OFF@ BLDG . SITE PLOT PLAN for: #366 CHEVRON/#367 FASTRIP #640 8001 White Lane Bakersfield, CA 93311 (661) 835-1490