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Home My WebLink AboutDERR-2025-001837FUEL SYSTEMS | GENERAL CONTRACTING | ENVIRONMENTAL SERVICES | WASTE SOLUTIONS ENERGY SOLUTIONS | AUTOMOTIVE & COMMERCIAL EQUIPMENT P.O. BOX 3360 DES MOINES, IA 50316 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HEADQUARTERS WWW.SENECACO.COM STORE.SENECACO.COM Seneca Account Rep: Phone: Date of Test: Scope of Work: Seneca Job # Customer PO # Technician: Certification:(see test reports attached) Testing Summary Test Summary Description Component Tested Date Tested Result Customer Information Name: Street Address: City: State: Zip: Contact: Phone Number: Site Information Site Name: Testing Summary Street Address: City: State: Zip: Facility No. Field Notes 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HE ADQUARTERS P.O. BOX 3360 DES MOINES, IA 50316 WWW.SENECACO.COM STORE.SENECACO.COM Testing Summary Testing Summary FUEL SYSTEMS | GENERAL CONTRACTING | ENVIRONMENTAL SERVICES | WASTE SOLUTIONS ENERGY SOLUTIONS | AUTOMOTIVE & COMMERCIAL EQUIPMENT Tank ID: ____________________________________________ ˜ In-Tank Gauging Probe. Model: ____________________ ˜ Annular Space or Vault Sensor. Model: ____________________ ˜ Piping Sump / Trench Sensor(s). Model: ____________________ ˜ Fill Sump Sensor(s). Model: ____________________ ˜ Mechanical Line Leak Detector. Model: ____________________ ˜ Electronic Line Leak Detector. Model: ____________________ ˜ Tank Overfill / High-Level Sensor. Model: ____________________ ˜ Other (specify equipment type and model in Section E on Page 2). Tank ID: ____________________________________________ ˜ In-Tank Gauging Probe. Model: ____________________ ˜ Annular Space or Vault Sensor. Model: ____________________ ˜ Piping Sump / Trench Sensor(s). Model: ____________________ ˜ Fill Sump Sensor(s). Model: ____________________ ˜ Mechanical Line Leak Detector. Model: ____________________ ˜ Electronic Line Leak Detector. Model: ____________________ ˜ Tank Overfill / High-Level Sensor. Model: ____________________ ˜ Other (specify equipment type and model in Section E on Page 2). Tank ID: ____________________________________________ ˜ In-Tank Gauging Probe. Model: ____________________ ˜ Annular Space or Vault Sensor. Model: ____________________ ˜ Piping Sump / Trench Sensor(s). Model: ____________________ ˜ Fill Sump Sensor(s). Model: ____________________ ˜ Mechanical Line Leak Detector. Model: ____________________ ˜ Electronic Line Leak Detector. Model: ____________________ ˜ Tank Overfill / High-Level Sensor. Model: ____________________ ˜ Other (specify equipment type and model in Section E on Page 2). Tank ID: ____________________________________________ ˜ In-Tank Gauging Probe. Model: ____________________ ˜ Annular Space or Vault Sensor. Model: ____________________ ˜ Piping Sump / Trench Sensor(s). Model: ____________________ ˜ Fill Sump Sensor(s). Model: ____________________ ˜ Mechanical Line Leak Detector. Model: ____________________ ˜ Electronic Line Leak Detector. Model: ____________________ ˜ Tank Overfill / High-Level Sensor. Model: ____________________ ˜ Other (specify equipment type and model in Section E on Page 2). Dispenser ID: ________________________________________ ˜ Dispenser Containment Sensor(s). Model: ____________________ ˜ Shear Valve(s). ˜ Dispenser Containment Float(s) and Chain(s). Dispenser ID: ________________________________________ ˜ Dispenser Containment Sensor(s). Model: ____________________ ˜ Shear Valve(s). ˜ Dispenser Containment Float(s) and Chain(s). Dispenser ID: ________________________________________ ˜ Dispenser Containment Sensor(s). Model: ____________________ ˜ Shear Valve(s). ˜ Dispenser Containment Float(s) and Chain(s). Dispenser ID: ________________________________________ ˜ Dispenser Containment Sensor(s). Model: ____________________ ˜ Shear Valve(s). ˜ Dispenser Containment Float(s) and Chain(s). Dispenser ID: ________________________________________ ˜ Dispenser Containment Sensor(s). Model: ____________________ ˜ Shear Valve(s). ˜ Dispenser Containment Float(s) and Chain(s Dispenser ID: ________________________________________ ˜ Dispenser Containment Sensor(s). Model: ____________________ ˜ Shear Valve(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 - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers’ Date of Test A. 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): ˜ System set-up ˜ Alarm history report Technican: Certification No. Testing Company: Test Date: Signature: _____________________________ 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HE ADQUARTERS P.O. BOX 3360 DES MOINES, IA 50316 WWW.SENECACO.COM STORE.SENECACO.COM FUEL SYSTEMS | GENERAL CONTRACTING | ENVIRONMENTAL SERVICES | WASTE SOLUTIONS ENERGY SOLUTIONS | AUTOMOTIVE & COMMERCIAL EQUIPMENT 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 test date. General Information Site Information: Customer Phone No.Customer Contact: Make/Model of Monitoring System: B. Inventory of Equipment Tested/Certifiedcheck the appropriate boxes to indicate specific equipment inspected/serviced: Monitoring System Certification 1 Facility No. Monitoring System Certification D. Results of Testing/Servicing ˜ Yes ˜ No*Is the audible alarm operational? ˜ Yes ˜ No*Is the visual alarm operational? ˜ Yes ˜ No* Were all sensors visually inspected, functionally tested, and confirmed operational? ˜ Yes ˜ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ˜ Yes ˜ No* ˜ N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? ˜ Yes ˜ No* ˜ N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? 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 No. ˜ Yes ˜ No* ˜ N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no 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? ________% ˜ 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. ˜ Yes* ˜ No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product; Water. If yes, describe causes in Section E, below. ˜ Yes ˜ No*Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable ˜ Yes ˜ 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: ___________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ ______________________________________________________________________________________________________ _________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ _________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Software Version Installed: Complete the following checklist: FUEL SYSTEMS | GENERAL CONTRACTING | ENVIRONMENTAL SERVICES | WASTE SOLUTIONS ENERGY SOLUTIONS | AUTOMOTIVE & COMMERCIAL EQUIPMENT 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HE ADQUARTERS P.O. BOX 3360 DES MOINES, IA 50316 WWW.SENECACO.COM STORE.SENECACO.COM Monitoring System Certification 4 Monitoring System Certification F.In-Tank Gauging / SIR Equipment: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 dete 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 for damage and residue buildup? Yes 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? 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. ˜ Check this box if LLDs are not installed.G.Line Leak Detectors (LLD): Yes No* N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: 3 g.p.h.; 0.1 g.p.h ; 0.2 g.p.h. Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes No* Was the testing apparatus properly calibrated? Yes No* N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Yes No* N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Yes No* N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? Yes No* N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? Yes No* N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes No* Were all items on the equipment manufacturer’s maintenance checklist completed? H.Comments: Complete the following checklist: *In the Section H, below, describe how and when these deficiencies were or will be corrected. Check this box if tank gauging is used only for inventory control. 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HEADQUARTERS P.O. BOX 3360 DES MOINES, IA 50316 WWW.SENECACO.COM STORE.SENECACO.COM Pass Fail FUEL SYSTEMS | GENERAL CONTRACTING | ENVIRONMENTAL SERVICES | WASTE SOLUTIONS ENERGY SOLUTIONS | AUTOMOTIVE & COMMERCIAL EQUIPMENT Monitoring System Certification 5 Monitoring System Certification Phone:Date: Tank Number Product Stored ATG Brand and Model 1.Tank Volume, gal. 2.Tank diameter, in. 3. After removing the ATG from the tank, has it been inspected and any damaged or missing parts replaced? 5. Does the fuel float level agree with the value programmed into the console? 6. Does the water float level agree with the value programmed into the console? 9. Inch level from the bottom when the water float first triggers an alarm? Test Results Technician:Signature: Site Name: Customer: Address: Address: City: State: Zip: City: Facility I.D. # :State:Zip: If any answers in Lines 3, 4, 5, or 6 are "No", the system has failed the test. Comments: Testing Company: This procedure is to determine whether the ATG is operating properly. See PEI/RP1200, Section 8.2 for the inspection procedure. This procedure is applicable to tank level monitor stems that touch the bottom of the tank when in place. Pass Fail Pass Fail Pass Fail Pass Fail Pass FailPass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail 4. Float moves freely on the stem without binding? 7. Inch level from bottom of stem when 90% alarm is triggered? 8. Does inch level at which the overfill alarm activates correspond with value programmed in the gauge? 10. Does inch level at which the water float alarm activates correspond with value programmed in the gauge? 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HEADQUARTERS P.O. BOX 3360 DES MOINES, IA 50316 WWW.SENECACO.COM STORE.SENECACO.COM _______________________________ FUEL SYSTEMS | GENERAL CONTRACTING | ENVIRONMENTAL SERVICES | WASTE SOLUTIONS ENERGY SOLUTIONS | AUTOMOTIVE & COMMERCIAL EQUIPMENT ATG-PEI 1 Automatic Tank Gauge Inspection Reference PEI/RP1200 -19 Appendix C-8 LIQUID SENSOR FUNCTIONALITY TESTING Facility Name: Owner: Address: Address: City, State, Zip Code: City, State, Zip Code: Facility I.D. #:Owner Phone #: Testing Company: Phone #: Date: This procedure is to determine whether liquid sensors located in the interstitial space of UST systems are able to detect the presence of water and fuel. See PEI/RP1200 Section 8.3 for the test procedure. Sensor Location . Be Very Specific Product Stored Type of Sensor Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Test Liquid Water Product Water Product Water Product Water Product Water Product Water Product Water Product Is the ATG console clear of any active or recurring warnings or alarms regarding the leak sensor? If the sensor is in alarm and functioning, indicate why. Yes No Yes No Yes No Yes No Yes No Yes No Yes No Is the sensor alarm circuit operational? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Has sensor been inspected and in good operating condition? Yes No Yes No Yes No Yes No Yes No Yes No Yes No When placed in the test liquid, does the sensor trigger an alarm? Yes No Yes No Yes No Yes No Yes No Yes No Yes No When an alarm is triggered, is the sensor properly identified on the ATG console? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Any “No” answers indicates the sensor fails the test. Test Results Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Comments: Tester’s Signature Tester’s Name (print) Latest Version 3/14/2022 Seneca Companies, Inc 515-262-5000 Reference PEI/RP1200 -19 Appendix C-8 LIQUID SENSOR FUNCTIONALITY TESTING Facility Name: Owner: Address: Address: City, State, Zip Code: City, State, Zip Code: Facility I.D. #:Owner Phone #: Testing Company: Phone #: Date: This procedure is to determine whether liquid sensors located in the interstitial space of UST systems are able to detect the presence of water and fuel. See PEI/RP1200 Section 8.3 for the test procedure. Sensor Location . Be Very Specific Product Stored Type of Sensor Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Discriminating Non-discrimi- nating Test Liquid Water Product Water Product Water Product Water Product Water Product Water Product Water Product Is the ATG console clear of any active or recurring warnings or alarms regarding the leak sensor? If the sensor is in alarm and functioning, indicate why. Yes No Yes No Yes No Yes No Yes No Yes No Yes No Is the sensor alarm circuit operational? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Has sensor been inspected and in good operating condition? Yes No Yes No Yes No Yes No Yes No Yes No Yes No When placed in the test liquid, does the sensor trigger an alarm? Yes No Yes No Yes No Yes No Yes No Yes No Yes No When an alarm is triggered, is the sensor properly identified on the ATG console? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Any “No” answers indicates the sensor fails the test. Test Results Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Comments: Tester’s Signature Tester’s Name (print) Latest Version 3/14/2022 Seneca Companies, Inc 515-262-5000 Date: Job #: Contact: Phone: Operation Pressure (PSI) Sump Condition Tank # Product LD Manufacturer LD Model Does LD Detect 3 GPH Leak Rate? Leak Rate LD Detected (GPH) Functional Element Holding Pressure Metering Pressure (PSI) Opening Time (Sec) License Number Comments: LD Serial Technician Signature Site Name: City: Site Address: State:Zip: Leak Detector 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HEADQUARTERS P.O. BOX 3360 DES MOINES, IA 50316 WWW.SENECACO.COM STORE.SENECACO.COM LD 1 FUEL SYSTEMS | GENERAL CONTRACTING | ENVIRONMENTAL SERVICES | WASTE SOLUTIONS ENERGY SOLUTIONS | AUTOMOTIVE & COMMERCIAL EQUIPMENT FUEL SYSTEMS | GENERAL CONTRACTING | ENVIRONMENTAL SERVICES | WASTE SOLUTION ENERGY SOLUTIONS | AUTOMOTIVE & COMMERCIAL EQUIPMENT Site Name: Site Address: -ob : City: State: =ip: Date: Scope of Work: Arrival Time to Site: Departure Time from Site: DP leak/Sump/SB Cathodic Protection MC/LLD Vapor Recovery Calibration Technician: Post-Test SiJnature: **By signing below, you confirm that the items listed above have been visually verified by you. Site Contact: Post-Test SiJnature: Inspector on site" Yes No If yes, please Jive name: Service TestinJ A.All B.TestinJ Yes No Notes: All shear valves have been set to open (if applicable). TestinJ and Service Environmental Checklist Dispatch Type: 4140 E. 14TH STREET DES MOINES, IA 50313 PHONE: 515-262-5000 CORPORATE HEADQUARTERS P.O. BOX 3360 DES MOINES, IA 50316 WWW.SENECACO.COM STORE.SENECACO.COM Testers must upload a copy of this completed form with reports/photos and email to Mark Shirley and Emma Petrowitz.