Appendix_C_Forms.pdf

APPENDIX C

Forms

Daily Readings Flow Meter Data - 2015

System OM Checklist – Weekly - 2015

Liquid Level Gauging Sheets – Weekly - 2015

Liquid Level Gauging Sheets – Monthly - 2015

Liquid Level Gauging Sheets – Semiannual - 2015

Connection 220 Wastewater Sample Log

Chain of Custody – System Sampling

Calibration Sheet – pH Meter Transmitter

Calibration Sheet – Oil Water Meter

Calibration Sheet - blank

Calibration Log - PID

Groundwater Sample Log

Chain of Custody – Groundwater Sampling

Equipment Service – Quality Control

Waste Acceptance Form

Monthly Container Inspection - SPCC

APPENDIX C, Forms (Continued)

Monthly Containment or After Storm Inspection - SPCC

Monthly Pipe – Valve Inspection - SPCC

Monthly Tank Inspection - SPCC

Annual Tank Inspection - SPCC

Emergency Response Plan – Slug Plan

DFSP Point Loma Recovery System Flow Meter, Flow Totalizer, Hour Meter and Pulse Counter Data

Location ID Instrument Units Date Time Meter Reading Liquid Level (ft) Comments/Notes/Tech

Main Compound TP-03 FQI-0081 gal

Main Compound TP-03 PLC screen Hr:Min

RO Compound R/O 1 Perm flow 1 gal

RO Compound R/O 2 Perm flow 2 gal

HW-01 Vault HW-01-m Flow meter gal

HW-01 (main PLC) HW-01-hr PLC screen Hr:Min

Sump A total fluids TP-A FI-0084 gal DTP: DTW:

Sump A (main PLC) TP-A hr PLC screen Hr:Min

Sump A product PTP-A Flow meter gal

Sump A Prod (PLC) PTP-A hr PLC screen Hr:Min

Sump B TP-B FI-0085 gal DTP: DTW:

Sump B (main PLC) TP-B hr PLC screen Hr:Min

Sump B product PTP-B Flow meter gal

Sump B Prod (PLC) PTP-B hr PLC screen Hr:Min

Cmpnd 1, SPAWAR Trans Pump Flow meter gal

Cmpnd 1, SPAWAR Trans Pump PLC screen Hr:Min

10MW-17, Cmpnd 1 10MW-17 Pulse counter Pulse

10MW-20, Cmpnd 1 10MW-20 Pulse counter Pulse

10MW-14,vault in lot 10MW-14 Pulse counter Pulse

VEX-02 VEX-02 Pulse counter Pulse

VEX-03 VEX-03 Pulse counter Pulse

VEX-04 VEX-04 Pulse counter Pulse

Remediation Cmpnd Influent Tank Flow meter gal

Remediation Cmpnd Conn 220 Flow meter gal

Remediation Cmpnd conn FOR Flow meter gal

DFSP Point Loma Weekly RRS O and M Task CHECKLIST

TASK DATE/TIME

COMPLETE By (init) READINGS/NOTES/ISSUES:

South SUMP A SKIMMER (clean, sample, %, belt adj) South SUMP A WATER/PRODUCT LEVEL (gauge & bail) South SUMP A HOIST & WINCH CHECK (lube as req'd) South SUMP A PANEL & PLATFORM CLEANING South SUMP A LEVEL PROBE CLEANING

North SUMP B SKIMMER (clean, sample, %, belt adj) North SUMP B WATER/PRODUCT LEVEL (gauge & bail) North SUMP B HOIST & WINCH CHECK (lube as req'd) North SUMP B PANEL & PLATFORM CLEANING South SUMP B LEVEL PROBE CLEANING

HORIZONTAL WELL VAULT CLEANOUT

HORIZONTAL WELL PUMP CHECKOUT

CARROLL ST VAULT CLEANOUT

CARROLL ST HW-01 SAMPLE (note pressure & % product) CARROLL ST SPAWAR SAMPLE (pressure & % product)

VEX 2 WELL AIRFILTER CHECK (reg setpt) VEX 2 BUBBLER AIRLINE/OP CHECK (reg setpt)

VEX 2 VAULT CLEANOUT

VEX 2 AP-4 PUMP CHECK (note if off, est pulse rate, etc.)

VEX 2 PULSE COUNTER CHECK (note if operating & value)

VEX 3 WELL AIRFILTER CHECK (reg setpt) VEX 3 BUBBLER AIRLINE/OP CHECK (reg setpt)

VEX 3 VAULT CLEANOUT

VEX 3 AP-4 PUMP CHECK (note if off, est pulse rate, etc.)

VEX 3 PULSE COUNTER CHECK (note if operating & value)

VEX 4 WELL AIRFILTER CHECK (reg setpt) VEX 4 BUBBLER AIRLINE/OP CHECK (reg setpt)

VEX 4 VAULT CLEANOUT

VEX 4 AP-4 PUMP CHECK (note if off, est pulse rate, etc.)

VEX 4 PULSE COUNTER CHECK (note if operating & value)

FIELD NOTES:

DFSP Point Loma Weekly RRS O and M Task CHECKLIST

TASK DATE/TIME

COMPLETE By (init) READINGS/NOTES/ISSUES:

SPAWAR COMPOUND CLEANOUT

SPAWAR AIR COMP CHECK (drain, reg set, filter, oil)

SPAWAR TRANSFER PUMP FILTER CLEANOUT

SPAWAR TRANSFER PUMP CHECK

SPAWAR TANK LEVEL SENSOR CHECK (clean) SPAWAR COMPOUND PIPING CHECK (all) SPAWAR PLC CHECK & ALARM REVIEW (note pump hrs)

SPAWAR PULSE COUNTERS OP CHECK

SPAWAR 10MW-14 CHECK (pump, vault, etc) SPAWAR 10MW-17 CHECK (pump, vault, etc) SPAWAR 10MW-20 CHECK (pump, vault, etc)

RRS COMPOUND CLEANUP

RRS TRANS PUMP CHECK (flow, pressure, etc.)

RRS AIR COMPRESSOR # 1 COND. DRAIN

RRS AIRLINE FILTERS CHECK

RRS AIRLINE DRYER CHECK

RRS AIR COMPRESSORS CHECK (oil, belts, drains, etc.)

RRS PNEU VALVE CHECK (op, reg setpoint, etc.)

RRS TANK PRODUCT LEVEL CHECK

RRS TOUCH SCREEN PANELS CHECK

RRS ALARM HISTORY

RRS DATALOGGER CHECK

RO COMPOUND CLEANOUT

RO SYSTEM PANELS CHECK

RO SYSTEM PUMPS CHECK

RO SYSTEM FILTERS CHECK

RO SYSTEM PIPING CHECK

RO OWS CHECK

FIELD NOTES:

WEEKLY LIQUID LEVELS GAUGED & RECORDED BY:_______________________

DFSP Point Loma Project #:__________________

Location Date Time Depth to Water

D

TW

R e

f. Depth to

Product D

TP

f.

TH

IC

K

N

ES

S

NOTES:

10MW-19 27 NP

10MW-23 18 NP

10MW-24 19 NP

10MW-25 17 NP

10MW-28 27 NP

10MW-29 17 NP

FISC-MW01 38 NP

FISC-MW03 24 NP

FISC-MW04 33 NP

FISC-MW05 25 NP

FISC-MW06 21 NP

FISC-MW08 37 NP

FISC-MW10 30 NP

FISC-MW11 28 NP

FISC-MW13 36 NP

FISC-MW14 19 NP

FISC-MW15 18 NP

FISC-MW16 27 NP

FISC-MW17 21 NP

FISC-MW18 19 NP

MT-04 101 NP

MT-05 99 NP

MT-06 94 NP

MT-07 141 NP

MT-08 136 NP

MT-10 48 NP

MT-11 67 66

MT-12 22 NP

MW-CU 30 NP

OS-MW01 46 NP

OS-MW02 42 42

0S-MW03 39 NP

0S-MW04 42 NP

OS-MW05 37 NP

OS-MW07 37 NP

T58-MW01 62 NP

T76-MW01 91 NP

T76-MW02 87 NP

T79-MW01 107 NP

T85-MW02 52 NP

T85-MW03 53 NP

T87-MW02 39 NP

MONTHLY LIQUID LEVELS GAUGED & RECORDED BY:_______________________

Location Date Time Depth to

Water

D

TW

R e f.

Depth to

Product

D

TP

R e f.

TH

IC

KN

ES

S

NOTES:

10MW‐14 31 NP pump

10MW‐17 27 NP pump

10MW‐19 27 NP

10MW‐20 26 NP pump

10MW‐23 18 NP

10MW‐24 19 NP

10MW‐25 17 NP

10MW‐28 27 NP

10MW‐29 17 NP

FISC‐MW01 38 NP

FISC‐MW03 24 NP

FISC‐MW04 33 NP

FISC‐MW05 25 NP

FISC‐MW06 21 NP

FISC‐MW08 38 NP

FISC‐MW10 30 NP

FISC‐MW11 28 NP

FISC‐MW12 26 26

FISC‐MW13 36 NP

FISC‐MW14 19 NP

FISC‐MW15 18 NP

FISC‐MW16 27 NP

FISC‐MW17 21 NP

FISC‐MW18 19 NP

MT‐04 101 NP

MT‐05 99 NP

MT‐06 94 NP

MT‐07 141 NP

MT‐08 136 NP

MT‐10 48 NP

MT‐11 67 66

MT‐12 22 NP

MW‐CU 30 NP

OS‐MW01 46 NP

DFSP Point Loma Project :__________________

Location Date Time Depth to

Water

D

TW

R e f.

Depth to

Product

D

TP

R e f.

TH

IC

K ‐N

ES

S

NOTES:

OS‐MW02 42 42

0S‐MW03 39 NP

0S‐MW04 42 NP

OS‐MW05 37 NP

OS‐MW07 37 NP

T58‐MW01 62 NP

T63‐MW06 52 NP

T76‐MW01 91 NP

T76‐MW02 87 NP

T79‐MW01 107 NP

T85‐MW01 78 NP

T85‐MW02 52 NP

T85‐MW03 53 NP

T87‐MW01 129 NP

T87‐MW02 39 NP

T87‐MW03 73 NP

RW‐S‐07 27 NP

RW‐S‐12 23 NP

RW‐S‐20 34 NP

RW‐S‐24 41 NP

RW‐S‐33 37 NP

RW‐S‐34 38 NP

Location Date Time Depth to

Water

D

TW

R e f.

Depth to

Product

D

TP

R e f.

TH

IC

KN

ES

S

NOTES:

10MW‐14 31 NP pump

10MW‐17 27 NP pump

10MW‐19 27 NP

10MW‐20 26 NP pump

10MW‐23 18 NP

10MW‐24 19 NP

10MW‐25 17 NP

10MW‐28 27 NP

10MW‐29 17 NP

FISC‐MW01 38 NP

FISC‐MW03 24 NP

FISC‐MW04 33 NP

FISC‐MW05 25 NP

FISC‐MW06 21 NP

FISC‐MW08 38 NP

FISC‐MW10 30 NP

FISC‐MW11 28 NP

FISC‐MW12 26 26

FISC‐MW13 36 NP

FISC‐MW14 19 NP

FISC‐MW15 18 NP

FISC‐MW16 27 NP

FISC‐MW17 21 NP

FISC‐MW18 19 NP

MT‐04 101 NP

MT‐05 99 NP

MT‐06 94 NP

MT‐07 141 NP

MT‐08 136 NP

MT‐10 48 NP

MT‐11 67 66

MT‐12 22 NP

MW‐CU 30 NP

OS‐MW01 46 NP

DFSP Point Loma Project :__________________

Location Date Time Depth to

Water

D

TW

R e f.

Depth to

Product

D

TP

R e f.

TH

IC

K ‐N

ES

S

NOTES:

OS‐MW02 42 42

0S‐MW03 39 NP

0S‐MW04 42 NP

OS‐MW05 37 NP

OS‐MW07 37 NP

T58‐MW01 62 NP

T63‐MW06 52 NP

T76‐MW01 91 NP

T76‐MW02 87 NP

T79‐MW01 107 NP

T85‐MW01 78 NP

T85‐MW02 52 NP

T85‐MW03 53 NP

T87‐MW01 129 NP

T87‐MW02 39 NP

T87‐MW03 73 NP

RW‐S‐07 27 NP

RW‐S‐12 23 NP

RW‐S‐20 34 NP

RW‐S‐24 41 NP

RW‐S‐33 37 NP

RW‐S‐34 38 NP

SEMI-ANNUAL LIQUID LEVELS GAUGED & RECORDED BY:_______________________

DFSP Point Loma Project # :__________________

Location Date Time Depth to Water (##.##')

D

TW

R ef

Depth to Product (##.##') D

TP

R ef

TH

IC

K N

ES

S

NOTES:

10MW-05 51 46

10MW-07 52 47

10MW-12 33 32

10MW-13 31 NP

10MW-14 31 NP pump

10MW-17 27 NP pump

10MW-19 27 NP

10MW-20 26 NP pump

10MW-23 18 NP

10MW-24 19 NP

10MW-25 17 NP

10MW-26 34 32

10MW-27 33 32

10MW-28 27 NP

10MW-29 17 NP

10MW-31 50 50

DGP-01B 67 NP

DGP-02B 67 NP

DGP-02C 67 NP

DGP-03B 51 NP

DGP-03C 50 NP

DGP-04B 26 NP

DGP-04C 25 NP

DGP-05B 18 NP

DGP-06 19 NP

DGP-07 19 NP

DGP-08 7 NP

DGP-09B 27 NP

DGP-10B 27 NP

DGP-11B 27 NP

DGP-12B 19 NP

DGP-13B 18 NP

FISC-MW01 38 NP

FISC-MW02 34 34

FISC-MW03 24 NP

FISC-MW04 33 NP

FISC-MW05 25 NP

Water (##.##')

D

TW

R ef

Depth to Product (##.##') D

TP

R ef

TH

IC

K N

ES

S

NOTES:

FISC-MW06R 21 NP

FISC-MW07 48 NP

FISC-MW08 38 NP

FISC-MW10 30 NP

FISC-MW11 28 NP

FISC-MW12 26 26

FISC-MW13 36 NP

FISC-MW14 19 NP

FISC-MW15 18 NP

FISC-MW16 27 NP

FISC-MW17 21 NP

FISC-MW18 19 NP

FNW-MW01 53 52

MT-01 53 50

MT-03 98 96

MT-04 101 NP

MT-05 99 NP

MT-06 94 NP

MT-07 141 NP

MT-08 136 NP

MT-10 48 NP

MT-11 67 66

MT-12 22 NP

MW-CU 30 NP

OS-MW01 46 NP

OS-MW02 42 42 0

0S-MW03 39 NP

0S-MW04 42 NP

OS-MW05 37 NP

OS-MW07 37 NP

PZ-02 54 NP

PZ-04 59 58

PZ-06 53 NP

PZ-07 48 NP

PZ-08 45 NP

PZ-09 53 NP

PZ-10 54 NP

Water (##.##')

D

TW

R ef

Depth to Product (##.##') D

TP

R ef

TH

IC

K N

ES

S

NOTES:

PZ-11 57 NP

PZ-12 56 NP

PZ-13 41 41

PZ-14 61 NP

PZ-15 63 NP

PZ-16 57 NP

PZ-17 53 NP

PZ-18 69 NP

PZ-19 92 66

PZ-20 71 NP

PZ-21 116 99

PZ-22 115 NP

PZ-23 107 NP

PZ-24 107 NP

PZ-25 120 106

PZ-26 29 NP

PZ-27 32 NP

PZ-28 27 NP

PZ-29 31 NP

PZ-30 148 NP

PZ-31 147 NP

PZ-32 134 NP

RW-S-07 27 NP

RW-S-12 23 NP

RW-S-20 34 NP

RW-S-24 41 NP

RW-S-33 37 NP

RW-S-34 38 NP

T45-MW02 58 54

T45-MW04 48 47

T57-MW01 46 46

T58-MW01 62 NP

T58-MW03 52 52

T58-MW05 48 46

T63-MW04 79 76

T63-MW05 69 64

T63-MW06 52 NP

Water (##.##')

D

TW

R ef

Depth to Product (##.##') D

TP

R ef

TH

IC

K N

ES

S

NOTES:

T63-MW07 73 NP

T63-MW08 83 NP

T63-MW09 124 118

T63-MW10 105 84

T63-MW11 98 84

T63-MW12A 89 NP

T63-MW12B 86 86

T63-MW12C 86 NP

T63-MW12D 87 NP

T63-MW13 57 57

T63-MW14 91 90

T63-MW15 64 59

T63-MW16 66 66

T63-MW17 98 83

T76-MW01 91 NP

T76-MW02 87 NP

T79-MW01 107 NP

T85-MW01 78 NP

T85-MW02 52 NP

T85-MW03 53 NP

T85-MW04 98 NP

T85-MW05 78 NP

T87-MW01 129 NP

T87-MW02 39 NP

T87-MW03 73 NP

VEX-01 49 NP

VEX-02 45 NP

VEX-03 42 NP

VEX-04 35 NP

Page _______ of _________

Date ______________________

Activity ______________ DFSP Point Loma Remediation System Monthly Sampling

Project Name/Number___________________________________________________________________

Sample ID____________________________________________________________

Sample Delivery Group (COC) #_____________________________________________

Sample Description_________________________________________________

Grab Sample @ _______________________________

FM-220 :

pHM-220 :

OWM-220 :

Comments:

CONTAINERS

_______500mL amber _______1L amber _______ 40 mL VOA

Glass Bottle Glass bottle Glass vial

_______500 mL Plastic _______250 mL Plastic _______ 125mL Plastic

HDPE bottle HDPE bottle HDPE bottle HCl (VOA)

Incude Comments on Final Report

CB&I Federal Services LLC

DFSP POINT LOMA REMEDIATION SYSTEM CONNECTION 220

WASTEWATER SAMPLING LOG

NaOH (500mL)

NaOH/ZnAc2

HNO3 (250mL)

H2SO4 (1L)

Forms_220 WW Conn Sample Log_revised 9-28-15.xls Page 1 of 1 9/28/2015

PL- __ __ __ __ __ __ - __ __ __

Ref. Document Number

Company Name: CB&I Federal Services, LLC Proj Number:

250ml -

HDPE -

HNO3

500 ml Amber glass

250ml -

HDPE -

HNO3

500 -

HDPE -

NaOH

150 ml-

HDPE

NaOH/ ZnAc2

Address: 1230 Columbia St. Suite 1200 Project Name:

City / State / Zip: San Diego, CA 92101 Project Location: 3 2 1 1 1 1 1 1

Project Manager: PO #:

Phone/Fax Number: Lab Destination:

Send Report To: Lab Contact:

Phone/Fax Number: Lab Address:

Address:

City: Lab phone #:

Project Contact:

Location Date Time Matrix

EFF

Remediation System Discharge

(Effluent) WW

PC

Remediation System Post

Clay/Pre Carbon WW

MID

Remediation system between carbon WW

INF

Remediation System Influent

Tank WW

Special Instructions: 10 Day TAT * List of Metals - Cd, Cr, Cu, Pb, Ni, Hg, Ag, Zn Method Codes Preservation Codes

Level 2 Report G = Grab HNO3 = Nitric Acid

Sampler(s) Name(s): Matrix Codes NaOH = Sodium Hydroxide

Relinquished By: Date: Time: Received By: Date: Time: DW = Drinking Water Ice = Cool 4 degrees C

WW = Waste Water ZnAOc = Zinc Acetate

Relinquished By: Date: Time: Received By: Date: Time: LIQ = Other Liquid HCl = Hydrochloric Acid

CFS Sample Number Method

G

G

G

G

Temperature Blank

Collection Information

VOA Vial - HCl

DFSP Pt. Loma

SYSTEM SAMPLING

CHAIN OF CUSTODY 1 of

System Sampling Number of Containers

Container Type/Preservation Code

250ml HDPE Amber Liter -H2SO4

C hl or id e (3

B

TE

X (8

0)

Le ad

(6

0B

O il an d

G re as e

-S G

T H

EM

(1

4)

C oo le r T em pe ra tu re

M et al s

(6

0B /7

0A

C ya ni de

(4

C

N /9

2A

Su lfi de (S

M

S

2)

Ig ni ta bi lit y

(1

0A

TP

H

- G R

O (8

5 )

TP

H

-D ie se l /

J et

F ue l (

B

Equipment Used

Calibration Data

Measuring and test equipment in the manufacture and inspection of the listed product are traceable to the National Institute of Standards and Technology.

Solution 10 Solution 4

Corrected Data

Solution 4 Solution 10

Before cal

Location: Conn 220

SN 61406121338

Georg Fisher Signet

PH Solution 4 and 10 Manufacture

199 Rosecrans Bldg 604

San Diego CA 92016

Scale: 0 To 14

Device Type: PH Transmitter

Tag No: PH-220 Technician Name: Alonzo Beehler

Model No: 3-9900-1

Calibration Data Sheet

Customer Information Manufacturer Information

Calibration Date: 1/9/2015

Name: Point Loma Navy Base Supplier: Georg Fischer Signet

Device Information Calibration Information

PO:

James.Horna Text Box

James.Horna Text Box

Calibration Data

Measuring and test equipment in the manufacture and inspection of the listed product are traceable to the National Institute of Standards and Technology.

Cal unnecessary at this time unit is within manufactures specs

Corrected Data

19.4 Before cal

Location: Conn 220

SN 41-1678-CE

Turner Designs

Check Point Orange set at 19.40 Manufacture

199 Rosecrans Bldg 604

San Diego CA 92016

Scale: 0 To 200 MGL

Device Type: Oil In Water Monitor Tag No: Oil Meter-220 Technician Name:

Model No: TD-4100XD

Calibration Data Sheet

Customer Information Manufacturer Information

Calibration Date:

Name: Point Loma Navy Base Supplier: Turner Designs

Device Information Calibration Information

PO:

Calibration Data Notes

Model No:

Calibration Data Sheet

Customer Information Manufacturer Information

Calibration Date:

Name: Point Loma Navy Base Supplier:

Device Information Calibration Information

PO:

Scale:

Device Type:

Tag No: Technician Name:

199 Rosecrans Bldg 604

San Diego CA 92016

Location:

Check Point set at Manufacture

Before cal

Note if Cal is unnecessary when unit is within manufacturer's specs

Corrected Data

Project Name: Sample Location: POINT LOMA

Project No.: Date and Time:

Information Recorded by:

Sampling Team Name Printed

Equipment: Portable PID Equipment/ID No.:

Analyte Cal. Std.

Standard Concentration

(ppm) Measured

Value (ppm)

Calibration Required?

(Y/N)

0.0 Ambient Air

Reference Std. 100 ppm

EQUIPMENT

Equipment: Water Quality Field Instrument

Equipment/ID No.:

Calibration check standard Lot and Expiration:

Analyte Cal. Std.

Cal Check Standard

Concentration Acceptance

Criteria Measured

Value

Recalibration Required?

(Y/N)

Conductivity Reference Std. (µS/cm) ± 15%

Turbidity Reference Std. (NTU) ± 15%

ORP Reference Std. ± 15%

4.0 pH units 4.0 ± 0.1 pH unit

7.0 pH units 7.0 ± 0.1 pH unit

Dissolved Oxygen Reference Std. ± 15%

Comments:

CALIBRATION FIELD LOG

pH

Post-Calibration Value (ppm)

VOCs (solvents and TPH)

Post- Calibration

Value

DFSP Pt. Loma

PID S/N Cal check std: 100 ppm isobutlyene

Project Name: DFSP Pt Loma Project No.:

Sample ID

EQUIPMENT / NOTES

Purging Method/Equipment: Micropurge Sampling Equipment/ID No.: Non-dedicated QED Portable Bladder Pump Flow Rate During Purging :

Note: Flowrate for VOC sampling should be no greater than 100 ml/min Daily field instrument calibration verification performed? Yes ___ No ___

PURGING INFORMATION

Measuring Point Drawdown depth limit (DDL) = DTWi + 0.3 (ft) Casing ID (in.)

Depth to Water - Initial (DTWi) (ft) Depth to Well Bottom (ft) PID Reading:

Screen Interval (ft):

FIELD CONDITIONS

Weather Conditions: □ Sunny □ Rain □ Wind Temperature:

Time of Reading Purge Rate (ml/min)

Dynamic Depth to

Water

Conductivity (µS/cm)

Temperature (oC / F) pH Turbidity

(NTU)

Purge Stabilization Criteria

Drawdown limit 0.3 ft

+10% + 10% +0.1 units + 10%

Sample No.:

Container(s) Type and Volume No. of

Containers Filtered

(Y/N) Parameters 40-ml VOA Vials 3 N EPA 8260B - BTEX/MTBE/Naphthalene

500 ml Amber Glass 2 N EPA 8015B - TPH as Diesel & JP5

If the water level is above the top of the screen, the pump should be set at the approximate mid-point of the screen. If the water level is below the top of the screen, set the pump between the water level and the bottom of the screen. ** Note : If there is less than 1.5ft of water, the well should be bailed dry and sampled on recharge.

Duplicate or MS/MSD Collected:

Preservatives HCl, Ice

Ice

Top of Casing Approximate depth of pump inlet*(ft):

ORP

(mV) DO (mg/L)

+ 10 mV + 10%

Date / Time Collected

Sample Collected by:

300 - 500 ml/min with water level drawdown less than 0.3 feet

GROUND WATER SAMPLE COLLECTION LOG

Site Location: DFSP Point Loma Well ID:

Page of

1230 Columbia St., Suite 1200 Project Number:

San Diego, CA 92101 Project Name: Pt.Loma Project Location: Semiannual GW Monitoring

Project Manager: Chris Corey Purchase Order #:

619-533-7330/ 619-239-1238 Shipment Date Send Report To: Rose Condit

Phone/Fax Number: 925-288-2151 Lab Destination:

Address: 4005 Port Chicago Hwy

City: Concord, CA, 94520 Lab Contact phone #:

HCl/Ice Ice

Sampler's Name(s): 3-VOA 2-500 ml Amber

Sample ID Date Time Method

LF GW

RB2015 NA BW 1 X X

TB2015 NA BW 1 X

Cooler Temp Blank X

Method Codes

Turnaround Time:__________ □ 24-hr □ 48-hr Level of QC Required: LF= low flow G = Grab

Standard TAT -10day □ 72-hr □ 5-day I II III Project Specific: Matrix Codes Relinquished By: Date: Received By: Date: DW = Drinking Water SO =Soil

Time: Time: GW = Ground Water BW= Blank Water Relinquished By: Date: Received By: Date: WW = Waste Water WP=Waste Product

Time: Time:

Analyses Requested

T P

H -D a n d T

P H

-J et

F u el w it h

G

A

V

IT

Y S

E P

A R

A T

IO

N rs

E P

A

5B

M S

/M S

D

C oo le r

T em p er at u re

CHAIN OF CUSTODY PL _ _ _ _ _ _ - _ _ _

1 1

Lab Contact:

B T

E X

/M T

B E

/ N ap h th al en

(E P

A

0B

T P

H -D a n d J

P -5

(E P

A

5B

M at ri x of co n ta in er s

Preservative

Collection Information Container Type

Location ID

Special Instructions: Level 2 Report Perform silica gel cleanup on TPH- extractables;

TPH- RL = 50 µg/L ; TPH-JF (C10-C16) & TPH-Diesel (C16-C24)

Rinse Blank

Trip Blank

Page of

1230 Columbia St., Suite 1200 Project Number:

San Diego, CA 92101 Project Name: Pt.Loma Project Location: Semiannual GW Monitoring

Project Manager: Chris Corey Purchase Order #:

619-533-7330/ 619-239-1238 Shipment Date Send Report To: Rose Condit

Phone/Fax Number: 925-288-2151 Lab Destination:

Address: 4005 Port Chicago Hwy

City: Concord, CA, 94520 Lab Contact phone #:

HCl/Ice Ice

Sampler's Name(s): 3-VOA 2-500 ml Amber

Sample ID Date Time Method

LF GW

RB2015 NA BW 1 X X

TB2015 NA BW 1 X

Cooler Temp Blank X

Method Codes

Turnaround Time:__________ □ 24-hr □ 48-hr Level of QC Required: LF= low flow G = Grab

Standard TAT -10day □ 72-hr □ 5-day I II III Project Specific: Matrix Codes Relinquished By: Date: Received By: Date: DW = Drinking Water SO =Soil

Time: Time: GW = Ground Water BW= Blank Water Relinquished By: Date: Received By: Date: WW = Waste Water WP=Waste Product

Time: Time:

Analyses Requested

T P

H -D a n d T

P H

-J et

F u el w it

G

A

V

IT

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Preservative

Collection Information Container Type

Location ID

Special Instructions: Level 2 Report Perform silica gel cleanup on TPH- extractables;

TPH- RL = 50 µg/L ; TPH-JF (C10-C16) & TPH-Diesel (C16-C24)

Rinse Blank

Trip Blank

DLA-E Environmental Prog Preparatory Control Worksheet Page 1 of 1 Revised 12-08-2011

DLA-E Environmental Program Equipment Service Quality Control Worksheet

CQC SM: Date: __/___/__

PROJECT No.: Project Title: EQUIPMENT SERVICE QC CON #: START

TIME:

Definable Feature of Work: Equipment Service QC

A. ACTIVITIES INCLUDED IN DEFINABLE FEATURE OF WORK

1 SHIPMENT OF EQUIPMENT TO OFFSITE REPAIR FACILITY

2 INSTALLATION OF EQUIPMENT AT SITE

3 RESUME SITE OPERATIONS

B. QUALITY CONTROL REQUIREMENTS

THE SUBSEQUENT INSPECTIONS, TESTS AND OBSERVATIONS SHALL VERIFY THE APPROPRIATE STANDARDS

REFERENCED IN SYSTEM DESIGN DRAWINGS ARE MET.

OK/NA INITIAL

1 SHIPMENT – List equipment and components to be shipped for service including serial number. Create packing slip.

2 SHIPMENT – Check all major parts noting condition and functionality status

3 SHIPMENT – Verify equipment is decontaminated and complies with DOT standards

4 SHIPMENT – Take photos of equipment prior to removal and prior to shipping

5 SHIPMENT – Verify packaging properly sealed to withstand transport

6 SHIPMENT – Verify packaging for proper ID markings, shipping labels and their visibility

7 SHIPMENT – Record tracking information for packages sent and received. Maintain records for delivery status of packages

8 VISUAL INSPECTION – Inspect received package against packing slip, verify serial number

9 VISUAL INSPECTION – Inspect major parts for condition and functionality, take photographs

10 EQUIPMENT INSTALL – Verify equipment is properly mounted and secured

11 EQUIPMENT INSTALL – Check equipment for alignment with coupled equipment

12 EQUIPMENT INSTALL – Verify leads correctly wired to power source and properly grounded, perform bump test to confirm rotation

13 EQUIPMENT INSTALL – Check fluid levels, verify all connected equipment & lines are in good working order

14 EQUIPMENT INSTALL – Photograph equipment installation, document any system modifications since repaired equipment was installed

15 EQUIPMENT OPERATION – Verify previously existing condition requiring service no longer exists

16 EQUIPMENT OPERATION – Check for excessive vibration, abnormal operational sound

17 EQUIPMENT OPERATION – Verify motor speed and electrical load (voltage & amperage), operational temperature within pump specifications

18 EQUIPMENT OPERATION – Verify reinstalled equipment is properly connected to preexisting adjacent equipment or fittings on drive end. Check seals for leaks

19 EQUIPMENT OPERATION – Verify automatic controls functioning properly

20 EQUIPMENT OPERATION – Verify system settings, flow rate, pressure, measurements, etc. within designed specifications

21 EQUIPMENT OPERATION – Check equipment settings and verify equipment is calibrated

C. QA/QC DEFICIENCY ITEMS

NAVFAC Southwest Environmental Services Doc ID: OTH-005 Industrial Waste/Oily Waste Facility Used In: IWOW-03, 08, 22, 27, 67 Bilge & Oily Waste Treatment System Facilities Revision #: 16 Revision Date: 03/19/2015

WASTE ACCEPTANCE FORM

/ / JULIAN DATE: ___________________

Transporter’s Co. / Truck # / Driver Name

Bulk Pumping # (Non-FRC): __________________ Activity #: _____ / _

CUSTOMER USE ONLY:

DATE: _____/______/_______

ACTIVITY NAME: BASE:

BUILDING / LOCATION: PHONE NUMBER:

JOB ORDER NUMBER (if available):

WASTE DESCRIPTION:

NBC-NI IWOW HAS THE APPROPRIATE PERMIT(S) FOR, AND WILL ACCEPT, THE WASTE THE GENERATOR IS SHIPPING. [40 CFR 264.12 (b)]

VOLUME (GALLONS):

FRC USE ONLY

BOWSER ID: TANK NO: SHOP NO:

PROCESS GENERATING WASTE: FRC WASTE PROFILE NUMBER:

CB&I PERSONNEL USE ONLY: BULK PROFILE # TRUCK DOI: NOT REQUIRED □ COMPLETED □

FACILITY: IWTP NI ORP NBSD BOWTS NBPL BOWTS NAB BOWTS

NBCNI ONLY: Manifest#: GENERATOR’S ID NUMBER: NON_HAZ

TIME ARRIVED: PUMP START TIME: PUMP END TIME:

PHYSICAL STATE: SLUDGE IN BOWSER/TANKER TRUCK: YES NO VOLUME (GALLONS):

FIELD TEST RESULTS (MG/L), if required (see FRC Profile List):

Total Cr Cr. (VI) CHLOR-D-TECT

CN HYDROCLOR-Q

pH: OTHER

TREATMENT GROUP: 1 – OW/GIW 2 – CONTAMINATED OW/GIW

3 – CHROME 4 – MIXED METALS

5 – CYANIDE 6 – PHENOL

7 – SPECIAL

TREATMENT TANK: BATCH NUMBER: TRACKING NUMBER:

MANAGEMENT METHOD CODE H135______

ACTIVITY REPRESENTATIVE:

PRINT NAME DATE

CB&I REPRESENTATIVE:

PRINT NAME DATE

CB&I TRUCK AUTHORIZATION:

PRINT NAME DATE Time WAF Issued

Total Truck Hours (Pac Trans):

Total Truck Hours over 4:

Note:

NAVFAC Southwest Environmental Services Doc ID: OTH-005 Industrial Waste/Oily Waste Facility Used In: IWOW-03, 08, 22, 27, 67 Bilge & Oily Waste Treatment System Facilities Revision #: 16 Revision Date: 03/19/2015

INSTRUCTIONS FOR COMPLETING WASTE ACCEPTANCE FORM

Waste Acceptance Form must accompany all wastewater shipments sent to the Environmental Service Centers: Industrial Waste Treatment Plant, Oily Waste Treatment Plant, or any of the BOWTS facilities. Instructions on how to complete the top, customer portion of the form follow:

ACTIVITY #.: Will be assigned by Scheduler.

TRANSPORTER INFORMATION: Must be filled out by the driver.

CUSTOMER USE ONLY (TOP BOX): Must be filled out by the customer or driver and will include the following information:

Bulk Pumping # (Non-FRC): Have the driver or customer record the bulk pumping number or the individual contract number for the load being delivered.

DATE: Date of the waste shipment.

ACTIVITY NAME: Enter activity name. (e.g. PWC Code 007 or vessel name).

BASE: Base where waste was generated. (e.g. Miramar).

PHONE NUMBER: Phone number for activity representative.

JOB ORDER NUMBER: Waste disposal billing Job Order Number.

WASTE DESCRIPTION: In this field write a brief, specific description of the waste such as Chrome Plating Rinse Tank Water.

FRC USE ONLY: Only FRC will fill out this section.

BOWSER ID: Id for the individual bowser delivering the waste.

SHOP NUMBER: Building or shop number from where the waste was derived.

TANK NUMBER: Tank from which the waste was derived.

PROCESS GENERATING WASTE: General description of the waste.

FRC WASTE PROFILE NUMBER: Profile number assigned by FRC composed of 3 letters and 5 numbers (e.g., IWW13-201)

CB&I PERSONNEL USE ONLY: Only CB&I personnel will fill out this section.

BULK PROFILE NUMBER: Profile number comprised of 2 letters and 2 numbers.

INDUSTRIAL WASTE PROFILE NUMBERS

PROFILE NUMBER WASTE STREAM

HW11 Cyanide Waste HW21 Caustic Only, pH > 12.5 HW31 Acidic Only, pH ≤ 2 HW41 Mixed Metal Waste HW51 Chrome Waste (over 0.32ppm) HW61 Phenol and Organic Waste HW71 Special Waste

OILY WASTE/GENERAL INDUSTRAIL WASTE (GIW) PROFILE NUMBER

NW21 GIW

NW91 AFFF without OW NW93 Rain/Comp Water HW91 Bilge/Oily Water/AFFF NW61 Other Non Hazardous Waste

JULIAN DATE: Written by waste receiving facility.

TIME WAF ISSUED: Written at time of truck inspection. (FRC bowsers do not undergo pre-transport inspections) TRUCK DOI: Choose if a truck DOI was required or not required. Required when a truck is offloading waste from vessel to shore (over water).

FACILITY: Choose disposal location for the identified waste stream.

MANIFEST #, EPA Generator ID #, NON_HAZ: If a manifest is used for transport, fill in these sections with the manifest number (located in box 4), Generator’s ID Number (located in Box 1), Non-hazardous Manifest ID number (located in box 1).

TIME ARRIVED: The time the bowser or tanker truck arrived on site.

PUMP START TIME: The time the bowser or tanker truck started pumping.

PUMP END TIME: The time the bowser or tanker truck finished pumping.

PHYSICAL STATE: Liquid or Solid.

SLUDGE IN BOWSER/TANKER TRUCK: Inspect bowser or tanker truck and record if sludge is present.

VOLUME (GALLONS): Total volume in gallons of the waste shipment.

FIELD TEST RESULTS (IF REQUIRED): For OW, Clor-D-Tect or Hydro-Clor. For IW, review FRC Profile List for required testing. Record field test results on WAF.

TREATMENT GROUP: Mark treatment group.

TRACKING NUMBER: Record the tracking number from the current month’s Waste Acceptance Tracking Log.

TREATMENT TANK: Record the Tank Number of where the waste was pumped into.

BATCH NUMBER: For IW only, record the batch folder number for the tank that the waste is being disposed into.

MANAGEMENT METHOD CODE: All waste streams accepted at the IW and OW facilities use the Management Method Code of H135 (discharge to sewer/POTW or NPDES (with prior storage – with or without treatment).

The bottom of the form must be signed and dated by a representative of the generating activity.

If you have any questions about how to complete the Waste Acceptance Form, please contact EPS, Operations Officer or Plant Supervisors.

FOR REFERENCE PURPOSES

Page 2 – Instructions for Waste Acceptance Form

Monthly Container Inspection SPCC Plan – DFSP Point Loma Remediation System

COPYRIGHT© 2011 STEEL TANK INSTITUTE

Section 4 Appendix C-13

STI SP001 Portable Container Monthly Inspection Checklist

General Inspection Information:

Inspection Date: Retain Until Date: (36 months from inspection date)

Prior Inspection Date: Inspector Name:

Containers Inspected (ID #’s):

Inspection Guidance:

For equipment not included in this Standard, follow the manufacturer recommended inspection/testing schedules and procedures.

The periodic AST Inspection is intended for monitoring the external AST condition and its containment structure. This visual inspection does not require a

Certified inspector. It shall be performed by an owner’s inspector who is familiar with the site and can identify changes and developing problems.

(*) designates an item in a non-conformance status. This indicates that action is required to address a problem.

Non-conforming items important to tank or containment integrity require evaluation by an engineer experienced in AST design, a Certified inspector, or a tank manufacturer who will determine the corrective action. Note the non-conformance and corresponding corrective action in the comment section.

Retain the completed checklists for 36 months.

Item Area: Area: Area: Area:

1.0 AST Containment/Storage Area

1.1 ASTs within designated

storage area?

Yes No* Yes No* Yes No* Yes No*

1.2 Debris, spills, or other fire

hazards in containment or storage area?

Yes* No Yes* No Yes* No Yes* No

1.3 Water in outdoor

secondary containment?

Yes* No Yes* No Yes* No Yes* No

1.4 Drain valves operable

and in a closed position?

Yes No* Yes No* Yes No* Yes No*

1.5 Egress pathways clear

and gates/doors operable?

Yes No* Yes No* Yes No* Yes No*

2.0 Leak Detection

2.1 Visible signs of leakage

around the container or storage area?

Yes* No Yes* No Yes* No Yes* No

3.0 Container

3.0 Noticeable container

distortions, buckling, denting or bulging?

Yes* No Yes* No Yes* No Yes* No

Monthly Container Inspection SPCC Plan – DFSP Point Loma Remediation System

Section 4 Appendix C-14

Comments:

Monthly Containment & After Storm Event Inspection SPCC Plan – DFSP Point Loma Remediation System

DLA

Section 4 Appendix C-15

SPILL CONTAINMENT AND DRAINAGE SYSTEM

MONTHLY INSPECTION & AFTER STORM EVENT CHECKLIST

DATE

INSPECTOR (Print full name then initial)

TANK/CONTAINMENT AREA IDENTIFICATION

Instructions: Complete this record for each monthly inspection and after each storm event. A

“YES” response requires an immediate corrective action.

ITEM YES NO DESCRIPTION / COMMENTS

A. Containment area has standing water.

(Must be empty and free from debris.)

B. Surface of accumulated water in berm has noticeable oil sheen. (If there is any oil present, recover any product with vacuum truck or by other means, then remove any remaining sheen with sorbent pads. If there is no oil present, drain berm by opening valve or empty by manually operated pump or ejectors and record such event.)

C. Containment berm valve left open.

(This valve must be in normal closed position.)

D. Ramps or containment walls are damaged or cracked.

E. Dikes have holes, cracks, vegetative growth, or other breaches that could result in leaks.

F. Curbing has holes, cracks, or other breaches that could result in leaks.

ADDITIONAL COMMENTS:

Monthly Pipeline & Valve Inspection SPCC Plan – DFSP Point Loma Remediation System

Section 4 Appendix C-17

PIPELINE & VALVE SYSTEM MONTHLY INSPECTION CHECKLIST

DATE

INSPECTOR (Print full name then initial)

PIPELINE SECTION/AREA IDENTIFICATION

PRIOR

INSPECTION

RETAIN RECORD (36 months from date of inspection)

CORRECTIVE ACTION REQUIRED - Yes or No (If yes, indicate date required by and detail in additional comment below )

Instructions: Complete this record for each monthly inspection and after each storm event. A

“YES” response requires an immediate action. Initial appropriate response.

ITEM YES NO DESCRIPTION / COMMENTS

A. Pipeline Check: Droplets of conveyed fluids

B. Pipeline Check: Discoloration of Pipe or Indication of corrosion

C. Pipeline Check: Nicks or Gouges in

Piping

D. Pipeline Check (suspended pipe):

Bowing of Pipe Between Supports

E. Pipeline Check (below grade):

Localized dead vegetation

F. Pipeline Check: Abrasion at Pipe

Supports, thru points or connections

G. Pipeline Check: Unprotected from

Vehicles

H. Storage of Transfer Hose outside dike

I. Pipeline Connection Vault: Containment area contains debris/fluids

J. Pipeline Connection Vault: Leak

Detection Sensor Inoperable

K. Pipeline Connection Vault: Lid Does not properly secure

Monthly Pipeline & Valve Inspection SPCC Plan – DFSP Point Loma Remediation System

Section 4 Appendix C-18

PIPELINE & VALVE SYSTEM MONTHLY INSPECTION CHECKLIST

L. Valve Check: Discoloration or Indication of corrosion

M. Valve Check: Evidence of Seepage from Seals

N. Valve Check: Improper Positioning of

Valve

O. Valve Check: Lock Missing (if required location for lock)

P. Valve Check: Issue with Operation (i.e.

valve cannot be open/closed)

Q. Are there other conditions which might affect continued safe operation or impact the site spill prevention plan

ADDITIONAL COMMENTS:

Initials of Inspector: Date of Inspection:

Monthly Tank Inspection SPCC Plan – DFSP Point Loma Remediation System

Section 4 Appendix C-3

STI SP001 Monthly Inspection Checklist

Tanks Inspected (ID #’s):

For equipment not included in this Standard, follow the manufacturer recommended inspection/testing schedules and procedures.

The periodic AST Inspection is intended for monitoring the external AST condition and its containment structure. This visual inspection does not require a

Certified inspector. It shall be performed by an owner’s inspector who is familiar with the site and can identify changes and developing problems.

Upon discovery of water in the primary tank, secondary containment area, interstice, or spill container, remove promptly or take other corrective action. Before discharge to the environment, inspect the liquid for regulated products or other contaminants and disposed of it properly.

(*) designates an item in a non-conformance status. This indicates that action is required to address a problem.

Non-conforming items important to tank or containment integrity require evaluation by an engineer experienced in AST design, a Certified inspector, or a tank manufacturer who will determine the corrective action. Note the non-conformance and corresponding corrective action in the comment section.

Retain the completed checklists for 36 months.

In the event of severe weather (snow, ice, wind storms) or maintenance (such as painting) that could affect the operation of critical components

(normal and emergency vents, valves), an inspection of these components is required as soon as the equipment is safely accessible after the event.

Item Task Status Comments

1.0 Tank Containment

1.1 Containment

structure Check for water, debris, cracks or fire hazard

Yes* No N/A

1.2 Primary tank Check for water Yes* No

1.3 Containment

drain valves Operable and in a closed position

Yes No* N/A

1.4 Pathways and

entries

Clear and gates/ doors operable

Yes No* N/A

2.0 Leak Detection

2.1 Tank Visible signs of

leakage Yes* No

2.2 Secondary

containment

Visible signs of leakage from tank into secondary containment

Yes* No

2.3 Surrounding

soil

Visible signs of leakage

Yes* No N/A

2.4 Interstice Visible signs of

leakage

Yes* No N/A

Section 4 Appendix C-4

Item Task Status Comments

3.0 Tank Equipment

3.1 Valves a. Check for leaks. Yes* No N/A

b. Tank drain valves must be kept locked.

Yes* No N/A

3.2 Spill

containment boxes on fill pipe

a. Inspect for debris, residue, and water in the box and remove.

Yes* No N/A

b. Drain valves must be operable and closed.

Yes* No N/A

3.3 Liquid level

equipment

a. Both visual and mechanical devices must be inspected for physical damage

Yes* No N/A

b. Check that the device is easily readable

Yes No* N/A

3.4 Overfill

equipment

a. If equipped with a “test” button, activate the audible horn or light to confirm operation.

This could be battery powered. Replace the battery if needed.

Yes No* N/A

b. If overfill valve is equipped with a mechanical test mechanism, actuate the mechanism to confirm operation.

Yes No* N/A

3.5 Check all tank

openings are properly sealed

Check for leaks corrosion and damage

Yes* No

4.0 Tank Attachments and Appurtances

4.1 Ladder and

platform structure

Secure with no sign of severe corrosion and damage?

Yes No* N/A

5.0 Other Conditions

5.1 Are there other conditions that should

be addressed for continued safe operation or that may affect the site spill prevention plan?

Yes* No

Section 4 Appendix C-5

Additional Comments:

Annual Tank Inspection SPCC Plan – DFSP Point Loma Remediation System

Section 4 Appendix C-7

STI SP001 Annual Inspection Checklist

Tanks Inspected (ID #’s):

For equipment not included in this Standard, follow the manufacturer recommended inspection/testing schedules and procedures.

The periodic AST Inspection is intended for monitoring the external AST condition and its containment structure. This visual inspection does not require a

Certified inspector. It shall be performed by an owner’s inspector who is familiar with the site and can identify changes and developing problems.

Remove promptly upon discovery standing water or liquid in the primary tank, secondary containment area, interstice, or spill container. Before discharge to the environment, inspect the liquid for regulated products or other contaminants and disposed of it properly.

In order to comply with EPA SPCC (Spill Prevention, Control and Countermeasure) rules, a facility must regularly test liquid level sensing devices to ensure proper operation (40 CFR 112.8(c)(8)(v)).

(*) designates an item in a non-conformance status. This indicates that action is required to address a problem.

Non-conforming items important to tank or containment integrity require evaluation by an engineer experienced in AST design, a Certified inspector, or a tank manufacturer who will determine the corrective action. Note the non-conformance and corresponding corrective action in the comment section.

Retain the completed checklists for 36 months.

Complete this checklist on an annual basis supplemental to the owner monthly-performed inspection checklists.

Note: If a change has occurred to the tank system or containment that may affect the SPCC plan, the condition should be evaluated against the current plan requirement by a Professional Engineer knowledgeable in SPCC development and implementation.

Item Task Status Comments

1.0 Tank Containment

1.1 Containment

structure Check for:

Holes or cracks in containment well or floor Washout Liner degredataion Corrosion Leakage Paint failure Tank settling

Yes* No N/A

2.0 Tank Foundation and Supports

2.1 Foundation Settlement or

foundation washout?

Yes* No

2.2 Concrete

pad or ring wall

Cracking or spalling? Yes* No N/A

Section 4 Appendix C-8

Item Task Status Comments

2.3 Supports Ceck for corrosion, paint failure, etc.

Yes* No N/A

2.4 Water

drainage

Water drains away from tank?

Yes No* N/A

2.5 Tank

grounding

Strap secured and in good condition?

Yes No* N/A

3.0 Cathodic Protection

3.1 Galvanic

cathodic protection system

Confirm system is functional, includes the wire connections for galvanic systems

Yes No* N/A

3.2 Impressed

current system

a. Inspect the operational components (power switch, meters, and alarms).

Yes No* N/A

b. Record hour meter, ahmeter, and voltmeter readings.

Yes No* N/A

4.0 Tank Shell, Heads, Roof

4.1 Coating Check for coating

failure Yes* No

4.2 Steel

condition

Check for:

Dents Buckling Bulging Corrosion Cracking

Yes* No

4.3 Roof slope Check for low points

and standing water

Yes* No N/A

5.0 Tank Equipment

5.1 Vents Verify that components

are moving freely and vent passageways are not obstructed for:

Emergency vent covers Pressure/vacuum vent poppets Other moving vent components

Yes* No

5.2 Valves Check the condition of

all valves for leaks, corrosion and damage.

Yes* No

Section 4 Appendix C-9

Item Task Status Comments

5.2.1 Anti-siphon, check and gate valves

Cycle the valve open and closed and check for proper operation.

Yes No* N/A

5.2.2 Pressure

regulator valve

Check for proper operation. (Note that there may be small 1/4 inch drain plugs in the bottom of the valve that are not visible by looking from above only)

Yes No* N/A

5.2.3 Expansion

relief valve

Check that the valve is in the proper orientation. (Note that fuel must be discharged back to the tank via a separate pipe or tubing.)

Yes No* N/A

5.2.4 Solenoid

valves

Cycle power to valve to check operation.

(Electrical solenoids can be verified by listening to the plunger opening and closing. If no audible confirmation, the valve should be inspected for the presence and operation of the plunger.)

Yes No* N/A

5.2.5 Fire and

shear valves

a. Manually cycle the valve to ensure components are moving freely and that the valve handle or lever has clearance to allow valve to close completely.

Yes No* N/A

b. Valves must not be wired in open position.

Yes No* N/A

c. Make sure fusible element is in place and correctly positioned.

Yes No* N/A

Section 4 Appendix C-10

Item Task Status Comments

d. Be sure test ports are sealed with plug after testing is complete and no temorary test fixture or component remains connected to valve.

Yes No* N/A

5.3 Interstitial

leak detection equipment-

Check the condition of equipment, including:

The window is clean and clear in sight leak guages.

The wire connections of electronic gauges for tightness and corrosion Activate the test button if applicable.

Yes No* N/A

5.4 Spill

containmen t boxes on fill pipe

a. If corrosion damage, or wear has compromised the ability of the unit to perform spill containment functions, replace the unit.

Yes* No N/A

b. Inspect the connections to the AST for tightness, as well as the bolts, nuts, washer for condition and replace if necessary

Yes* No N/A

c. Drain valves must be operable and closed.

Yes* No N/A

5.5 Strainer a. Check that the

strainer is clean and in good condition.

Yes No* N/A

b. Access strainer basket and check cap and gasket seal as well as bolts.

Section 4 Appendix C-11

Item Task Status Comments

5.6 Filter a. Check that the filter

is in good condition and is within the manufacturer’s expected service life.

Replace as necessary.

Yes No* N/A

b. Check for leaks and decreased fuel flow

Yes No* N/A

5.7 Flame

arrestors

Follow manufacturer’s instructions. Check for corrosion and blockage of air passages.

Yes* No N/A

5.8 Leak

detector for submersible pump systems

Test according to manufacturer’s instructions and authority having jurisdiction (AHJ).

Verify leak detectors are suited and properly installed for aboveground use.

Yes No* N/A

5.9 Liquid level

equipment

a. Has equipment been tested to ensure proper operations?

Yes No* N/A

b. Does equipment operate as required?

Yes No* N/A

c. Follow manufacturer’s instructions.

Yes No* N/A

5.10 Overfill

equipment

a. Follow manufacturer’s instructions and regulatory requirements for inspection and functionality verification.

Yes No* N/A

b. Confirm device is suited for above ground use by the manufacturer

Section 4 Appendix C-12

Item Task Status Comments

6.0 Insulated Tanks

6.1 Insulation Check condition of

instulation for:

Missing sections Areas of moisture Mold Damage

Yes* No N/A

6.2 Insulation

jacket or cover

Check for damage that will allow water intrusion

Yes* No N/A

7.0 Miscellaneous

7.1 Electrical

wiring and boxes

Are they in good condition?

Yes No* N/A

7.2 Labels and

tags

Ensure that all labels and tags are intact and readagble.

Additional Comments:

(Issued September 30, 2015)

EMERGENCY RESPONSE PLAN

The Emergency Response Plan (ERP) must be kept with the Slug Discharge Plan and SPCC Plan at all times. It must be followed in the event of a 'worst case scenario release" that requires rapid/emergency response, such as, when human health & safety is at immediate risk, the release could potentially reach the bay if not contained immediately, or when the release of any known quantity has reached the bay.

Facility Name: DFSP POINT LOMA REMEDIATION SYSTEM Facility Address: NBPL Bldg 604, 199 Rosecrans Street, Point Loma, CA 92106

1. If an unauthorized release occurs, the following actions will be performed:

A. RESTRICT ACCESS TO SPILL AREA. CONTAIN SPILL, IF POSSIBLE. NOTIFY SUPERVISOR

B. ANSWER THE FOLLOWING QUESTIONS:

Substance spilled?

Quantity Spilled: Estimated: Actual:

Location of Spill:

Date Occurred: Time:

Description of Affected Area:

WEATHER CONDITIONS: Wind Direction/Speed: Tide:

Surface Water conditions:

SOURCE: Ship Fuel Dept: Other:

Cause:

Action Taken: _ Estimated Manpower, Material Equipment to Clean/Control Spill:

Assistance from Outside Activities/Agencies:

Actual Man Hours Expended:

Samples were/were not taken:

Containment Method:

Removal Method:

DATE/TIME OF: Discharge stopped:

Corrective action cleanup complete:

Person Making Report: Name:

After Action Report Sent: Y ( ) N ( )

2. THE FACILITY INCIDENT COMMANDER OR FUEL DEPOT DISPATCHER SHALL NOTIFY

AUTHORITIES AS FOLLOWS:

A. WATER OR LAND SPILL: If the hazardous substance is listed on the Business Inventory Plan, and meets or exceeds the reportable quantity, or if oil spill on land is more than 5 gallons; or visible sheen is formed on water surface, every effort possible should be made to notify the Facilities Incident Commander within the first 15 minutes of discovering the spill for instructions. It is important to remember that containment takes precedent over notification, but every effort should be made to notify both the Facilities Incident Commander (FIC), the state Office of Emergency services (OES), and National Response Center (NRC) as soon as possible after the spill has been discovered. Notification of additional authorities can follow later, but not more than 24 hours later.

EMERGENCY RESPONSE PLAN

1. Qualified Individual Facility Incident Commander (619) 726-7423 (CDO); (619) 553-7400 (Base CO)

POC at agency Control number Date: Time: Notified: Y ( ) N ( )

2. NBPL Environmental Department (619) 533-0526

3. National Response Center (NRC) 1-800-424-8802

Control number Date: Time: Notified: Y ( ) N ( )

4. Office of Emergency Services 1-800-852-7550 POC at agency

Date: Time: _ Notified: Y ( ) N ( )

5. Fuel Depot OSOT personnel if required and other OSOT backup if needed.

6. Department of Environmental Health (DEH) Work Hrs (619) 338-2222 After Hrs (619) 565-5659

POC at agency

Date: Time: _ Notified: Y ( ) N ( )

7 Department of Fish and Game (916) 445-0045

8. FLC Terminal Director (619) 553-1314 (office)

(619) 250-9806 (cell) (858) 292-8834 (home) CDO (Pager) (619) 556-5500 PIN 8777

9. NBPL Port Operations Office (if required) (619) 553-9785 (Dispatch)

10. SSC Pacific Marine Mammal Enclosures (water spill only) (619) 206-6828

POC at agency Scott Price; Alt – Dr. Mark Xitco (619) 204-1307

EMERGENCY RESPONSE PLAN

11. Federal Fire Department. 9-911

POC at agency

12. Regional Water Quality Control Board (RWQCB) (619) 516-1990

13. California Highway patrol (if spill is on public highway) 911

13. NAVFAC-SW Water Program Director (619) 532-2273

POC:

Person making notifications:

B. FAX SPILL REPORT ASAP TO THE ENVIRONMENTAL COMPLIANCE MANAGER (Luis Perez) AT 619-553-8657.

C. CLEANUP/CONTAIN SPILL:

1. Water: Activate the On-Scene Operations Team.

2. Land: If substance is relatively harmless and your personnel are trained and have proper protective equipment/tools, clean spill. If substance is hazardous or you are in doubt, contact the Federal Fire Department at 9-911 or Super Facility Incident Commander for assistance.

D. SEND UNIT SITREP AND AFTER ACTION REPORT AS REQUIRED