HomeMy WebLinkAboutSB989 2013SWRCB, January 2002 Page __ of __
Secondary Containment Testing Report Form
This form is intended for use by contractors peiforming periodic testing of UST second01y containment systems. Use the
appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and
printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION --·-
Facility Name: Mt. Vernon & Columbus Arco AM/PM I Date of Testing: 8/29/2013
Facility Address: 2698 Mt. Vernon A venue
Facility Contact: Monty Hawatmeh I Phone: 661-703-7273
Date Local Agency Was Notified of Testing : 8/19/2013
Name of Local Agency Inspector (if present during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services
Technician Conducting Test: Bryan A Self
Credentials: x CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester
License Type: CSLB I License Number:804904
Manufacturer Trainin2;
Manufacturer Component(s) Date Training Expires
UST 11/22/2013
Installaton!Retrofit
UST Service ICC 1-28-2015
technician
Star. Smith. Fibercast Fiber Glass Systems N.A.
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not Repairs Component Pass Fail Not Repairs
Tested Made Tested Made
87 Fill X 0 0 0 0 0 0 0
91Fi11 X 0 0 0 0 0 0 0
87 STP X 0 0 X 0 0 0 0
91 STP X 0 0 0 0 0 0 0
87 Annular X 0 0 0 0 0 0 0
91 Annular X 0 0 0 0 0 0 0
87 Product Line X 0 0 X 0 0 0 0
91 Product Line X 0 0 0 0 0 0 0
UDC 1 &2 X 0 0 0 0 0 0 0
UDC2&3 X 0 0 0 0 0 0 0
UDC 5 &6 X 0 0 0 0 0 0 0
UDC7&8 X 0 0 0 0 0 0 0 -----
If hydrostatic testing was performed, describe what was done with the water after completion of tests:
Water was gut back into test trailer and waste drum
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING TlflS TESTING
To the best of n91 knowledge, the facts stated in this document are accurate and in full compliance with Legal requirements
t. fk;j_ Technician's Signature: ;;;~ -¢
7
Date: 8/29/2013
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SWRCB, January 2002 Page __ of __
4. TANK ANNULAR TESTING
Test Method Developed By: D Tank Manufacturer x Industry Standard D Professional Engineer
D Other (Specify)
Test Method Used: D Pressure x Vacuum D Hydrostatic
D Other (Specify)
Test Equipment Used: Calibrated Gages Equipment Resolution:0.0625"
Tank #Reg./Super Tank# Tank# Tank#
Is Tank Exempt From Testing?1 DYes X No DYes X No DYes DNo DYes DNo
Tank Capacity: 20,000 12,000
Tank Material: FRP FRP
Tank Manufacturer: XerXes XerXes
Product Stored: RegularUL Super UL
Wait time between applying
pressure/vacuum/water and 5Min. 5 Min.
starting test:
Test Start Time: I 0:15am I 0:15am
Initial Reading (R1): -10 Hg -10 Hg
Test End Time: I I :15am I 1:15am
Final Reading (.Ry): -10 Hg -10 Hg
Test Duration: 1 hour I hour
Change in Reading (~R1): 0.00" 0.00"
Pass/Fail Threshold or Criteria: 0.00" 0.00"
Test Result: X Pass DFail X Pass DFail D Pass DFail D Pass DFail
Was sensor removed for testing? X Yes DNo DNA XYes DNo DNA DYes DNo DNA DYes DNo DNA
Was sensor properly replaced and X Yes DNo DNA XYes DNo DNA DYes DNo DNA DYes DNo DNA verified functional after testing?
Comments-(include information on repairs made prior to testing, and recommendedfol/ow-upforfai/ed tests)
1 Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary
containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment
testing. {California Code of Regulations, Title 23, Section 2637(a)(6)}
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SWRCB, January 2002 Page_ of_
5. SECONDARY PIPE TESTING
Test Method Developed By: 0 Piping Manufacturer x Industry Standard 0 Professional Engineer
0 Other (Specify)
Test Method Used: xPressure 0 Vacuum 0 Hydrostatic
0 Other (Specify)
Test Equipment Used: Calibrated Gages Equipment Resolution:0.0625"
Piping Run #87 Piping Run #91 Piping Run# Piping Run#
Piping Material: FRP FRP
Piping Manufacturer: Smith Smith
Piping Diameter: 3" 3"
Length of Piping Run: 150' 175'
Product Stored: RegularUL SuperUL
Method and location of Test boot Test boot piping-run isolation:
Wait time between applying
pressure/vacuum/water and 5Min. 5 Min.
startin~ test:
Test Start Time: 3:00pm !O:OOam '
Initial Reading (RJ): 5" PSI 5" PSI
Test End Time: 4:00pm I 1:00am i
Final Reading (RF): 5" PSI 5" PSI
Test Duration: I hour l hour
Change in Reading (R,-R1): 0.00" 0.00"
Pass/Fail Threshold or 0.00" 0.00" Criteria:
Test Result: X Pass OFail X Pass OFaH 0 Pass OFaiJ 0 Pass 0 Fail
Comments-(include information on repairs made prior to testing, and recommendedfollow-up[or foiled tests)
SWRCB, January 2002 Page_ of_
6. PIPING SUMP TESTING
Test Method Developed By: D Sump Manufacturer x Industry Standard D Professional Engineer
D Other (Specify)
Test Method Used: DPressure DVacuum x Hydrostatic
D Other (Specify)
Test Equipment Used: Ts-sts Equipment Resolution:
Sump#87UL Sump#91 UL Sump# Sump#
Sump Dian1eter: 42" 42"
Sump Depth: 64" 64"
Sump Material: FRP FRP
Height from Tank Top to Top of No Penetration No Penetration Highest Piping Penetration:
Height from Tank Top to Lowest 31" 31" Electrical Penetration:
Condition of sump prior to testing: Clean&Dry Clean &Dry
Portion of Sump Tested1 Pipe Penetration Pipe Penetration
Does turbine shut down when
sump sensor detects liquid (both
product and water)?"
X Yes DNo DNA X Yes DNo DNA DYes DNo DNA DYes DNo DNA
Turbine shutdown response time NA NA
Is system programmed for fail-safe
shutdown?' X Yes DNo DNA XYes DNo DNA DYes DNo DNA DYes DNo DNA
Was fail-safe verified to be DYes DNo XNA DYes DNo XNA DYes DNo DNA DYes DNo DNA operational?•
Wait time between applying
pressure/vacuum/water and starting 5Min. 5Min.
test:
Test Start Time:
Initial Reading (R1):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading (RF""R,):
Pass/Fail Threshold or Criteria:
Test Result: X Pass DFail X Pass D Fail D Pass D Fail D Pass DFail
Was sensor removed for testing? XYes DNo DNA XYes DNo DNA DYes DNo DNA DYes DNo DNA
Was sensor properly replaced and X Yes DNo DNA XYes DNo DNA DYes DNo DNA DYes DNo DNA verified functional after testing?
Comments -(if!clude information on repairs made prior to testing. and recommended [ollow-upfor foiled tests)
1 If the entire depth of the sump is not tested, specify how much was tested. If the answer to ill1Y of the questions indicated with an
asterisk(*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160)
SWRCB, January 2002 Page __ of __
.. -·. -----.. ---. ---.•. .. -----------
Test Method Developed By: D UDC Manufacturer x Industry Standard D Professional Engineer
D Other (Specify)
Test Method Used: D Pressure D Vacuum x Hydrostatic
D Other (Specify)
Test Equipment Used: Ts-sts Equipment Resolution:
UDC# 1&2 UDC# 3&4 UDC#5&6 UDC#7 & 8
UDC Manufacturer: Unknown Unknown Unknown Unknown
UDC Material: FRP FRP FRP FRP
UDCDepth: 30" 30" 30" 30"
Height from UDC Bottom to Top 11" 11" 11" II"
of Highest Piping Penetration:
Height from UDC Bottom to 7" 7'' 7" 7''
Lowest Electrical Penetration:
NA Clean & Dry Clean & Dry Clean &Dry Clean & Dry
Portion ofUDC Tested1 High Penetration High Penetration High Penetration Penetration
Does turbine shut down when
UDC sensor detects liquid (both X Yes DNo DNA XYes DNo DNA XYes DNo DNA XYes DNo DNA
product and water)?•
Turbine shutdown response time NA NA NA NA
Is system programmed for fail-
safe shutdownf X Yes DNo DNA XYes DNo DNA XYes DNo DNA XYes DNo DNA
Was fail-safe verified to be XYes DNo DNA XYes DNo DNA XYes DNo DNA XYes DNo DNA operational?'
Wait time between applying 5 Min. 5 Min. 5Min. 5Min.
pressure/vacuum/water and
starting test
Test Start Time:
Initial Reading (R1):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading (RF-R1):
Pass/Fail Threshold or Criteria:
Test Result: X Pass D Fail X Pass DFail X Pass DFail X Pass D Fail
Was sensor removed for testing? XYes DNo DNA XYes DNo DNA XYes DNo DNA XYes DNo DNA
Was sensor properly replaced and XYes DNo DNA XYes DNo DNA XYes DNo DNA XYes DNo DNA verified functional after testing?
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Comments-(include information on repairs made prior to testing, and recommended[ollow-up[orfailed tests)
1 If the entire depth of the UDC is not tested, specifY how much was tested. If the answer to ill!X of the questions indicated with an
asterisk(*) is "NO" or ''NA", the entire UDC must be tested. (See SWRCB LG-160)
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SWRCB, January 2002 Page_ of_
8. FILL RISER CONTAINMENT SUMP TESTING
Facility is Not Equipped With Fill Riser Containment Sumps D
Fill Riser Containment Sumps are Present, but were Not Tested D
Test Method Developed By: D Sump Manufacturer X Industry Standard D Professional Engineer
D Other (Specify)
Test Method Used: D Pressure D Vacuum X Hydrostatic
D Other (Specify)
Test Equipment Used: Equipment Resolution:
Fill Sump #87 UL Fill Sump #91 UL Fill Sump# Fill Sump#
Sump Diameter: 46" 46"
Sump Depth: 65" 65"
Height from Tank Top to Top of 20" 20"
Highest Pioing Penetration:
Height from Tank Top to Lowest II" II"
Electrical Penetration:
Condition of sump prior to Clean & Dry Clean & Dry
I testing:
Portion of Sump Tested Pipe Penetration Pipe Penetration I
Sump Material: FRP FRP
Wait time between applying 5 Min. 5Min.
pressure/vacuum/water and
starting test:
Test Start Time:
Initial Reading (R1):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading CRrRI):
Pass/Fail Threshold or Criteria:
Test Result: X Pass 0 Fail X Pass DFail D Pass DFail D Pass DFail
Is there a sensor in the sump? X Yes DNo X Yes DNo DYes DNo [J Yes DNo
Does the sensor alarm when
either product or water is X Yes DNo XYes DNo DYes DNo DYes DNo
detected?
Was sensor removed for testing? X Yes DNo XYes DNo DYes DNo DNA DYes DNo DNA
Was sensor properly replaced and X Yes DNo DNA XYes DNo DNA DYes DNo DNA DYes DNo DNA verified functional after testing? -I---
Comments-(include information on repairs made prior to testing, and recommendedjollow-upforfoiled tests)
SWRCB, January 2002 Page_ of_
9. SPILL/OVERFILL CONTAINMENT BOXES
Facility is Not Equipped With SpiiVOverfill Containment Boxes 0
Spill/Overfill Containment Boxes are Present, but were Not Tested 0
Test Method Developed By: 0 Spill Bucket Manufacturer x Industry Standard 0 Professional Engineer
0 Other (Specify)
Test Method Used: 0 Pressure 0 Vacuum x Hydrostatic
0 Other (Specify)
Test Equipment Used: Ts-sts Equipment Resolution:
Spill Box #87 fill west Spill Box #87fill east Spill Box #87 vapor Spill Box #87 vapor
west east
Bucket Diameter:
Bucket Depth:
Wait time between applying
pressure/vacuum/water and
starting test:
Test Start Time:
Initial Reading (R1):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading (R,R1):
Pass/Fail Threshold or
Criteria:
Test Result: 0 Pass OFail 0 Pass OFail 0 Pass 0 Fail 0 Pass 0 Fail -·-·-·--·-·---
Comments-(include information on repairs made prior to testing, and recommended[ollow-up[or foiled tests)
All Soil! Buckets were tested with the annual Monitorin2: Certification.
~fiDE"+.
CJo ~ ~UST(J. Job Order /Invoice #: 31~
~fiDE"+, ;iJsii ~ +' ~"~tuc1'0 ~,CES•~ Date caned Time To WhOm
Name:
Street:
City:
Terms:
"BULD WITH COHFIOtNCE"
Lie. 970703
"COMPUAHCE WITH CONFIIlENCF
Lic.804904
Toll Free #: 1-800-339-9930
Confidence UST
16250 Meacham Road
Bakerslicld CA 93314
Site Name: .A~o AMPM
Street: z(,q9, MT V6P...Nt1AJ
City: RA~F?SFJEl /") State: ert Zip:
Store No:
Oescliotion of work oerformed: Ft-..Ll. ~v~F..v> &f'3Cf TF-.C"T.I.-vt'-.
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TRAVEL and LABOR (0.5 Hour Minimum Labor Charge) OVERTIME (5:00 PM -7o00 AM)
Date Technician(s) Name Start End Total OT Start OTEnd OTTotal
Rmfi, f5tiCAV1 A·'$r(F Travel
Labor _5}{.
Travel
Date Technlcian(s) Name Start End Total OT Start OTEnd OTTotal
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Labor • Travel
Date Techn1cian(s) Name Start End Total OT Start OTEnd OTTotal
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Labor
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SUPPLIES-MATERIALS-RENTALS Check One
Qty. UST Parts Site Parts
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COMMENTS
Storo Employee Print Name:
Storo Employee Signature
INVOICE-\
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