HomeMy WebLinkAboutSB989 2013SWRCB, January 2002 Page __ of __
Secondary Containment Testing Report Form
This form is intended for use by contractors pe1jorming periodic testing of UST secondary containment systems. Use the
appropriate pages of this form to report results for all components tested. The completedform, written test procedures, and
printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulat01y agency.
1. FACILITY INFORMATION
Facility Name: Metro Mart I Date ofTesting: 8/30/13
Facility Address: 4600 Stine Rd. Bakersfield, Ca. 93312
Facility Contact: Mike I Phone: 661-83 1-0836
Date Local Agency Was Notified ofTesting: 8/27113
Name of Local Agency Inspector (if present during testing): N/A
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services
Technician Conducting Test: Frank Landa
Credentials: x CSLB Licensed Contractor o SWRCB Licensed Tank Tester
License Type: CSLB I License Number:804904 ICC# 8180171/8018524
Manufacturer Training
Manufacturer Component(s) Date Training Expires
UST 11122/2013
lnstallaton/Retrofit
UST Service ICC 1-28-2015
technician
Star. Smith. Fibercast Fiber Glass Systems N.A.
3. SUMMARY OF TEST RESULTS
t-Not Repairs 1 Not Repairs Component Pass Fail Component Pass Fail Tested Made Tested Made
DSL Annular X [] , UDC# 1-2 X u 0 l
87# 1 Annular X ~ n n UDC # 3-4 X u "' 87#2 Annular X [J [) 0 UDC #5-6 X 0 0 0
91 Annular X 0 n UDC# 7-8 X 0 0 0
DSL Secondary X 0 n X UDC # 9-10 X 0 0 0
87# 1 Secondary X 0 n 0 DSL Fill Bucket X [) [J 0
87#2 Secondary X 0 n X 87 #1 Fill Bucket X n n 0
91 Secondary X 0 0 0 87 # 1 Vapor Bucket X 1 0 0
DSL STP 0 X 0 0 87 # 2 Fill Bucket X 0 0 0
87#1 STP X n ~ 0 87 # 2 Vapor Bucket X 0 0 :::J .....
87#2 STP X n 0 0 91 Fill Bucket X 0 0 0
91 STP X .J2_ n ~ 91 Vapor Bucket X 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
RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best of my knowled~:=nent are accurate and in full compliance with legal requirements
Technician's Signature: ._.. Date: 8/30/13
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 #DSL Tank #87#1 Tank#87#2 Tank #91
Is Tank Exempt From Testing?1 DYes X No DYes X No DYes X No DYes X No
Tank Capacity: Unknown Unknown Unknown Unknown
Tank Material: Steel Steel Steel Steel
Tank Manufacturer: Unknown Unknown Unknown Unknown
Product Stored: DSL Regular Regular Premium
Wait time between applying
pressure/vacuum/water and 5 Min. 5 Min. 5 Min. 5Min.
starting test:
Test Start Time: 8:30am 8:30am 8:30am 8:30am
Initial Reading (R1): IOHG IOHG IOHG IOHG
Test End Time: 9:30am 9:30am 9:30am 9:30am
Final Reading (Rr): IOHG IOHG IOHG 10 HG
Test Duration: I Hour I Hour I Hour I Hour
Change in Reading (RF-Rr): 0.00" 0.00" 0.00" 0.00"
Pass/Fail Threshold or Criteria: 0.00" 0.00" 0.00" 0.00"
Test Result: X Pass DFail X Pass 0 Fail X Pass DFail X Pass DFail
Was sensor removed for testing? DYes DNo DNA DYes DNo DNA DYes DNo DNA DYes DNo DNA
Was sensor properly replaced and DYes DNo DNA DYes DNo DNA DYes DNo DNA DYes DNo DNA verified functional after testing?
Comments -(include information on repairs made prior to testing, and recommended.follow-upfor.failed 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)}
!
i
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: x Pressure 0 Vacuum 0 Hydrostatic
0 Other (.SpecifY)
Test Equipment Used: Calibrated Gages Equipment Resolution:0.0625"
Piping Run # DSL Piping Run# 87 #1 Piping Run #87 #2 Piping Run #91
Piping Material: Fiberglass Fiberglass Fiberglass Fiberglass
Piping Manufacturer: Smith Smith Smith Smith
Piping Diameter: 3" 3" 3" 3"
Length of Piping Run: 80' 100' 100' 100'
Product Stored: DSL Regular Regular Premium
Method and location of Boot in STP Boot in STP Boot in STP Boot in STP piping-mn isolation:
Wait time between applying
pressure/vacuum/water and 5 Min. 5 Min. 5 Min. 5 Min.
starting test:
Test Start Time: 9:00am 9:00am 9:00am 9:00am
Initial Reading (R1): 5 PSI 5 PSI 5 PSI 5 PSI
Test End Time: 10:00 am 10:00 am IO:OO am 10:00 am
Final Reading (RF): 5 PSI 5 PSI 5 PSI 5 PSI
Test Duration: 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 0.00" 0.00" 0.00" 0.00" Criteria:
Test Result: X Pass 0 Fail X Pass 0 Fail X Pass OFail X Pass 0 Fail
Comments -(include information on repairs made prior to testing, and recommended.follow-up .for.failed tests)
Replaced (1) 3.5x 2.4 a test boot in DSL STP, and in 87#2 STP
SWRCB, January 2002 Page __ of_
6. PIPING SUMP TESTING
Test Method Developed By: D Sump Manufacturer x Industry Standard D Professional Engineer
D Other (Spec[fy)
Test Method Used: D Pressure D Vacuum x Hydrostatic
D Other (SpecifY)
Test Equipment Used: Ts-sts Equipment Resolution:
Sump #DSL Sump #87 #I Sump #87#2 Sump #91
Sump Diameter: 40" 36" 36" 36"
Sump Depth: 60" 60" 60" 60"
Sump Material: Fiberglass Fiberglass Fiberglass Fiberglass
Height from Tank Top to Top of 18" Highest Piping Penetration: 16" 16" 16"
Height from Tank Top to Lowest 24" Electrical Penetration: 20" 20" 20"
Condition of sump prior to testing: Clean Clean Clean Clean
Portion of Sump Tested 1 20" 18" 18" 18"
Does turbine shut down when
sump sensor detects liquid (both DYes DNo XNA DYes DNoXNA DYes DNoXNA DYes DNo XNA
product and water)?•
Turbine shutdown response time NA NA NA NA
Is system programmed for fail-safe
shutdown?· DYes DNo XNA DYes DNoXNA DYes DNoXNA DYes DNo XNA
Was fail-safe verified to be DYes DNo XNA DYes DNoX NA DYes DNoXNA DYes ONo XNA operational?•
Wait time between applying
pressure/vacuum/water and starting SMin. 5 Min. SMin. SMin.
test:
Test Start Time:
Initial Reading (R1): ~--...... '"""II. I
Test End Time: ~ee1N l,;ON "'~~Trtl -,VI~ -Final Reading (RF): Resl Jlts -r<esu tS
Test Duration:
Change in Reading (RF-R!):
Pass/Fail Threshold or Criteria:
Test Result: D Pass X Fail X Pass D Fail X Pass DFail X Pass DFail
Was sensor removed for testing? X Yes DNo DNA X Yes DNo DNA X Yes DNo DNA X Yes DNo DNA
Was sensor properly replaced and X Yes DNo DNA X Yes DNo DNA XYes DNo DNA X Yes DNo DNA verified functional after testing?
Comments -(include information on repairs made prior to testing, and recommended.follow-up.for.failed tests)
DSL STP fails. possible problem with tank_c_Ql_l_ar
1 If the entire depth of the sump is not tested, specify how much was tested. If the answer to~ of the questions indicated with an
asterisk(*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160)
I
SWRCB, January 2002 Page __ of __
'· \,Jl,..I.J.L:J.I..'--.L'.I..U.I...&;J..l"V~•' '-'...._,.L.,...._.L-.........._,. ... ,. • ...,.~,.,...._ ,.....,...,._ .a ~-
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#S-6 UDC # 7-8
UDC Manufacturer: Bravo Bravo Bravo Bravo
UDC Material: Fiberglass Fiberglass Fiberglass Fiberglass
UDC Depth: 37" 37" 37" 37"
Height from UDC Bottom to Top 18" 18" 18" 18"
of Highest Piping Penetration:
Height from UDC Bottom to 0" 0" 0" 0"
Lowest Electrical Penetration:
Condition ofUDC prior to Clean Clean Clean Clean
testing:
Portion of UDC Tested 20" 20" 20" 20
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?*
DYes DNo X NA DYes DNoXNA DYes DNo XNA DYes DNo XNA
Turbine shutdown response time NA NA NA NA
Is system programmed for fail-
safe shutdown?* DYes DNo XNA DYes DNoX NA DYes DNo XNA DYes DNo XNA
Was fail-safe verified to be DYes DNo XNA DYes DNoXNA DYes DNo XNA DYes DNo XNA operational?•
Wait time between applying 5 Min 5 Min 5 Min. 5 Min.
pressure/vacuum/water and
starting test """
-.... --•• -Test Stmt Time: ~ """" I ~I lr'r"\t\1 -.;;;Jt:t: •• , vUf~
Initial Reading (R1): -~""' II~ 1-'-'· .. R~c:.r •ltc::
Test End Time: KeSl lltS --
Final Reading (RF):
Test Duration:
Change in Reading (RF-R1):
Pass/Fail Threshold or Criteria:
Test Result: X Pass DFail X Pass OFail X Pass D Fail X Pass D Fail I
Was sensor removed for testing? X Yes DNo DNA X Yes DNo DNA XYes DNo DNA X Yes DNo DNA I
Was sensor properly replaced and XYes DNo DNA X Yes DNo DNA X Yes DNo DNA X Yes DNo DNA I verified functional after testing?
Comments -(include information on repairs made prior to testing, and recommended.follow-upforfailed tests)
1 If the entire depth of the UDC is not tested, specify how much was tested. If the answer to~ of the questions indicated with an
asterisk(*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160)
SWRCB, January 2002 Page __ of __
'· Ul"'UIJI'.-UIOI ..1!.11..,0.1!11.'-'-'-'l" .. '"'~ .,J.T.A...&:./.1, • ....,..., '-' A.AJ ..... ••~,-
Test Method Developed By: J UDC Manufacturer x Industry Standard 'l Professional Engineer
Other (Specify)
Test Method Used: Pressure D Vacuum x llydrostatic
Other (Specify)
Test Equipment Used: Ts-sts Equipment Resolution:
UDC # 9-10 UOC# UDC# UDC#
UDC Manufacturer: Bravo
UDC Material: Fiberglass
UDC Depth: 37''
Height from UDC Bottom to Top 18"
of Highest Piping Penetration:
Height from UDC Bottom to 0"
Lowest Electrical Penetration:
Condition of UDC prior to Clean
testing:
Portion of UDC Tested 20"
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?•
n Yes DNo XNA DYes DNo NA DYes ONo Dl\:A []Yes D No DNA
Turbine shutdown response time NA
Is system programmed for fail-
safe shutdown?· • Yes No XNA C.. Yes uNo NA DYes LJNo DNA DYes nNo [ NA
Was fail-safe verified to be ..... Yes No X NA ._,Yes :J No NA DYes "No NA [.,Yes L'No rNA operational?•
Wait time between applying 5 Min
pressure/vacuum/water and
starting test
Test Start Time: ~--I ·'"" ... Initial Reading (R1): """" I 'lv\JI~
Test End Time: RP-~ ultc::
Final Reading (RF):
Test Duration:
Change in Reading (RF-R1):
Pass/Fail Threshold or Criteria:
Test Result: X Pass D Fail D Pass DFail D Pass D Fail D Pass D Fail
Was sensor removed for testing? X Yes No DNA Yes DNo DNA DYes ONo r'JNA [)Yes CJNo DNA
Was sensor properly replaced and X Yes 0 No DNA Yes DNo DNA DYes DNo nNA 0 Yes nNo DNA verified functional after testing? !....
Comments-(include information on repairs made prior to testing, and recommended.follow-up[or.fai/ed test~)
1 If the entire depth of the UDC is not tested, specify how much was tested. If the answer to .!illY of the questions indicated with an
asterisk(*) is "NO" or "NA'', the entire UDC must be tested. (See SWRCB LG-160)
SWRCB, January 2002 Page_ of_
9. SPILL/OVERFILL CONTAINMENT BOXES
Facility is Not Equipped With Spill/Overfill 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 OVacuum x Hydrostatic
0 Other (SpecifY)
Test Equipment Used: Ts-sts Equipment Resolution:
Spill Box # DSL Fill Spill Box# 87 #1 Fill Spill Box # 87 #1 Spill Box # 87 #2 Fill i Vapor
Bucket Diameter: 12" 12" 12" 12"
Bucket Depth: 13" 13" 13" 13"
Wait time between applying
pressure/vacuum/water and 5 Min 5 Min 5 Min 5 Min
starting test:
Test Start Time:
Initial Reading (R1):
Test End Time: SP-P-INC ~ON ::>ee lNl ~ON
Final Reading (Rr): Do~•• If~ Re~u It~ I
Test Duration: --·-'"'""' '
' Change in Reading (Rr-R1):
Pass/Fail Threshold or
Criteria:
Test Result: X Pass 0 Fail X Pass 0 Fail X Pass OFail X Pass OFail
Comments -(include information on repairs made prior to testing, and recommendedfollow-up.for failed tests)
Installed new fill ca]2S_Qn_a1Lbuckets.
SWRCB, January 2002 Page_ of_
9. SPILL/OVERFILL CONTAINMENT BOXES
Facility is Not Equipped With Spill/Overfill 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#2 Spill Box #91 Fill Spill Box #91 Vapor Spill Box# Vapor
Bucket Diameter: 12" 12" 12"
Bucket Depth: 13" 13" 13"
Wait time between applying
pressure/vacuum/water and 5 Min. 5 Min. 5 Min.
starting test:
Test Start Time:
Initial Reading (R1): ~--INrnt..• I
Test End Time: -·-... D~""· .14.-
Final Reading (RF): 1'-C~UIL~ I
I I
Test Duration:
Change in Reading (RF-R1):
Pass/Fail Threshold or
Criteria:
Test Result: X Pass OFail X Pass 0 Fail X Pass OFail 0 Pass OFail
Comments -(include information on repairs made prior to testing, and recommended.follow-up.forfailed tests)
~f\D~+.
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\UST;
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"SUlLO WITH CONFIDENCE"
Lic.970703
~fiDE"+,
()0 ~ ~USTcl "'I,CES•~
"COMPLIANCE WITH CONFIDENCE"
Lie. 804904
Toll Free #: 1-800-339-9930
Job Order /Invoice #: 3\3l/
I ~p~e1f3 lime I To Whom I ~;;;;jb
l
Site Name: \'J\,Q.-~ S §4\/\ ld\.. J Name: Confidence UST
Street: L.U,Q_ 00 _ -$ k N__ e.G_ Ll
City: \3 ~ ~f',-t\C/state: (Af.} Zip: 'f3:?{)tC( Street: 16250 Meacham Road
City: Bakersfield, CA 93314
Terms: Store No:
...... / Description of work performed: k.S f'.' {)$._ ~{S C-:j ~ 1'
""'-~ I+ !IJ J4f\ILCL lcrvs-Pc...-5S {t..f\
A. t ( .<\or /)/1 dut "--Pt..s5 €1!L
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TRAVEL and LABOR
Start OTTotal
Travel ;c;()
Labor
Travel
Date I Technician(s) Name I I Start t End I Total I I OT Start I OTEnd I OTTotal
Travel --Labor --Travel
Date I Technician(s) Name I . I Start I End I Total I l OT Start I OTEnd I OTTotal
Travel --
Labor --Travel
SUPPLIES -MATERIALS-RENTALS Check One
USTPa~ Site Parts
COMMENTS
Store Employee Print Name: TeChnician Print Name:
Date I TeChnician Signature: Date
SITE -CANARY
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91FILL
ii:ST STA:mo 9:51 Al1
TEST STARiEO Ce/30/2013
6EG Ill LEVEL 3.11986 l'l
EtlD r:HE 10:07 AM
EI.O DAiE 08/30/2013
Et.O LEVEL 3. 4975 :u
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TEST S1 ARiEO ~:51 AH
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!:EGW LEVEL 1, !3120 ltl
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EID LEVEL 1. 9083 PI
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EtD LEVEL 3,11975 IN
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TEST STARTED 11:22 AH
TEST STARTED 08/30/2013
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TEST STARTED 08/30/2013
BEGIIJ E\JEL 6. 8757 It•
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E~D OATE 08/30/2013
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BEGIN LEVEL 6, 5938 ltl
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EI.S DATE 05/30/2013
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F.IIO OATE 08/30/2013 Et:O LEVEL 3. 39111 IN
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Er(l DATE Ot/30/2013
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':::::r sTARTEu :.!:::b Hl
-EST SW:TED k/30i20:3
:lEG:l~ LE\'EL tl,liQ32 jt;
Er:u TIPE 1: ll Ft:
E::O CGiF OK/30/2013
E:;[; LEIJEL a. d~l31 1.'1
L~AK i11RESrOLJ :l. 90? l 'J
TEST RESLL i F•t,SSF!J
uur.n 10
IES STARTED 12:56 fM
TEST STA"Tto
8EG!I! LEVEL
EI,O i!HE
EI;[J DATE
F:;[) LE•JEL
Oc/30t2?1J
11,5627 HI
1:11 r'l
•x.I:.0/20'3
a. s.s3a w
LEt7ol' rHRFSHO~L C. OC•2 :I;
TtST RES~ki PASSED
MEii::O MAF:·
d600 S T HJE RO
P,A~EEC![LD (A 83309
06/30/20i3 i :2.:. fN
S~':t' ~Fi>~ TtSl Hf.:-QR;
J!JCI ~
TfSi STAP.•EfJ
EST s-~no
8EG It; LEI.EL
END TIME
FNO DATE
t:tjfJ LEVEL
l FA'< THRESHOd;
TEST RESULT
i: i3 ~t'
):./3': 12·~ 13
u.a'm I':
1:.!c; F-'1
08/30/2013
11. n83n IN
C'. C02 l'l
f'ASSED
UOC810
TEST STARTED 1:;~ ~M
TES' SlflfHED 03/30/2013
BEGW LEVEL 4, 5533 Ill
EIJO TIME 1:26 PM
Et;[J DATE 08/30i2013
E~IO LEVEL a, SW U!
EAfl T!iREShOl D 0. 002 I 'I
~EST RtSLti PASSED