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HomeMy WebLinkAbout2012 RESULTS4Sz SWRCB, January 2002 Page _L of Secondary Containment Testing Report Form , This form is Wended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of thisform 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: A -ONE FOOD STORE Date of Testing: 220/12 Facility Address: 1200 "H" STREET, BAKERSFIELD Facility Contact: Phone: Date Local Agency Was Notifled of Testing: Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Comm Technician Cmiducting Test RYAN MASON Credentials: X CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester License Type: I License Number: Manufacturer Manufacturer Trainine Component(s) Date Trainir► Expires INCON TS -STS 10/5/13 i �0�� 3. SUNEVIARY OF TEST RESULTS If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the factr stated In this document are accurate and in fill compliance with legal requirements Technician's Signature: 2e _ , Date: 220/12 (1 / i Comm • • • . . 1. ©� i �0�� 11-1 IFF1 IM • a • . . . ©n■ �0■ 0��� on�■o aor.�o - ©oc�o� noor� oo; 0000 o © ©o /1/100 ©nrso 0000 no■r.�o 0/100 n000 or�oo nnoo ao�o onnio; anoo 0000 0000 If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the factr stated In this document are accurate and in fill compliance with legal requirements Technician's Signature: 2e _ , Date: 220/12 (1 / i SWRCB, January 2002 S_ SWC)NDARY PIPE TESTING L-4,5LM Z Page -L- of 4 Test Method Developed By: ❑ Piping Manufacturer X Industry Standard 0 Professional Engineer ❑ Other (Specify) Test Method Used: X Pressure ❑ Vacuum ❑ Hydrostatic ❑ Other (Spec) Test Equipment Used: Equipment Resolution: Piping Run #87 #1 Piping Run #91 #1 Piping Run # Piping Run # Piping Material: PLASTIC PLASTIC Piping Manufacturer. APT APT Piping Diameter: 1.5" 1.5" Length of Piping Run: 60' 60' Product Stored. GASOLINE GASOLINE Method and location of piRing-run isolation: BOOT IN SUMP BOOT IN SUMP Wait time between applying pressure /vacuum/water and starting test 30 MIN 30 MIN Test Start Time: 1:30 1:30 Initial Reading (R): 5 5 Test End Time: 2:30 2:30 Final Reading (RF): 5 5 Test Duration: 1 HOUR 1 HOUR. Change in Reading (Pq N: 0 0 Pass/Fail Threshold eshold or Criteria: + / -0.00 +1-0,00 Test Resnit: X Pass [7 Fau7 X Pass 0 Fall U Pass ❑Fail B Pass 0 Fait COMMentS — (include information on repairs made prior to testing and recommended follow -up f r foiled tests) SWRCB, January 2002 6. PIPING SUMP TESTING LotGz Page 3 of f Test Method Developed By: ❑ Sump Manufacturer 0 Industry Standard 0 Professional Engineer O Other (Specify) Test Method Used: o Pressure o vacuum o Hydrostatic O Other (Spec) Test men Used: Equipment Resolution: Sump #97 Sump # Sump # Sump # Sump Diameter 49" Sump Depth: 36" Sump Material: FIBERGLASS Height from Tank Top to Top of 20" Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: 24" Condition of sump prior to testing: GOOD Portion of Sump Tested' 22" Does turbine shut down when sump sensor detects liquid (both ❑ Yes O No X NA ❑ Yes 0 No DNA O Yes 0 No DNA O Yes D No DNA product and water)?* Turbine shutdown response time Is system programmed for fail -safe D Yes O No X NA O Yes O No O NA O Yes D No DNA 0 Yes ONO ONA shutdownf Was fail-safe verified to be O Yes ❑ No X NA ❑Yes 0 No DNA O Yes ❑ No ❑ NA D Yes ❑ No DNA onal ?• Wait time between applying pressmWvacuum/water and starting 30 MIDI test Test Start Time: 12:31 12 :51 Initial Reading t Ra: 6.395 6.395 Test End Time: 12 :46 12:46 FhW Reading (RF): 6.395 6395 Test Duration: 1SMINi 15MIN Change in Reading (RF-N: 0 0 Pass/Fad Threshold or Criteria: +1-0.00 + / -0.00 Test. Resalt: X. Pass 0 Far? 0 Pass . O Fail 0 Pass ❑ Fail ❑ Pass 0 Fail Was sensor removed for testing? X Yes ❑ No 0 NA 0 Yes 0 No ❑ NA 0 Yes ❑ No ❑ NA O Yes O No DNA Was sensor p r o p e r l y replaced a n d verified finxctional after ? O Y e s O No 0 NA O Yes ONO O N A I O Yes O No DNA 0 Yes ❑ No ❑ NA COMMentS — rnalude n formation on repairs made prior to testing and recommended follow -up for failed tests) ' if the entire depth of the sump is not tested, specify how much was tested If the answer to My of the questions indicated with an asterisk M is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160) SWRCB, January 2002 7_ TTNi)F.R_DTfiPF.NfiF.R CONTAYNMFNT nTDCI TESTING Page �' of Test Method Developed By: 0 UDC Manufacturer 0 Industry Standard 0 Professional Engineer ❑ Other (Specify) Test Method Used: 0 Pressure 0 Vacuum 0 Hydrostatic 0 Other ( Specify') Test Equipment Used: Equipment Resolution: UDC #1/2 UDC #3/4 UDC # UDC # UDC Manufac- wer: TCI TO UDC Material: PLASTIC PLASTIC UDC 28" 30" Height from UDC Bottom to Top of Hizhest Piping Penetration: 12" 12" Height from UDC Bottom to Lowest Electrical Penetration: 6" 6" Condition of UDC prior to testis CLEAN CLEAN Portion of UDC Tested 14" 14" Does turbine shut down when UDC sensor detects liquid (both product and water)?* 0 Yes 0 No X NA ❑ Yes 0 No X NA 0 Yes 0 No 0 NA 0 Yes 0 No 0 NA Turbine shutdown response time Is system programmed for fail safe shutdown? 0 Yes ❑ No X NA ❑ Yes 0 No X NA 0 Yes ❑ No ❑ NA 0 Yes ❑ No 0 NA Was fail -safe verified to be 'oral ?• 0 Yes 0 No X NA 0 Yes 0 No X NA ❑ Yes 0 No ❑ NA ❑ Yes 0 No 0 NA Wait time between applying pressure/vacuum/water and swting test 30MIN 30MIN Test Start Time: 12:31 12:51 12:31 12:51 Initial Reading 5.422 5.422 4.202 4.202 Test End Time: 12:46 1:06 12:46 1 :06 Final Reading 5.422 5.422 4.202 4.202 Test Duration: IMN 15MTN 15NUN 15MN Change in 0 0 0 0 Pass/Fail Threshold or Criteria: + / -0.00 + / -0.00 + / -0.00 +7-0.00 Test Result~ X Pass 0 Fall X. Pass 0 Fall 0 Pass 0 Fail 0 Pass 0 Fail Was sensor removed for testis X Yes 0 No ❑ NA X Yes 0 No ❑ NA ❑ Yes ❑ No ❑ NA 0 Yes ❑ No 0 NA Was sensor properly replaced and verified functional after X Yes 0 No 0 NA X Yes 0 No 0 NA 0 Yes ❑ No 0 NA 0 Yes 0 No 0 NA Comments — (uxlude information on repairs made prior to testing, and recommended follow -up for failed test) If the entire depth of the UDC is not tested, specify how much was tested. If the answer to My of the questions indicated with an asterisk ( *) is "NO" or `NA ", the entire UDC must be tested. (See SWRCB LG -160) Al FOODMART s 12e@HSi RAKERSFIELt� 81/@9/2822 12:46 PM SUMP LEAK TEST REPORT 87ST? TEST STARTED 12:31 PM TEST STARTED 01/99/2012 BEGIN LEVEL 6.3959 IN END TIME 12:46 PM END DATE 01/09/2812 END LEVEL 6.3959 IN LEAK THRESHOLD 0.602 IN TEST RESULT PASSED 3-4 END LEVEL TEST STARTED 12 :31 PM TEST STARTED 01/69/2012 '. BEGIN LEVEL 4.2826 IN END TIME 12 :46 PH END DATE 01/89/2012 END LEVEL 4.2826 IN LEAK THRESHOLD 0.802 IN TEST RESULT PASSED 1 -2 TEST STARTED 12:31 PM TEST STARTED 01/89/2012 BEGIN LEVEL 5.4226 IN END TIME 12:46 PM END DATE 81/09/2812 END LEVEL 5.4225 IN LEAK THRESHOLD 0.802 IN TEST RESULT PASSED Al t�DMART 1208 H ST 8AKERSFIELD 81/69/2812 1,66 Ph SUMP LEAK TEST REPORT 87STP TEST STARTED 12-51 PM TEST STARTED 01/09/2812 BEGIN LEVEL 6.3958 IN END TIME 1:06 PM END DATE 01/09/2012 END LEVEL 6.3958 IN LEAK THRESHOLD 6.882 IN TEST RESULT PASSED 3 -4 TEST STARTED 12 :51 Pty TEST STARTED 01/89/2012 BEGIN LEVEL 4.2026 IN END TIME 1:86 PM END DATE 01/89/2812 . END LEVEL 4.2824 IN LEAK THRESHOLD 0.882 iN TEST RESULT PASSED 1 -2 TEST STARTED 12:51 PM TEST STARTED 81/09/2012 BEGIN LEVEL. 5.4224 IN END TIME 1 :06 Pm, END DATE 01/09/2012 � END LEVEL 5.4224 IN LEAK THRESHOLD 0.882 IN TEST RESULT PASSED . . I I u6k-� SB989 TESTING FAILURE REPORT SITE NAME: A -ONE FOOD STORE DATE: 2/20/12 THE FOLLOWING COMPONENTS WERE REPLACEDWI"AIRED TO COMPLETE TESTING. REPAIRS: NONE LABOR: NONE PARTS INSTALLED: NONE NAME: TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE.