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SWRCB, January 2002
Page 1 of 1
Secondary Containment Testing Report Form
This form is intended for use by contractors performing periodic testing of UST secondary 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: 7- ELEVEN #16329, MKT 2368 Date of Testing: 6/7/2012
Facility Address: 1701 PACHECO ROAD , BAKERSFIELD, CA 93307
Facility Contact: Manager Phone: 834 -1350
Date Local Agency Was Notified of Testing: 6/l/2012
Name of Local Agency Inspector (if present during testing): None Present
2. TESTING CONTRACTOR INFORMATION
Company Name: TANKNOLOGY INC.
Pass
Technician Conducting Test: Alan Evans
Not
Tested
Credentials: r CSLB Licensed Contractor
R SWRCB Licensed Tank Tester
License Type:
License Number: 04 -1669
Manufacturer
Manufacturer Training
Component(s) Date Training Expires
Incon
STS 4/1/2014 .:
X
Spill Box TI RUL SIPHON rul 2 fill
X
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3. SUMMARY OF TEST RESULTS '
Component
Pass
Fail
Not
Tested
Repairs
Made
Component
Pass
Fail
Not
Tested
Repair
Made
(Tank I - rul 2) STP Containment 1 to 1/2
X
Spill Box TI RUL SIPHON rul 2 fill
X
(Tank 2 - rul) STP Containment I to STP
Containment 2
X
Spill Box T1 RUL SIPHON rul 2 vapor
X
STP Containment for Tank I rul 2 - 1 .
X
Spill Box T1 RUL SIPHON rut 2 vapor
X
STP Containment for Tank I rul 2 - 1
X
Spill Box T2 RUL MAIN rul fill
X
STP Containment for Tank 2 rul - 1
X
Spilt Box T2 RUL MAIN rul fill
X
STP Containment for Tank 2 rul - I
X
Spill Box T2 RUL MAIN rul vapor
X
STP Containment for Tank 3 put - 1
X
Spill Box T2 RUL MAIN rul vapor
X
STP Containment for Tank 3 put - 1
X
Spill Box T3 PUL put fill
X
UDC # 1/2
X
Spill Box T3 PUL put vapor
X
UDC # 3/4
X
UDC # 3/4
X
Spill Box TI RUL SIPHON rul 2 fill
X
If hydrostatic testing was performed, describe what was done with the water after completion of tests: Test water pumped out and
removed by Nieto
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal ',requirements
Technician's Signature: A Date: 012012 i
WO: 3402382
SWRCB, January 2002
5. SECONDARY PIPE TESTING
Page 1 of 1
Test Method Developed By: r--J Piping Manufacturer [ Industry Standard r Professional Engineer
Other (Specify)
Test Method Used By: r Pressure r-- Vacuum r Hydrostatic
r7 Other (Specify)
Test Equipment Used: 4" oil filled
au a Equipment Resolution: 0
4m „s
(Tank 1 jrul2)
CI ) (:aE ci
Cont me 1'to STP
A.,
wnContamment
ft
Piping Material:
Poly
Poly
Piping Manufacturer:
Unknown
Unknown
Piping Diameter:
2 in.
2 in.
in.
in.
Length of Piping Run:
10 ft.
10 ft.
ft.
ft.
Product Stored:
RUL 2
RUL
Method and location of
Booted
Booted
piping-run isolation:
Wait time between applying
pressure /vacuum/water and
15 min
15 min
min
min
starting test:
Test Start Time:
09:30:00
Initial Reading (Rl):
5.10000 PSI
Test End Time:
10:30:00
Final Reading (RF):
- 3.10000 PSI
Test Duration:
15 hr
Change in Reading (RF -Rl):
- 8.20000 PSI
Pass/Fail Threshold or
+/-0.00000
+/-
Criteria:
8ik
Ti
Test Result �t
� C:n
ti, rt
.� r �j
R
k E
a �a tw , { 1 t n
a� '.�
R�
s-r kT ua: A '" r..
..�-
...i € i. Sw�
�"
_a11 +. +a /+
FF ..yy,��FF......�� ail"
li. k..�,'.v �,it.t
iy s
N.Ch �h� Gk'h �t
a.. ...N, yn
k ,rw'k.' 4;
Comments- (include information on repairs made prior to testing, and recommended follow -up for failed tests)
87 syphon line from tank 1 -2 is TCI white bone colored single wall Flex piping. 87 main 3x2 test boot blew apart when line was being pressured
up, boot dried out and brittle. 91 product line did not seem to have secondary or access to it, no test boot and entry fitting looked to be standard 2"
entry not 3" with secondary. Bostik all over fittings inside sumps.
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SWRC13, January 2002 Page 1 of 2
6. PIPING SUMP TESTING
Test Method Developed By: Tank Manufacturer r Industry Standard r_! Professional, Engineer
r- Other (Specify)
Test Method Used By: Pressure r Vacuum R_ Hydrostatic'
rl Other (Specify)
Test Equipment Used: INCON
Equipment Resolution: 0.002 in,
STP Containment for
STP Containment for
STP Containment for
STP Containment for
Tank I rul 2 - I
Tank 1 rul 2 - 1
Tank 2 rul - I
Tank 2 rul - 1
Sump Diameter:
42.00 in.
42.00 in.
42.00 in.
42.00 in.
Sump Depth:
43.00 in.
43.00 in.
43.00 in.
43.00 in.
Sump Material:
Polyethylene
Polyethylene
Polyethylene
Polyethylene
Height from Tank Top to Top of
Highest Piping Penetration:
10.00
10.00
16.00
16.00
Height from Tank Top to Lowest
Electrical Penetration:
6.00
6.00
6.00
6.00
Condition of sump prior to testing:
OK
OK
OK
OK
Portion of Sump Tested'
18
18
18
18
Does turbine shut down when
sump sensor detects liquid (both
0- Yes C9 No r NA
!w Yes r No r NA
r Yes re No M NA
r Yes r Nor NA
product and water)?*
Turbine shutdown response time
sec
sec
sec
sec
Is system programmed for fail -safe
ra Yes r No r NA
r5 Yes r% No r NA
r Yes r Nor NA
r' Yes M No C NA
shutdown ?*
Was fail -safe verified to be
, Yes ;r1 Nor NA
C-' Yes r-1 Nor NA
01 Yes r No r- NA
% .Yes r No r. NA
operational?*
t
Wait time between applying
pressure /vacuum/water and starting
15 min
15 min
15 min
15 min
test
Test Start Time:
12:21:00
12:41:00
11:42:00
11:58:00
Initial Reading (RI):
5.15530 in.
5.15560 in.
5.31520 in.
5.31580 in.
Test End Time:
12:37:00
12:56:00
11:57:00
12:13:00
Final Reading (RF):
5.15550 in.
5.15560 in.
5.31570 in.
5.31580 in.
Test Duration:
15 min
15 min
15 min
15 min
Change in Reading (RF -RI) :
0.00020 in.
0.00000 in.
0.00050 in.
i 0.00000 in.
Pass/fail Threshold or Criteria:
+/-0.00200
+/-0.00200
+/-0.00200
+/-'0.00200
�. }.; xra i° �:� } :• FL 5ht SS
r •:,. yar „G x
- r. ;.< ,r'r - t Nt +-,F
.dfi :..,uBCx3k.'.y"1tt.
ca {i'r r. .. . k 3�:..;a.
,Pase,t�
Was sensor removed for testing?
r Yes r No r NA
r Yes r No r- NA
t~ Yes r No M NA
C Yes C No 0 NA
Was sensor properly replaced and
•0 Yes r No 0 NA
r Yes r No T NA
r Yes r No C NA
04 Yes (Z7 No r NA
verified functional after testing?
i
Comments ? (include information on repairs made prior to leaving, and recommended follow -up for failed tests)
T2 87 main tank STP sump not tested due to bad test boot.
Note: bostik all over fittings inside all sumps.
if the entire depth of the sump is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire sump
must be tested.
SWRCB, January 2002 Page 2 of 2
6- PIPING .qI MP TF.CTTNG
Test Method Developed By: r7 Tank Manufacturer 110� Industry Standard Professional, Engineer
F'� Other (Specify).
Test Method Used By: r Pressure r Vacuum r Hydrostatic
r:' Other (Specify)
Test Equipment Used: INCON
Equipment Resolution: 0.002 in.
STP Containment for
STP Containment for
d C
Mg
Tank 3 pul - 1
Tank 3 pul - 1
Sump Diameter:
42.00 in.
42.00 in.
in.
in.
Sump Depth:
43.00 in.
43.00 in.
in.
in.
Sump Material:
Polyethylene
Polyethylene
Height from Tank Top to Top of
Highest Piping Penetration:
10.00
10.00
Height from Tank Top to Lowest
Electrical Penetration:
6.00
6.00
Condition of sump prior to testing:
OK
OK
Portion of Sump Tested'
18
18
Does turbine shut down when
sump sensor detects liquid (both
C Yes C ? No !? NA
C Yes Co No (. NA
r Yes M No 0 NA
0 Yes' GO No r NA
product and water)?*
Turbine shutdown response time
sec
sec
sec
sec
Is system programmed for fail -safe
C Yes r No is NA
(T Yes(? No G NA
Cw Yes r-1 No C NA
ro ;Yes r No C NA
shutdown ?*
Was fail -safe verified to be`
(' Yes C No is NA
r Yes 0 No C NA
(` Yes C No Cam° NA
% Yes r No 0 NA
operational?*
Wait time between applying
,
pressure /vacuum/water and starting
15 min
15 min
min
min
test
Test Start Time:
11:42:00
11:58:00
Initial Reading (RI):
6.22760 in.
6.22810 in.
Test End Time:
11:57:00
12:13:00
Final Reading (RF):
6.22810 in.
6.22730 in.
Test Duration:
15 min
15 min
Change in Reading (RF -RD :
0.00050 in.
- 0.00080 in.
Pass/Fail Threshold or Criteria:
+/-0.00200
+/-0.00200
+/_
+/-
"p
CestResult 'sa"�
�wJ4� s'
;�i'�ws
K�
�..,VA.
4,
t y • : :
Was sensor removed for testing?
0 Yes C No C NA
C Yes C No (:, NA
r Yes r No (x NA
0 Yes Q No r NA
Was sensor properly replaced and
(? Yes r No 0 NA
(m Yes % No C NA
% Yes G No C NA
- C;a .Yes Q No C NA
verified functional after testing?
Comments 7 (include information on repairs made prior to testing, and recommended follow -up for failed tests)
T2 87 main tank STP sump not tested due to bad test boot. Note: bostik all over fittings inside all sumps. j
1 If the entire depth oft I he sump is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire sump
must be tested.
SWRCB, January 2002
7. UNDER - DISPENSER CONTAINMENT (UDC) TESTING
Test Method Developed By: r UDC Manufacturer r Industry Standard r Professional Engineer
M Other (Specify)
Test Method Used By: r Pressure r vacuum M Hydrostatic
Ca Other (Specify)
Test Equipment Used: IN N Equipment Resolution:
UDC Manufacturer:
UDC Material:
UDC Depth:
Height from UDC Bottom to Top of
Highest Piping Penetration:
Height from UDC Bottom to Lowest
Electrical Penetration:
Condition of UDC prior to testing:
Portion of UDC Testedt
Does turbine shut down when UDC
sensor detects liquid (both product and
water)? -
Turbine shutdown response time
Is system programmed for fall -safe
shutdown?-
Was fall -safe verified to be operational?-
Walt time between applying
pressure /vacuum /water and starting test
Test Start Time:
Initial Reading (RI):
Test End Time:
Final Reading (RF):
Test Duration:
Change In Reading (RF-RI)
Pass /Fail Threshold or Crlterla:
Test Result �`F��' {qty.
Was sensor removed for testing?
was sensor properly replaced and
verified functional after testing?
Unknown
Polyethylene
30.00
12.00
8.00
OK
15
r Yes Ca' No r?- NA
sec
r Yes r No f: NA
(r! Yes f^ No r NA
15 min
10:34:00
5.34860 in.
10:49:00
5.28070 in.
15 min
0.06790 In.
+/- 0.00200
C.'r Yes M No Cp NA
r• Yes r No Cns NA
Unknown
Polyethylene
30.00
12.00
8.00
OK
15
r Yes r Nor NA
sec
C Yes r No r NA
r Yes r No r NA
15 min
10:15:00
4.55820 in.
10:30:00
4.55810 In.
15 min
- 0.00010 In.
+/- 0.00200
r For yi) Pasx
rs Yes r No r NA
% Yes r Nor NA
#3/4 bi r,`u of
Unknown
Polyethylene
30.00
12.00
8.00
OK
15
r Yes r No C., NA
sec
r Yes r No r• NA
r, Yes r, No ro, NA
15 min
10:49:00
4.55580 In.
10:49:00
4.55610 in.
15 min
0.00030 In.
+/- 0.00200
'�- -%= a
Passq
r Yes r No 01 NA
r Yes r No r NA
Comments 7 (include information on repairs made prior to testing, and recommended follow -up for failed tests) '
Page 1 of 1
I
rw Yes f+ No r NA
sec
0 Yes % Nor NA
( Yes r No r NA
min
r.Yes C No r NA
r= Yes C0 No C7 NA
UDC 1/2 failed multiple tests. Note: bostik all over all fittings inside udc's.
_— - ---- -- . ..............
!
t If the entire depth of the UDC Is not tested. snerifv how much was tested. If the answer to anv of the nuestlnns indicated with an asterisk f *) Is ?NO? or 7NA7. the
entire UDC must be tested.
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Page 1 of 3
SPILL /OVERFILL CONTAINMENT BOXES
Facility is Not Equipped With Fill Riser Containment Sumps P
Fill Riser Containment Sumps are Present, but were Not Tested r.1
Test Method Developed By: r Spill Bucket Manufacturer r" Industry Standard r Professional Engineer
r Other (Specify):
Test Method Used By: ry Pressure r Vacuum C Hydrostatic
r7 Other (Specify):
Test Equipment Used: INC N
Equipment Resolution: 0.002 ln.
"12
Gyl
rat'':
Tank'S1 �RULSIPHON: >RUl 2`
&'j., -
>.` hFlll `Dlrect��
TTank Tl`RUL SIPHON RUt 2i
+� FII1Dlrect"
an T1�RULrSIPHONRUC
tL4'{" 'Y+Y4t"�!
Vii:; �Uapor�Dlcectrn
Tank,ssTn1�IRU�L,SIPHON,RUL 2
�� Vapora
�Dlrect,
Bucket Diameter:
12.00
12.00
12.00
12.00
Bucket Depth:
14.00
14.00
14.00
14.00
Wait time between
t
ap plying
Pressure /vacuum /water
15 min
15 min
15 min
15 min
and starting test
Test start Time:
09:34:00
09:54:00
09:34:00
09:54:00
Initial Reading oy:
4.0538 in.
4.0523 In.
5.6649 In.
5.6636 In.
Test End Time:
09:49:00
10:10:00
09:49:00
10:10:00
Final Reading (Rd:
4.0525 In.
4.0520 in.
5.6638 In.
5.6632 In.
Test Duration:
15 min
15 min
15 min
15 min
Change in Reading pyn,7
0.00 in.
0,00 in.
0.00 in.
0.00 In.
Pass /Fall Threshold or
Criteria:
0.0020
+/- 0.0020
+/- 0.0020
+/ 0.0020
Test Result `
Z t # Passe
r
k1 Pass r��
Pass
t
.. " ",w�,.�. .,r.nm �.
�..te!vv o ,.�w'-
n;.a it
�, .un �r.e. k',
�, PBSS
i�z
Comments 7 (include information on repairs made prior to testing, and recommended follow -up for, fall led tests)
W0: 3402382
Page 2 of 3
SPILL /OVERFILL CONTAINMENT BOXES
Facility is Not Equipped With Fill Riser Containment Sumps R
Fill Riser Containment Sumps are Present, but were Not Tested r
Test Method Developed By: !" Spill Bucket Manufacturer r'. Industry Standard f' Professional Engineer
Other (Specify):
Test Method Used By: f" Pressure r vacuum ry Hydrostatic
C Other (Specify):
est'E ul ment Used: I INCON
Equipment Resolution: 0.002 in
,#. T �; -:i
I i L r'i ti
`RULINl1IN
;SNZIi
�;',
Box #
.`I'• . k� I
il$pII iii
�+�v.7'
RULE
4'i - S�ilvl.
Fill Directs
,fank;T2.kRULMAINRUL.
¢ .Sit .- •--s R '.
FilleDirect,-
TanklT2 RUL MAIN RU
, vT,. M 'Tl .S J §C4 R R
Vapory Dire�etvaryy{orpirect
,ank2aRUL:MAIN RUI
r� -' k. '�'i "K h ks
',
y 9y,gI
7��
,
Bucket Diameter:
12.00
12.00
12.00
I
12.00
Bucket Depth:
14.00
14.00
14.00
14.00
Walt time between applying
Pressure/vacuum/water and
15 min
15 min
15 min
15 min
starting test
Test Start Time:
11:01:00
11:17:00
11:01:00
11:17:00
Initial Reading ryy
5.2925 in.
5.2923 in.
6.6104 in.
6.6101 in.
Test End Time:
11:16:00
11:32:00
11:16:00
11:32:00
Final Reading P,):
5.2924 In.
5.2926 in.
6.6104 In.
6.6103 In.
Test Duration:
15 min
15 min
15 min
.15 min
Change In Reading sA):
0.00 in.
0.00 in.
0.00 In.
0.00 In.
Pass Fall Threshold or Criteria:
+/- 0.0020
+/- 0.0020
+/- 0.0020
+/- 0.0020
L
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Result�r�
,a��
Pass{
pasjsl`�Passi�
_
aSS� ,fin i
„St
C
�..I.
a. s, :�...
i
Comments ? (include information on repairs made prior to testing, and recommended follow -up for failed tests)
Page 3 of 3
SPILL /OVERFILL CONTAINMENT BOXES
Facility is Not Equipped With Fill Riser Containment Sumps �+
Fill Riser Containment Sumps are Present, but were Not Tested r
Test Method Developed By: r Spill Bucket Manufacturer r Industry Standard Q, Professional Engineer
r Other (Specify):
Test Method Used By: r Pressure r vacuum M, Hydrostatic
r` Other (Specify):
Test Equipment Used: INCON
Equipment Resolution: 0.002 In
—x v iu b t u
ir �
d Y
' M 1/
SIll B
€ i B9J x #��
III
PUL' PUL
Tank�T3 PUL�PUL,
�I Spill Box #�
Spi1lBox # i,
t t�
a �,�r
tTankT3
Fill�'�Direct
,r
�`
Vapor Direct
a
s_ p
FIBM ,
Bucket Diameter:
12.00
12.00
Bucket Depth:
14.00
14.00
i
Walt time between applying
pressure /vacuum /water and
15 min
15 min
min
min
starting test
I
Test Start Tlme:
12:41:00
12:41:00
Initial Reading (y):
5.0486 in.
4,1687 in.
Test End Time:
12:56:00
12:56:00
Final Reading (Ft,):
4.9901 In.
4.1295 In.
Test Duration:
15 min
15 min
Change In Reading n Si:
-0.06 In.
-0.04 in.
Pass /Fail Threshold or Criteria:
+/- 0.0020
+/- 0.0020
TestResult �i�
~Fall"'
wv
G� Fanj��
4`r r � xr
��"
mom `"
Comments 7 (include information on repairs made prior to testing, and recommended follow -up for failed tests)
91 fill and vapor buckets failed multiple tests
WO: 3402382