HomeMy WebLinkAboutSB989 6/17/11SWR-CB, January 2002
Page 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
DateofTesting: 06/17/2011
Facility Address: 1701 PACHECO ROAD , BAKERSFIELD, CA, 93307
Facility Contact: Manager
Phone: ( 661) 834 -1350
Date Local Agency Was Notified of Testing: 06/07/2011
Name of Local Agency Inspector (if present during testing): ESTHER
2. TESTING CONTRACTOR INFORMATION
Company Name: TANKNOLOGY, INC.
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Technician Conducting Test:
DANIEL VISSER
Credentials:
x❑
CSLB Licensed Contractor
SWRCB Licensed Tank Tester
License Type: A
License Number: 743160
Manufacturer
Manufacturer Training
Component(s)
Date Training Expires
INCON
TS -STS
06/01/2012
3. SUMMARY OF TEST RESULTS
Component
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Component
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If hydrostatic testing was performed, describe what was done with the water after completion of tests:
WATER WAS LEFT ON SITE IN SGAL. BUCKET LABELLED.
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
A / I4-1 ' 06/17/2011
Technician's Signature: � «z�,,X C,u. Date:
SWRCB, January 2006
9. Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed.form 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: 06/17/2011
Facility Address: 1701 PACHECO ROAD , BAKERSFIELD, CA, 93307
Facility Contact: Manager
Phone: ( 661) 834 -1350
Date Local Agency Was Notified of Testing: 06/07/2011
Name of Local Agency Inspector (if present during testing): ESTHER
2. TESTING CONTRACTOR INFORMATION
Company Name: TANKNOLOGY, INC.
Technician Conducting Test: DANIEL VISSER
Credentials :
❑X
CSLB Contractor
❑ ICC Service Tech. ❑
SWRCB Tank Tester
E
Other (Specify) A
License Number: 743160
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: El Hydrostatic ❑ Vacuum ❑ Other
Test Equipment Used: INCON
Equipment Resolution: + - - 0020
Identify Spill Bucket(By Tank
Number, Stored Product, etc.)
2 REG VAPOR
Z 2 REG VAPOR
3
4
Bucket Installation Type:
X❑ Direct Bury
❑ Contained in Sump
X❑ Direct Bury
❑ Contained in Sump
❑ Direct Bury
❑ Contained in Sump
❑ Direct Bury
❑ Contained in Sump
Bucket Diameter:
ill,
ill,
Bucket Depth:
12 "
12 "
Wait time between applying
vacuum /water and starting test:
15MIN
15MIN
Test Start Time (TI ):
917
933
Initial Reading (RI ):
5.6628
5. 6615
Test End Time (TF ):
932
948
Final Reading (R F ):
5.6616
5 . 6 615
Test Duration:
15MIN
15MIN
Change in Reading (R F - RI ):
-.0012
0
Pass /Fail Threshold or
Criteria:
.0020
.0020
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TestFul� ` g , „.t�
*�n,
k X Pas,Fat�X
I?asss, Fail K
may=- °
Pass Failx;
{3
r
Pass Fail
Comments - (include information on repairs made prior to testing, and recommended follow -up for failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician's Signature:�`� (�, '"1 Date:
06/17/2011
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SITE DIAGRAM
J'pp Tanknology
8501 N MOPAC EXPRESSWAY, SUITE 400
AUSTIN, TEXAS 78759
(512) 451 -6334
FAX (512) 459 -1459
TEST DATE: 06/17/11 WORK ORDER NUMBER3184335
CLIENT: 7 —ELEVEN, INC. SITE:7— ELEVEN #16329, MKT 2368
7 -11 #16329 DUMP -
CAS 1701 PACHECO RD STER
BAKERSFIELD, CA 93307
661.834.1350 m
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Printed 07/07/2011 08:06 MTUTTLE
Work Order: , 3184335
SUMP LEAK 11"EST REPOR-11
"rfE-'l':,T RESULT PASSED
11 167-12Q
SUMP LEAK TEO-IT REPORT
TEST START7D 911-7,7 AN
TEST OTARTED 06/1.7/201.1
BEGIN LEVEL 5.6615 IN
END TTNV 9: 4'81 AM
END DATE 06/17/220 11
LEAK THRESHOLD 0.002'IN
Tunkuologyhu. 11000 N. MoPuc Expressway, Suite jOO. Austin, Texas 78750
11000 N. MoPac Expressway, Suite 500
Austin, Texas 78759
Phone: (512) 451 -6334
Fax: (512) 459 -1459
BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
INSPECTOR CRAIG PERKINS
1501 TRUXTUN AVE.
BAKERSFIELD, CA. 93301
Test Date: 06/17/2011
Order Number: 3184335
Dear Regulator,
Date Printed and Mailed: 07/07/2011
Enclosed are the results of recent testing performed at the following facility:
7- ELEVEN #16329, MKT 2368
1701 PACHECO ROAD
BAKERSFIELD, CA. 93307
Testing performed:
Secondary Containment -Spill Container
Sincerely,
o KA '`
Dawn Kohlmeyer
Manager, Field Reporting