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Home My WebLink About989 5-21-12SWRCB, January 2002 Pass Page of 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 (f applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: USA Liquor Date of Testing: 5/21/2012 Facility Address: 1720 South Union Avenue, Bakersfield, CA 93307 Facility Contact: Refaat I Phone: 661 -917 -1790 Date Local Agency Was Notified of Testing : 4/30/2012 Name of Local Agency Inspector (if present during testing): None 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services Pass Fail Technician Conducting Test: Bryan A Self Repairs Made Component Credentials: x CSLB Licensed Contractor x SWRCB Licensed Tank Tester Not Tested License Type: CSLB UDC 1 -2 License Number:804904 ❑ Manufacturer Manufacturer Training Component(s) Date Training Expires Franklin Fueling TS -STS 1 -06 -2013 UST Service technician ICC 7 -5 -2013 Star. Smith. Fibercast Fiber Glass Systems N.A. ❑ ❑ 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made UDC 1 -2 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ UDC 3 -4 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 87 STP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 91 STP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ Diesel STP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 87 Secondary X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 91 Secondary X ❑ ❑ ❑ ❑ ❑ ❑ ❑ Diesel Secondary X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 87 Annular X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 91 Annular X ❑ ❑ ❑ ❑ ❑ ❑ ❑ Diesel Annular X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ If hydrostatic testing was performed, describe what was done with the water after completion of tests: Water was out back into test trailer and waste drum CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this docujuegt are accurate and in full compliance with legal requirements Technician's Signature: SWRCB, January 2002 Page of 4. TANK ANNULAR TESTING Test Method Developed By: ❑ Tank Manufacturer x Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure x Vacuum ❑ Hydrostatic ❑ Other (Specify) Test Equipment Used: Calibrated Gages Equipment Resolution:0.0625" Tank # 87 Annular Tank # 91 Annular Tank #Diesel Annular Tank # Is Tank Exempt From Testing ?' ❑ Yes X No ❑ Yes X No ❑ Yes X No ❑ Yes ❑ No Tank Capacity: 10,000 10,000 10,000 Tank Material: Steel Steel Steel Tank Manufacturer: Unknown Unknown Unknown Product Stored: 87 91 Diesel Wait time between applying pressure /vacuum /water and starting test: 5 Minutes 5 Minutes 5 Minutes Test Start Time: 12:45 pm 12:45 pm 12:45 pm Initial Reading (Rj): -10 Hg -10 Hg -10 Hg Test End Time: 1:45 pm 1:45 pm 1:45 pm Final Reading (RF): -10 Hg -10 Hg -10 Hg Test Duration: 1 Hour I Hour 1 Hour Change in Reading (RF -R,): 0.00" 0.00" 0.00" Pass /Fail Threshold or Criteria: 0.00" 0.00" 0.00" Test Result. X Pass ❑ Fail X Pass ❑ Fail X Pass ❑ Fail ❑ Pass ❑ Fail Was sensor removed for testing? X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) 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)1 SWRCB, January 2002 Page of 5. SECONDARY PIPE TESTING Test Method Developed By: ❑ Piping Manufacturer x Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: x Pressure ❑ Vacuum ❑ Hydrostatic ❑ Other (Specify) Test Equipment Used: Calibrated Gages Equipment Resolution:0.0625" ' " Piping Run # 87 Piping Run # 91 Piping Run# Diesel Piping Run # Piping Material: FRP FRP FRP Piping Manufacturer: Amron Amron Amron Piping Diameter: 3.00" 3.00" 3.00" Length of Piping Run: 100' 150' 150' Product Stored: 87 91 Diesel Method and location of piping-run isolation: Test Boot Test Boot Test Boot Wait time between applying pressure /vacuum /water and starting test: 5 Minuets 5 Minuets 5 Minuets Test Start Time: 1:00 pm 1:00 pm 1:00 pm Initial Reading (Rj): 5.00 "PSI 5.00 "PSI 5.00 "PSI Test End Time: 2:00 pm 2:00 pm 2:00 pm Final Reading (RF): 5.00 "PSI 5.00 "PSI 5.00 "PSI Test Duration: 1 Hour I Hour 1 Hour Change in Reading (RF -R,): 0.00" 0.00" 0.00" Pass /Fail Threshold or Criteria: 0.00" 0.00" 0.00" Test Result: X Pass ❑ Fail X Pass El Fail X Pass ❑Fail ❑Pass ❑Fail Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) SWRCB, January 2002 Page of 6. PIPING SUMP TESTING Test Method Developed By: ❑ Sump Manufacturer x Industry Standard ❑ Professional Engineer ❑ Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum x Hydrostatic ❑ Other (Specify) Test Equipment Used: Ts -sts Equipment Resolution: � °14 "R''.. iud x ' XR'. Sump # 87 Sump # 91 Sump #Diesel Sump # Sump Diameter: 42.00" 42.00" 42.00" Sump Depth: 43.00" 44.00" 41.00" Sump Material: FRP FRP FRP Height from Tank Top to Top of Highest Piping Penetration: 10.00" 12.00" 10.00" Height from Tank Top to Lowest Electrical Penetration: 12.00" 16.00" 14.00" Condition of sump prior to testing: Clean & Dry Clean & Dry Dirty Portion of Sump Tested' Pipe Penetration Pipe Penetration Pipe Penetration Does turbine shut down when sump sensor detects liquid (both product and water)?* X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA []Yes ❑ No ❑ NA Turbine shutdown response time 4.2 Seconds 4.2 Seconds 4.2 Seconds Is system programmed for fail -safe shutdown?* X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was fail -safe verified to be operational?* X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Wait time between applying pressure /vacuum /water and starting test: 4.7 Seconds 4.7 Seconds 4.7 Seconds Test Start Time: Initial Reading (Ri): Test End Time: ®e Final Reading (RF): Results Test Duration: Change in Reading (RF -R,): Pass /Fail Threshold or Criteria: Test Result: X Pass ❑ Fail X Pass ❑ Fail X Pass ❑ Fail ❑ Pass ❑ Fail Was sensor removed for testing? X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testin ? X Yes []No ❑ NA 11 X Yes ❑ No ❑ NA X Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA 1 Comments — (include information 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 as of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160) W 3HI se SWRCB, January 2002 7. UNDER- DISPENSER CONTAINMENT (UDC) TESTING Page of Test Method Developed By: ❑ UDC Manufacturer x Industry Standard ❑ Professional Engineer ❑ Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum x Hydrostatic ❑ Other (Specify) Test Equipment Used: Ts -sts Equipment Resolution: UDC # 1 -2 UDC # 3 -4 UDC # UDC # UDC Manufacturer: Bravo Bravo UDC Material: Steel Steel UDC Depth: 8.00" 8.00" Height from UDC Bottom to Top N.A. N.A. of Highest Piping Penetration: Height from UDC Bottom to N.A. N.A. Lowest Electrical Penetration: Condition of UDC prior to Clean & Dry Clean & Dry testing: Portion of UDC Tested Pipe Penetration Pipe Penetration Does turbine shut down when UDC sensor detects liquid (both ❑ Yes ❑ No X NA []Yes ❑ No X NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA product and water) ?* Turbine shutdown response time N.A. N.A. Is system programmed for fail - safe shutdown ?* ❑ Yes ❑ No X NA []Yes ❑ No X NA ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA Was fail -safe verified to be o erational ?* ❑ Yes ❑ No X NA ❑ Yes ❑ No X NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Wait time between applying 5 Minutes 5 Minutes pressure /vacuum /water and starting test Test Start Time: Initial Reading (R,): Test End Time: Final Reading (RF): KOSUITS Test Duration: Change in Reading (RF -Rj): Pass /Fail Threshold or Criteria: Test Result: X Pass ❑ Fail X Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Was sensor removed for testing? ❑ Yes ❑ No X NA ❑ Yes ❑ No X NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? ❑ Yes ❑ No X NA ❑ Yes ❑ No X NA =[]Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) If the entire depth of the UDC is not tested, specify how much was tested. If the answer to a� of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) ' Mail see SWRCB, January 2002 Page of 8. FILL RISER CONTAINMENT SUMP TESTING Facility is Not Equipped With Fill Riser Containment Sumps X Fill Riser Containment Sumps are Present, but were Not Tested ❑ Test Method Developed By: ❑ Sump Manufacturer ❑ Industry Standard ❑ Professional Engineer ❑ Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum ❑ Hydrostatic ❑ Other (Spec) Test Equipment Used: Equipment Resolution: Fill Sump # Fill Sump # Fill Sump # Fill Sump # Sump Diameter: Sump Depth: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested Sump Material: Wait 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 -R,): Pass /Fail Threshold or Criteria: Test Result: ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Is there a sensor in the sump? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Does the sensor alarm when either product or water is detected? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor removed for testing? ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA ❑Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed Tests) SWRCB, January 2002 Page of 9. SPILL /OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill /Overfill Containment Boxes ❑ Spill /Overfill Containment Boxes are Present, but were Not Tested X Test Method Developed By: ❑ Spill Bucket Manufacturer x Industry Standard ❑ Professional Engineer ❑ Other (Spec) Test Method Used: ❑ Pressure ❑ Vacuum x Hydrostatic ❑ Other (Specify) Test Equipment Used: Ts -sts Equipment Resolution: Spill Box # Spill Box # Spill Box # Spill Box # Bucket Diameter: Bucket Depth: Wait time between applying pressure /vacuum /water and starting test: Test Start Time: Initial Reading (R,): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF -R,): Pass /Fail Threshold or Criteria: Test Result: ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) All the Spill buckets are tested annually with the monitor certification. USA L I QUOI,'. 100 S ONIGN Q 6fi 1- 917 -17 :1 014HRI) CA HKI 05/2 1!?Cj 121 81STP i'F�T LEV�L t:?( EN0 C-5/21/2012 Ep* L- ,, I K ES U,_ PASSEL 9PSTP NAT LOK 1152 f:! tw I iME 27 F-11 Lliil !i 050V20I? W L K W M UN pl? .71 TAPIR 192 nk I` ENO TIME 1: 2 PM 11011 D. r 05/21/2U12 7ts1 E :.Eso! I FAS,;1—1') Nc 11 psi smqQ 1"I PH 50 S4W. JnV212 Whi Gva. 073 M L11D !ME 1:27 it' kin L,,vL! XQ P: ljl,Fi LIC",)N. !,�O J U111011 A%jE CA 17- W90 1:43 Pm !LAr em ,U! h, 151Q 1.11 D40 TIME 1:43 FIM F!10 LEVEL. 6, 15910 1N LSI; F1 - S ( i L I 91-ST? ME 1.2 it SMR45 116 pIll L., lj�L �1, :0 13 !N EW I IrlE 1:43 PM 0 DAI I N LBO TOM, fl; TEST RESULT PASSED UK 21 W MAW 1 *8 pm SfA- 'ED TUN LOU I 8DA I r; Dlll i I ME 1:113 PM ,-fiu W,2112012 10VI LCV• L 0. r; (3,", 1 rl AK TO WT A W2 P! i-L�T KFSU 1 PASSM, LSD L WIX)P !NILIN AVE 'NIN102 2•7 W FM ;E J ME ?M7 Hi -Ei4li DhT,- 05%2I/2012 Um Lou 1 too IN 1,. L'S I I L -6SECI 100 S ISHOW ME i/2u Pl� JL Ii' m". 161 REID,: NEW abfWkhL 2an &I 05i2'./2012 IN FND 11ML 3:03 PM E110 L-A,E 05/21/2012 "m U va 1 M02 ;14 -LAU. (),,l;-vz III TLS Won' PM% I) :"!Ar, ELI 05/2 4AM LINK h.-..103 i;: 1-NU Tlilk 1:43 PH !2 Elf LEVEL. B, 4W4 IN )ESl RESULT ME 1.2 it SMR45 116 pIll L., lj�L �1, :0 13 !N EW I IrlE 1:43 PM 0 DAI I N LBO TOM, fl; TEST RESULT PASSED UK 21 W MAW 1 *8 pm SfA- 'ED TUN LOU I 8DA I r; Dlll i I ME 1:113 PM ,-fiu W,2112012 10VI LCV• L 0. r; (3,", 1 rl AK TO WT A W2 P! i-L�T KFSU 1 PASSM, LSD L WIX)P !NILIN AVE 'NIN102 2•7 W FM ;E J ME ?M7 Hi -Ei4li DhT,- 05%2I/2012 Um Lou 1 too IN 1,. L'S I I L -6SECI 100 S ISHOW ME i/2u Pl� JL Ii' m". 161 REID,: NEW abfWkhL 2an &I 05i2'./2012 IN FND 11ML 3:03 PM E110 L-A,E 05/21/2012 "m U va 1 M02 ;14 -LAU. (),,l;-vz III TLS Won' PM% I)