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HomeMy WebLinkAbout2008 989 RESULTSA. p p p S WRCB, January 2002 Page L 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 (if applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Date of sting: e Facility Address: q Facility Contact: Phone: Z Date Local Agency Was Notified of esting : Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name. Technician Conducting Test: Credentials: @ICSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester License Type: Cj4Zj,,1A Manufacturer License Number. Manufacturer Traintne Component(s) Date Training Expires 3. qI MMARY OF TFRT RF.CTTI.TC If hydrostatic testing was performed, describe what was done with the water after completion of tests: 4-z- 4C.- aG�Tl,r CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge7thef�acls stated ' this document are accurate and in full compliance with legal requirements Technician's Signature: Date:1 — 2 0. oo�o . - .. VO�.= ago© 1. �r�o �01 MEM■, If hydrostatic testing was performed, describe what was done with the water after completion of tests: 4-z- 4C.- aG�Tl,r CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge7thef�acls stated ' this document are accurate and in full compliance with legal requirements Technician's Signature: Date:1 — 2 0. 4_ TANK ANNIIT.AR TRQTTN!_ Test Method Developed By: 0 Tank Manufacturer Industry Standard 0 Professional Engineer 0 Other (Spec) Test Method Used: 0 Pressure acuum 0 Hydrostatic 0 Other (Sped) Test Equipment Used: --- NERMIME111= 1§01000 Tank # Tank # I? ZQL Equipment Resolution: ,ri Tank # Tank # Is Tank Exempt From Testing?' 0 Yes 911;F0 0 Yes 3-ido 0 Yes ❑ No 0 Yes 0 No Tank Capacity: Tank Material: Tank Manufacturer: Lai hay-44 r 14 A611-41 Product Stored: Wait time between applying " pressure/vacuum/water and starling—test: Test Start Time: Initial Reading (Rj): Test End Time: Final Reading (RF): z Test Duration: Change in Reading (RF -RO: .� Pass/Fail Threshold or Criteria: _ 2 2-46 Ai °,.Test Result: I'a�'s, �1 N" L�Psis O C?Ai 0 Pass. 0 Ba>�- , ";ars. OFaII Was sensor removed for testing? des 0 No 0 NA Wf—es 0 No DNA 0 Yes 0 No ❑ NA 0 Yes 0 No 0 NA Was sensor properly replaced and verified functional after test' ? I es 0 No 0 NA I Ries 0 No ❑ NA 0 Yes 0 No ❑ NA ❑Yes 0 No ❑ NA Comments — (include information on repairs made prior to testing, and recommendedfollow -Mfor failed tests) I 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. {Catifomia Code of Regulations, Title 23, Section 2637(a)(6)) SWRCB, January 2002. 5_ gF.fYINnARV PTPP. TPCTTN(`_ Page 3 of 7 Test Method Developed By: D Piping Manufacturer CHOustry Standard 0 Professional Engineer 0 Other (Specify) Test Method Used: ressure .. 0 Vacuum 0 Hydrostatic 0 Other (Specify) Test Equipment Used: ,, Equipment Resolution: A,1,1- Piping Run # Iyl Piping,Run # oF7 Piping Run # Piping Run # Piping Material: 1< Piping Manufacturer: , Piping Diameter: Length of Piping Run: ' Product Stored: Method and location of piping-run isolation: Wait time between applying pressure/vacuum/water and starting test: ^ Test Start Time: 4. Initial Reading (RI): t Test End Time: , MA Final Reading (RF): Test Duration: Change in Reading (RF -R,): Pass/Fail Threshold or Criteria: Test Result: O li' .04, :Pass 0, Pa1I O:PasS•... COMMClltS — (include information on repairs made prior to testing, and recommended follow -up forfailed tests) SWRCB, January 2002 K_ PTPINC: CTTMP TV4ZTTNr_ Page I/ of J_ Test Method Developed By: 0 Sump Manufacturer B ndustry Standard 0 Professional Engineer 0 Other (Specify) Test Method Used: ❑ Pressure 0 Vacuum �'1Iydrostatic ❑ Other (Spec) Test Equipment Used: Equipment Resolution: p Sump # W, Air I Sump # Sump # Sump # Sump Diameter. v , Sump Depth: 41,9,r ., Sump Material: 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' Does turbine shut down when sump sensor detects liquid (both product and water)?* &I-es 0 No 0 NA i8'res 0 No ❑ NA 0 Yes 0 No 0 NA 0 Yes 0 No ❑ NA Turbine shutdown response time Is system programmed for fail -safe shutdown ?' d -Yes 0 No 0 NA R-Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA 0 Yes ❑ No ❑ NA Was fail -safe verified to be operational?* ids ❑ No 0 NA des ❑ No DNA 0 Yes 0 No 0 NA 0 Yes ❑ No ❑ NA Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (RO: t Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF -Ri): Pass/Fail Threshold or Criteri a T est Result: ❑Passe G Bass, itll D Pass Q Fuil D' Pass O Fail Was sensor removed for testing? L?Yes 0 No 0 NA &Yvs 0 No 0 NA ❑ Yes 0 No ❑ NA ❑ Yes ❑ No ❑ NA Was sensor properly replaced and verified functional after testing? es ❑ No 0 NA Z-Y�es 0 No DNA ❑ Yes ❑ No 0 NA ❑ Yes 0 No DNA Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) r%, t I _ -� , _ -..- _ _ i i . L i . I I t If the entire depth of the sump is not tested, specify how much was tested. If the answer to jLny of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160) SWRCB, January 2002 7_ 1 NDRR_D1CPF.NCi+.R V(4NTATNMFNT rrTY)r TFCTTN!_ Page of Test Method Developed By: 0 UDC Manufacturer lndustry Standard ❑ Professional Engineer 0 Other (Sped Test Method Used: 0 Pressure ❑ Vacuum Pflydrostatic ❑ Other (Spec) Test Equipment Used: Ice'l Equipment Resolution: UDC # UDC # _ UDC # SEEM UDC # 2-g UDC Manufacturer: UDC Material: UDC De the " " Height from UDC Bottom to Top of Highest Pipiag Penetration: {" K Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested Does turbine shut down when UDC sensor detects liquid (both product and water ?* E"17-es 0 No ❑ NA Bles 0 No DNA 8'fes O No DNA e Yes 0 No 0 NA Turbine shutdown response time i Is system programmed for fail- safe shutdown?� B'Yes ❑ No ❑ NA 9-Ye 0 No ❑ NA Fifes 0 No ❑ NA Wits 0 No ❑ NA Was fail -safe verified to be operational?* tTYes ❑ No ❑ NA R'Ies 0 No DNA E 'Yes ❑ No ❑ NA Cis ❑ No 0 NA Wait time between applying pressurelvacuum/water and starting test Test Start Time: 1111AL A.a, Initial Reading (R,): Test End Time: Final Reading RF ): Test Duration: rft 44 Change in Reading Rr44 Pass/Fail Threshold or Criteria: est= Re §ulf: amass ❑ Fail 4-, 3, 011; 0 atk:. , E3* as# .' 0 ail as8• - 0 Eaii; . Was sensor removed for testing? es 0 No ❑ NA ties 0 No DNA s'Yes 0 No 0 NA Gres 0 No ❑ NA Was sensor properly replaced and verified functional after testing? es ❑ No 0 NA kr Y es ❑ No 0 NA 61& ❑ No 0 NA des ❑ No 0 NA Comments — (include information on repairs made prior to testing, and recommended follow -up forfailed 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) 0 0 SWRCB, January 2002 R_ Firs, RTCF.R r0NTATNMF.NT CTTMP TTi.CTTN(_ Page � of ? Facility is Not Equipped With Fill Riser Containment Sumps Fill Riser Containment Sumps are Present, but were Not Tested 0 Test Method Developed By: ❑ Sump Manufacturer 0 Industry Standard ❑ Professional Engineer 0 Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum ❑ Hydrostatic 0 Other (Specify) Test Equipment Used: Fill Simp # Fill Sump # Equipment Resolution: Fill Sum p# 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 S Material: Wait time between applying pressure/vacuum/water and startin test: Test Start Time: Initial Reading Test End Time: Final Reading Test Duration: Change in Reading R, : Pass/Fail Threshold or Criteria: Te`stItesult: 0 Pass 0 Fail ❑bass. D fail : ❑Pass; .uFfiil ❑ Pass 0 Fait Is there a sensor in the sump? ❑ Yes ❑ No 0 Yes 0 No ❑ Yes 0 No 0 Yes 0 No Does the sensor alarm when either product or water is detected? 0 Yes 0 No 0 NA 0 Yes 0 No 0 NA ❑ Yes ❑ No 0 NA 0 Yes 0 No 0 NA Was sensor removed for testing? 0 Yes D No 0 NA 0 Yes 0 No ❑ NA D Yes ❑ No DNA Dyes ❑ No 0 NA Was sensor properly replaced and verified functional after testing? 0 Yes ❑ No ❑ NA 0 Yes ❑ No ❑ NA 0 Yes 0 No D NA 0 Yes 0 No DNA Comments — (include information on repairs made prior to testing, and recommended follow -up forfailed tests) 0 l a 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 ❑ Test Method Developed By: 0 Spill Bucket Manufacturer ndustry Standard ❑ Professional Engineer 0 Other (Spec) Test Method Used: D Pressure 0 Vacuum hydrostatic 0 Other (Spec) Test Equipment Used: 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 (Rj): Test End Time: , Final Reading (RF): Test Duration: Change in Reading (RF -R4);_ _o Pass/Fail Threshold or Criteria: 2"All At , TeSY Result;, O'Pas.s. .10 Faii P rash . 01i &i�':: O iQas�C,:; aP'atl R, Pass 0 Fail. COMMIAS —(include information on repairs made prior to testing, and recommended fallow -up for failed tests)