HomeMy WebLinkAboutSB989 2012SWRCB, January 2002
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Secondary Containment Testing Report Form
This form is intended far 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.forrr, written test procedures, and
printouts.from tests (if applicable), should be provided to thefacility owner /operatorforsubmittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: Lucky 7 0
1 Date of Testing: 5/3/12
Facility Address: 726 S. Union Ave., Bakersfield, CA 93307
Facility Contact: Moe
Phone: 661- 324 -8516
Date Local Agency Was Notified of Testing : 4/30/12
Name of Local Agency Inspector (if present during testing): Ester Bakersfield fire dept
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services
Pass
Fail
Technician Conducting Test: Frank Landa
Repairs
Made
Component
Credentials: x CSLB Licensed Contractor
❑ SWRCB Licensed Tank Tester
Not
Tested
License Type: CSLB
DSL SLAVE SECONDARY
License Number:804904
❑
Manufacturer
Manufacturer Training
Component(s)
Date Training Expires
Franklin Fueling
TS -STS
9/20/12
UST Service
technician
ICC
2/2/13
Star. Smith. Fibercast
Fiber Glass Systems
N. A.
91 VAPOR BUCKET
X
❑
3. SUMMARY OF TEST RESULTS
Component
Pass
Fail
Not
Tested
Repairs
Made
Component
Pass
Fail
Not
Tested
Repairs
Made
DSL SLAVE SECONDARY
X
❑
❑
❑
87 VAPOR BUCKET
X
❑
1H1
❑
DSL SECONDARY
X
❑
❑
❑
91 VAPOR BUCKET
X
❑
❑
❑
87 SECONDARY
X
❑
❑
❑
❑
❑
❑
❑
91 SECONDARY
X
❑
❑
❑
❑
❑
❑
❑
DSL SLAVE STP
X
❑
❑
❑
❑
❑
❑
❑
DSL STP
X
❑
❑
❑
❑
❑
❑
❑
87 STP
X
❑
❑
❑
❑
❑
❑
❑
91 STP
X
❑
❑
❑
❑
❑
❑
❑
UDC 1 -2
X
❑
❑
❑
❑
❑
❑
❑
UDC 3 -4
X
❑
❑
❑
❑
❑
❑
❑
UDC 5 -6
X
❑
❑
❑
❑
❑
❑
❑
UDC 7 -8
X
❑
❑
❑
❑
❑
❑
❑
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 TECH
To the hest of my knowledge, the fgf&yl ateu
PONSIBLE FOR CONDUCTING THIS TESTING
ent are accurate and in full compliance with legal requirements
Technician's Sienature�� \t1V// �,— Date: 5/3/12
SWRCB, January 2002
5. SECONDARY PIPE TESTING
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Test Method Developed By: ❑ Piping Manufacturer x Industry Standard ❑ Professional Engineer
❑ Other (Spec)
Test Method Used: x Pressure ❑ Vacuum ❑ Hydrostatic
❑ Other (Spec)
Test Equipment Used: Calibrated Gages
Equipment Resolution:0.0625"
Piping Run #DSL
SLAVE
Piping Run #DSL
Piping Run #87
Piping Run #91
Piping Material:
FIBERGLASS
FIBERGLASS
FIBERGLASS
FIBERGLASS
Piping Manufacturer:
SMITH
SMITH
SMITH
SMITH
Piping Diameter:
3"
3"
3"
3"
Length of Piping Run:
4'
40'
100'
100'
Product Stored:
DSL
DSL
REGULAR
PREMIUM
Method and location of
piping-run isolation:
BOOT IN STP
BOOT IN UDC 7 -8
BOOT IN STP
BOOT IN STP
Wait time between applying
pressure /vacuum /water and
starting test:
5 MIN.
5 MIN.
5 MIN.
5 MIN.
Test Start Time:
9:30 AM
9:30 AM
9:30 AM
11:00 AM
Initial Reading (R,):
5 PSI
5 PSI
5 PSI
5 PSI
Test End Time:
10:30 AM
10:30 AM
10:30 AM
12:00 PM
Final Reading (RF):
5 PSI
5 PSI
5 PSI
5 PSI
Test Duration:
I HOUR
1 HOUR
I HOUR
IHOUR
Change in Reading (RF -R,):
0.00"
0.00"
0.00"
0.00"
Pass /Fail Threshold or
Criteria:
0.00"
0.00"
0.00"
0.00"
Test Result:
X Pass ❑ Fail
X Pass ❑ Fail
X Pass ❑ Fail
X Pass ❑ Fail
Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests)
Had to adiust boot in udc 5/6 for 91 secondary to pass
SWRCB, January 2002
6. PIPING SUMP TESTING
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Test Method Developed By: ❑ Sump Manufacturer x Industry Standard ❑ Professional Engineer
❑ Other (Specify)
Test Method Used: ❑ Pressure ❑ Vacuum x Hydrostatic
❑ Other (Spec)
Test Equipment Used: Ts -sts
Equipment Resolution:
Sump #dsl slave
Sump #DSL
Sump # 87
Sump #91
Sump Diameter:
30"
36"
36"
36"
Sump Depth:
44"
46"
43"
33"
Sump Material:
Fiberglass
Fiberglass
Fiberglass
Fiberglass
Height from Tank Top to Top of
Highest Piping Penetration:
19"
40"
12"
9"
Height from Tank Top to Lowest
Electrical Penetration;
11"
12"
12"
5"
Condition of sump prior to testing:
Clean
Clean
Clean
Clean
Portion of Sump Tested'
21"
14"
14"
11"
Does turbine shut down when
sump sensor detects liquid (both
product and water)?*
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
Turbine shutdown response time
N/A
N/A
N/A
N/A
Is system programmed for fail -safe
shutdown ?*
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
Was fail -safe verified to be
operational?*
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
Wait time between applying
pressure /vacuum/water and starting
test:
5 MIN
5 MIN
5 MIN
5 MIN
Test Start Time:
Initial Reading (Rj):
Test End Time:
e
Final Reading (RF):
Results
Test Duration:
Change in Reading (RF -Ri):
Pass/Fail Threshold or Criteria:
Test Result:
X Pass ❑ Fail
X Pass ❑ Fail
X Pass ❑ Fail
X Pass ❑ Fail
Was sensor removed for testing?
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
Was sensor properly replaced and
verified functional after testing?
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests)
Had to seal all electrical fittinpa's with volcom to make pass
' If the entire depth of the sump is not tested, specify how much was tested. If the answer to ny of the questions indicated with an
asterisk ( *) is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160)
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SWRCB, January 2002
7. UNDER- DISPENSER CONTAINMENT (UDC) TESTING
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Test Method Developed By: ❑ UDC Manufacturer x Industry Standard ❑ Professional Engineer
❑ Other (Specie)
Test Method Used: ❑ Pressure ❑ Vacuum x Hydrostatic
❑ Other (Spec)
Test Equipment Used: Ts -sts
Equipment Resolution:
UDC #1 -2
UDC # 3 -4
UDC # 5 -6
UDC # 7 -8
UDC Manufacturer:
Unknown
Unknown
Unknown
unknown
UDC Material:
Fiberglass
Fiberglass
Fiberglass
Fiberglass
UDC Depth:
32"
32"
32"
32"
Height from UDC Bottom to Top
of Highest Piping Penetration:
15"
15"
15"
15"
Height from UDC Bottom to
Lowest Electrical Penetration:
22"
22"
22"
22"
Condition of UDC prior to
testing:
Clean
Clean
Clean
clean
Portion of UDC Tested
17"
17"
17'
17"
Does turbine shut down when
UDC sensor detects liquid (both
product and water) ?*
I ❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
Turbine shutdown response time
N/A
N/A
N/A
N/A
Is system programmed for fail-
safe shutdown ?*
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
Was fail-safe verified to be
o erational ?*
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
❑ Yes ❑ No X NA
Wait time between applying
pressure /vacuum /water and
starting test
5 MIN
5 MIN
5 MIN
5M1N
Test Start Time:
Initial Reading (R,):
See
Test End Time:
Results
Final Reading (RF):
Test Duration:
Change in Reading (RF -R,):
Pass /Fail Threshold or Criteria:
Test Result:
X Pass ❑ Fail
X Pass ❑ Fail
X Pass ❑ Fail
X Pass ❑ Fail
Was sensor removed for testing?
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
Was sensor properly replaced and
verified functional after testing?
X Yes ❑ No El NA
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
X Yes ❑ No ❑ NA
Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests)
1 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)
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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: ❑ Spill Bucket Manufacturer x Industry Standard ❑ Professional Engineer
❑ Other (Spec)
Test Method Used: ❑ Pressure ❑ Vacuum x Hydrostatic
❑ Other (Spec)
Test Equipment Used: Ts -sts
Equipment Resolution:
Spill Box #87 Spill Box #91 Spill Box # Spill Box #
Bucket Diameter:
12"
12"
Bucket Depth:
14"
14"
Wait time between applying
pressure /vacuum/water and
starting test:
5 MIN
5 MIN
Test Start Time:
10:30 AM
10:30 AM
Initial Reading (R,):
8"
8"
Test End Time:
11:30 AM
11:30 AM
Final Reading (RF):
8"
8"
Test Duration:
1 HOUR
I HOUR
Change in Reading (RF -R,):
0.00
0.00
Pass /Fail Threshold or
Criteria:
0.00
0.00
Test Result:
X Pass ❑ Fail
X Pass ❑ Fail
❑ Pass ❑ Fail
❑ Pass ❑ Fail
Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests)
1 hour visual
91STP
TEST STARTED 9:41 AM
TEST STARTED 05/03/2012
BEGIN LEVEL 2,1355 IN
END TIME 9:57 AM
END DATE 05/03/2012
END LEVEL 2.1351 IN
LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED
UDC 5 -6
TEST STARTED 10:19 AM
TEST STARTED 05/03/2012
BEGIN LEVEL 2,5199 IN
END TIME 10:34 AM
END DATE 05/03/2012
END LEVEL 2,5210 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED
UDC3 -4
TEST STARTED 10:19 AM
TEST STARTED 05/03/2012
BEGIN LEVEL 4,3926 IN
END TIME 10:34 AM
END DATE 05/03/2012
END LEVEL 4,3942 IN
LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED
LUCKY 7 3
726 S UNION AVE
BAKERSFIELD CA
661 - 324 -8516
05/03/2012 11:21 AM
SUMP LEAK TEST REPORT
DSL SLV
TEST STARTED 11:06 AM
TEST STARTED 05/03/2012
BEGIN LEVEL 2,7852 IN
END TIME 11 :21 AM
END DATE 05/03/2012
END LEVEL 2.7849 IN
LEAK THRESHOLD 0,002 IN
EST RESULT PASSED
DSLSTP
TEST STARTED 11:06 AM
TEST STARTED 05/03/2012
BEGIN LEVEL 1,3543 IN
END TIME 11:21 AM
END UATE 05/03/2012
END LEVEL 1.3543 IN
LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED
UDC 7 -8
TEST STARTED 11:06 AM
TEST STARTED 05/03/2012
BEGIN LEVEL 1,2487 IN
END TIME 11:21 AM
END DATE 05/03/2012
END LEVEL 1,2483 IN
LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED
87 STP
TEST STARTED 11:06 .AM
TEST STARTED 05/03/2012
BEGIN LEVEL 4,0074 IN
END TIME 11:21 AM
END DATE 05/03/2012
END LEVEL 11,0072 IN
LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED
LUCKY 7 3
726 S UNION AVE
BAKERSFIELD CA
661- 324 -8516
05/03/2012 12:52 PM
SUMP LEAK TEST REPORT
UDC 1 -2
TEST STARTED 12:37 PM
TEST STARTED 05/03/2012
BEGIN LEVEL 4,1223 IN
END TIME 12:52 PM
END DATE 05/03/2012
END LEVEL 4,1226 IN
LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED