HomeMy WebLinkAboutSB989 2014SWRCB, January 2002 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 (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: California Mini Mart Date of Testing: 1/14/2014
Facility Address: 1129 Union Ave. Bakersfield, Ca.
Facility Contact: Phone:
Date Local Agency Was Notified of Testing :
Name of Local Agency Inspector (if present during testing):
2. TESTING CONTRACTOR INFORMATION
Company Name: Advanced Compliance
Technician Conducting Test: Bruce W. Hinsley
Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester
License Type: C61/D40 License Number: 971259
Manufacturer Training
Manufacturer Component(s) Date Training Expires
Incon TS-STS 9/17/2014
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
Tank #1 STP Sump X 87 UL Main Product Line X
Tank #2 STP Sump X 91 UL Product Line X
Tank #3 STP Sump X Diesel Line X
Tank #4 STP Sump X Product Line Tanks 1 to 2 X
Tank #1 Fill Sump X UDC #1-2 X
Tank #2 Fill Sump X UDC #3-4 X
Tank #3 Fill Sump X UDC #5-6 X
Tank #4 Fill Sump X UDC #7-8 X
Tank #1 Fill Bucket X Tank #1 Annular Space X
Tank #2 Fill Bucket X Tank #2 Annular Space X
Tank #3 Fill Bucket X Tank #3 Annular Space X
Tank #4 Fill Bucket X Tank #4 Annular Space X
If hydrostatic testing was performed, describe what was done with the water after completion of tests:
Containments were clean, water was removed from site and be used in future testing.
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:________________________________________________ Date: 1/14/2014
SWRCB, January 2002 Page ____ of ____
4. TANK ANNULAR TESTING
Test Method Developed By: Tank Manufacturer X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: Pressure X Vacuum Hydrostatic
Other (Specify)
Test Equipment Used: Equipment Resolution:
Tank # 1 Tank # 2 Tank # 3 Tank # 4
Is Tank Exempt From Testing?1 Yes x No Yes x No Yes x No Yes x No
Tank Capacity: 10,000 10,000 10,000 10,000
Tank Material: FRP FRP FRP FRP
Tank Manufacturer: Xerxes Xerxes Xerxes Xerxes
Product Stored: 87 UL 87 UL 91 UL DIESEL
Wait time between applying
pressure/vacuum/water and
starting test:
10 Min. 10 Min. 10 Min. 10 Min.
Test Start Time: 12:00 12:00 12:00 12:00
Initial Reading (RI): 10” Hg. 10” Hg. 10” Hg. 10” Hg.
Test End Time: 13:00 13:00 13:00 13:00
Final Reading (RF): 10” Hg. 10” Hg. 10” Hg. 10” Hg.
Test Duration: 1 Hr. 1 Hr. 1 Hr. 1 Hr.
Change in Reading (RF-RI): 0” Hg. 0” Hg. 0” Hg. 0” Hg.
Pass/Fail Threshold or Criteria: 2.0” Hg. 2.0” Hg. 2.0” Hg. 2.0” Hg.
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)
1 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)}
SWRCB, January 2002 Page ____ of ____
5. SECONDARY PIPE TESTING
Test Method Developed By: Piping Manufacturer X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: X Pressure Vacuum Hydrostatic
Other (Specify)
Test Equipment Used: Nitrogen / Pressure Gauge Equipment Resolution:
Piping Run # 87 UL Piping Run # Tank 1 to 2 Piping Run # 91 UL Piping Run # Diesel
Piping Material: Fiberglass Fiberglass Fiberglass Fiberglass
Piping Manufacturer: A/O Smith A/O Smith A/O Smith A/O Smith
Piping Diameter: 3” 3” 3” 3”
Length of Piping Run: 75’ 10’ 75’ 75’
Product Stored: 87 UL 87 UL 91 UL Diesel
Method and location of
piping-run isolation: Test Boot Test Boot Test Boot Test Boot
Wait time between applying
pressure/vacuum/water and
starting test:
10 Min. 10 Min. 10 Min. 10 Min.
Test Start Time: 12:00 12:00 12:00 12:00
Initial Reading (RI): 5.0 Psi. 5.0 Psi. 5.0 Psi. 5.0 Psi.
Test End Time: 13:00 13:00 13:00 13:00
Final Reading (RF): 5.0 Psi. 5.0 Psi. 0.0 Psi. 0.0 Psi.
Test Duration: 1 Hr. 1 Hr. 1 Hr. 1 Hr.
Change in Reading (RF-RI): 0.0 Psi. 0.0 Psi. 5.0 Psi. 5.0 Psi.
Pass/Fail Threshold or
Criteria: 0.2 Psi. 0.2 Psi. 0.2 Psi. 0.2 Psi.
Test Result: X Pass Fail X Pass Fail Pass X Fail Pass X 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: Incon TS-STS Equipment Resolution: 0.0002
Sump # 1 Sump # 2 Sump # 3 Sump # 4
Sump Diameter: 42” 42” 42” 42”
Sump Depth: 64” 64” 64” 64”
Sump Material: FRP FRP FRP FRP
Height from Tank Top to Top of
Highest Piping Penetration: 40” 42” 42” 42”
Height from Tank Top to Lowest
Electrical Penetration: 12” 12” 12” 12”
Condition of sump prior to testing: Clean Clean Clean Clean
Portion of Sump Tested1 70% 70% 70% 70%
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 X Yes No NA
Turbine shutdown response time 3 Sec. 3 Sec. 3 Sec. 3 Sec.
Is system programmed for fail-safe
shutdown?* X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Was fail-safe verified to be
operational?* X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Wait time between applying
pressure/vacuum/water and starting
test:
10 Min. 10 Min.
10 Min.
10 Min.
Test Start Time: 17:30/17:45 14:57/15:15
Initial Reading (RI): 6.5995 /6.5995 7.3254/7.3255
Test End Time: 17:45/18:00 14:13/15:30
Final Reading (RF): 6.5996 /6.5983 7.3256/7.3256
Test Duration: 30 Min. 30 Min.
Change in Reading (RF-RI): 0.0001/0.0012 Visible Failure 0.0002/0.0001 Visible Failure
Pass/Fail Threshold or Criteria: 0.002 0.002 0.002 0.002
Test Result: X Pass Fail Pass X Fail X Pass Fail Pass X 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)
1 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. (See SWRCB LG-160)
SWRCB, January 2002 Page ____ of ____
7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING
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: Incon TS-STS Equipment Resolution: 0.0002
UDC # 1-2 UDC # 3-4 UDC # 5-6 UDC # 7-8
UDC Manufacturer: Unknown Unknown Unknown Unknown
UDC Material: FRP FRP FRP FRP
UDC Depth: 26” 26” 26” 26”
Height from UDC Bottom to Top
of Highest Piping Penetration:
10” 10” 10” 10”
Height from UDC Bottom to
Lowest Electrical Penetration:
N/A N/A N/A N/A
Condition of UDC prior to
testing:
Clean Clean Clean Clean
Portion of UDC Tested1 50% 50% 50% 50%
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?*
X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Turbine shutdown response time 3 Seconds 3 Seconds 3 Seconds 3 Seconds
Is system programmed for fail-
safe shutdown?* X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Was fail-safe verified to be
operational?* X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Wait time between applying
pressure/vacuum/water and
starting test
10 Min.
10 Min.
10 Min.
10 Min.
Test Start Time: 15:33/15:50 15:33/15:50 15:33/15:50 15:33/15:50
Initial Reading (RI): 7.4952/7.4959 6.5771/6.5772 6.3066/6.3071 6.5467/6.5467
Test End Time: 15:49/16:05 15:49/16:05 15:49/16:05 15:49/16:05
Final Reading (RF): 7.4954/7.4958 6.5771/6.5770 6.3071/6.3072 6.5465/6.5461
Test Duration: 30 Min. 30 Min. 30 Min. 30 Min.
Change in Reading (RF-RI): 0.0002/0.0001 0.0000/0.0002 0.0005/0.0001 0.0002/0.0006
Pass/Fail Threshold or Criteria: 0.002 0.002 0.002 0.002
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)
SWRCB, January 2002 Page ____ of ____
8. 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 (Specify)
Test Method Used: Pressure Vacuum X Hydrostatic
Other (Specify)
Test Equipment Used: Incon TS-STS Equipment Resolution: 0.0002
Spill Box # 1 Spill Box # 2 Spill Box # 3 Spill Box # 4
Bucket Diameter: 12” 12” 12” 12”
Bucket Depth: 12” 12” 12” 12”
Wait time between applying
pressure/vacuum/water and
starting test:
10 Min. 10 Min. 10 Min. 10 Min.
Test Start Time: 12:56/13:13 12:56/13:13 13:33/13:49 13:33/13:49
Initial Reading (RI): 4. 1938/4. 1930 7.1336/7.1378 2.3875/0.5230 3.1736/3.1734
Test End Time: 13:12/13:28 13:12/13:28 13:48/14:04 13:48/14:04
Final Reading (RF): 4. 1930/4. 1925 7.1329/7.1360 2.3880/0.5232 3.1733/3.1733
Test Duration: 30 Min. 30 Min. 30 Min. 30 Min.
Change in Reading (RF-RI): 0.0008/0.0005 0.0007/0.0018 0.0005/0.0002 0.0003/0.0001
Pass/Fail Threshold or
Criteria:
0.002 0.002 0.002 0.002
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)