HomeMy WebLinkAbout2012 RESULTSSWRCB, January 2002 Page i of
Secondary Containment Testing Report Form
Thisform is intendedfor use by contractorsperforming periodic testing ofUST secondary containment systems. Use the
appropriate pages ofthisform to report resultsfor all components tested. The completedform, written testprocedures, and
printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1- FAf iT.ITV TNF0RMATInN
Facility Name: LUCKY 7 FOOD STORE Date of Testing: 4/2/12
Facility Address: 2501 WHITE LANE, BAKERSFIELD
Facility Contact: I Phone:
Date Local Agency Was Notified of Testing : ' 3/2/12
Name of Local Agency Inspector (tfpresent during testing): ERNIE MEDINA
2. TESTING CONTRACTOR INFORMATION
Company Name: Rich Environmental
Technician Conducting Test: RICH PHILLIPS
Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester
License Type: C61 /D40 A HAZ License Number: 809850
Manufacturer Training
Manufacturer Component(s) Date Training Expires
INCON TS -STS 6/11/2012
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
UNL87 ANNULAR X PLUS89 FILL SUMP X
PLUS89 ANNULAR X PREM91 FILL SUMP X
PREM91 ANNULAR X UNL87 VAPOR BOX X
UNL87 SEC PIPE X PLUS89 VAPOR BOX X
PLUS89 SEC PIPE X PREM91 VAPOR BOX X
PIREM91 SEC PIPE X p
UNL87 STP X
PLUS89 STP X
IPREM91 STP X
UDC #1/2 X
UDC ` #3/4 X
u`UNL87 FILL SUMP X
If hydrostatic testing was performed, describe what was done with the water after completion oftests:
CERTIFICATION OF TECHYICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best ofmy knowledge, thefacts sta in this document are accurate and infull compliance with legal requirements
Technician's Signature: Date: 4 !1
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SWRCB, January 2002
A TANK ANNiTT.AR TF.CTTNf_
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Test Method Developed By: 0 Tank Manufacturer X Industry Standard 0 Professional Engineer
0 Other (Specify)
Test Method Used: 0 Pressure X Vacuum Hydrostatic
0 Other (Specify)
Test Equipment Used: 4" DIAL GAUGE Equipment Resolution:
Tank #87
Is Tank Exempt From Testing ?` 0 Yes X No
Tank #89 Tank #91 Tank #
0 Yes X No 0 Yes X No 0 Yes 0 No
Tank Capacity: 10000 10000 10000
Tank Material: FIBERGLASS FIBERGLASS FIBERGLASS
Tank Manufacturer: UNKNOWN UNKNOWN UNKNOWN
Product Stored: UNL87 PLUS89 PREM91
Wait time between applying
pressure/vacuum/water and
starting test:
30MIN 30M[N 30MIN
Test Start Time: 11:00 11:45 1:00
Initial Reading R): 10 10 10
Test End Time: I2:00 12:45 2 :00
final.Reading (RF): 10 10 10
Test Duration: 60 MIN 60 MIN 60 MIN
Change in Reading (RF -Rj): 0 0 0
Pass/Fail Threshold or Criteria: 0 0 0
Test Result:. X Pass Fail X Pass 0 Fail X Pass 0 Fail 0 Pass Fail
4V sensor removed for testing? X Yes 0 No 0 NA X Yes 0No DNA X Yes No NA Yes No NA
R as;-setisor properly replaced and
erified functional after testing? X Yes No 0 NA X Yes []No NA X Yes 0 No 0NA 0 Yes 0 No 0 NA
bin, i nits — ('include information on repairs made prior to testing, and recommendedfollow -up forfailed tests)
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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 ofRegulations, Title 23, Section 2637(a)(6)1
SWRCB', January 2002
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Test Method Developed By: Piping Manufacturer X Industry Standard Professional Engineer
Other (Sped)
Test Method Used: X Pressure Vacuum Hydrostatic
Other (Specify)
Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: .5%
Piping Run #87 Piping Run 489 Piping Run #91 Piping Run #
Piping Material: FIBERGLASS FIBERGLASS FIBERGLASS
Piping Manufacturer: SMITH SMITH SMITH
Piping Diameter: 3" 3" 3"
Length ofPiping Run: 100, 100' 100,
Product Stored: UNL87 PLUS89 PREM91
Method and location of
piping-run isolation: BOOT IN SUMP BOOT IN SUMP BOOT IN SUMP
Wait time between applying
pressure/vacuum/water and
starting test:
30 MIN 30 MIN 30 MIN
Test Start Time: 4:00 4:00 4:00
Initial:Reading (R): 5.5 5.5 5.5
Test End Time: 5 :00 5:00 5:00
CFinnyReading (RF): 5.5 5.5 5.5
Test Duration: 60 MIN 60 MIN 60 MIN
Change in Reading (RF -R): 0 0 0
Pass/Fail Threshold or
criteria: 0 0 0
f'oi.ResWt- .. X Pass Fail X Pass .Fail X Pass Fail Pass Fail
p Comments — (include information on repairs made prior to testing, andrecommendedfollow -upforfailed tests)
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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: 0 Pressure 0 Vacuum X Hydrostatic
Other (Specify)
Test Equipment Used: INCON TS -STS Equipment Resolution:
Sump #87 STP Sump 989 STP Sump #91 STP Sump #
Sump Diameter: 41" 41" 41"
Sump Depth: 64" 64" 64"
Sump Material: FIBERGLASS FIBERGLASS FIBERGLASS
Height from Tank Top to Top of 24" 24" 24"
Highest Piping Penetration:
Height from Tank Top to Lowest
Electrical Penetration: 22" 22" 22"
Condition ofsump prior to testing: GOOD GOOD GOOD
Portion of Sump Tested' 26" 26" 26"
Does turbine shut down when
sump sensor detects liquid (both Yes No X NA D Yes No X NA 0 Yes 0No XNA 0 Yes No NA
duci and water)?*
Turbine shutdown response time
Ls.syAem programmed for fail -safe
shutdown? Yes No X NA 0 Yes No X NA Yes No X NA 0 Yes No NA
1Jas fail -safe verified to be
o erational ? p Yes 0 No X NA 0 Yes 0 No X NA Yes 0 No X NA Yes No NA
Wait time between applying
pressure/vacuum/water and starting 30 MIN 30 MIN 30 MIN
test:
K_::Time: 10:48 11:04 10:48 11:04 10:48 11 :04
alReading (R0: 4.391 4.391 4.496 4.496 3.002 3.001
Test -End Time: 11:03 11:19 11:03 11:19 11:03 11:19
Final Reading (RF): 4.391 4.390 4.496 4.496 3.602 3.603
Testburation: 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN
Change in Reading (RF-N: 000 -.001 000 000 000 002
Pam/Fail'Threshold or Criteria: 002 -.002 002 002 002 002
Test Result: X Pass D Fail X Pass D Fail X Pass D Fail 0 Pass 0 Fail
Was sensor removed for testing? X Yes D No NA X Yes D No NA XYes 0No NA Yes No NA
Was sensor properly replaced and
verified functional after testing? X Yes 0 No DNA X Yes No NA X Yes 0No NA Yes 0No 0 NA
Cotriments. — (include information on repairs made prior to testing andrecommendedfollow -upforfailed tests)
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i Ifthe entire depth ofthe sump is not tested, specify how much was tested. If the answer to gay ofthe questions indicated with an
asterisk M is "NO" or "NA ", the entire sump must be tested. (See SWRCB LO -160)
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SWRCB, January 2002
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Page 6 of 1
Test Method Developed By: UDC Manufacturer X Industry Standard Professional Engineer
Other (Spec)
Test Method Used: Pressure Vacuum X Hydrostatic
D Other (Spec)
Test Equipment Used: INCON TS -STS Equipment Resolution:
UDC #112
UDC Manufacturer: UNKNOWN
UDC #3/4 UDC # UDC it
UNKNOWN
UDC Material: FIBERGLASS FIBERGLASS
UDC De the 30" 30"
Height from UDC Bottom to Top
ofHighest Piping Penetration:
14" 14"
Height from UDC Bottom to
Lowest Electrical Penetration:
10" 10"
Condition ofUDC prior to
testis
GOOD GOOD
Portion ofUDC Tested 10" 10"
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?*
Yes No X NA D Yes No XNA Yes No DNA Yes No NA
Turbine shutdown response time
Is system programmed for fail-
safe shutdown? Yes D No X NA C1 Yes No X NA Yes No DNA Yes No NA
operational?*
fail -safe verified to be
o rop Yes No X NA Yes No XNA Yes D No NA D Yes No NA
Wait time between applying
presstuWvacuum/water and
ag test
30MIN 30MIN
Test Start Time: 12:38 12:58 12:38 12:58
Initial Reading (Rj): 5.396 4.137 4.140
Test End Time: 12:53 12:53 1:13
inalReadin (RF): 5.395 P5.393 4.138 4.140
estl7uration: 15MIN 15MIN 15MIN
Chan e' in Readin R,): 001 001 000
PasiNhil Threshold or Criteria: 002 002 002
eat:Resnit: X Pass Fail X Pass Fail Pass Fail Pass Fail
Was sensor removed for testing? X Yes No NA X Yes No NA Yes No DNA D Yes No NA
Was sensor. properly replaced and
verified functional after testing? X Yes No NA X Yes No NA D Yes No NA 0 Yes No NA
Coil mentS — (include information on repairs made prior to testing and recommendedfollow -upforfailed tests)
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ifthe entire depth of the UDC is not tested, specify how much was tested. Ifthe answer to my ofthe 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
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Facility is Not Equipped With Fill Riser Containment Sumps
Fill Riser Containment Sumps are Present, but were Not Tested
Test Method Developed By: Sump Manufacturer X Industry Standard Professional Engineer
0 Other (Specie)
Test Method Used: Pressure Vacuum X Hydrostatic
Other (Spec)
Test Equipment Used: INCON TS -STS Equipment Resolution:
Fill Sump Fill Sump # Fill Sump #
Sum Diameter: 7Top 7Sump
Sum Depth:
Height from Tank Top
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
pressureivacuum/water and
starting test:
30MIN 30MIN 30MIN 30MIN
Test Start Time:
Yriltial Reading R):
Test End Time:
Final Readin (RF):
Test Duration: 15MIN 15MIN 15MIN I5MIN 15MIN 15MIN 15M1N 15MIN
Change in Reading RF-R :
Pass/Fail Threshold or Criteria:
Test Result: Pass Fail Pass Fail Pass Fail Pass Fail
J4there;a sensor in the sump? Yes No Yes No 0 Yes No Yes No
Does the sensor alarm when
either product or water is
detected?
0 Yes No NA Yes No NA Yes No NA Yes No NA
Was sensor removed for testing? Yes No NA Yes No NA 0 Yes 0 No NA 0 Yes No NA
Was sensor properly replaced and
verified functional after testing? Yes No NA Yes No NA Yes []No DNA 0 Yes 0 No NA
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C6mments — (include information on repairs made prior to testing, and recommendedfollow -up forfailed tests)
NO FILL SUVTS
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SWRCB, January 2002 Page of
9 RPTT.TJ(IVF.RFiT.T. C't NTATNIVTF.NT RnXTS
Facility is Not Equipped With Spill/Overfill Containment Boxes
Spin/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: El Pressure Vacuum X Hydrostatic
Other (Spec)
Test Equipment Used: INCON TS -STS Equipment Resolution:
Spill Box 487 VPR Spill Box #89 VPR Spill Box 991 VPR Spill Box #
Bucket Diameter: 12" I2" 12"
Bucket Depth: 14" 14" 14"
Wait time between applying
pressure /vacuum/water and
starting test:
30MIN 30MIN 30MIN
Test Start Time: 9:51 10:09 9:51 10:09 9:51 10:09
Initial Reading (Rj): 5.866 5.866 5.293 5.292 3.914 3.914
Test End Time: 10:06 10:24 10 :06 10:24 10:06 10:24
Final Reading (RF): 5.866 5.866 5.293 5.291 1 3.915 3.9I4
lest Duration: 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN
Chaage,in Reading (RF-Ro: 000 000 000 001 001 000
Past,TailThreshold or
eria: 002 002 002 002 002 002
Tesir.Resnit: = X Pass Fail X pass Fail X Pass Fail 11 Pass Fail
Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests)
LUCK' 7 LUCKY 7 • UJWH f
2501 WHITE LN
2501 WHITE LN 2501 WHITE LN SAKERSFIELD CABAKERSFIELDCABAKERSFIELDCA
04/02/2012 » RPi
04/02/2012 10:45 AM 04/02/2012 11:19AAM
SUmH LEAK TEST REPO SUMP LEAK TEST REPORT SUMP LEAK TEST REPORT
87VPR 87STP 87STP
TEST STARTED 9:51 AM TEST STARTED 10:30 AM TEST STARTED 11:04 AM
TEST STARTED 04/02/2012 TEST STARTED 04/02/2012 TEST STARTED 04/02/2012
BEGIN LEVEL 5.8662 IN BEGIN LEVEL 4.3921 IN BEGIN LEVEL 4.3'910 IN
END TIME 10:06 AM END TIME 10:45 AM END TIME 11:19 AM
END DATE 04/02/2012 END DATE 04/02/2012 END DATE 04/02/2012
END LEVEL 5.8663 IN END LEVEL 4.3913 IN END LEVEL 4.3907 IN
LEAK THRESHOLD 0.N2 IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED TEST ;RESULT PASSED
91STP
89VPR 89STP
TEST STARTED 10:30 AM
TEST STARTED 9:51 AM TEST STARTED 04/02/2012 TEST STARTED 11:04 AM
TEST STARTED 04/02/2012 BEGIN LEVEL 3.6032 IN TEST STARTED 04/02/2012
BEGIN LEVEL 5.2931 IN END TIME 10:45 AM BEGIN LEVEL 4.4960 IN
END TIME 10:06 AM END DATE 04/02/2012 END TIME 11:19 AM
END DATE 04/02/2012 END LEVEL 3.6025 IN END DATE 04/02/2012
END LEVEL 5.2923 IN LEAK THRESHOLD 0.002 IN END LEVEL 4.4961 IN
LEAK: THRESHOLD 0.002 IN TEST RESULT PASSED LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED TEST RESULT PASSED
91UPR 91STP
TEST STARTED 9:51 AM TEST STARTED 11:04 AM
TEST STARTED 04/02/2012 TEST STARTED 04/02/2012BEGINLEVEL3.9149 IN BEGIN LEVEL 3.6018 INENDTIME10:06 AM END TIME 11:19 AM
END DATE 04/02/2012 END DATE W02/2012
END LEVEL 3.9150 IN LUCKY 7 END LEVEL 3.6035 IN
LEAK THRESHOLD 0.002 IN 2501 WHITE LN LEAK THRESHOLD 0.002 INTESTRESULTPASSEDBAKERSFIELDCATESTRESULTPASSED
04/02/2012 11:03 AM
LUCKY 7 LUCKY 72501WHITELNSUMPLEAKTESTREPORT251cHITfBAKERSFIELDCA LeyER„ FIELD
n 04i02i2012
87STP CA
04/02 `2y1210:24 AM
TEST STARTED 10:48 AM 22:33 pM5, MPSUMPLEAKTESTREPORTTESTSTARTED04 /02/2012 LEAK' TESTBEGINLEVEL4.3914 IN REpGRT
87VPR END TIME 11:03 AM UAC1 -2; END DATE 04/02/2012 TESTTESTSTARTED10:09 AM END LEVEL. 4. 91,,N.,.:.; ,:.; STARTTESTTESTSTARTED04/02/2012 LEAK THRESHOLD 0..002 IN STpR7Ep 12:18 YMBEGIN@'/02/2012BEGINLEUEL5.5664 IN TEST RESULT PASSED LEVELENDTIME S•3971ENDTIME10:24 AM
END DATE 04/02/2012
INrENDDATE22:33 pM
END LEVEL 5.8663 IN 89STP END LEUEL NSb2/2012LEAKOLD0.002 TEST RESULTO 0- TEST RESULT SSED TEST STARTED 10:48 AM
821
IN
TEST STARTED 04/02/2012 PASSED
BEGIN LEVEL 4.4961 IN
89UPR END TIME 11:03 AM
END DATE 04/02/2012
TEST STARTED 10:09 AM END LEVEL 4.4960 IN
TEST STARTED 04/02/2012 LEAK THRESHOLD 0.002 IN
BEGIN LEVEL 5.2921 IN TEST RESULT PASSED
END TIME 10:24 AM
END. DATE. 04/02/2012
END:LEUEL. 5.2913 IN 91STP
LEAK'THRESHOLD 0.002 IN'
TEST RESULT PASSED TEST STARTED 10:48 ftM
TEST STARTED 04/02/2012
BEGIN LEVEL 3.6023 IN
91VPR END TIME 11:03 AM
END DATE 04/02/2012
TEST STARTED 10:09 AM END LEVEL 3.6020 IN
ST'SIARTED 04 /02/2012 LEAK THRESHOLD 0.002 IN
BEGIN LEVEL 3.9147 IN TEST RESULT PASSED
END' 'T IME' 10:24 AM
END DATE 04/02/2012
END LEVEL: 3.9147 IN
LEAK THRESHOLD 0.002 IN
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LUCKY 7 '
2501 WHITE LN
BAKERSFIELD CA
04/02/2012 12:54 PM
SUMP LEAK TEST REPORT
UDC1 -2
TEST STARTED 12:38 PM
TEST STARTED 04/02/2012
BEGIN LEVEL 5.3960 IN
END TIME 12:53 RM
END DATE 04/02/2012
END LEVEL 5.3955 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED
UDC3 -4
TEST STARTED 12:38 PM
TEST STARTED 04/02/2012
BEGIN LEUEL 4.1374 In
END TIME 12:53 PM
END DATE 04/02/2012
END LEVEL 4.1389 IN
LEAK THRESHOLD' 0.002 IN
TEST RESULT PASSED
LUCKY 7
250! WHITE Lk
BAKERSFIELD CA
04/02/2012 1:13 PIS
SUMP LEAK TEST REPORT
UDC1 -2
TEST STARTED 12:58 PM
TEST.STARTED 04/02/2012
BEGIN LEVEL 5.3947 IN
END TIME 1:13 Psi
END DATE 04/02/2012
END LEVEL 5.3934 IN
LERK THRESHOLD 0.002 IN
TEST RESULT PASSED
UDC3 -4
TEST STARTED
TEST STARTED
BEGIN LEVEL
END TIME
END DATE
END LEVEL
LEAK THRESH01
TEST RESULT
12:58 PM
04/02/2012
4.1401 IN
1:13 PM
04/02/2012
4.1407 IN
D 0.002 IN
PASSED
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SB989 TESTING FAILURE REPORT
SITE NAME: LUCKY 7 FOOD STORE DATE: 4/2/12
THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE
TESTING.
REPAIRS: NONE
LABOR: NONE
Win; •
PARTS INSTALLED: NONE
u •-
NAME: TITLE:
SIGNATURE:
THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING
THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR
THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR
ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF
ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE.
A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR
CONVIENENCE.