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HomeMy WebLinkAboutSB-989 Results 12/5/2011PO -S t lvSWRCB, January 2002 Page 4- of Secondary Containment Testing Report Form Thisform is intendedfor use by contractors performing periodic testing of UST secondary containment systems. Use the appropriatepages ofthisform to report resultsfor all components tested The completedform, written testprocedures, and printoutsfrom tests (cfapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: OAK STREET MOBIL Date of Testing: 12/5/11 Fail Facility Address: 2 OAK STREET, BAKERSFIELD Repairs Made Facility Contact Phone: Fail Date Local Agency Was Notified ofTesting: 10/31/11 Repairs Made Name of Local Agency Inspector (ifpresent during testing: X 2. TESTING CONTRACTOR INFORMATION Company Name: Rich Environmental Technician Conducting Test: RICH PHILLIPS Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester License Type: C61040 A HAZ License Number. 809850 Manufacturer Trainina Manufacturer Component(s) Date Trainin& Expires INCON TS -STS 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made 87REG ANNULAR X UDC #7/8 X 91PREM ANNULAR X UDC #9 /10 X DIESEL ANNULAR X 87REG FILL SUMP X 1 87REG SECONDARY PIPE X 91PREM FILL SUMP X 91PREM SEC PIPE X DIESEL FILL SUMP X DIESEL SEC PIPE X 0 87REG VAPOR BUCKET X 0 0 87REG STP X 0 91PREM VAPOR BKT X 91PREM STP X 0 0 DIESEL STP X 0 UDC #1/2 X UDC #3/4 X D UDC #5/6 X 7C Ifhydrostatic testing was performed, describe what was done with the water after completion of tests: RECYCLE AND REUSED CERTIFICATION OF TECHNIC40 RESPONSIBLE FOR CONDUCTING THIS TESTING To the best ofmy knowledge, thefacts stated is document are accurate and infull compliance with legal requirements Technician's Signature: Date: 12/5/11 SWRCB, January 2002 4. TANK TESTING Lf q(otiZ Page yof '5 Test Method Developed By: Tank Manufacturer X Industry Standard Professional Engineer Other (Spec) Test Method Used: Pressure X Vacuum Hydrostatic Other (Spec) Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: Tank # REG87 Tank # PREM91 Tank # DIESEL Tank # Fis Tank Exempt From Testing?' Yes X No Yes X No D Yes X No Yes No ank Capacity: 10000GAL 10000GAL I OOOOGAL Tank Material: STEEL STEEL STEEL Tank Manufacturer: UNKNOWN UNKNOWN UNKNOWN Product Stored: REG87 PREM91 DIESEL Wait time between applying pressure/vacuum/water and starting test: 30MIN 30MIN 30MIN Test Start Time: 9:30 9:30 10:45 Initial Reading (R1): 10HG IOHG 10.5HG Test End Time: 10:30 10:30 11:45 Final Reading (RF): l OHG lOHG 10.5HG Test Duration: 60 MIN 60 MIN 60 MIN Change in Reading (RF -R,): 0 0 0 Pass/Fail Threshold or Criteria: 0 0 0 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 recommendedfollow -upforfailed 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(ax6)1 SWRCB, January 2002 5. SECONDARY PIPE TESTING Page 3 of 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: 4" DIAL GAUGE Equipment Resolution: .5% Piping Run # REG87 Piping Run # Piping Run # PREM91 Piping Run # DSL Piping Material: FIBERGLASS FIBERGLASS FIBERGLASS Piping Manufacturer. UNKNOWN UNKOWN UNKNOWN Piping Diameter: 2" 2" 2" Length ofPiping Run: 75' 65' 50' Product Stored: REG87 PREM91 DIESEL Method and location of i in -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: 9:15 9:15 9:15 Initial Reading (Ri): 6.0 5.0 5.0 Test End Time: 10:15 10:15 10:15 Final Reading (RF): 6.0 5.0 5.0 Test Duration: 60 MIN 60 MIN 60 MIN Change in Reading (RF-R ): 0 0 0 Pass/Fail Threshold or Criteria: 0 0 0 Test Result: X Pass Fail X Pass Fail X Pass Fail Pass Fail Comments — (include information on repairs made prior to testing, and recommended. follow -upforfailed tests) SWRCB, January 2002 6. PIPING SUMP TESTING Page _J_ of Test Method Developed By: Sump Manufacturer X Industry Standard Professional Engineer Other (Spec) Test Method Used: Pressure Vacuum X Hydrostatic Other (Specify) Test Equipment Used: INCON TS -STS Equipment Resolution: Sump Diameter: Sump # 87 Sump # 91 Sump # DIESEL Sump # 39" 39" 39" Sump Depth: 57" 57" 57" Sump Material: FIBERGLASS FIBERGLASS FIBERGLASS Height from Tank Top to Top of Highest Piping Penetration: 20" 17" 17" Height from Tank Top to Lowest Electrical Penetration: 21" 24" 22" Condition ofsump prior to testing: GOOD GOOD GOOD Portion of Sump Tested' 22" 19" 19" Does turbine shut down when sump sensor detects liquid (both product and water)? . Yes No X NA Yes No XNA Yes No X NA Yes No NA Turbine shutdown response time Is system programmed for fail -safe shutdown ?* Yes 0 No X NA Yes 0 No X NA Yes No X NA 0 Yes No 0 NA Was fail -safe verified to be operational?* Yes 0 No X NA Yes 0 No X NA Yes No XNA 0 Yes No NA Wait time between applying pressure/vacuum /water and starting test: 30 MIN 30 MIN 30 MIN Test Start Time: 12:37 12:53 12:37 12:53 11:30 11:46 Initial Reading (R): 5.316 5.315 3.780 3.780 4.611 4.611 Test End Time: 12:52 1:08 12:52 1:08 11:45 12:01 Final Reading (RF): 5.315 5.314 3.781 3.782 4.610 4.610 Test Duration: 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN Change in Reading (RF -Ri): 001 001 001 002 001 001 Pass/Fail Threshold or Criteria: 002 002 002 002 002 002 Test Result: X Pass Fail X Pass Fail X Pass Fail Pass Fail Was sensor removed for testing? X Yes 0 No NA X Yes No NA X Yes No NA 0e No NA Was sensor properly replaced and verified functional after testin ? X Yes No NA X Yes No NA X Yes No 0 NA Yes No 0 NA Comments — (include information on repairs made prior to testing, and recommendedfollow -upforLailed tests) If the entire depth ofthe sump is not tested, specify how much was tested. Ifthe answer to any ofthe questions indicated with an asterisk(*) is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160) SWRCB, January 2002 7. UNDER- DISPENSER CONTAINMENT (UDCI TESTING y Page 6 of Test Method Developed By: 0 UDC Manufacturer X Industry Standard 0 Professional Engineer 0 Other (Specify) Test Method Used: Pressure 0 Vacuum X Hydrostatic Other (Spec) Test Equipment Used: INCON 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 De 28" 28" 28" 28" t: Height from UDC Bottom to Top of Highest Piping Penetration: 10" 10" 10" 10" Height from UDC Bottom to Lowest Electrical Penetration: 4" 4" 4" 4" Condition ofUDC prior to testing: GOOD GOOD GOOD GOOD Portion ofUDC Tested 12" 12" 12" 12" Does turbine shut down when UDC sensor detects liquid (both product and water)'? Yes No X NA 0 Yes 0 No X NA 0 Yes 0 No X NA Yes 0 No X NA Turbine shutdown response time Is system programmed for fail- safe shutdown ?* Yes No X NA 0 Yes 0No X NA Yes No XNA Yes No XNA Was fail -safe verified to be operational?* Yes No X NA Yes No X NA Yes 0 No XNA Yes 0 No X NA Wait time between applying pressure/vacuum/water and starting test 30MIN 30MIN 30MIN 30MIN Test Start Time: 2 :05 2:28 2:05 2:28 2:05 2:55 2:55 3:11 Initial Reading (RO: 2.348 2.349 4.537 4.536 4.760 4.627 3.123 3.123 Test End Time: 2:20 2:41 2:20 2:41 2:20 3:10 3:10 3:27 Final Reading (RF): 2.349 2.848 4.536 4.536 4.760 4.687 3.123 3.123 Test Duration: 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN Change in Reading RF-Ri : 001 001 001 001 000 000 000 -.0001Pass/Fail Threshold or Criteria: 002 002 002 002 002 1 -.002 002 -.002 Test Result: X Pass Fait X Pass 0 Fail X Pass 0 Fail X Pass 0 Fail Was sensor removed for testing? X Yes 0 No 0 NA X Yes 0No 0NA X Yes No NA X Yes 0 No DNA Was sensor properly replaced and verified functional after testin ? X Yes 0 No NA X Yes 0No 0NA X Yes No 0 NA X Yes No NA Comments - (include information on repairs made prior to testing, andrecommendedfollow-upforfailed tests) Ifthe entire depth of the UDC is not tested, specify how much was tested. If the answer to MX of the questions indicated with an asterisk (*) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) SWRCB, January 2002 7_ iiNnFR- niSPENSER CONTAINMENT (UDC) TESTING Page of Test Method Developed By: UDC Manufacturer X Industry Standard Professional Engineer Other (Spec) Test Method Used: 0 Pressure Vacuum X Hydrostatic Other (Spec) Test Equipment Used: INCON TS -STS Equipment Resolution: UDC Manufacturer: UDC # 9/10 UDC # UDC # UDC # UNKNOWN UDC Material: FIBERGLASS UDC Depth: 28" Height from UDC Bottom to Top of Highest Piping Penetration: 10" Height from UDC Bottom to Lowest Electrical Penetration: 4" Condition of UDC prior to testing: GOOD Portion of UDC Tested 12" Does turbine shut down when UDC sensor detects liquid (both product and water)?* 0 Yes 0 No X NA Yes 0No NA 0 Yes 0 No 0 NA 0 Yes 0 No 0 NA Turbine shutdown response time Is system programmed for fail- safe shutdown ?* Yes 0 No X NA 0 Yes 0No 0 NA Yes 0 No 0 NA 0 Yes No NA Was fail -safe verified to be operational?* 0 Yes No X NA 0 Yes No NA 0 Yes 0 No 0 NA 0 Yes 0No NA Wait time between applying pressure/vacuum /water and starting test 30MIN Test Start Time: 2:26 2:55 Initial Reading 2.350 2.352 Test End Time: 2:41 3:10 Final Reading F): 2.350 2.353 Test Duration: 15MIN 15MIN Change in Reading F-R): 000 001 Pass/Fail Threshold or Criteria: 002 002 Test Result: X Pass Fail Pass Fail 0 Pass D Fail 0 Pass 0 Fail Was sensor removed for testing? X Yes 0 No DNA 0 Yes 0No 0 NA 0 Yes No NA 0 Yes 0 No 0 NA Was sensor properly replaced and verified functional after testin ? X Yes 0 No 0 NA 0 Yes 0No 0 NA Yes No DNA 0 Yes No NA COmmentS — (include information on repairs madeprior to testing, and recommendedfollow -upforfailed tests) If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any ofthe questions indicated with an asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) SWRCB, January 2002 8. FILL RISER CONTAINMENT SUMP TESTING Page -1 of e I 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 0 Professional Engineer Other (Spec) Test Method Used: Pressure 0 Vacuum X Hydrostatic 0 Other (Specify) Test Equipment Used: INCON TS -STS Equipment Resolution: Fill Sump # 87 Fill Sump # 91 Fill Sump # DSL Fill Sump # Sum Diameter: 39" 39" 39" Sump De the 57" 57' 57" Height from Tank Top to Top of Highest Piping Penetration: 20" 18" 19" Height from Tank Top to Lowest Electrical Penetration: 22" 24" 23" Condition of sump prior to testing: GOOD GOOD GOOD Portion ofSump Tested 22" 20" 21" Sump Material: FIBERGLASS FIBERGLASS FIBERGLASS Wait time between applying pressure /vacuum/water and starting test: 30MIN 30MIN 30MIN Test Start Time: 12:37 12:53 12:37 12:53 11:30 11:46 Initial Reading (RD-. 2.559 2.559 5.845 5.845 2.389 2.389 Test End Time: 12:52 1:08 12:52 1:08 11:45 12:01 Final Reading Test Duration: 15MIN 15MIN 15MIN 15MIN 15M1N 15MIN Change in Reading (RF -R,): 000 -.000 001 001 000 000 Pass/Fail Threshold or Criteria: 002 -.002 002 002 002 002 Test Result: X Pass 0 Fail X Pass Fail X Pass Fail 0 Pass Fail Is there a sensor in the sump? 0 Yes X No Yes X No 0 Yes X No 0 Yes 0 No Does the sensor alarm when either product or water is detected? 0 Yes No X NA 0 Yes 0 No X NA Yes No X NA 0Yes No DNA Was sensor removed for testing? 0 Yes No X NA Yes 0 No X NA Yes No X NA 0Yes No NA Was sensor properly replaced and verified functional after testin ? Yes No X NA Yes No X NA 0 Yes No X NA Yes No NA Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) 2.559 2.559 5.844 5.844 2.389 2.389 SWRCB, January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page q of q 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 0 Professional Engineer Other (Spec) Test Method Used: Pressure Vacuum X Hydrostatic Other (Spec) Test Equipment Used: INCON TS-STS Equipment Resolution: Spill Box #87VPR Spill Box #91VPR Spill Box # Spill Box # Bucket Diameter. 12" 12" Bucket Depth: 16" 16" Wait time between applying pressure/vacuum/water and starting test: 30MIN 30MIN Test Start Time: 11:30 11:46 11:30 11:46 Initial Reading (R): 1.493 1.473 1.218 1.218 Test End Time: 11:45 12:01 11:45 12:01 Final Reading (RF): 1.473 1.474 1.218 1.2I8 Test Duration: 15MIN 15MIN 15MIN 15MIN Change in Reading (RF -&): 000 001 000 000 Pass/Fail Threshold or Criteria 002 002 002 002 Test Result: X Pass Fail X Pass Fail Pass Fail Pass Fail Comments — (include information on repairs made prior to tesft and recommendedfollow -upforfailed tests) n MOBIL IGB IL i90B I L 2 OAK Si 2 OAK Si 2 OAK ST BAKERSFIELD CA BAKERSFIELD CA JBAKERSFIELDCA' 12 %05/2011 11:45 AN 12/05/2011 12:01 Phi 12/05/2011 12 :52 PM SUMP LEAK TEST REPORT SUMP LEAK TEST REPORT SUMP LEAK TEST REPORT 87VPR 87VPR 87FILS TEST STARTED 11:30 AM TEST STARTED 11:46 AM TEST STARTED 12:37 PM TEST STARTED 12/05/2011 TEST STARTED 12/05/2011 TEST STARTED 12/05/2011 BEGIN LEVEL 1.4736 IN BEGIN LEVEL 1.4736 .IN BEGIN LEVEL 2.5594 IN END TIME 11:45 AM END TIME 12:01 PM END TIME 12:52 FM END DATE s, 12/05/2011 END DATE 12/05/2011 END DATE 12/05/2011 END LEVEL 1.4739 IN ERA LEVEL 1.4743 IN 0.002 END LEVEL 2..5596 IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED TEST RESULT PASSED TEST RESULT PASSED 91VPR 91VPR 91FILS TEST STARTED 11:30 AM TEST STARTED ii: 46 AM TEST STARTED 12 :37 PM TEST STARTED 12/05/2011 TEST STARTED 12/05/2011 TEST STARTED 12/05/2011 BEGIN LEVEL 1.2185 IN BEGIN LEVEL 1.2188 IN BEGIN LEVEL 5.8453 IN END TIME 11:45 Am END TIME END DATE 12:0i'PM 12/05/2011 END TIME 12:52 PM END DATE END LEVEL 12/05/2011 1.2187 IN END LEVEL 1.2186 IN END LEVEL END DATE 01112/05/22/05/2 IN LEAK THRESHOLD 9,602 IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED TEST RESULT PASSED TEST RESULT PASSED DSLFILS DSLFILS TEST STARTED 11:30 AM TEST STARTED 11 :46 AM 91STP TEST STARTED 12/05/2011 TEST STARTED BEGIN LEVEL 201112/05/ /65/ IN2 TEST STARTED 12:37 PMBEGINLEVEL END TIME 2.3892 IN 11:45 AM END TIME 12:01 Phi TEST STARTED BEGIN 12/05/2011 END DATE 12/05/2011 END DATE 12/65/2011 LEVEL END TIME 3.7809 IN 12:52 PllENDLEVEL LEAK THRESHOLD 2.3891 IN 0.002 IN END LEVELEND THRESHOLD 2.3890 IN 0.002 IN END DATE 12/05/2011 TEST RESULT PASSED TEST RESULT PASSED END LEVEL 3.7810 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED DSLSTP DSLSTP TEST STARTED 11 :30 AM TEST STARTED 11:46 AM TEST STARTED 12/05/2011 TEST STARTED 12/05/2011 BEGIN LEVEL 4.6112 IN BEGIN LEVEL 4.6113 IN END TIME 11:45 AM END TIME 12:01 PM END DATE 12/05/2011 END DATE 12/05/2011 END LEVEL 4.6109 IN END LEVEL 4.6107 IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED TEST RESULT PASSED n 108IL MOBIL 2 OAK ST 2 OAK ST BAKERSFIELD CA BAKERSFiELD LA 12/05/2011 2:20 Rhl 12/05/2011 1:09 Ph SUMP LEAK TEST REPORT JUMP LEAK TEST REPORT uDC1 -2 Vroe IL 37FILS TEST STARTED 2:05 PM 2 OAK ST BAKERWIELD CA TEST STARTED 12;53 PM TEST STARTED 12. .,05/2011 1 ?/05/201/. TEST STARTED 12/05/2611 BEGIN LEVEL 2.34$3 IN I6 Ph BEGIN LEVEL 2.5595 IN END TIME 1:08 PM END TIME 2:20 PM END DATE 12/05/2011 SUMP LEAK TEST REPORT END DATE 12/05/2011 END LEUEL 2.3494 iN END LEVEL 2.5595 IN LEAK THRESHOLD 0.002 IN UDC?-E; LEAK THRESHOLD 0.002 IN TEST RESULT PASSED TEST STARTEDTESTRESULTPASSEDTESTSTARTED 12/05/226111, 25/ UDC3 -4 BEGIN LEVEL 3.1237 IN 91FILS TEST STARTED 2:05 PM END TIME 3:10 PptENDDATE12/05/2011 TEST STARTED 12:53 PM TEST STARTED 12/05/201.1 END LEVEL 3.1236 INLEAKTESTSTARTED12/05/2011 BEGIN LEVEL 4.5373 IN THRESHOLD 0.002 INTESTBEGINLEUEL5.8450 IN END TIME 2:20 PM RESULT PASSED END TIME 1:08 Ph1 END DATE 12/05/2011 END DATE 12/05/2011 END LEVEL 4.5369 IN END LEVEL 5.8449 IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED TEST RESULT PASSED UDC5 -6 UDC5 -6 87STP TEST STARTED 2:05 PM TEST STARTED 2:55 PM TEST STARTED 12:53 PM TEST STARTED 12/05/2011 TEST STARTED 12/05/2011 TEST STARTED 12/05/2011 BEGIN LEVEL 4.7607 IN BEGIN LEVEL 4.6875 IN BEGIN LEVEL 5.3159 IN END TIME 2:20 PM END TIME 3:10 PM END TIME 1:08 Ph END DATE 12/05/2011 END DATE 12f05/2011 END DATE 12/05/2011 END LEVEL 4.7604 IN END LEVEL 4.6875 IN END LEVEL 5.3145 IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED TEST RESULT PASSED TEST RESULT PASSED UDC9 -10 91STP I'1081L 2 OAK SF TEST STARTED 2 :55 PM TEST STARTED 12:53 FM BAK[RSFIELp TEST STARTED 12/05/2011 TEST STARTED 12/05/2011 IN CA 12/ 05'2011 BEGIN LEVEL 2.3523 IN BEGIN LEVEL 3.7809 2 :41 END TIME 3:10 PM, END TIME 1:68 PM PPiSUMP END DATE 12/05/2011 END DATE 12/05/2611 LEAD TEST REPORT END LEVEL 2.3532 IN END LEVEL 3.7824 IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0.002 IN UDC/ -2 TEST RESULT PASSED TEST RESULT PASSED TEST STARTED 2:26 PMEDBEGINLIEU 2/20FNDTIME2.3496 INENDDATE SDG9 -10 EI4D LEVEL 12/05/20 PM i 1081L TEST STARTED 2:26 PM EST RESULTOLD a 002 IN j OAK ST TEST STARTED 12/05/2011 PASSEL) BAKERSFIELD CA BEGIN LEVEL 2.3503 IN 2:41 PM t pi,3_4 12/05/2011 3:27 PMENDTIME1G/B5/2011ENDDATE2.3505 IN TEST STARTED SUMP LEAK TEST REPORTENDLEVELLEAKTHRESHOLD0-002 FGINSLEVELL) 12152011 UDC7 -8 TEST RESULT ASSED END 7.iME 4.5367 INENDDATE2:41 PN TEST STARTED 3:11 PMkND112/951- TEST STARTED 12/05/2011LEAKTHEE4.5367tINOLD BEGIN LEVEL 3.1238 IN UDCS-6 TEST kE$ULT 0.8e2 IN END TIME 3 :27 PhiENDDATE12/05/2011 3:11 PMTEST $TARTED / /2011 14.6875 END LEVEL 3.1239 IN LEAK THRESHOLD 0.002 INTESTSTARTEDINTESTRESULTPASSEDBEGINLEVEL3.27 PMENDTIME12/05/2011NDDATE14.6875 INENDLEVEL0.602 INTHRESHOLDLEAKPASSED TEST RESUL.TL 0-TI / SB989 TESTING FAILURE REPORT SITE NAME: OAK STREET MOBIL DATE: 12 /5/11 THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS: dc--d 1- LABOR: PARTS INSTALLED: 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.