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Secondary Containment 'Testing Report Form
Thisform is intendedfor use by contractorsperforming periodic testing of USTsecondary containment systems. Use the
appropriate pages ofthis form to report resultsfor all components tested. The completedform, written testprocedures, and
printouts from tests (ifapplicable), should beprovided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: Metro Station I Date of Testing: 5/13/2011
Facility Address: 4600 Stine Road, Bakersfield CA 93309
Facility Contact: Baseem "Sam" Abed Phone: (661) 496 -0838
Date Local Agency Was Notified of Testing: 5/11/2011
Name of Local Agency Inspector (rfpresent during testing): Ernie
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services
Pass
Technician Conducting Test: Wayne T. Girard ICC# 8092943 STS/Franklin Fueling #3877033703
Credentials: x CSLB Licensed Contractor SWRCB Licensed Tank Tester
License Type: C -61 / D40
Pass
License Number:804904
Manufacturer
Manufacturer Training
Component(s)
Franklin Fueling TS -STS 1/22/2013
X
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
91 SB Fill X UDC #2 X
91 SB Vapor X UDC #3 X
87 #1 SB Fill X I UDC #4 X 1
87 #1 SB Vapor X UDC #5 X
87 #2 SB Fill X 91 Annular X
87 #2 SB Vapor X 87 #1 Annular X
DSL SB Fill X 87 #2 Annular X
91 STP X DSL Annular X
87 #1 STP X 91 Secondary X
87 #2 STP X 87 #1 Secondary X
DSL STP X 87 #2 Secondary X
UDC #1 X I I DSL Secondary X I
Ifhydrostatic testing was performed, describe what was done with the water after completion oftests:
Water was put back into test trailer and waste drum.
CERTIFICATION OF ECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best ofmy knowledge, thefa stated In thls do ment accurate and infull compliance with legal requirements
Technician's Signature: %/`— DAW 5/13/2011
SWRCB, January 2002
4. TANK ANNULAR TESTING
Page 2 of 8
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: Calibrated Gauges Equipment Resolution:0.1" Hg
Tank # 1 / 91 Tank # 2 / 87 #1 Tank # 3 / 87 #2 Tank # 4 / DSL
Is Tank Exempt From Testing?' Yes x No Yes x No Yes x No Yes x No
Tank Capacity: 12k 12k 12k 12k
Tank Material: Fiberglass Fiberglass Fiberglass Fiberglass
Tank Manufacturer: unknown unknown unknown unknown
Product Stored: 91 gasoline 87 gasoline 87 gasoline Diesel
Wait time between applying
pressure /vacuum/water and
starting test:
5 min. 5 min. 5 min. 5 min.
Test Start Time: 11:15am 11:15am 9:50am 10:10am
Initial Reading (Rj): 5.0" Hg 5.0" Hg 5.0" Hg 5.0" Hg
Test End Time: 12:15pm 12:15pm 10:50am 11: 1Oarn
Final Reading (RF): 5.0" Hg 5.0" Hg 5.0" Hg 5.0" Hg
Test Duration: I hour 1 hour 1 hour 1 hour
Change in Reading (RF -Rj): 0.0" Hg 0.0" Hg 0.0" Hg 0.0" Hg
Pass/Fail Threshold or Criteria: No change No change No change No change
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 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 ofRegulations. Title 23, Section 2637(a)(6)1
SWRCB, January 2002
5. SECONDARY PIPE TESTING
Page 3 of 8
Test Method Developed By: Piping Manufacturer x Industry Standard Professional Engineer
Other (Spec)
Test Method Used: x Pressure Vacuum Hydrostatic
Other (Specify)
Test Equipment Used: Calibrated Gauges Equipment Resolution:0.Ipsi
Piping Run # 1 / 91 Piping Run # 2 / 87 #1 Piping Run # 3 / 87#
21
Piping Run # 4 / DSL
Piping Material: Fiberglass Fiberglass Fiberglass Fiberglass
Piping Manufacturer: unknown unknown unknown unknown
Piping Diameter: 4" 4" 4" 4"
Length of Piping Run: 90' 80' 70' 60'
Product Stored: 91 gasoline 87 gasoline 87 gasoline 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:
5 min. 5 min. 5 min. 5 min.
Test Start Time: 11:05am 11:05am 9:50am 10:10am
Initial Reading (Rj): 5.0 psi 5.0 psi 5.0 psi 5.0 psi
Test End Time: 12:05pm 12:05pm 10:50am 11:10am
Final Reading (RF): 5.0 psi 5.0 psi 5.0 psi 5.0 psi
Test Duration: I hour 1 hour 1 hour 1 hour
Change in Reading (RF -Rj): 0.0 psi 0.0 psi 0.0 psi 0.0 psi
Pass/Fail Threshold or
Criteria: No change No change No change No change
Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail
CoMua IMtS — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests)
SWRCB, January 2002
6. PIPING SUMP TESTING
Page 4 of 8
Test Method Developed By: Sump Manufacturer x Industry Standard Professional Engineer
Other (Spec)
Test Method Used: Pressure Vacuum x Hydrostatic
Other (Spec)
Test Equipment Used: TS -STS Equipment Resolution: .000 1"
Sump # 1 / 91 Sump # 2 / 87 #1 Sump # 3 / 87 #2 Sump # 4 / DSL
Sump Diameter: 34" 34" 34" 40"
Sump Depth: 60" 60" 60" 60"
Sump Material: Fiberglass Fiberglass Fiberglass Fiberglass
Height from Tank Top to Top of
Highest Piping Penetration: 16" 16" 16" 18"
Height from Tank Top to Lowest
Electrical Penetration: 20" 20" 20" 24"
Condition ofsump prior to testing: Clean Clean Clean Clean
Portion of Sump Tested' Penetrations Penetrations Penetrations Penetrations
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
Is system programmed for fail -safe
shutdown?*
Yes No X NA Yes No X NA Yes No XNA Yes No X NA
Was fail -safe verified to be
operational?*
Yes No X NA Yes No XNA Yes No XNA Yes No X NA
Wait time between applying
pressure /vacuum/water and starting
test:
15 min. 15 min. 15 min. 15 min.
Test Start Time:
Initial Reading (RI):
Test End Time:
Final Reading (RF): See INOON
Test Duration:
Change in Reading (RF -RI):
Pass/Fail Threshold or Criteria:
Test Result: X Pass Fail Pass X Fail Pass X 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
Gommenb — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests)
Ifthe entire depth of the sump is not tested, specify how much was tested. Ifthe answer to pay ofthe 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
Page 5 of 8
Test Method Developed By: UDC Manufacturer x Industry Standard
Other (Spec)
Professional Engineer
Test Method Used: Pressure
Other (Spec)
Vacuum x Hydrostatic
Test Equipment Used: IN -CON STS Equipment Resolution: 0001
UDC # 1 UDC # 2 UDC # 3 UDC # 4
UDC Manufacturer: Bravo Bravo Bravo Bravo
UDC Material: FRP FRP FRP FRP
UDC Depth: 36" 36" 36" 36"
Height from UDC Bottom to Top
of Highest Piping Penetration: 20" 20" 20" 20"
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 Tested Pipe Penetrations Pipe Penetrations Pipe Penetrations Pipe Penetrations
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?*
Yes No X NA Yes No X NA Yes No X NA Yes No XNA
Turbine shutdown response time
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 Tune:
Initial Reading Ri):
Test End Time:
Final Reading (RF): Sim Mr-CIN
Test Duration: I jChangeinReading (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 recommendedfollow -up forfailed tests)
Ifthe entire depth ofthe UDC 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 UDC must be tested. (See SWRCB LG -160)
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SWRCB, January 2002
7. UNDER- DISPENSER CONTAINMENT (UDC)
Test Method Developed By: 0 UDC Manufacturer x Industry Standard 0 Professional Engineer
Other (Specify)
Test Method Used: 0 Pressure 0 Vacuum x Hydrostatic
0 Other (Spec)
Test Equipment Used: IN -CON STS Equipment Resolution: .0001
UDC # 5 UDC # UDC # UDC #
UDC Manufacturer: Bravo
UDC Material: FRP
UDC Depth: 36"
Height from UDC Bottom to Top
of Highest Pi2ing Penetration:
2011
Height from UDC Bottom to
Lowest Electrical Penetration: N/A
Condition of UDC prior to
testing:
Clean
Portion of UDC Tested Pipe Penetrations
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?*
0 Yes No X NA Yes No 0 NA 0 Yes No 0 NA 0 Yes No NA
Turbine shutdown response time
Is system programmed for fail-
safe shutdown ?*
0 Yes No X NA Yes No NA Yes No NA Yes No NA
Was fail -safe verified to be
operational ?*
Yes No X NA Yes No NA 0 Yes No NA Yes 0 No NA
Wait time between applying
pressure /vacuum/water and
starting test
5 min.
Test Start Time:
Initial Reading (R,):
Test End Time: See INIC01
Final Reading (RF):
Test Duration:
Change in Reading (RF -Ri):
Pass/Fail Threshold or Criteria:
Test Result: X Pass Fail Pass Fail Pass Fail Pass Fail
Was sensor removed for testing? X Yes No 0 NA 0 Yes 0 No NA 0 Yes 0 No NA 0 Yes 0 No NA
Was sensor properly replaced and
verified functional after testin ? X Yes No 0 NA 0 Yes 0 No NA 0 Yes No NA Yes 0 No 0 NA
COII9MIAS — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests)
1 If the entire depth ofthe UDC is not tested, specify how much was tested. If the 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
9. SPILL/OVERFILL CONTAINMENT BOXES
Page 7 of 8
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: .0001"
Spill Box # 1 / 91F Spill Boa # 2 / 91V Spill Box # 3 / 871F Spill Box # 4 / 871V
Bucket Diameter: 12" 12" 12" 12"
Bucket Depth: 15" 15" 15" 1Y,
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:
Final Reading (RF):
Test Duration:
Change in Reading (RF -Rj):
Pass/Fail Threshold or
Criteria: 002" 002" 002" 002"
Test Result: Pass X Fail X Pass Fail Pass X Fail X Pass Fail
COMMIMts — (include information on repairs madeprior to testing, and recommendedfollow -upforfailed tests)
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SWRCB, January 2002
9. SPILL/OVERFILL CONTAINMENT BOXES
Page 8 of8
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: .0001"
Spill Box # 5 / 872F Spill Boa # 6 / 872V Spill Box # 7 / DSL F Spill Box #
Bucket Diameter: 12" 12" 12"
Bucket Depth: 15" 15" 15"
Wait time between applying
pressure /vacuum/water and
starting test:
5 min. 5 min. 5 min.
Test Start Time:
Initial Reading (R,):
Test End Time:
Final Reading (RF):
Test Duration:
Change in Reading (RF -R,):
Pass/Fail Threshold or
Criteria: 002" 002" 002"
Test Result: Pass X Fail X Pass Fail Pass X Fail Pass Fail
Comments — (include information on repairs made prior to testing, andrecommendedfollow -upforfailed tests)
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GBi WK 661- Q96 -Or3v 061 - 496 -0av
JUVOICE 26341 IINDICE 2V4 i 111VOICk 26341
45/13/2011 1t1:5G AM 45;'13 /1011 11:36 n+° Uj /'1 ;, /2611 i2:lij i'H
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9i 5i1F' 3'2 *W S 3 ` USL SIP
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TES", SWG 01131all t o; STARTE& 0511312JII CS7 STARIEG 05(73/2011
b£1:1k LEVEL -.6530 11: BEUIN LEVEL 6.76f:2 III 6U.IN IEVEL 1.?Nl :it
E16 l I IIf 10:54 AM E10 i IMF 11:36 AM Off) TIRE 12:10 PII
EI1U [LATE 05/13/2011 EIID DA1t 05/13/20H EI:D WE 05/117/2011
NO LEti, 3.5103 R! I EvEL 4.7673 1N fj LEVEL 1.6744 111
1,EP4 TR'1FSKLu 4, iu?2 111 EAY THRESHOLD 0.002 111 LZAY THRESHOLD 0.0412 IN
IN REST : FAILED IEST kcISLILi PASSED TEST RESik I FAILED
11 SBV 372 5 bG 12 SIP
IM. S11AR10 10:30 AIT IN biARIED I1:e'J AM IFSI iAk1tD 1`:5j AM
iE5T STWED 051 15/20 1 1 FES1 STARTED L15; 13/2011 TEST STARTED 35/I3/2011
aE, IN LEVEL 5. i4jf III EGPN LFVEI. 2. 2301 ;N 60;IN LEVEL 1.65517 111
TJV TIME 101:54 AM Elio TIME 11:36 AM ENUITIME 12:10 PM
111) DATE 05/1312011 ErtD DATE 05113 /2011 Eix1 DATE 05113/•1011
Eli LEVft 5.7441 111 110 LEVEL 2.1925 In END LEVEL 1.4931 N1
LEA,. 14RESkCi_D ti'. 0G2 Its CAD 11,110;; ::I LEAK "MRE5HOLL 0.002 Ut
1EaT RESULT PASSED IFST RESL T FAILED TES? RESULT FAILED
871 SY USE. SNF
51 S +++ii'cIi lU: zi: AM b( 5i „EiEU 1 is j t;tM1
TFzJ S7ARiET. 0j/ 1312011 I /;11'
LEVE. 3.9419 Ic: Efi ir. L VEI ?. V028 Ito
E1lG T I IF 10:54 AM LIID TIME 11:36 AM
EQ (WE 05/ 1'/2'.111 E16 Wt U5/ 131N I I
Elio LEilf1 ?.:a.' t III E1IU LEVE' G. X844 IN
LEAY 11'1 MOLD 0.002 I1; LEAP T1f'ESkTU ). 742 IN
IFST RESULT FAILED ES1 RESULT FAILED
871 SBV
TEy: SIAk;EU 10:0 e.
TtS1 SihRTED 05/13/2011
ELGIN LEVEL 5. 2026 IN'
EIIU i IME 10:54 AM
END HATE 05/13/2011
EIID LEVEL 5.2013 !N
LEAK THRESH10 0.402 Ila
IEST RESULT PASSEU
MEip.6 SiAi toll
460U SANE ROAD
811*P riEt:, CA 5,1303
l't61- {198 -OP3v
A IWOICF 26341
15/13/2,011 1:10 Ptl
510r LEAN. TEST R'LPUlT
91 SIP
Ea STARItu 12:55 PM
T T STAitfEU 05/13/2011
rETillt LEVEi 3.2752 IN
ENO TIME 1:1L1 PM
EtiD UAIE 05/13/2011
1110 LEVEL 3.274,1 IN
Ek THRESH80 0.002 IN
TEST RESULT PASSED
I71 STP
iLST Sf6klEb ;2:55 F11
TEST STARTED 05/13/2011
t1E;3fII LE +Et. 2.fr: ilI
END TIME 1:10 Ph
END DATE 05/13/2011
FND LEVEL 2.63'28 IN
EA:: KEvl1T.;_G 0.002 IN
TESL RESULT FAILED
L l ;ANIF1: 12:55 PM
TEST STARTED 05/1.312011
OEGIII LEVEL 3. do"m IN
EEIIG TIME 1:10 PM
END DATE 05/1300 11
END LEVEL 3,2110 IN
Uk 1HRESHOLD 0.002 111
rEsi RESULT PASSED
METRO SIATIDI tk.IRO SIAl iGN
4600 STINE ROAD 450G Slat ROAD
bA+tEFS; iEi.(1 54x0, FIELD i-A 2330 "1
661 - 496 -OE3E 651- U 6 -4 3z
IWICE 26841 INVDICE 2fir4T
5113 /'1011 1: 52 fl9 051 131 PO) 1 2:43, M
fi ;iMF Lt.Ak TLST nff't1n1 x'1Mt' ; i=A.Y. lESi u''uY!
UDC 2 UDC 4
iE51 SIPRirli 1:06 PI1 r S,Hj !iii 7 ti;
TEST STARIEU 05/13/2011 LI; ;;Hf :i!U a:lojnill
2FGfII LEVEL 3.2255 IN rGill LEVEL 5.2449 III
END 11ME 1:51 PM rND 1111E 2:43 PM
RU DATE 05/13/2011 ENU DATE 05/13/201;
Tun LEVEL 3. 2246 IN i t ;.. ' t !i L 5.2051 a:
LEAI'. THRESHOLD 0.002 It: C s. c +ArtiH LtJ 0. Ci02 1N
TESI RESOLI' PASSED i_; RE1;1u f PASSED
UDC 3 UDC 5
iLS. S1APibb 1:36 pm TB: `;!MrFri 2'Jt fM
TESL STARTED 05/13/2011 TEST E.!*IEG 05/13/201'
5GIN LEVEL 1.2369 IN gF;;iN LEVEL 2.+522 lH
END TIME 1:51 PM Etf) TIME 2:43 PM
ENO WE 05/13/2011 ErtG DATE 05/13/2'J11
END LEVEL 1.2361 It: END I.t.UFT 2,1150= IN
I.Ex. THRESHOLD G.002 IN LEW WE:.-iC: 0.05 it'
TEST RESOLi PASSED TEST REST;;_,, PASSED