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Home My WebLink About#721 SB-989 RESULTS 5-4-16SWRCB, 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: Date of Testing: Facility Address: 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: Technician Conducting Test: Credentials: CSLB Licensed Contractor SWRCB Licensed Tank Tester License Type: License Number: Manufacturer Training ManufacturerComponent(s)Date TrainingExpires 3.SUMMARY OF TEST RESULTS ComponentPassFail Not Tested Repairs Made ComponentPassFail Not Tested Repairs Made If hydrostatic testing was performed, describe what was done with the water after completion of tests: 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:_________________________ $POGJEFODF6454FSWJDFT *OD ")B[ $% 17 #7721/Fastrip#22(North)05/04/2016 4013SouthHStreet Bakersfield,CA93304 OmeroGarcia(661)393-7000 04/06/2016 ShaneGardner CameronMason ✔ ICC CAUSTServiceTechnician 10/13/2016 INCON TS-STS 10/16/2016 87Annular ✔UDC15-16 91Annular ✔ DieselAnnular ✔ 87SecondaryLine ✔ 91SecondaryLine ✔ DieselAnnularLine ✔ 87STPSump ✔ DieselSTPSump ✔ UDC9-10 ✔ UDC11-12 ✔ UDC13-14 ✔ 91STPSump ✔ ✔ UDC17-18 ✔ UDC19-20 ✔ 87VaporSpillBucket ✔ 91VaporSpillBucket ✔ 05/04/2016 SWRCB, January 2002 Page ____ of ____ 4.TANK ANNULAR TESTING Test Method Developed By: Tank Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: Tank # Tank # Tank # Tank # Is Tank Exempt From Testing?1 Yes No Yes No Yes No Yes No Tank Capacity: Tank Material: Tank Manufacturer: ProductStored: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): TestDuration: Change in Reading (RF-RI): Pass/Fail Threshold or Criteria: Test Result: Pass Fail Pass Fail Pass Fail Pass Fail Was sensor removed for testing? Yes No NA Yes No NA Yes No NA Yes No NA Was sensor properly replaced and verified functional after testing? Yes No NA Yes No NA Yes No NA 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)} 27 ✔ ✔ CalibratedGauges 0.0625" 87 ✔ 12,000gal. Steel/FRP ModernWelding 87Annular 5min. 0.00" 1hour -10.00 hg 10:15 am -10.00 hg 9:15 am 0.0625" ✔ ✔ ✔ 91 ✔ 12,000gal. Steel/FRP ModernWelding 91Annular 5min. 9:15 am -10.00 hg 10:15 am -10.00 hg 1hour 0.00" 0.0625" ✔ ✔ ✔ Diesel ✔ 12,000gal. Steel/FRP ModernWelding DieselAnnular 5min. 9:15 am -10.00 hg 10:15 am -10.00 hg 1hour 0.0625" ✔ ✔ ✔ SWRCB, January 2002 Page ____ of ____ 5.SECONDARY PIPE TESTING Test Method Developed By: Piping Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: Piping Run # Piping Run # Piping Run # Piping Run # PipingMaterial: Piping Manufacturer: PipingDiameter: Length of Piping Run: ProductStored: Method and location of piping-run isolation: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): TestDuration: Change in Reading (RF-RI): Pass/Fail Threshold or Criteria: Test Result: Pass Fail Pass Fail Pass Fail Pass Fail Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests) 37 ✔ ✔ CalibratedGauges 0.0625" 87 FRP Smith 3.00" 120' 87Secondary TestBoot 5min. 9:15 am 5.00 PSI 10:15 am 5.00 PSI 1hour 0.00 0.0625" ✔ 91 FRP Smith 3.00" 120' 91Secondary TestBoot 5min. 9:15 am 5.00 PSI 10:15 am 5.00 PSI 1hour 0.00 0.0625" ✔ Diesel FRP Smith 3.00" 120' DieselSecondary TestBoot 5min. 9:15 am 5.00 PSI 10:15 am 5.00 PSI 1hour 0.00 0.0625" ✔ SWRCB, January 2002 Page ____ of ____ 6.PIPING SUMP TESTING Test Method Developed By: Sump Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: Sump # Sump # Sump #Sump # Sump Diameter: Sump Depth: Sump Material: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested1 Does turbine shut down when sump sensor detects liquid (both product and water)?* Yes No NA Yes No NA Yes No NA Yes No NA Turbine shutdown response time Is system programmed for fail-safe shutdown?* Yes No NA Yes No NA Yes No NA Yes No NA Was fail-safe verified to be operational?* Yes No NA Yes No NA Yes No NA Yes No NA Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-RI): Pass/Fail Threshold or Criteria: Test Result: Pass Fail Pass Fail Pass Fail Pass Fail Was sensor removed for testing? Yes No NA Yes No NA Yes No NA Yes No NA Was sensor properly replaced and verified functional after testing? Yes No NA Yes No NA Yes No NA 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) See Incon Results 4 7 ✔ ✔ TS-STS 0.00" 87 37.00" 47.00" FRP 10.00" 10.00" Clean HighPenetration ✔ NA ✔ ✔ 5min. ✔ ✔ ✔ 91 37.00" 47.00" FRP 14.00" 15.00" Clean HighPenetration ✔ NA ✔ ✔ 5min. ✔ ✔ ✔ Diesel 37.00" HighPenetration ✔ NA ✔ 5min. ✔ ✔ ✔ ✔ Clean 15.00" 13.00" FRP 47.00" SWRCB, January 2002 Page ____ of ____ 7.UNDER-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: UDC Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: UDC # UDC # UDC # UDC # UDC Manufacturer: UDC Material: UDC Depth: Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested1 Does turbine shut down when UDC sensor detects liquid (both product and water)?* Yes No NA Yes No NA Yes No NA Yes No NA Turbine shutdown response time Is system programmed for fail- safe shutdown?* Yes No NA Yes No NA Yes No NA Yes No NA Was fail-safe verified to be operational?* Yes No NA Yes No NA Yes No NA Yes No NA Wait time between applying pressure/vacuum/water and starting test Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-RI): Pass/Fail Threshold or Criteria: Test Result: Pass Fail Pass Fail Pass Fail Pass Fail Was sensor removed for testing? Yes No NA Yes No NA Yes No NA Yes No NA Was sensor properly replaced and verified functional after testing? Yes No NA Yes No NA Yes No NA 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 any of the questions indicated with an asterisk (*) is “NO” or “NA”, the entire UDC must be tested. (See SWRCB LG-160) See Incon Results 57 ✔ ✔ TS-STS 0.00" 9-10 HighPenetration Clean 4.00" 12.00" 29.00" Plastic Environ ✔ NA ✔ 5min. ✔ ✔ ✔ ✔ 11-12 NA ✔ 5min. ✔ ✔ HighPenetration Clean 4.00" 10.00" 29.00" Plastic Environ ✔✔ ✔ ✔ 13-1415-16 Environ Environ Plastic Plastic 29.00"29.00" 10.00"10.75" 4.00"4.00" Clean Clean HighPenetration HighPenetration ✔✔ ✔ ✔ ✔ ✔ NANA ✔✔ ✔✔ 5min.5min. ✔ UDC's 9-10, 11-12, 13-14 and 15-16 failed due to suspected bad piping penetrations. SWRCB, January 2002 Page ____ of ____ 7.UNDER-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: UDC Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: UDC # UDC # UDC # UDC # UDC Manufacturer: UDC Material: UDC Depth: Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested1 Does turbine shut down when UDC sensor detects liquid (both product and water)?* Yes No NA Yes No NA Yes No NA Yes No NA Turbine shutdown response time Is system programmed for fail- safe shutdown?* Yes No NA Yes No NA Yes No NA Yes No NA Was fail-safe verified to be operational?* Yes No NA Yes No NA Yes No NA Yes No NA Wait time between applying pressure/vacuum/water and starting test Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-RI): Pass/Fail Threshold or Criteria: Test Result: Pass Fail Pass Fail Pass Fail Pass Fail Was sensor removed for testing? Yes No NA Yes No NA Yes No NA Yes No NA Was sensor properly replaced and verified functional after testing? Yes No NA Yes No NA Yes No NA 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 any of the questions indicated with an asterisk (*) is “NO” or “NA”, the entire UDC must be tested. (See SWRCB LG-160) See Incon Results 68 ✔ ✔ TS-STS 0.00" 17-18 Plastic HighPenetration Clean 6.00" 12.00" 29.00" Plastic Environ ✔ NA ✔ 5min. ✔ ✔ ✔ ✔ 19-20 NA ✔ ✔ 5min. ✔ ✔ HighPenetration Clean 6.00" 12.00" 29.00" Environ ✔ ✔ 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 Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: Spill Box # Spill Box # Spill Box # Spill Box # BucketDiameter: BucketDepth: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): TestDuration: Change in Reading (RF-RI): Pass/Fail Threshold or Criteria: Test Result: Pass Fail Pass Fail Pass Fail Pass Fail Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests) 9:15am 77 ✔ ✔ Lake Test 0.00" 87Vap 91Vap 12.00"12.00" 12.00"12.00" 5min.5min. 9:15 am 11.00"11.00" 0.00" 10:15 am 10:15 am 11.00"11.00" 1hour 1hour 0.00" 0.00"0.00" ✔✔