HomeMy WebLinkAbout SB989 Results 2016SWRCB, 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: #3347 Fastrip Date of Testing: 9/15/16
Facility Address: 2698 Oswell St. Bakersfield, CA 93301
Facility Contact: Andy Phone: 661-872-8283
Date Local Agency Was Notified of Testing : 9/14/16
Name of Local Agency Inspector (if present during testing): Shane
2. TESTING CONTRACTOR INFORMATION
Company Name: Jaco Oil Company
Technician Conducting Test: Matthew Cheney
Credentials: x CSLB Licensed Contractor „ SWRCB Licensed Tank Tester
License Type: A, HAZ, D-40 License Number: 970529
Manufacturer Training
Manufacturer Component(s) Date Training Expires
Franklin Fueling Incon Level 4 3/16/2017
ICC Service Technician 1/29/2017
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
UDC 5-6 X „ „ X „ „ „ „
„ „ „ „ „ „ „ „
„ „ „ „ „ „ „ „
„ „ „ „ „ „ „ „
„ „ „ „ „ „ „ „
„ „ „ „ „ „ „ „
„ „ „ „ „ „ „ „
„ „ „ „ „ „ „ „
„ „ „ „ „ „ „ „
„ „ „ „ „ „ „ „
„ „ „ „ „ „ „ „
„ „ „ „ „ „ „ „
If hydrostatic testing was performed, describe what was done with the water after completion of tests:
Water was pumped back into drums for reuse
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:_________________________
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:
Product Stored:
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 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 „ 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 #
Piping Material:
Piping Manufacturer:
Piping Diameter:
Length of Piping Run:
Product Stored:
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):
Test Duration:
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)
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: x Pass „ Fail „ Pass „ Fail „ Pass „ Fail „ Pass „ Fail
Was sensor removed for testing? x Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA
Was sensor properly replaced and
verified functional after testing? x 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)
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-STS Equipment Resolution: .0001”
UDC # 5-6 UDC # UDC # UDC #
UDC Manufacturer: Unknown
UDC Material: Fiberglass
UDC Depth: 27”
Height from UDC Bottom to Top
of Highest Piping Penetration:
12”
Height from UDC Bottom to
Lowest Electrical Penetration:
4”
Condition of UDC prior to
testing:
Clean
Portion of UDC Tested1 A.P.P.
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?*
x Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA
Turbine shutdown response time Immediate
Is system programmed for fail-
safe shutdown?* x Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA
Was fail-safe verified to be
operational?* x Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA
Wait time between applying
pressure/vacuum/water and
starting test
15 minutes
Test Start Time: 8:11
Initial Reading (RI): 5.7120
Test End Time: 8:26
Final Reading (RF): 5.7117
Test Duration: 15 minutes
Change in Reading (RF-RI): .0003
Pass/Fail Threshold or Criteria: +/- .002
Test Result: x Pass „ Fail „ Pass „ Fail „ Pass „ Fail „ Pass „ Fail
Was sensor removed for testing? x Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA
Was sensor properly replaced and
verified functional after testing? x 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)
Re-glassed leaking sump wall
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)
SWRCB, January 2002 Page ____ of ____
8. FILL RISER CONTAINMENT SUMP TESTING
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 „ Industry Standard „ Professional Engineer
„ Other (Specify)
Test Method Used: „ Pressure „ Vacuum „ Hydrostatic
„ Other (Specify)
Test Equipment Used: Equipment Resolution:
Fill Sump # Fill Sump # Fill Sump # Fill Sump #
Sump Diameter:
Sump Depth:
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 Tested
Sump Material:
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
Is there a sensor in the sump? „ Yes „ No „ Yes „ No „ Yes „ No „ Yes „ No
Does the sensor alarm when
either product or water is
detected?
„ Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA „ Yes „ No „ NA
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)
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 #
Bucket Diameter:
Bucket Depth:
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
Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests)