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Home My WebLink About4800 Fairfax SB-989 11-2-16SWRCB, 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[ $% 19 #9933/Fastrip 11/02/2016 4800FairfaxRoad Bakersfield,CA OmeroGarcia(661)393-7000 09/30/2016 Kris Karns CameronMason ✔ ICC CAUSTServiceTechnician 10/13/2018 INCON TS-STS 10/14/2018 87 Annular ✔Diesel STP 91 Annular ✔ Diesel Annular ✔ 87Secondary ✔ 91Secondary ✔ DieselSecondary ✔ 87Vent ✔ DieselVent ✔ Vapor Return ✔ 87 STP ✔ 91 STP ✔ 91Vent ✔ ✔ UDC 1-2 ✔ UDC 3-4 ✔ UDC 5-6 ✔ UDC 7-8 ✔ UDC 9-10 ✔ UDC 11-12 ✔ 87 Fill Sump ✔ 91 Fill Sump ✔ Diesel Fill Sump ✔ 87VaporBucket ✔ 91VaporBucket ✔ Water was returned to test tank. 11/02/2016 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)} 29 ✔ ✔ CalibratedGauges 0.0625" 87 ✔ 12,000 FRP Unknown 87 5 Mins 0.00 hg 1 Hour -10.00 hg 2:15 pm -10.00 hg 1:15 pm 0.00 hg ✔ ✔ ✔ 91 ✔ 12,000 FRP Unknown 91 5 Mins 1:15 pm -10.00 hg 2:15 pm -10.00 hg 1 Hour 0.00 hg 0.00 hg ✔ ✔ ✔ Diesel ✔ 12,000 FRP Unknown Diesel 5 Mins 1:15 pm -10.00 hg 2:15 pm -10.00 hg 1 Hour 0.00 hg 0.00 hg ✔ ✔ ✔ 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) 39 ✔ ✔ CalibratedGauges 0.0625" 87 FRP Smith 3.00" 180.00' 87 TestBoot 5min. 1:15 pm 5.00 PSI 2:15 pm 5.00 PSI 1hour 0.00" 0.00" ✔ 91 FRP Smith 3.00" 190.00' 91 TestBoot 5min. 1:15 pm 5.00 PSI 2:15 pm 5.00 PSI 1hour 0.00" 0.00" ✔ Diesel FRP Smith 3.00" 200.00' Diesel TestBoot 5min. 1:15 pm 5.00 PSI 2:15 pm 5.00 PSI 1hour 0.00" 0.00" ✔ VR FRP Smith 3.00" 180.00' Vapor TestBoot 5min. 1:15 pm 5.00 PSI 2:15 pm 5.00 PSI 1hour 0.00" 0.00" ✔ 87 product secondary failed in UDC 3-4 and 5-6 due to impact shear valves forcing donuts down into boot where a clamp cannot be installed. 91 product secondary failed in dispenser 1-2 due to torn test boot. Vapor return secondary failed due to torn test boot in dispenser 1-2. 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) 49 ✔ ✔ CalibratedGauges 0.0625" 87Vent FRP Smith 3.00" 100' 87Vent TestBoot 5min. 1:15 pm 5.00 PSI 2:15 pm 5.00 PSI 1hour 0.00" 0.00" ✔ 91Vent FRP Smith 3.00" 100' 91Vent TestBoot 5min. 1:15 pm 5.00 PSI 2:15 pm 5.00 PSI 1hour 0.00" 0.00" ✔ DSLVent FRP Smith 3.00" 100' Diesel TestBoot 5min. 1:15 pm 5.00 PSI 2:15 pm 5.00 PSI 1hour 0.00" 0.00" ✔✔ 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 5 9 ✔ ✔ TS-STS 0.002" Regular 43.50" 61.50" FRP 14.00" 15.00" Clean Pipe Penetration ✔ N/A ✔ ✔ 5 Mins 1hour 0.00" ✔ Super 43.50" 61.50" FRP 14.00" 15.00" Clean Pipe Penetration ✔ N/A ✔ ✔ 5 Mins 1hour 0.00" ✔ ✔ ✔ Diesel 43.50" Pipe Penetration ✔ N/A ✔ 0.00" 1hour 5 Mins ✔ ✔ ✔ ✔ ✔ Clean 15.00" 14.00" FRP 61.50" 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 69 ✔ ✔ TS-STS 0.002" 1/2 PipePenetration Clean N/A N/A 10.00" FRP Bravo ✔ N/A ✔ 5min. 0.00" ✔ ✔ ✔ 1hour ✔ 3/4 N/A ✔ 0.00" ✔ 1hour 5min. ✔ ✔ PipePenetration Clean N/A N/A 10.00" FRP Bravo ✔ ✔ ✔ 5/67/8 Bravo Bravo FRP FRP 10.00"10.00" N/A N/A N/A N/A Clean Clean PipePenetration PipePenetration ✔✔ ✔ ✔ ✔ ✔ N/A N/A ✔✔ ✔✔ 5min.5min. 1hour1hour 0.00"0.00" ✔ 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 79 ✔ ✔ TS-STS 0.002" 9/10 FRP PipePenetration Clean 12.00" 14.00" 36.00" FRP Bravo ✔ N/A ✔ 5min. 0.00" ✔ ✔ ✔ 1hour ✔ 11/12 N/A ✔ 0.00" ✔ 1hour 5min. ✔ ✔ PipePenetration Clean 12.00" 14.00" 36.00" Bravo ✔ ✔ 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): TestDuration: 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) See Incon Results 89 ✔ ✔ TS-STS 0.002" 87 91Diesel 42.50"42.50"42.50 58.00"58.00"58.00" 18.00"18.00"17.00" 18.00"19.00"16.00" Clean Clean Clean Pipe Penetration Pipe Penetration Pipe Penetration FRPFRPFRP 5 Mins.5 Mins5 Mins ✔✔✔ ✔✔✔ ✔✔ ✔ ✔ ✔✔ ✔✔ 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) 11:30 am 99 ✔ ✔ Lake Test 0.00" 87 91 12.00"12.00" 12.00"12.00" 5min 5min 11:30 am 11.00"11.00" 0.00" 12:30 pm 12:30 pm 11.00"11.00" 1hour 1hour 0.00" 0.00"0.00" ✔✔