HomeMy WebLinkAboutSB989 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: 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:_________________________
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14
#7776/Howard'sMarket 11/10/2016
3300PlanzRoad Bakersfield,CA93309
OmeroGarcia(661)393-7000
10/18/2016
ShaneGardner
BryanSelf
✔✔
ICC CAUSTServiceTechnician 06/08/2017
INCON TS-STS 11/09/2018
UDC1-2 ✔
UDC3-4 ✔
87FillSpillBucket ✔
87VaporSpillBucket ✔
91FillSpillBucket ✔
91VaporSpillBucket ✔
DieselFillSpillBucket ✔
11/10/2016
All test water was put back into test trailer
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
24
✔
✔
TS-STS 0.002"
1-2
PIpePenetration
Dry
NA
4.00"
9.00"
FRP
Western
✔
NA
✔
5min.
0.00"
✔
✔
✔
1hour
✔
3-4
NA
✔
0.00"
✔
1hour
5min.
✔
✔
PIpePenetration
Dry
NA
4.75"
9.00"
FRP
Western
✔
✔
✔
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)
See Incon results
34
✔
✔
TS-STS 0.002"
87-F 87-V 91-F 91-V
12.00"12.00"12.00"12.00"
12.00"12.00"12.00"12.00"
5min.5min.5min.5min.
1hour 1hour 1hour 1hour
0.00"0.00"0.00"0.00"
✔✔✔✔
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)
See Incon results
1010
✔
✔
TS-STS 0.002"
DSL-F
12.00"
12.00"
5min.
1hour
0.00"
✔
,-
JACo 7776
33OO PLANZ RD iAC0 77i6
33OO PLANZ RD
BAKERSFiELD CA 33309
11/1012016 10i51 Al1
SUI'IP LEAK TEST REPORT
UDC 1-2
BAKERSFIELD CA S3309
1111012016 ',10:51 AN
SUHP LEAK TEST REPORT
87 FIL
TEST STARTED 10:36 AI4
TEST STARTED 11110/2016
BEGIN LEVEL 5. g'I35 IN
END TII4E 10:51 AI.I
END DATE 1111012016
END LEVEL 5.9132 IN
LEAK THRESHOLD O, OO2 IN
IEST RESULT PASSED
87 VAP
TEST STARTED 10:36 AI'I
TEST STARTED 11I'I0/2016
BEGIN LEVEL 7.3680 IN
END TII.IE 10:51 A1'I
END DATE 11/10/20'16
END LEVEL 7,3673 IN
LEAK THRESHOLD O. OO2 IN
TEST RESULT fiMSSTO
END TII,IE 10:51 Atl
END DATE 11/1012016
END LEVEL 7.3277 IN
LEAK THRESHOLD O. OO2 IN
TEST RESULT PASSEO
JAC0 7776
33OO PLANZ RD
8A(ERSFIELD CA 93309
11/10/2016 il:21 Atl
SUHP LEAK IESI REPORT
TEST SIARTED
TEST STARTED
BEGIN LEVEL
END TIIlE
END DATE
END LEVEL
10:36 Al'l
111 10/2016
1,3156 IN
10:51 AH
iui0/20i6
1,3164 IN
91 l/AP
TEST SmgTEg**"10"LQ6* A"[_"*_, ,
TEST STARTED'I'I/10/2016
BEGIN LEVEL 7.3266 IN
91 FIL
TEST STARTED 1 1 :05 AI,I
IEST STARTED 11/10/2016
BEGIN LEVEL 6,7724 IN
END TIt'tE 11:2.1 At1
END oATE 11/10/2016
END LEVEL 6.7715 IN
LEAK THRESHOLD O. OO2 IN
TEST RESULI PASSED
LEAli THRESHOLD O, OC2 IN
TEST RESULT PASSED
UDC 3-4
TEST STARTED 10:36 AI4
TEST STARTED 11/1012016
BEGIN LEVEL 2.6474 IN
END TII'IE .IO:51
AH
END DATE 1111012116
END LEVEL 2.6474 IN
LEAK THRESHOLD O. OO2 IN
TESI RESULT PASSED
DSL FIL
TEST STARTED 10:36 AI'I
TEST STARTED 11/10/2016
BEGIN LEVEL 5.3673 IN
END Tit4E 10:51 AI'l
END DATE 1U1O/2O16
END LEVEL 5.3672 IN
LEAK THRESHOLD O. OO2 ]N
TEST RESULT PASSED