HomeMy WebLinkAboutSB989 RESULTS 2017SWRCB, 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
Manufacturer Component(s)Date TrainingExpires
3.SUMMARY OF TEST RESULTS
Component PassFail Not
Tested
Repairs
Made Component PassFail 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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1 7
#7773/Fastrip #31 01/17/2017
3501Mt.VernonAvenue Bakersfield,CA93306
OmeroGarcia (661)393-7000
12/29/2016
None
KyleSelf
✔
ICC CAUSTServiceTechnician 10/28/2018
INCON TS-STS 11/08/2018
87 STP ✔91 Annular
87 Product Secondary ✔✔
91 STP ✔
91 Product Secondary ✔
Diesel STP ✔
Diesel Secondary ✔
Transition Sump ✔
UDC 3-4 ✔
UDC 5-6 ✔
UDC 7-8 ✔
87 Annular ✔
UDC 1-2 ✔
✔
Diesel Annular ✔
87 Fill Bucket ✔
87 Vapor Bucket ✔
91 Fill Bucket ✔
91 Vapor Bucket ✔
Diesel Fill Bucket ✔
Diesel Vapor Bucket ✔
01/17/2017
Water was hauled off by Confidence UST SERVICES
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)}
2 7
✔
✔
CalibratedGauges 0.00"
87
✔
12,000
Steel
Smith
87 Gasoline
5min
0.00hg
1 hour
-10.00hg
11:30 am
-10.00hg
10:30 am
0.00
✔
✔
✔
Diesel
✔
12,000
Steel
Smith
DIESEL
5min
10:30 am
-10.00hg
11:30 am
-10.00hg
1 hour
0.00hg
0.00
✔
✔
✔
91
✔
12,000
Steel
Smith
91 gasoline
5min
10:30 am
-10.00hg
11:30 am
-10.00hg
1 hour
0.00hg
0.00
✔
✔
✔
✔
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)
3 7
✔
✔
CalibratedGauges 0.00"
87
Fiberglass
Smith
3.00"
125.00'
87 gasoline
Test boot
5min
10:00am
5.00psi
11:00am
5.00psi
1 hour
0.00psi
0.00psi
✔
Diesel
Fiberglass
Smith
3.00"
135.00'
DIESEL
Test boot
5min
10:00am
5.00psi
11:00psi
5.00psi
1 hour
0.00psi
0.00psi
✔
91
Fiberglass
Smith
3.00"
150.00"
91 gasoline
Test boot
5min
10:00am
5.00psi
11:00am
5.00psi
1 hour
0.00psi
0.00psi
✔
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)
Please see Incon results:
4 7
✔
✔
TS-STS 0.00"
87
43.00"
45.00"
Fiberglass
24.00"
12.00"
Clean dry
Highest penetration
✔
N/A
✔
✔
5min
15 min
+-0.002"
✔
✔
✔
Diesel
43.00"
45.00"
Fiberglass
23.00"
15.00"
Clean dry
Highest penetration
✔
N/A
✔
✔
5min
15 min
+-0.002"
✔
✔
✔
91
43.00"
Highest penetration
✔
N/A
✔
+-0.002"
15mim
5min
✔
✔
✔
✔
Clean dry
12.00"
23.00"
Fiberglass
45.00"
Transfer sump
36.00"
39.00"
Fiberglass
18.00"
13.00"
Clean dry
Highest penetration
✔
✔
✔
+-0.002"
15 min
5min
✔
✔
✔
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
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)
Please see Incon results:
5 7
✔
✔
TS-STS 0.00"
1-2
Highest penetration
Clean dry
10.00"
13.00"
26.00"
Fiberglass
Unknown
✔
N/A
✔
5min
+-0.002"
✔
✔
15min
✔
3-4
N/A
✔
+-0.002"
✔
15min
5min
✔
✔
Highest penetration
Clean dry
10.00"
13.00"
26.00"
Fiberglass
Unknown
✔
✔
5-6 7-8
Unknown Unknown
Fiberglass Fiberglass
26.00"26.00"
13.00"13.00"
10.00"10.00"
Clean dry Clean dry
Highest penetration Highest penetration
✔✔
✔
✔
✔
✔
N/A N/A
✔✔
✔✔
5min 5min
15min 15min
+-0.002"+-0.002"
✔✔ ✔Pass Fail
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)
6 7
✔
✔
TS-STS 0.00"
87 Fill 87Vap 91 Fill 91Vap
12.00"12.00"12.00"12.00"
14.00"14.00"14.00"14.00"
5min 5min 5min 5min
11:00am
10:00am 10:00am 10:00am
8.75"9.00"
0.00"0.00"
11:00am 11:00am 11:00am 11:00am
8.75"9.00"9.25"
1 hour 1 hour 1 hour 1 hour
10:00am
9.25"9.00"
0.00"0.00"
0.0625"0.0625"0.0625"0.0625"
✔✔✔✔
All buckets will hold 5 gallons
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)
10:00am
77
✔
✔
TS-STS 0.00"
DSL F DSL V
12.00"12.00"
14.00"14.00"
5min 5min
10:00am
8.75"9.00"
0.00"
11:00am 11:00am
8.75"9.00"
1 hour 1 hour
0.00"
0.0625"0.0625"
✔✔
All buckets will hold 5 gallons