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Home My WebLink AboutSB989 RETEST 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:_________________________ $POGJEFODF6454FSWJDFT *OD ")B[ $% 13 #9933/Fastrip 12/21/2016 4800FairfaxRoad Bakersfield,CA OmeroGarcia(661)393-7000 KyleSelf ✔ ICC CAUSTServiceTechnician 10/28/2018 INCON TS-STS 11/08/2018 87secondary ✔ 91secondary ✔ 91STP ✔ Vapor return secondary ✔ UDC 1-2 ✔ UDC 3-4 ✔ UDC 5-6 ✔ UDC 7-8 ✔ Test water was hauled off by Conﬁdence UST SERVICES. 12/21/2016 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) 23 ✔ ✔ CalibratedGauges 0.0625" 87 FRP Smith 3.00" 180.00' 87 Gasoline Test Boot 5min 10:00am 5.00psi 2:00pm 5.00psi 1 hour 0.00psi 0.0625psi ✔ 91 Frp Smith 3.00 190.00' 91 Gasoline Test Boot 5min 10:00am 5.00psi 11:00am 5.00psi 1 hour 0.00psi 0.0625psi ✔ Vapor retu FRP Smith 4.00" 190.00' Vapor Test boot 5min 10:00am 5.00psi 11:00am 5.00psi 1 hour 0.00psi 0.0625psi ✔✔ First test of 87 product secondary was a fail discovered leaking book inside dispenser 3-4 UDC removed old boot installed new boot wait 45 min for glue to dry retested. All test then passed.and are within compliance. 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: 3 3 ✔ ✔ TS-STS 0.002" 91 STP 43.50" 61.50" FRP 14.00" 15.00" Clean/dry Pipe Penetration ✔✔ 5 Sec ✔ ✔ 5 Mins 1 hour 0.002" ✔ ✔ ✔ 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) ✔ ✔ 1-2 Pipe penetration Clean/dry N/A N/A 10.00" FRP Bravo ✔ ✔ 5min ✔ ✔ ✔ 15min ✔ ✔ 3-4 ✔ ✔ 15min 5min ✔ ✔ Pipe penetration Clean/dry 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/dry Clean/dry Pipe penetration Pipe penetration ✔✔ ✔ ✔ ✔ ✔ ✔✔ ✔✔ 5min 5min 15min15min ✔✔