HomeMy WebLinkAboutSB989 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:_________________________
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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
✔✔