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Home My WebLink AboutSB989 RE-TEST 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 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:_________________________ $POGJEFODF6454FSWJDFT *OD ")B[ $% 110 #3367/Fastrip#640(East)12/08/2016 8001WhiteLane Bakersfield,CA93309 OmeroGarcia (661)393-7000 ShaneGardner KyleSelf ✔ ICC CAUSTServiceTechnician 10/07/2018 INCON TS-STS 10/14/2018 87Annular ✔DieselSTP 91Annular ✔ DieselAnnular ✔ 87Secondary ✔ 87VentSecondary ✔ 91Secondary ✔ 91VentSecondary ✔ DieselVentSecondary ✔ VaporReturnSecondary ✔ 87STP ✔ 91STP DieselSecondary ✔ ✔ ✔ UDC13-14 ✔ UDC15-16 ✔ UDC17-18 ✔ UDC19-20 ✔ UDC21-22 ✔ UDC23-24 ✔ 87FillSump ✔ 91FillSump ✔ DieselFillSump ✔ 87-1FillSpillBucket ✔ 87-2FillSpillBucket ✔ 12/08/2016 Test water was hauled off by Conﬁdence UST SWRCB, 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:_________________________ $POGJEFODF6454FSWJDFT *OD ")B[ $% 210 #3367/Fastrip#640(East)12/08/2016 8001WhiteLane OmeroGarcia (661)393-7000 ShaneGardner KyleSelf ✔ ICC CAUSTServiceTechnician 10/07/2018 INCON TS-STS 10/14/2018 91FillSpillBucket ✔ DieselFillSpillBucket ✔ 87-1VaporSpillBucket ✔ 87-2VaporSpillBucket ✔ 91VaporBucket ✔ VentBox ✔ 12/08/2016 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)} 310 ✔ ✔ CalibratedGauges 0.00" 87 ✔ 12,000 Steel Unknown 87Unleaded 15 min. 0.00 1hour -10hg 10:15 am -10hg 9:15 am 0.00" ✔ ✔ ✔ 91 ✔ 12,000 Steel Unknown 91Unleaded 15 min. 9:15 am -10 hg 10:15 am -10hg 1hour 0.00" 0.00" ✔ ✔ ✔ Diesel ✔ 12,000 Steel Unknown Diesel 15 min. 9:15 am -10 hg 10:15 am -10hg 1 hour 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) 7 10 ✔ ✔ TS-STS 0.00" 87 38.00" 57.00" Fiberglass 36.00" 14.00" Clean 18.00" ✔ NA ✔ ✔ 15min 10:22am 3.4060" 10:37am 3.3767" 15min 0.0293" 0.00" ✔ ✔ ✔ NA Diesel NA Hydrostatic test in 87 STP sump tested multiple times above product penetration test failed. Tested multiple times below product penetration test passed all penetrations are near the same level in the sump . Recommend resealing all penetrations.