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Home My WebLink AboutSB989 4-21-17SWRCB, 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[ $% 1 5 #1001/WholesaleFuels,Inc.04/21/2017 2200EastBrundageLane Bakersfield,CA93307 OmeroGarcia(661)393-7000 03/03/2017 Kris Karns KyleSelf ✔ ICC CAUSTServiceTechnician 10/28/2018 INCON TS-STS 11/08/2018 T1ClearDieselFillBucket ✔UDCClearDiesel2 T2DyedDieselFillBucket ✔ T2DyedDieselVaporBucket ✔ T3ClearDieselVaporBucket ✔ T487FillBucket ✔ T487VaporBucket ✔ T5DyedDieselFillBucket ✔ UDCDyedDiesel1 ✔ UDCDyedDiesel2 ✔ UDCDyedDiesel3 ✔ UDCClearDiesel1 ✔ T6DyedDieselFillBucket ✔ ✔ UDC 87 ✔ 04/21/2017 Water was hauled off by conﬁdence UST services. 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) Please see incon results 25 ✔ ✔ TS-STS 0.00" DD1 Entire depth Clean dry N/A N/A 24.00" Steel Unknown ✔ N/A ✔ 5min 0.002" ✔ ✔ ✔ 15 min ✔ DD2 N/A ✔ 0.002" ✔ 15 min 5min ✔ ✔ Entire depth Clean dry N/A N/A 24.00" Steel Unknown ✔ ✔ DD3CD1 Unknown Unknown Steel Steel 24.00"24.00" N/A N/A N/A N/A Clean dry Clean dry Entire depth Entire depth ✔✔ ✔ ✔ ✔ ✔ N/AN/A ✔✔ ✔✔ 5min 5min 15 min15 min 0.002"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) Please see incon results 35 ✔ ✔ TS-STS 0.00" CD2 Steel Entire depth Clean dry N/A N/A 24.00" Steel Unknown ✔ N/A ✔ 5min 0.002" ✔ ✔ ✔ 15 min ✔ 87 N/A ✔ 0.002" ✔ 15 in 5min ✔ ✔ Entire depth Clean dry N/A N/A 24.00" Unknown ✔ ✔ 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) Please see incon results 45 ✔ ✔ TS-STS 0.00" T1 CDF T2 DDF T4 87F T5 DDF 12.00"12.00"12.00"12.00" 12.00"12.00"12.00"12.00" 5min 5min 5min 5min 0.0625"0.0625"0.0625"0.0625" ✔✔✔✔ 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) Please see incon results 55 ✔ ✔ TS-STS 0.00" T3CDV T487VT6 DDF T2 DDV 12.00"12.00"12.00"12.00" 12.00"12.00"12.00"12.00" 5min 5min 5min 5min 0.0625 0.0625"0.0625"0.0625" ✔✔✔✔