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:________________________________________________
$POGJEFODF6454FSWJDFT
*OD
")B[
$%
110
#3346/Fastrip#621 02/01/2017
80534thStreet Bakersfield,CA93301
OmeroGarcia (661)393-7000
01/30/2017
Shane Gardner
Kyle Self
✔
ICC CAUSTServiceTechnician 10/28/2018
INCON TS-STS 11/08/2018
87-1Annular ✔UDC1-2
87-2Annular ✔
91Annular ✔
DieselAnnular ✔
87-1Secondary ✔
87-2Secondary ✔
91Secondary ✔
87-1STP ✔
87-2STP ✔
91STP ✔
DieselSTP ✔
DieselSecondary ✔
✔
UDC3-4 ✔
UDC5-6 ✔
UDC7-8 ✔
TransitionSumpWest ✔
TransitionSumpEast ✔
87-1FillSump ✔
87-2FillSump ✔
91FillSump ✔
DieselFillSump ✔
87-1FillSpillBucket ✔
87-1VaporSpillBucket ✔
Date:__________________________ 02/01/2017
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:________________________________________________
$POGJEFODF6454FSWJDFT
*OD
")B[
$%
210
#3346/Fastrip#621 02/01/2017
80534thStreet
OmeroGarcia (661)393-7000
01/30/2017
Shane Gardner
Kyle Self
✔
ICC CAUSTServiceTechnician 10/28/2018
INCON TS-STS 11/08/2018
87-2FillSpillBucket ✔
87-2VaporSpillBucket ✔
91FillSpillBucket ✔
91VaporSpillBucket ✔
DieselFillSpillBucket ✔
DieselVaporSpillBucket ✔
Water was hauled off by Confidence UST SERVICES
Date:_______________________ 02/01/2017
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
87-1
✔
12,000gal.
Steel
ModernWelding
87
5 min.
0.00"
1hour
-10.00hg
10:30 am
-10.00hg
9:30 am
0.00"
✔
✔
✔
87-2
✔
12,000gal.
12,000gal.
ModernWelding
87
5min.
9:30 am
-10.00hg
10:30 am
-10.00hg
1hour
0.00"
0.00"
✔
✔
✔
91
✔
12,000gal.
12,000gal.
ModernWelding
91
5 min.
9:30 am
-10.00hg
10:30 am
-10.00hg
1 hour
0.00"
0.00"
✔
✔
✔
Diesel
✔
12,000gal.
12,000gal.
ModernWelding
Diesel
5min.
9:30 am
-10.00hg
10:30 am
-10.00hg
1hour
0.00"
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)
410
✔
✔
CalibratedGauges 0.00
87-1
FRP
Smith
3.00"
150'
87
TestBoot
5min.
10:00am
5.00psi
11:00am
5.00psi
1 hour
0.00psi
0.00"
✔
87-2
FRP
Smith
3.00"
160'
87
TestBoot
5min.
10:00am
5.00psi
11:00am
5.00psi
1 hour
0.00psi
0.00"
✔
91
FRP
Smith
3.00"
170'
91
TestBoot
5min.
10:00am
5.00psi
11:00am
5.00psi
1hour
0.00psi
0.00"
✔
Diesel
FRP
Smith
3.00"
180'
Diesel
TestBoot
5min.
10:00am
5.00psi
11:00am
5.00psi
1hour
0.00psi
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)
Please see Incon results:
5 10
✔
✔
TS-STS 0.00"
87-1
36.00"
57.00"
FRP
22.00"
15.00"
Clean dry
PipePenetration
✔
NA
✔
✔
5min,
15 min
0.00"
✔
✔
✔
87-2
36.00"
57.00"
FRP
18.00"
16.00"
Clean dry
PipePenetration
✔
NA
✔
✔
5min,
15min
0.00"
✔
✔
✔
91
36.00"
PipePenetration
✔
NA
✔
0.00"
15min
5min,
✔
✔
✔
✔
Clean dry
20.00"
15.00"
FRP
57.00"
Diesel
36.00"
57.00"
FRP
22.00"
14.00"
Clean dry
PipePenetration
✔
NA
✔
✔
0.00"
15min
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 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:
610
✔
✔
TS-STS 0.00"
1-2
PipePenetration
Clean dry
3.00"
9.50"
31.00"
FRP
Western
✔
NA
✔
5min.
0.00"
✔
✔
✔
15min
✔
3-4
NA
✔
0.00"
✔
15min
5 min.
✔
✔
PipePenetration
Clean dry
3.00"
9.50"
31.00"
FRP
Western
✔
✔
5-6 7-8
Western Western
FRP FRP
31.00"31.00"
9.50"9.50"
3.00"3.00"
Clean dry Clean dry
PipePenetration PipePenetration
✔✔
✔
✔
✔
✔
NA NA
✔✔
✔✔
5min.5min.
15min 15min
0.00"0.00"
✔✔
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:
710
✔
✔
TS-STS 0.00"
TransWest
FRP
PipePenetration
Clean dry
3.00"
9.50"
31.00"
FRP
Western
✔
NA
✔
5min.
0.00"
✔
✔
✔
15min
✔
TransEast
NA
✔
0.00"
✔
15min
5min.
✔
✔
PipePenetration
Clean dry
3.00"
9.50"
31.00"
Western
✔
✔
SWRCB, January 2002 Page ____ of ____
8.FILL RISER CONTAINMENT SUMP TESTING
Facility is Not Equipped With Fill Riser Containment Sumps
Fill Riser Containment Sumps are Present, but were Not Tested
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:
Fill Sump # Fill Sump # Fill Sump # Fill Sump #
Sump Diameter:
Sump Depth:
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 Tested
Sump Material:
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
Is there a sensor in the sump? Yes No Yes No Yes No Yes No
Does the sensor alarm when
either product or water is
detected?
Yes No NA Yes No NA Yes No NA Yes No NA
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)
810
✔
✔
✔
TS-STS 0.00"
87-187-291Diesel
36.00"36.00"36.00"36.00"
57.00"57.00"57.00"57.00"
NANANA NA
14.00"14.00"14.00"14.00"
CollarCollarCollarCollar
FRPFRPFRP FRP
5min.5min.5min.5min.
0.00"0.00"0.00"0.00"
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)
910
✔
✔
TS-STS 0.00"
87-1F 87-1V 87-2F 87-2 V
12.00"12.00"12.00"12.00"
12.00"12.00"12.00"12.00"
5 min.5min.5min.5min.
9.00"
10:00am 10:00am 10:00am
9.00"9.25"
0.00"0.00"
11:00am 11:00am 11:00am 11:00am
9.00"9.25"8.75"
1 hour 1 hour 1 hour 1 hour
10:00am
8.75"9.00"
0.00"0.00"
0.0625"0.0625"0.0625"0.0625"
✔✔✔✔
87-2 vapor bucket failed first test was replaced and passed hydrostatic test after replacement..
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 10
✔
✔
TS-STS 0.00"
DSLF DSL V91F91V
12.00"12.00"12.00"12.00"
12.00"12.00"12.00"12.00"
5min.5min.5min.5min.
0.00"0.00"
11:00am
8.75"
1 hour
0.00"
0.0625"0.0625"0.0625"0.0625"
✔✔✔✔
10:00am 10:00am
11:00am
10:00am
11:00am
10:00am
11:00am
8.75"9.00"9.25"
9.25"
9.00"
9.00"9.00"
1 hour 1 hour 1 hour
0.00"