HomeMy WebLinkAboutSB989 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
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
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19
#3362/Fastrip#633 08/01/2016
6401SouthHStreet Bakersfield,CA93304
OmeroGarcia(661)393-7000
07/13/2016
ShaneGardner
CameronMason
✔
ICC CAUSTServiceTechnician 10/13/2016
INCON TS-STS 10/16/2016
87ProductSecondary ✔UDC5-6
91ProductSecondary ✔
DieselProductSecondary ✔
VaporReturnSecondary ✔
87VentSecondary ✔
91VentSecondary ✔
DieselVentSecondary ✔
91STPSump ✔
DieselSTPSump ✔
UDC1-2 ✔
UDC3-4 ✔
87STPSump ✔
✔
UDC7-8 ✔
87FillSump ✔
91FillSump ✔
DieselFillSump ✔
87FillSpillBucket ✔
91FillSpillBucket ✔
DieselFillSpillBucket ✔
87VaporSpillBucket ✔
91VaporSpillBucket ✔
08/01/2016
Water was returned to test tank.
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)}
29
✔
✔
CalibratedGauges 0.00"
87
✔
91
✔
Diesel
✔
Wet annulars.
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)
39
✔
✔
CalibratedGauges 0.00"
87Prod
FRP
Smith
3.00"
150'
RegularUnleaded
TestBoot
5min.
9:30 am
5.00 PSI
10:30 am
5.00 PSI
1hour
0.00"
0.00"
✔
91Prod
FRP
Smith
3.00"
160'
PremiumUnleaded
TestBoot
5min.
10:45 am
5.00 PSI
11:45 am
5.00 PSI
1hour
0.00"
0.00"
✔
DSLProd
FRP
Smith
3.00"
170'
Diesel
TestBoot
5min.
10:45 am
5.00 PSI
11:45 am
5.00 PSI
1hour
0.00"
0.00"
✔
87Vent
FRP
Smith
3.00"
150'
RegularUnleaded
TestBoot
5min.
9:30 am
5.00 PSI
10:30 am
5.00 PSI
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)
49
✔
✔
CalibratedGauges 0.00"
91Vent
FRP
Smith
3.00"
120'
PremiumUnleaded
TestBoot
5min.
10:45 am
5.00PSI
11:45 am
5.00PSI
1hour
0.00PSI
0.00"
✔
DSLVent
FRP
Smith
3.00"
170'
Diesel
TestBoot
5min.
10:45 am
5.00PSI
11:45 am
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)
See Incon Results
5 9
✔
✔
TS-STS 0.002"
87
36.00"
50.00"
FRP
28.00"
15.00"
Clean
PipePenetration
✔
NA
✔
✔
5min.
0.00"
✔
✔
✔
91
36.00"
50.00"
FRP
28.00"
15.00"
Clean
PipePenetration
✔
NA
✔
✔
5min.
0.00"
✔
✔
✔
Diesel
36.00"
PipePenetration
✔
NA
✔
0.00"
5min.
✔
✔
✔
✔
Clean
15.00"
28.00"
FRP
50.00"
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)
See Incon Results
69
✔
✔
TS-STS 0.002"
1-2
PipePenetration
Clean
3.00"
9.50"
31.00"
FRP
Western
✔
NA
✔
5min.
0.00"
✔
✔
✔
✔
3-4
NA
✔
0.00"
✔
5min.
✔
✔
PipePenetration
Clean
3.00"
9.50"
31.00"
FRP
Western
✔
✔
5-67-8
Western Western
FRP FRP
31.00"31.00"
9.50"9.50"
3.00"3.00"
Clean Clean
PipePenetration PipePenetration
✔✔
✔
✔
✔
✔
NANA
✔✔
✔✔
5min.5min.
0.00"0.00"
✔✔
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)
See Incon Results
79
8791DSL
36.00"36.00"36.00"
42.00"42.00"42.00"
N/AN/A N/A
20.00"20.00"20.00"
Clean Clean Clean
Pipe PenetrationPipe Penetration Pipe Penetration
FiberglassFiberglass Fiberglass
5 Min 5 Min5 Min
✔✔✔
✔✔✔
✔✔
✔
✔
✔✔
✔✔✔
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)
89
✔
✔
Lake Test 0.00"
87Fill 91Fill DSLFi
12.00"12.00"12.00"
12.00"12.00"12.00"
5min.5min.5min.
9:30 am 9:30 am
11.00"11.00"
0.00"0.00"
10:30 am 10:30 am 10:30 am
11.00"11.00"11.00"
1 Hour 1 Hour 1 Hour
11.00"
0.00"
0.00"0.00"0.00"
✔✔✔
9:30 am
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
Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests)
99
✔
✔
Lake Test 0.00"
91V
12.00"
12.00"
5min.
11.00"
0.00"
✔
12.00"
12.00"
5 min.
9:30 am
11.00"
10:30 am
1 Hour
0.00"
0.00"
✔Pass Fail
9:30 am
11.00"
10:30 am
11.00"
1 Hour
0.00"