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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: 4010 ARCO Date of Testing: 5/24/2018
Facility Address: 4010 Wible Rd. Bakersfield, Ca.
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: Advanced Compliance
Technician Conducting Test: Bradley W. Hinsley
Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester
License Type: C61/D40 License Number: 971259
Manufacturer Training
Manufacturer Component(s) Date Training Expires
Incon TS-STS 10/13/2019
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
87M STP Sump X 87M Vapor Bucket X
87S STP Sump X 87S Vapor Bucket X
91 STP Sump X 91 Vapor Bucket X
Diesel STP Sump X Diesel Vapor Bucket X
87M Fill Sump X 87M Product Line X
87S Fill Sump X 91 Product Line X
91 Fill Sump X Diesel Product Line X
Diesel Fill Sump X 87M-87S Transitional Line X
87M Fill Bucket X 87M-91 Transitional Line X
87S Fill Bucket X 91-Diesel Transitional Line X
91 Fill Bucket X 87M Annular Space X
Diesel Fill Bucket X 87S Annular Space X
If hydrostatic testing was performed, describe what was done with the water after completion of tests:
Containments were clean, water was filtered and used for future testing.
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: 5/24/2018
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.
4. FACILITY INFORMATION
Facility Name: 4010 ARCO Date of Testing: 5/24/2018
Facility Address: 4010 Wible Rd. Bakersfield, Ca.
Facility Contact: Phone:
Date Local Agency Was Notified of Testing :
Name of Local Agency Inspector (if present during testing):
5. TESTING CONTRACTOR INFORMATION
Company Name: Advanced Compliance
Technician Conducting Test: Bradley W. Hinsley
Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester
License Type: C61/D40 License Number: 971259
Manufacturer Training
Manufacturer Component(s) Date Training Expires
Incon TS-STS 10/13/2019
6. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
91 Annular Space X
Diesel Annular Space X
UDC 1-2 X
UDC 3-4 X
UDC 5-6 X
UDC 7-8 X
UDC 9-10 X
UDC 11-12 X
If hydrostatic testing was performed, describe what was done with the water after completion of tests:
Containments were clean, water was filtered and used for future testing.
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: 5/24/2018
SWRCB, January 2002 Page ____ of ____
7. TANK ANNULAR TESTING
Test Method Developed By: Tank Manufacturer X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: Pressure X Vacuum Hydrostatic
Other (Specify)
Test Equipment Used: Equipment Resolution:
Tank # 87M Tank # 87S Tank # 91 Tank # Diesel
Is Tank Exempt From Testing?1 Yes x No Yes x No Yes x No Yes x No
Tank Capacity: 10,000 10,000 10,000 10,000
Tank Material: FRP FRP FRP FRP
Tank Manufacturer: Xerxes Xerxes Xerxes Xerxes
Product Stored: 87 UL 87 UL 91 UL Diesel
Wait time between applying
pressure/vacuum/water and
starting test:
10 Min. 10 Min. 10 Min. 10 Min.
Test Start Time: 13:00 13:00 13:00 13:00
Initial Reading (RI): 10” Hg. 10” Hg. 10” Hg. 10” Hg.
Test End Time: 14:00 14:00 14:00 14:00
Final Reading (RF): 10” Hg. 10” Hg. 10” Hg. 10” Hg.
Test Duration: 1 Hr. 1 Hr. 1 Hr. 1 Hr.
Change in Reading (RF-RI): 0” Hg. 0” Hg. 0” Hg. 0” Hg.
Pass/Fail Threshold or Criteria: 2.0” Hg. 2.0” Hg. 2.0” Hg. 2.0” Hg.
Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail
Was sensor removed for testing? X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Was sensor properly replaced and
verified functional after testing? X Yes No NA X Yes No NA X Yes No NA X 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)}
SWRCB, January 2002 Page ____ of ____
8. SECONDARY PIPE TESTING
Test Method Developed By: Piping Manufacturer X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: X Pressure Vacuum Hydrostatic
Other (Specify)
Test Equipment Used: Nitrogen / Pressure Gauge Equipment Resolution:
Piping Run # 87M Pro Piping Run #91 Pro Piping Run #Dsl Pro Piping Run #87S-87M
Piping Material: Fiberglass Fiberglass Fiberglass Fiberglass
Piping Manufacturer: A/O Smith A/O Smith A/O Smith A/O Smith
Piping Diameter: 3” 3” 3” 3”
Length of Piping Run: 65’ 65’ 65’ 10’
Product Stored: 87 UL 91 UL Diesel N/A
Method and location of
piping-run isolation: Test Boot Test Boot Test Boot Test Boot
Wait time between applying
pressure/vacuum/water and
starting test:
10 Min. 10 Min. 10 Min. 10 Min.
Test Start Time: 11:30 11:30 11:30 11:30
Initial Reading (RI): 5.0 Psi. 5.0 Psi. 5.0 Psi. 5.0 Psi.
Test End Time: 12:30 12:30 12:30 12:30
Final Reading (RF): 5.0 Psi. 5.0 Psi. 5.0 Psi. 5.0 Psi.
Test Duration: 1 Hr. 1 Hr. 1 Hr. 1 Hr.
Change in Reading (RF-RI): 0.0 Psi. 0.0 Psi. 0.0 Psi. 0.0 Psi.
Pass/Fail Threshold or
Criteria: 0.2 Psi. 0.2 Psi. 0.2 Psi. 0.2 Psi.
Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail
Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests)
SWRCB, January 2002 Page ____ of ____
9. SECONDARY PIPE TESTING
Test Method Developed By: Piping Manufacturer X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: X Pressure Vacuum Hydrostatic
Other (Specify)
Test Equipment Used: Nitrogen / Pressure Gauge Equipment Resolution:
Piping Run # 87M-91 Piping Run # 91-Dsl Piping Run # Piping Run #
Piping Material: Fiberglass Fiberglass
Piping Manufacturer: A/O Smith A/O Smith
Piping Diameter: 3” 3”
Length of Piping Run: 10’ 10’
Product Stored: N/A N/A
Method and location of
piping-run isolation: Test Boot Test Boot
Wait time between applying
pressure/vacuum/water and
starting test:
10 Min. 10 Min.
Test Start Time: 11:30 11:30
Initial Reading (RI): 5.0 Psi. 5.0 Psi.
Test End Time: 12:30 12:30
Final Reading (RF): 5.0 Psi. 5.0 Psi.
Test Duration: 1 Hr. 1 Hr.
Change in Reading (RF-RI): 0.0 Psi. 0.0 Psi.
Pass/Fail Threshold or
Criteria: 0.2 Psi. 0.2 Psi.
Test Result: X Pass Fail X Pass Fail Pass Fail Pass Fail
C – Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests)
SWRCB, January 2002 Page ____ of ____
10. PIPING SUMP TESTING
Test Method Developed By: Sump Manufacturer X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: Pressure Vacuum X Hydrostatic
Other (Specify)
Test Equipment Used: Incon TS-STS Equipment Resolution: 0.0002
Sump # 87M STP Sump # 87S STP Sump # 91 STP Sump # Diesel STP
Sump Diameter: 48” 48” 48” 48”
Sump Depth: 66” 67” 67” 68”
Sump Material: FRP FRP FRP FRP
Height from Tank Top to Top of
Highest Piping Penetration: 31” 30” 30” 28”
Height from Tank Top to Lowest
Electrical Penetration: 15” 15” 14” 16”
Condition of sump prior to testing: Clean Clean Clean Clean
Portion of Sump Tested1 50% 50% 50% 50%
Does turbine shut down when
sump sensor detects liquid (both
product and water)?*
X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Turbine shutdown response time 3 Sec. 3 Sec. 3 Sec. 3 Sec.
Is system programmed for fail-safe
shutdown?* X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Was fail-safe verified to be
operational?* X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Wait time between applying
pressure/vacuum/water and starting
test:
10 Min. 10 Min.
10 Min.
10 Min.
Test Start Time: 14:41 17:38 16:48 16:06
Initial Reading (RI): 3.4500 6.3719 5.5723 4.2543
Test End Time: 14:56 17:53 17:03 16:21
Final Reading (RF): 3.4507 6.3714 5.5731 4.2540
Test Duration: 15 Min. 15 Min. 15 Min. 15 Min.
Change in Reading (RF-RI): 0.0007 0.0005 0.0008 0.0003
Pass/Fail Threshold or Criteria: 0.002 0.002 0.002 0.002
Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail
Was sensor removed for testing? X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Was sensor properly replaced and
verified functional after testing? X Yes No NA X Yes No NA X Yes No NA X 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)
SWRCB, January 2002 Page ____ of ____
11. UNDER-DISPENSER CONTAINMENT (UDC) TESTING
Test Method Developed By: UDC Manufacturer X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: Pressure Vacuum X Hydrostatic
Other (Specify)
Test Equipment Used: Incon TS-STS Equipment Resolution: 0.0002
UDC # 1-2 UDC # 3-4 UDC # 5-6 UDC # 7-8
UDC Manufacturer: Unknown Unknown Unknown Unknown
UDC Material: FRP FRP FRP FRP
UDC Depth: 15” 15” 15” 15”
Height from UDC Bottom to Top
of Highest Piping Penetration:
N/A N/A N/A N/A
Height from UDC Bottom to
Lowest Electrical Penetration:
N/A N/A N/A N/A
Condition of UDC prior to
testing:
Clean Clean Clean Clean
Portion of UDC Tested1 50% 50% 50% 50%
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?*
X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Turbine shutdown response time 3 Seconds 3 Seconds 3 Seconds 3 Seconds
Is system programmed for fail-
safe shutdown?* X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Was fail-safe verified to be
operational?* X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Wait time between applying
pressure/vacuum/water and
starting test
10 Min.
10 Min.
10 Min.
10 Min.
Test Start Time: 06:40 06:40 06:40 07:30
Initial Reading (RI): 1.9177 2.1482 0.5801 2.1818
Test End Time: 06:55 06:55 06:55 07:45
Final Reading (RF): 1.9176 2.1484 0.5800 2.1810
Test Duration: 15 Min. 15 Min. 15 Min. 15 Min.
Change in Reading (RF-RI): 0.0001 0.0002 0.0001 0.0008
Pass/Fail Threshold or Criteria: 0.002 0.002 0.002 0.002
Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail
Was sensor removed for testing? X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Was sensor properly replaced and
verified functional after testing? X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests)
SWRCB, January 2002 Page ____ of ____
12. UNDER-DISPENSER CONTAINMENT (UDC) TESTING
Test Method Developed By: UDC Manufacturer X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: Pressure Vacuum X Hydrostatic
Other (Specify)
Test Equipment Used: Incon TS-STS Equipment Resolution: 0.0002
UDC # 9-10 UDC # 11-12 UDC # UDC #
UDC Manufacturer: Unknown Unknown
UDC Material: FRP FRP
UDC Depth: 15” 15”
Height from UDC Bottom to Top
of Highest Piping Penetration:
N/A N/A
Height from UDC Bottom to
Lowest Electrical Penetration:
N/A N/A
Condition of UDC prior to
testing:
Clean Clean
Portion of UDC Tested1 50% 50%
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?*
X Yes No NA X Yes No NA Yes No NA Yes No NA
Turbine shutdown response time 3 Seconds 3 Seconds
Is system programmed for fail-
safe shutdown?* X Yes No NA X Yes No NA Yes No NA Yes No NA
Was fail-safe verified to be
operational?* X Yes No NA X Yes No NA Yes No NA Yes No NA
Wait time between applying
pressure/vacuum/water and
starting test
10 Min.
10 Min.
Test Start Time: 08:05 07:30
Initial Reading (RI): 1.5171 2.7754
Test End Time: 08:20 07:45
Final Reading (RF): 1.5181 2.7750
Test Duration: 15 Min. 15 Min.
Change in Reading (RF-RI): 0.0010 0.0004
Pass/Fail Threshold or Criteria: 0.002 0.002
Test Result: X Pass Fail X Pass Fail Pass Fail Pass Fail
Was sensor removed for testing? X Yes No NA X Yes No NA Yes No NA Yes No NA
Was sensor properly replaced and
verified functional after testing? X Yes No NA X 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
SWRCB, January 2002 Page ____ of ____
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 X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: Pressure Vacuum X Hydrostatic
Other (Specify)
Test Equipment Used: Incon TS-STS Equipment Resolution: 0.0002
Fill Sump #87M Fill Fill Sump #87S Fill Fill Sump #91 Fill Fill Sump #Diesel
Sump Diameter: 42” 42” 42” 42”
Sump Depth: 63” 65” 65” 64”
Height from Tank Top to Top of
Highest Piping Penetration:
N/A N/A N/A N/A
Height from Tank Top to Lowest
Electrical Penetration:
14” 14” 14” 14”
Condition of sump prior to
testing:
Clean Clean Clean Clean
Portion of Sump Tested 35% 35% 35% 35%
Sump Material: FRP FRP FRP FRP
Wait time between applying
pressure/vacuum/water and
starting test:
10 Min.
10 Min.
10 Min.
10 Min.
Test Start Time: 15:22 15:22 15:22 16:06
Initial Reading (RI): 4.6228 5.7170 5.3281 5.6381
Test End Time: 15:37 15:37 15:37 16:21
Final Reading (RF): 4.6212 5.7165 5.3289 5.6381
Test Duration: 15 Min. 15 Min. 15 Min. 15 Min.
Change in Reading (RF-RI): 0.0016 0.0005 0.0008 0.0000
Pass/Fail Threshold or Criteria: 0.002 0.002 0.002 0.002
Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail
Is there a sensor in the sump? X Yes No X Yes No X Yes No X Yes No
Does the sensor alarm when
either product or water is
detected?
X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Was sensor removed for testing? X Yes No NA X Yes No NA X Yes No NA X Yes No NA
Was sensor properly replaced and
verified functional after testing? Yes X No NA X Yes No NA X Yes No NA X Yes No NA
Comments – 87M Fill 208 sensor went into alarm when placed back into sump after testing, and will not go out of
alarm. Needs to be replaced.
SWRCB, January 2002 Page ____ of ____
13. 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 X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: Pressure Vacuum X Hydrostatic
Other (Specify)
Test Equipment Used: Incon TS-STS Equipment Resolution: 0.0002
Spill Box # 87M FB Spill Box # 87S FB Spill Box # 91 FB Spill Box # Dsl FB
Bucket Diameter: 12” 12” 12” 12”
Bucket Depth: 12” 12” 12” 12”
Wait time between applying
pressure/vacuum/water and
starting test:
10 Min. 10 Min. 10 Min. 10 Min.
Test Start Time: 13:03 12:45 13:28 13:54
Initial Reading (RI): 5.2988 7.2332 7.5109 6.3556
Test End Time: 13:18 13:00 13:43 14:09
Final Reading (RF): 5.2985 7.2340 7.5109 6.3546
Test Duration: 15 Min. 15 Min. 15 Min. 15 Min.
Change in Reading (RF-RI): 0.0003 0.0008 0.0000 0.0010
Pass/Fail Threshold or
Criteria:
0.002 0.002 0.002 0.002
Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail
Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests)
SWRCB, January 2002 Page ____ of ____
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 X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: Pressure Vacuum X Hydrostatic
Other (Specify)
Test Equipment Used: Incon TS-STS Equipment Resolution: 0.0002
Spill Box # 87M VB Spill Box # 87S VB Spill Box # 91 VB Spill Box # Dsl VB
Bucket Diameter: 12” 12” 12” 12”
Bucket Depth: 12” 12” 12” 12”
Wait time between applying
pressure/vacuum/water and
starting test:
10 Min. 10 Min. 10 Min. 10 Min.
Test Start Time: 14:21 13:28 Visual 14:41
Initial Reading (RI): 3.9118 4.9361 Failure 5.7994
Test End Time: 14:36 13:43 14:56
Final Reading (RF): 3.9136 4.9361 5.7997
Test Duration: 15 Min. 15 Min. 15 Min.
Change in Reading (RF-RI): 0.0018 0.0000 0.0003
Pass/Fail Threshold or
Criteria:
0.002 0.002 0.002
Test Result: X Pass Fail X Pass Fail Pass X Fail X Pass Fail
Comments – 91 Vapor Bucket was leaking out of the bottom of the bucket. Visual Failure.