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HomeMy WebLinkAbout5600 AUBURN STREET (7)r SWRCB, January 2002 Page / of 2 Secondary Containment Testing Report Form This form is intendedfor use by contractors performing periodic testing of USTsecondary containment systems. Use the appropriate pages ofthisform to report results for all components tested. The completedform, written test procedures, and printouts from tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. I- FAC'ILITV INFORMATION Facility Name: n4dl4r Date of Testing: Facility Address: ,(00 Facility Contact: Phone: 71- % Date Local Agency Was Notified of Testi.ig Name of Local Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: ISLAND PETROLEUM BUILDERS, INC. Technician Conducting Test: E7C Credentials: X CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester License Type: C -10 License Number: 776846 Manufacturer Training Manufacturer Component(s) Date Training Expires INCON STS OPERATION 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made 7 STE X 0 U 0 D 0 0 0 1 0 D 0 0 i 0 0 u u Ll 0 Cl 0 0 0 0 D D 0 0 0 D' i 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 is state this docu a accurate and in full compliance with legal requirements Technician's Signature: - Date: Z o"/ r SWRCB, January 2002 6 PIPING SUMP TESTING Page ,z of Pest Method Developed By: X Sump Manufacturer 0 Industry Standard Professional Engineer Other (Spec) Test Method Used: 0 Pressure 0 Vacuum X Hydrostatic 0 Other (Specify) Test Equipment Used: INCON TS -STS y i ? -c; t - ,¢w g , r t ^Gtt Sump # Sump # Equipment Resolution: 0.0000 d".`QicN74+.e7=••k^:.'R'Y.!!k#- Surnp # Sump # Sump Diameter: Sump Depth: Sump Material: Height from "tank "fop to Top of Hi0hest piping Penetration: l Height from Tank "fop to Lowest Electrical Penetration: Condition of sump prior to testing: soL9 Portion of Sump 'tested Does turbine shut down when sump sensor detects liquid (both product and water) ? 0 Yes 0 No NA 11 0 Yes 0 No NA 0 Yes No NA 0 Yes 0 No NA Turbine shutdown response time I s system programmed for fail-safe shutdown ? Yes D No A Yes O No NA Yes 0 No 0 NA 0 Yes 0 No DNA Was fail -safe verified to be operational?' Yes No NA DYes ONo DNA OYes No DNA OYes No DNA Wait time between applying pressure /vacuum water and starting test: 30 MIN 30 MIN 30 MIN 30 MIN Test Start Time: 10! I Q.;SZ I I Initial Reading (Ri): 7257K 51 / Test End Time: Q,'S/ 111-07 I l I Final Reading (R,:): 5- /72nd I I Test Duration: 15 MIN / 15 MIN 15 MINI 15 MIN 15 MIN / 15 MIN 15 MIN / 15 MIN Change in Reading (R,: -R,): 4-,6003 !,..0 003 I l Pass /Fail Threshold or Criteria: 0.0002 0.0002 0.0002 0.0002 Test Result: Pass 0 Fail Pass 0 Fail Pass Fail Pass Fail Was sensor removed for testing? YY es 0 No C1 NA O Yes O No DNA 0 Yes O No DNA Yes 0 No 0 NA Was sensor properly replaced and verified fiutctional alter testin ? Jb( Yes No NA Yes No DNA Yes No NA 0 Yes 0 No DNA Com mentS - (include information on repairs made prior to testing, and recommendedfollow- 6" led testa) I f the entire depth of' the sump is not tested, specify how much was tested. if the answer to q_ny of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160) i iSLP.ND PETROLEUM BUILDERS, INC. Cust No CIRCLE K 8605 5600 AUBUW.! BAKERSFIELD CA 04/201/2011 10:51 AM SUM' LEAK TEST REPORT 87T'_s TEST STARTED 10:36 AM TEST STARTED 04/20/2011 BEGIN LEUEL 7.2564 IN END TIME 10:51 AM END DATE 04/20/2011 END LEVEL 7.2567 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSEL} CIRCLE K 8605 5600 AUBUY! AKERSFIELD CA 04/20/201? 11:07 AM SUMP LEAK TEST REPORT 87Tc. TEST STARTED 10:52 AM TEST STARTED 04/20/2011 SEGIN LEVEL 7.2567 IN END TIME 11:07 AM END DATE 04/20/2011 END LEUEL 7.2564 IN LEAK THRESHOLD 03.002 IN TEST RESULT PASSED Job No, 8 /%Ce Address 5(') {Qu&xir 7 Sk City: Page _ /of Island Petroleum Builders, Inc. bU E. rfancis Jt., Unit H untano, l.N Jl !blvTel: (909) 923-9373 • Fax: (909) 923 -9372 C SITE NO. PO NO. CUSTOMER NAM C /l1 3 j % V JOB NO. PAGE NO. OF ADDRESS / , 5' V ^ elkly S 1/Sf /LL L S- WAS JOB COMPLETED REPORTED PROBLEM /SE 7IRE¢ UESTED n YES NO SERVICES / REPAIRS PERFORMED MATERIAL DESCRIPTION MATERIAL QTY PRICE AMOUNT vQ ST CIRCLE h FC)CD STORE NO, ;,= TRAVELTIME TO SUBTOTAL MATERIAL MARK UP % TRAVEL TIME FROM TOTAL MATERIALTOTALTAAVELTIME OTHER CHARGES AMOUNT CONTRACTOR CONFIRMED SERVICE CALL TOTOTAL MATERIAL DATE TIME AM PM ARRIVALAT SITE TOTAL LABOR CHARGE TOTAL TRAVELTIMEPERSONCONTACTEDATSITEDEPARTURETIMEFROMSITE TOTAL MILEAGEPERSONWHOPLACEDCALLTOTALTIMEONSITE OTHER CHARGES PR1 E i . PRINT NAME S.. P E TOTAL OFF SITE TIME TOTAL SERVI 'S SIG SERVICEPERSONS SIGNATURE ORIZED SIGN E TOTAL HOURS TODAY 77-z T BAKERSFIELD CITY FIRE DEPARTMENT -- INSPECTION RECORD Post this Card at the Job Site and DO NOT Remove for Duration of Work inspection Request Phone No. (661) 326 -3979 UST NEW INSTALL DESCRIPTION DATE SIGNATURE BACKFILL 011 BMW IA PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF TANK TESTING UST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE MISC. ACTIVITY REMARKS: AST NEW INSTALL DESCRIPTION DATE SIGNATURE lr l ©D 6 I ` 11FIRMEMO 011 BMW IA AST REMOVAL DESCRIPTION DATE SIGNATURE T O'PERATI ^ 4' OF ANYY'SYSTEIIA; AL . ST1Affi, E /s-001AST SYSTEMSiSHALL BE I.WmIgg IVIiPI j ND A GEP D BrY TI Bb ERSFIEL1D C1ITOWI AtP,XRTMENT', f E DEPARTM'ENT(fjN, ALz); , BUILDING ADDRESS: rr.J $T JOB DESCRIPTION: OCCUPANCY TYPE: OWNER: iieZko PERMIT NO. CONTRACTOR: if PHONE # -Fds ',73 - ?373 FD 1743 Island Petroleum Builders, Inc. 1843 S. Campus Ave. Ontario CA 91761 Mailing: 7470 SVL Box, Victorville CA 92395 Date: May 11, 2011 To: Bakersfield Fire Department Co: Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661 - 326 -3979 Fax: 661 - 852 -2171 From: Jill Dressel Delivery by: Mail Regarding: Circle K Site 2708605 5600 Auburn Street, Bakersfield CA 93306 Attached: SB989 Re -test / Final following repairs 04/20/2011 Permit No. 11- 10000086 909.923.9373 - Fax 909.923.9372 - License No. 776846