The URL can be used to link to this page

Home My WebLink About5201 WHITE LANE (3)F.? / V7 SWRCB, January 2002 Page % of Secondary Containment Testing Report Form Thisform is intendedfor use by contractors performingperiodic testing ofUSTsecondary containment systems. Use the appropriate pages ofthisform to report results for all components tested. The completedform, written test procedures, and printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: GOOD SAMARITAN I Date ofTesting: 10/21/11 Facility Address: 5201 WHITE LANE, BAKERSFIELD Facility Contact: Phone: Date Local Agency Was Notified ofTesting: Name ofLocal Agency Inspector (tfpresent during testing): STEVE UNDERWOOD 2. TESTING CONTRACTOR INFORMATION Company Name: Rich Environmental Pass Technician Conducting Test: RICH PHILLIPS Not Tested Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester License Type: C61/1)40 A HAZ Fail License Number. 809850 Manufacturer Manufacturer Training Component(s) Date Training Expires INCON TS -STS 6/11/2012 0 0 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made DSL ANNULAR X 0 0 DSL SUPPLY SEC PIPE X 0 D 0 0 0 DSL RETURN SEC PIPE X I 1 1 DSL STP X 0 p DSL UDC X DSL FILL SUMP D X 0 0 0 DSL SPILL BOX X 0 0 0 1 0 0 0 0 0 0 0 0 0 0 D 0 0 Ifhydrostatic testing was performed, describe what was done with the water after completion oftests: CERTIFICATION OF TE IAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best ofmy knowledge, thefacts s in this document are accurate and infull compliance with legal requirements Technician's Signature: Date: 10/21/11 SWRCB, January 2002 Page 2— of a f Test Method Developed By: Tank Manufacturer X Industry Standard Professional Engineer 0 Other (Specify) Test Method Used: 0 Pressure X Vacuum 0 Hydrostatic Other (Spec) Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: Tank # DSL Is Tank Exempt From Testing?l Yes X No Tank # Tank # Tank # Yes 0 No 0 Yes No 0 Yes 0 No Tank Capacity: 1000 Tank Material: STEEL Tank Manufacturer: UNKNOWN Product Stored: DIESEL Wait time between applying pressure/vacuum/water and test: 30 MIN starting Test Start Time: 12:00 Initial Reading (R): 1 OHG Test End Time: 1:00 Final Reading (RF): l OHG Test Duration: 60 MIN Change in Reading (RF -RD: OHG Pass/Fail Threshold or Criteria: OHG Test Result: X Pass Fail Pass 0 Fail 0 Pass Fail Pass Fail Was sensor removed for testing? X Yes No 0 NA Yes No NA 0 Yes No NA Yes No 0NA Was sensor properly replaced and verified functional after testin ? X Yes No 0 NA 0 Yes 0 No NA 0 Yes No 0 NA 0 Yes No NA Comments — (include information on repairs made prior to testing, and recommendedfollow -up forfailed tests) 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, (Califomia Code of Regulations, Title 23, Section 2637(a)(6)) SWRCB, January 2002 Page I of!2— 5. SECONDARY PIPE TESTING Test Method Developed By: 0 Piping Manufacturer X Industry Standard 0 Professional Engineer 0 Other (Specify) Test Method Used: X Pressure Vacuum Hydrostatic 0 Other (Specify) Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: .5% Piping Run #DSL SUPPLY Piping Run #DSL RETURN piping Run # Piping Run # Piping Material: FIBERGLASS FIBERGLASS Piping Manufacturer: UNKNOWN UNKNOWN Piping Diameter: 3" 3" Length ofPiping Run: 50' 50' Product Stored: DIESEL, DIESEL Method and location of piping-run isolation: Wait time between applying pressure /vacuum/water and starting test: Test Start Time: Initial Reading (Rj): VISUAL FAIL VISUAL FAIL Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-R,): Pass/Fail Threshold or Criteria: Test Result: Pass X Fail Pass X Fail Pass Fail Pass 0 Fail Comments — ('include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) VISUAL FAIL CLAM SHELLS AT GENERATOR END LEAKING WHERE HARD PIPE ENDS AT TOP OF CLAM SHELLS SWRCB, January 2002 6. PIPING SUMP TESTING 41-4 19L Page of Test Method Developed By: 0 Sump Manufacturer X Industry Standard 0 Professional Engineer 0 Other (Spec) Test Method Used: 0 Pressure Vacuum X Hydrostatic 0 Other (Spec) Test Equipment Used: INCON TS-STS Equipment Resolution: Sump # DSL Sump # Sump # Sump # Sump Diameter: 77 36" Sump epth448" Sump Material: FIBERGLASS Height from Tank Top to Top of Highest Piping Penetration: 16" Height from Tank Top to Lowest Electrical Penetration: 30" Condition of sump prior to testing: CLEAN Portion of Sump Tested' 18" Does turbine shut down when sump sensor detects liquid (both product and water) ?' Yes X No NA Yes 0 No NA Yes No NA 0 Yes 0 No 0 NA Turbine shutdown response time N/A Is system programmed for fail -safe shutdown ?* 0 Yes X No DNA Yes No NA Yes 0 No NA Yes 0No 0 NA Was fail -safe verified to be operational?* Yes X No NA 0 Yes No DNA Yes No NA Yes 0No NA Wait time between applying pressure /vacuum/water and starting test: 30 MIN Test Start Time: 12:22 12:40 Initial Reading (111): 3.037 2.906 Test End Time: 12:37 12:55 Final Reading (RF): 2.929 2.761 Test Duration: 15MIN 15MIN Change in Reading (RF -Rj): 108 .145 Pass/Fail Threshold or Criteria: 002 .002 Test Result: 0 Pass X Fail 0 Pass Fail Pass 0 Fail Pass Fail Was sensor removed for testing? X Yes No NA Yes No NA 0 Yes No DNA 0 Yes No 0NA Was sensor properly replaced and verified functional after testing? X Yes 0 No 0 NA Yes No NA Yes No NA 0 Yes 0 No NA Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) SUCTION SYSTEM TESTED BELOW PENETRATIONS STILL FAILING Ifthe entire depth ofthe sump is not tested, specify how much was tested. Ifthe answer to My ofthe questions indicated with an asterisk ( *) is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160) SWRCB, January 2002 Page of 7. UNDER- DISPENSER CONTAINMENT (UDQ TESTING Test Method Developed By: UDC Manufacturer X Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure 0 Vacuum X Hydrostatic Other (Specify) Test Equipment Used: INCON TS -STS Equipment Resolution: UDC # UDC # UDC # UDC # UDC Manufacturer: UDC Material: UDC De th: 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 Tested Does turbine shut down when UDC sensor detects liquid (both product and water)?* 0 Yes No NA Yes []No NA Yes No 0 NA 0 Yes No 0 NA Turbine shutdown response time Is system programmed for fail- safe shutdown ?' yes ONO DNA Yes No NA Yes No NA Yes No NA Was fail -safe verified to be operational?* Yes No NA Yes No NA 0 Yes No NA 0 Yes No NA Wait time between applying pressure/vacuum/water and test 30MIN 30MIN 30MIN 30MIN starting Test Start Time: Initial Reading (Rj): Test End Time: Final Reading Test Duration: 15NIIN 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN 15M1N in Reading (Rf-Ri): Change Pass/Fail Threshold or Criteria: Test Result: 0 Pass 0 Fail Pass 0 Fail Pass 0 Fail Pass Fail Was sensor removed for testing? Yes No NA Yes ONO NA Yes No NA Yes No NA Was sensor properly replaced and verified functional after testing? Yes No 0 NA Yes No 0 NA 0 Yes 0 No NA Yes No NA Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) NO UDC Ifthe entire depth ofthe UDC is not tested, specify how much was tested. Ifthe answer to any ofthe questions indicated with an asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) SWRCB, January 2002 8. FILL RISER CONTAINMENT SUMP TESTING Page of Facility is Not Equipped With Fill Riser Containment Sums Fill Riser Containment Sumps are Present, but were Not Tested 0 Test Method Developed By: 0 Sump Manufacturer X Industry Standard 0 Professional Engineer Other (Spec) Test Method Used: Pressure 0 Vacuum X Hydrostatic Other (Spec) Test Equipment Used: INCON TS -STS Equipment Resolution: Fill Sump # Sum Diameter: Fill Sump # Fill Sump # Fill Sump # Sum De the Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition ofsump prior to testing: Portion of Sump Tested Sump Material: Wait time between applying pressure/vacuum /water and starting test: 30MIN 30MIN 30MIN 30MIN Test Start Time: Initial Reading (RO: Test End Time: Final Reading (R& Test Duration: 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN 15MfN 15MIN Change in Reading (RF-R ): P&%Tail Threshold or Criteria: Test Result: Pass Fail 0 Pass Fail Pass 0 Fail 0 Pass Fail Is there a sensor in the sump? 0 Yes No 0 Yes No Yes No Yes No Does the sensor alarm when either product or water is detected? Yes 0 No NA Yes 0 No NA Yes No NA Yes 0 No NA Was sensor removed for testing? Yes No NA Yes 0 No NA Yes 0No NA Yes No 0 NA Was sensor properly replaced and verified functional after testing. yes No NA Yes No NA Yes 0 No NA Yes No 0 NA Comments — (include information on repairs made prior to testing, andrecommendedfollow -upforfailed tests) N® FILL SUMPS SWRCB, January 2002 9. SPILIJOVERFILL CONTAINMENT BOXES LAy MLI Page -77— of n 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 0 Other (Spec) Test Method Used: Pressure Vacuum X Hydrostatic Other (Spec) Test Equipment Used: INCON TS -STS Equipment Resolution: Spill Box # rucket Diameter: 12" Spill Box # Spill Box # Spill Box # Depth: 14" e between applying pressure /vacuum/water and starting test: 15MIN Test Start Time: 9:00 Initial Reading W: 14" Test End Time: 10:00 Final Reading (RF): 14" Test Duration: 1 HOUR Change in Reading (RF -RD: 0 Pass/Fail Threshold or Criteria: 0 Test Result: X Pass 0 Fail 0 Pass 0 Fail 0 Pass 0 Fail 0 Pass Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) 44111LI SB989 TESTING FAILURE REPORT SITE NAME: /J -00D AM A/2 / 7-A V DATE: / U -- yl - l / ADDRESS: J' %D I LA/M 1 Z-P TECHNICIAN: RICH PIVLLIPS 13A Xe_L_4)__f THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS: 1° TA s r, o)' lam c-,(--An-) d l q tL-1-1 )--- 0'65 --A P-brJ- LABOR: PARTS INSTALLED: NAME: TITLE: SIGNATURE• THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH: ENVIRONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE.