HomeMy WebLinkAbout4203 MING AVENUE (7)SWRCB, January 2002
P,95S
Page of
Secondary Containment Testing Report Form
Thisform is intendedfor use by contractors performing periodic testing of UST secondary containment systems. Use the
appropriate pages ofthisform to report resultsfor all components tested. The completedform, written test procedures, and
printouts from tests (f applicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: M &S Enterprises Date of Testing: 5/23/12
Facility Address: 4203 Ming Ave.
Facility Contact: Augustine Phone: 661- 834 -1076
Date Local Agency Was Notified of Testing: 5/2/12
Name of Local Agency Inspector (ifpresent during testing):
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services
Pass Fail
Technician Conducting Test: Frank J Landa
Repairs
Made Component
Credentials: x CSLB Licensed Contractor SWRCB Licensed Tank Tester
Not
Tested
License Type: CSLB
87 N. Secondary
License Number:804904
Manufacturer
Manufacturer Trainin:?
Component(s) Date Training Expires
Franklin Fueling TS -STS 9/20/12
UST Service
technician
ICC 2/2/13
Star. Smith. Fibercast Fiber Glass Systems N.A.
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
87 N. Secondary X
87 South Syphon Secondary X
El El El
If hydrostatic testing was performed, describe what was done with the water after completion oftests:
Water was out back into test trailer and waste drum
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To Ilse best ofmy knowledge, thefacts stated in this.,46cument are accurate and infull compliance with legal requirements
Technician's SienatureJ Date: 5/23/12
SWRCB, January 2002
5. SECONDARY PIPE TESTING
Page of
Test Method Developed By: Piping Manufacturer x Industry Standard Professional Engineer
Other (Sped)
Test Method Used: x Pressure Vacuum Hydrostatic
Other (Spec)
Test Equipment Used: Calibrated Gages Equipment Resolution:0.0625"
Piping Run #87 north Piping Run #87
S.Syphon Piping Run# Piping Run #
Piping Material: Fiberglass Fiberglass
Piping Manufacturer: Smith Smith
Piping Diameter: 3" 3"
Length of Piping Run: 200' 5'
Product Stored: None Regular
Method and location of
piping-run isolation: Boot in stp Boot in stp
Wait time between applying
pressure /vacuum/water and
starting test:
5 Min. 5 Min.
Test Start Time: Exempt from testing 10:00 am
Initial Reading (R,): See notes 5 Psi
Test End Time: 11:00 am
Final Reading (RF): 5 Psi
Test Duration: I hr
Change in Reading (RF -R,): 0.00
Pass /Fail Threshold or
Criteria: 0.00" 0.00"
Test Result: Pass Fail X Pass Fail Pass Fail Pass Fail
Comments — (include information on repairs made prior to testing, and recommendedfollow -upforjailed tests)
87 North Sec. is exempt from testing. Line not connected to turbin
87 South siphon line passed, installed (1) 3.5x2.4 split boot, and (1) 3.5x2.6 split
boot