HomeMy WebLinkAbout4200 ASHE ROAD (7)SWRCB, January 2002 Page-L of
Secondary Containment Testing Report Form
Thisform is intendedfor use by contractors performingperiodic resting ofUSTsecondary containment systems. Usa the
appropriate pages ofthisform to report resultsfor all components tested The completedform, written testprocedures, andprintoutsfromtests (1fapplicable), should beprovided to thefacility owner /operatorfor submittal to the local regulatory agency.
i 1FAt1YT.TTV 1NW('jRMATION
Facilit Name: 4 t"4 FN.y _ U i571f - - G L - 1947VA4 Date ofTestin :
Facility Address: y)eo i C9-
Facility Contact: Phone:
Date Local Agency Was Notified ofTesting:
Name of Local Agency Inspector (Ifpresent during testing):
2 TESTING CONTRACTOR INFORMATION
Company Name: RICH ENVIRONMENTAL
I Pass
Technician Conducting Test: ty,.,; on-5
Not
Tested
Credentials: 3CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester
License Type. C611D40
ManLfacturer
Manufacturer
License Number: 809850
Training
C m onen s Date Traininp. Expires
INCON INCON TS -STS
tiL, 7 ig 1 L vt.K
3. SUMMARY OF TEST RESULTS
Component I Pass Fail Not
Tested
Repairs
Made Component Pass Fall Not
Tested
Repairs
Made
tiL, 7 ig 1 L vt.K
L64,WE ot_ SE for g U
t. 7 Sir(. C7 OIL PffE 1&-te i0
bsls1 Ste. 9 0 0 ort. ILL J,--ijf 0 R1
0 0 D CJ
0 0
vi0 c, i -J fA U
uD 3- y o r1
D,FS6 %G Scy-
0 0 0
0 El 1j
Ifhydrostatic testing was performed, describe what was done with the water after completion oftests:
RECYCLE AND REUSFD
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best ofmy knowledge, thefacts .crated in this document are accurate and In, full compliance will: legal requirements
Technician's Signature: Date:
SWRCB, January 2002
d. TANK ANNULAR TESTING
Lebo
Page Of
Test Method Developed By: Tank Manufacturer Industry Standard Professional Engineer
0 Other (Spect&)
Test Method Used: Pressure IM Vacuum Hydrostatic
d Other (Specify)
Test Equipment Used: 41n. DIAL GAUGE Equipment Resolution: . 5%
t 4; ' / fi
r V
Tank Tank# Tank# Tank# PXSEL.
Is Tank Exempt From Testing ?' Cl Yes 9 No El Yes Sd No Yes No 0 Yes [,No*
rank Capacity: 000 iapOp O
Tank Material: 5MEL Sri S7
Tank Manufacturer: v v vew"O V K o..
Product Stored: vtit_ ') Q16S£t, w 014-
Wait time between applying
pressure/vacuum /water and
starting test:
30 ' 3d..• -v 3010-1
Test Start Time: AO
Initial Reading (Rj):
Test End Time: j , Al y
Fiiial Reading (R[:):
Test Duration:
Change in Reading (RF -&): J 046 d
Pass /Fail Threshold or Criteria: 0/14 046
Test Result; R Pass Fail OZPass D Fail e Pass Fail Pass r] Fail
Was sensor removed for testing? Yes 0 No NA KYes No NA Yes No NA 0 Yes 0 No C NA
Was sensor properly replaced and
verified functional after testing? yes D No NA XYes 0 No NA b Yes No DNA Yes No 0 NA
Comments— (include 4Vormation on repairs mode prior to testing and recomniendedfollow -u 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. (Californ ia Code ofRegulations. Title 23, Section 2637(a)(6)1
S WRCB, January 2002
5. SECONDARY PIPE TESTING
a. \b8o
Page —L of 7
Test Method Developed By: 0 Piping Manufacturer id Industry Standard 0 Professional Engineer
0 Other (Specj&)
Test Method Used: 11 Pressure 0 Vacuum Ei Hydrostatic
0 Other (Specify)
Test Equipment Used: 4 in. DIAL GAUGE
Piping Run # Piping Run # 05 L
Equipment Resolution: . 5%
Piping Run Na Piping Run #
Piping Material: Fj 6A26 LA j Ft
Piping Manufacturer:
Piping Diameter:
Length ofPiping Run:
Product Stored:
Method and location of
i in -run isolation: 04271 , S iv
Wait time between applying
pressure/vacuum /water and
starting test:
36 ..,1 • %.j
UT
Test Start 'time: 10.Q—
Initial Reading (111): S)
Test End Time: Q Je
Final Reading (Rr): L /
Test Duration: v 7
Change in Reading (RF-R,): Q S 1 0 p5 /
Pass/Fail Threshold or
Criteria: GP5 / lJ 1
Test Result: Pass 0 Fall Pass 0 Fall O Pass 0 Fail 0 Pass 0 Fall
Comments — (include information on repairs madeprior to testing, andrecommendedfollow -upforfailedtests)
SWRCB, January 2002
6. PIPING SUMP TESTING
a.M107A:
Page l_I of
Test Method Developed By: Sump Manufacturer ® Industry Standard Professional Engineer
D Other (Spec(fy)
Test Method Used: Pressure 'Vacuum A] Hydrostatic
0 Other (Specie)
Test Equipment Used: INCON TS—STSTS—STS
Sump Sump # DS L
Equipment Resolution: , Ooo in .
Sump #.W /p Sump #
Sump Diameter:
Sump Depth:
Suinp Material: 1 I
Height from Tank Top to Top of
Highest Pieing Penetration:
Height from Tank Top to Lowest
Electrical Penetration:
Condition ofsump prior to testing:
Portion of Sump Tested'
Does turbine shut down when
sump sensor detects liquid (both
product and water ?.
R4Yes D No NA JXYes DNo DNA D Yes 0No DNA D Yes 0140 DNA
Turbine shutdown response time
Is system programmed for fail -safe
shutdown?* Yes 0 No NA 9 Yes DNo DNA 0 Yes ONO ONA O Yes No DNA
Was fail -safe verified to. be
operational? . JC Yes D No DNA JOYes DNo NA Yes No DNA 1 Yes DNo NA
Wait time between applying
pressure/vacuum /water and starting
test:
J ) M , n J 36) ,-1 • v N- n
r
Tcst Start Time: 07oey... 10. 14— U / 1214^
Initial Reading (R,): 61171"&„• w • v
Test End Tinte: l : 0i— s1l
Final Reading (RF): Q,.> y
Test Duration: v t .ti GA-1
Change in Reading (Rr -R,): pap, , Do at`; doo....0 , u
Pass/Fail Threshold or Criteria: p,, v ,, y • N
Test Result: Z Pass Fail Pass D Fall Pass Fait D Pass Fall
Was sensor removed for testing? Yes DNo DNA Yes DNo DNA OYes DNo 0 N Yes DNo DNA
Was sensor properly replaced and
verified functional after testing? Yes 0 No NA JWYes DNo DNA Yes No NA Yes DNo DNA
Comments — (include information on repairs made prior to testing andrecommendedfollow -upforfailed Tests)
If the entire depth of the sump is not tested, specify how much was tested. Ifthe answer to any of the questions indicated with anasterisk (•) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG -160)
SWRCB, January 2002
7. UNDER - DISPENSER CONTAINMENT (UDQ TESTING
aye )0
Page of?
Test Method Developed By: UDC Manufacturer Id Industry Standard Professional Engineer
Other (Spec)
Test Method Used: 0 Pressure D Vacuum 5 Hydrostatic
Other (S ec)
Test Equipment Used: INCON TS —STS
UDC # /—,A UDC #
Equipment Resolution: .000in.
UDC H UDC #
UDCManufacturer. w"-'
UDC Material' 514 01 L4 LK S
UDC Depth-, ol 7,
Height from UDC Bottom to Top
of Highest Piping Penetration:
a p
Height from UDC Bottom to
Lowest Electrical Penetration:
Condition of UDC prior to
testing: L ^t i) ' t LJg: +-V
Portion ofUDC Tested v
Does turbine shut down when
UDC sensor detects liquid (both
product and water )f
IdYes No NA Wes No NA Yes No Cl NA 0 Yes 0 No NA
Turbine shutdown response time L G
Is system programmed for fail-
safe shutdown?* 9Yes ONo NA TdYes ONo DNA Yes ONo DNA Yes ONo DNA
Was fail -safe verified to be
operational?* W Yes No 0 NA XYes No NA Yes 0No D NA Yes 0 No 0 NA
Wait time between applying
pressure /vacuunVwater and
starting test
Test Start Time:
Initial Reading ( N .v 7•Yyi ° i 1.1) •+
Test End Time:
Final Reading F): 7, y
Test Duration: j ti
Change in Reading RF -RI); 00,v ew,•J
Pass/Fail Threshold or Criteria: 00 .,, a. od .,t d0 •v
Teat Result: 19 Pass 0 Fail A Pass Fail Pass Fait Pass 0 Fail
Was sensor removed for testing? Yes 0 No 0 NA Z Yes 0N NA 0 Yes No DNA 0 Yes 0N E) NA
Was sensor properly replaced and
verifiedfied functional after testi T Yes No 0 NA VYes 0 No 0 NA Cl Yes ONo DNA_ D Yes ONo NA
Comments — (include infOrmation on repairs made prior to testing and recommendedjollow -up forjailed tests)
Ifthe entire depth of the UDC is not tested, specify how much was tested. If the 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
A vyur. RiCF.R r0NTATNMFNT SUMP TESTING
Page (S of 1
Facility is Not Equipped With Fill Riser Containment Sums 0
Fill Riser Containment Sum s are Present, but were Not Tested 0
Test Method Developed By: Sump Manufacturer 31ndustry Standard 0 Professional Engineer
D Other (Specify)
Test Method Used: Pressure D Vacuum 9 Hydrostatic
Other (Spec)
Test Equipment Used: INCON TS —STS
Fill Sum # Fill Sump# l7$l__.
Equipment Resolution: .000in.
Fill Sump #tJ 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: rte J
Test Start Time:
Initial Reading Fr):
Test End Time:
Final Reading RF ):
Test Duration:
Change in Readin R,):
Pass/Fail Threshold or Criteria:
Test Result: Pass 0 Fail Pass Fail 0 Pass 0 Fail D Pass 0 Fall
Is there a sensor in the sump? Yes No 0 Yes DNo 0 Yes DNo Yes 0 No
Does the sensor alarm when
either product or water is
detected?
D Yes No DNA O Yes 0 No NA Yes No DNA 0 Yes 0 No n NA
Was sensor removed for testin ? 0 Yes No DNA D Yes DNo NA yes DNo NA Yes No NA
Was sensor properly replaced and
verified functional after testing? Dyes No 0 NA DYes DNo DNA Yes DNo DNA 0 Yes DNo I?NA
Comments — (include information on repairs made prior to Jesting, andrecommended follow -upfor ailed tests)
VD FILL Sjej
SWRCB, January 2002
o SPILUOVERFILL CONTAINMENT BOXES
Page -7 of
Facility is Not EAuipped With S ilUOverfi1I Containment Boxes 0
Spill /Overfill Containment Boxes are Present, but were Not Tested
Test Method Developed By: 0 Spill Bucket Manufacturer
0 Other (Speci
2 Industry Standard Professional Engineer
Test Method Used: 0 Pressure
Other (Specify)
Vacuum 99 Hydrostatic
Test Equipment Used, INCON TS -STS
Spill BOX #Vff Spill Box #
Bucket Diameter: ,ti
Equipment Resolution: • 000in .
Spill Box # Spill Box #
Bucket Depth:
Wait time between applying
pressure/vacuum /water and
startin test:
Test Stan Time:
Initial Reading (Ra): 7. >iaj.v 7•,•+
Test End Time:
Final Reading (R}): 7.Ytd.v 7.300,
Test Duration: J I Is--% n^)
Change in Reading (RF-Rt): pp),v v
Pass/Fail Threshold or
Criteria: moo), , Cdol •'
Test Result: A Pass 0 Fail Pass Fall 0 Pass 0 Fail 0 Pass p Fail
Comments - (include informatlon on repairs mode prior to testing and recommendedfollow -upforjailed tests)
DSLSTP
TEST STARTED 10:15 AM
TEST STARTED 04/09/2007
BEGIN LEVEL 5.3680 IN
END TIME 10:31 AM
END DATE 04/09/2007
END LEVEL 5.3687 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED
DSLSTP
TEST STARTED 10:31 AMTESTSTARTED04/09/2007BEGINLEVEL5.3686 INENDTIME10:47 AMENDDATE04/09/2007ENDLEVEL5.3696 INLEAKTHRESHOLD0.002 INTESTRESULTPASSED
87STP
TEST STARTED 10:00 AM
TEST STARTED 04/09/2007
REGTN i_EVEL 6.7662 IN
END TIME 10:15 AM
FND DATE 04/09/2007
END LEVEL 6.7664 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED
87STP
TEST STARTED 10:31 AMTESTSTARTED04/09/2007BEGINLEVEL5,7684 INENDTIME10:47 AMENDDATE04/09/2007ENDLEVEL6.7703 INLEAKTHRESHOLD0.002 INTESTRESULTPASSED
DANAMA BUENA VISTA
4200 ASHE RD
3AKERSFIELD
04/09/2007 10:31 AM
SUMP LEAK TEST REPORT
87VAP
TEST STARTED 10:15 AM
TEST STARTED 04/09/2007
BEGIN LEVEL 7.2137 IN
END TIME 10:31 AM
END DATE 04/09/2007
END LEVEL 7.2185 IN
LEAK, THRESHOLD 0.002 IN
TEST RESULT PASSED
NAM RUENA VISTA4200ASHERD6AKERSFIELD
04/09/2007 11:11 AM
U'1? '_EAK TEST REPORT
37VAP
TEST STARTED 10 :56 AMTESTSTARTED04/09/20037BEGINLEVEL7.2003 INENDTIME11:11 ANENDDATE04/09/2007ENDLEVEL7.2002 INLEAKTHRESHOLD0.002 INTESTRESULTPASSED
i
r
ANAMA 9UENA VISTA
4200 ASHE RD
3AKERSFIELD
04:09/200? 11:55 AM
SIJMP i_EAK TEST REPORT
TEST STARTED 11:40 AM
TEST STARTED 04/09/2007.
BEGIN LEVEL 7.4469 IN
END TIME 11:55 AM
END DATE 04/09/2007
END LEVEL 7.4479 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT. PASSED
3 -4
TEST STARTED 11:40 AM
TEST STARTED 04/09/2007
BEGIN LEVEL 2.7723 IN
END TIME 11:55 AM
END DATE 04/09/2007
ND LEVEL 2.7726 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED
ANAMA BUENA VISTA
4200 ASHE RD
3AKERSFIELD
84/09'2007 12:13 PM
SUMP _EAK TEST REPORT
1 -2
TEST STARTED 1158 AM
TEST STARTED 04/09/2007
BEGIN LEVEL 7.4478 IN
END TIME 12:13 PM
END DATE 04/09/2007
END LEVEL 7.4481 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED
3 -4
TEST STARTED 11 :58 AM
TEST STARTED 04/09/2007
BEGIN LEVEL 2.7727 IN
END TIME 12:13 PM
END DATE 04/09/2007
END LEVEL 2.7724 IN
LEAK THRESHOLD 0.002 IN
T73T RESULT PASSED
P(2-1 v7'-
S)6/L/
SB989 TESTING FAILURE REPORT
SITE NAME: 14A &n4 608+4 VIS" TL/VWI- dlJMt;j DATE: 4f-
ADDRESS: y)yV &MC 40 TECHNICIAN: /QY4'U a 1 sa v
CITY:
SITE CONTACT:
THE FOLLOWING COMPONENTS WERE REPLACED /REPAIRED TO COMPLETE THE SB989
TESTING•
LIST OF PARTS REPLACED / REPAIRED:
REPAIR$:
LABOR:
14-,O t"C
PARTS INSTALLED:
votIJ5
WE
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