HomeMy WebLinkAbout402 CHESTER (2)SWRCB, January 2002 Page --1— of 17
Secondary Containment Testing Report Form
Thisform is intendedfor use by contractors performing periodic testing ofUST secondary containment systems. Use the
appropriate pages ofthisform to report resultsfor all components tested The completedform, written -test procedures, and
printouts from tests (fapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
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: C61040 A HAZ License Number: 809850
Manufacturer
Manufacturer Training
Component(s) Date Training Expires
INCON TS -STS 6/11/2012
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
UNL87 ANNULAR X
PREM91 ANNULAR X 0 D 0
UNL887 SEC PIPE X EI 0 1 0
PREM 91 SEC PIPE X
UNL87 STP SUMP X D 0
PREM91 STP SUMP X
UDC # 1/2 X
UDC #3/4 X D
UNL87 FILL SUMP X 0
PREM 91 FILL SUMP X a
UNL87 VPR BOX X
PREM 91 VPR BOX X p n
Ifhydrostatic testing was performed, describe what was done with the water after completion of tests:
CERTIFICATION OF TEC -IAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best ofmy knowledge, thefacts s this document are accurate and infull compliance with legal requirements
Technician's Signature: Date: 08/18/11
SWRCB, January 2002
4. TANK ANNULAR TESTING
Page 2— of
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: 4" DIAL GAUGE
Tank 487 Tank #91
Is Tank Exempt From Testing ?` Yes XNo Yes X No
Equipment Resolution:
Tank # Tank #
Yes No Yes No
Tank Capacity: 12000 8000
Tank Material: STEEL STEEL
Tank Manufacturer: UNKNOWN UNKNOWN
Product Stored: UNL87 PREM91
Wait time between applying
pressure /vacuum/water and
starting test:
30MIN 30MIN
Test Start Time: 9:30 10:45
Initial Reading (Rj): IOHG IOHG
Test End Time: 10:30 11:45
Final Reading (RF): 10140 IOHG
Test Duration: 60 MIN 60 MIN
Change in Reading (RF -R,): 00 00
Pass/Fail "threshold or Criteria: 00 00
i. I r r i4 `.!t,l =1;"
re!!
t' f• 1, 'i s i r j'jr i i j tfi
Was sensor removed for testing? X Yes No NA X Yes No NA Yes 0 No NA Yes No NA
Was sensor properly replaced and
verified functional after testing? X Yes Q No NA X Yes No NA Yes No NA Yes No NA
Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed 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. {California Code of Regulations, Title 23,, Section 2637(a)(6))
tk 3Z\ 1
SWRCB, January g2002Page S of
5. SECONDARY PIPE TESTING
Test Method Developed By: C Piping Manufacturer X Industry Standard Professional Engineer
Other (Specify)
Test Method Used X Pressure Vacuum G Hydrostatic
Other (Specify)
Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: .5%
Piping Run #87
Piping Material: PLASTIC
Piping Run #91 Piping Run # Piping Run #
PLASTIC
Piping Manufacturer: APT APT
Piping Diameter: 1.5" 1.5"
Length of Piping Run: 75' 75'
Product Stored: UNL87 PREM91
Method and location of
piping-run isolation: BOOT IN SUMP BOOT IN SUMP
Wait time between applying
pressure /vacuum /water and
starting test:
30 MIN 30 MIN
Test Start Time: 10:45 10 :45
Initial Reading (RI): 5.5 5.5
Test End Time: 11:45 11 :45
Final Reading (Fr): 5.5 5.5
Test Duration: 60 MIN 60 MIN
Change in Reading (RF -Rj): 00 00
Pass/Fail Threshoid or
Criteria:
s
tS IL :
0 PSI
t -' n! ' 1 P0 i
0 PSI
t
Comments (include information on repairs made prior io testing, andrecommendedfollow -upforfailed tests)
437A r
c fSWRB, January 2402 Page of /
6. PIPING SUMP TESTING
Test Method Developed By: 0 Sump Manufacturer X Industry Standard Professional Engineer
D Other (Spec)
Test Method Used: 0 Pressure Vacuum X Hydrostatic
D Other (Spec)
Test Equipment Used: INCON TS -STS Equipment Resolution:
Sump #87 Sump #91 Sump # Sump #
Sump - Diameter: 37" 37"
Sump Depth: 60" 60"
Sump Material: FIBERGLASS FIBERGLASS
Height from Tank Top to Top of
Highest Piping Penetration: 26" 23"
Height from Tank Top to Lowest
Electrical Penetration: 21" 21"
Condition of sump prior to testing: CLEAN CLEAN
Portion of Sump Tested' 28" 25"
Does turbine shut down when
sump sensor detects liquid (both
product and water ?*
Yes No C NA 0 Yes No DNA Yes No NA Yes No NA
Turbine shutdown response time
Is system p ogrammed for fail -safe
shutdown?
0 yes D No DNA 0 Yes 0 No DNA 0 Yes D No D NA 0 Yes 0 No NA
Was fail -safe verified to be
o erational ?* 0 Yes No O NA Yes No DNA Yes No NA 11 Yes 0 No NA
Wait time between applying
pressure /vacuum/water and starting
test:
30 MIN 30 MIN
Test Start Time:
Initial Reading (Rj):
Test End Time:
Final Reading (RF):
Test Duration: 15MIN 15MIN 15MM 15MIN
Change in Reading (RF -Ri):
Pass/Pail Threshold or Criteria:
etRcult• .,..' ;t _ .,, 4i.i'
0 Yes No NA
rHi.
Yes No NA
lot
r,,;i'
Yes No NA C Yes C No NAWassensorremovedfortesting?
Was sensor properly replaced and
verified functional after testing? 0 yes D No D NA 0 Yes 0N NAF Yes L No DNA ED Yes No ONA
FAILING UNDER PRODUCT LINE PENETRATION
If the entire depth ofthe sump is not tested, specify how much was tested. If the answer to AU of the questions indicated with an
asterisk ( *),is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160)
SWRCB, January 2402
7. UNDER - DISPENSER CONTAINMENT (UDO TESTING
4 :)u l
Page
61"
of l
Test Method Developed By: UDC Manufacturer X Industry Standard Professional Engineer
Other (Spec)
Test Method Used: Pressure Vacuum X Hydrostatic
Other (Spec)
Test Equipment Used: INCON TS-STS Equipment Resolution:
UDC #1/2 UDC #3/4 UDC # UDC #
UDC Manufacturer: TCI TCI
UDC Material: PLASTIC PLASTIC
UDC Depth: 30" 30"
Height from UDC Bottom to Top
of Hi hest Piping Penetration:
12" 12"
Height from UDC Bottom to
Lowest Electrical Penetration:
14" 14"
Condition of UDC prior to
testing:
CLEAN CLEAN
Portion of UDC Tested 14" 14"
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?*
Yes No NA Yes No NA Yes No NA Yes No NA
Turbine shutdown response time
Is system programmed for fail-
safe shutdown ?*
Yes No NA C Yes C No NA Yes No NA Yes No NA
Was fail -safe verified to be
o rationial ?* Yes C No NA Yes No NA Yes No NA Yes No NA
Wait tim6 between applying
pressure /vacuum /water and
starting test
30MIN 30MIN
Test Start Time:
Initial Reading
Test End Time:
Final Reading Rr):
Test Duration: 15MIN 15MIN 15MIN 15MIN
Change in Reading (RF -RI):
Pass/Fail Threshold or Criteria:
Yes No NA 7Yes .
PP! .
Was sensor removed for testing? No NA Yes No C NA Yes No 7-1 NA
Was sensor properly replaced and
verified functional after testin ? C Yes No NA Yes C No C NA Yes No NA Yes No NA
Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests)
If the entire depth of the UDC is not tested, specify how much was tested. If the answer to anv 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
Lk D LA t
Page 6 .. 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: Sump Manufacturer X Industry Standard Professional Engineer
Other (Specify)
Test Method Used: Pressure Vacuum X Hydrostatic
Other (Specify)
Test Equipment Used -, TNCON TS -STS
Fill Sum # Fill Sum p#
Sump Diameter:
Equipment Resolution:
Fill Sumg # Fill Sump #
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:
30MIN 30MIN 30MIN 30MIN
Test Start Time:
Initial Reading (Rj ):
Test End Time:
Final Reading (Ry)!
Test Duration: 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN 1. 15MIN
in Reading (RF -R, ): Change
Pass/FaiI Threshold or Criteria:
s:., .:;;; : ::.::::::.:, s :::f,:..,. is z;n;• ti r
iii'.;;. d,liili;)!ii;i35i!Y,'k`li 'Ui'..,i:!'`
s there a sensor in the sump?
nt •r ijj .+
Yes No
e i. ; .
Yes No
fi• 0
Yes No
r. a+ +.1 : j +;
Yes No
Does the sensor alarm when
either product or water is
detected?
0 Yes No NA Yes No NA O Yes G No NA Yes No NA
Was sensor removed for testing? C Yes No NA Yes No NA Yes D No NA Yes No DNA
Was sensor properly replaced and
verified functional after testin ? Yes No NA Yes No NA Yes No NA Yes No NA
Comments (include information on repairs made prior (o testing, and recommendedfollow -upfor failed tests)
N® FILL SUMPS
SWRCB, January 2002
9. SPILIJOVERFELL CONTAINMENT BOXES
r) u [
Page of 13
Facility is Not Equipped With S itl /Overfill Containment Boxes
Spill /Overfill Containment Boxes are Present, but were Not Tested 0
Test Method Developed By: Spill Bucket Manufacturer X Industry Standard Professional Engineer
0 Other (Specify)
Test Method Used: 0 Pressure Vacuum X Hydrostatic
Other (Spec)
Test Equipment Used: TNCON TS -STS Equipment Resolution:
Spill Box #87 SPILL
Bucket Diameter: 12"
Spill.Box #87 VPR Spill Box #91 SPILL Spill Box 991 VPR
12" 12" 12"
Bucket Depth: 16" 16" 16" 16"
Wait time. between applying
pressure /vacuum/water and
starting test:
30MIN 30MIN 30MIN 30MTN
Test Start Time: 10:17 10:34 10:17 10:34
Initial Reading (Rt): 2.688 2.688 5.473 5.473
Test End Time: 10 :32 10:49 10:32 10:49
Final Reading (RF): 2.688 2.688 5.473 5..473
Test Duration: 15MIN I SMIN 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN
Change in Reading (RF -RJ):. 000 000 000 000
Pass /Fail Threshold or
Criteria: 002 002 002 002
@ t` !?:i,,;'.'tti, Y' i lit l• , .c i,i ' : [ 't
ANT
i • iii : i t ;t
Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests)
s
SUMP LEAK
h s:
T ;,.,T FAF 1'E' Oc'•! 10 1 1
klillV' LEUE.!. 1.7245
4D TiME
tNU 0OTE os /1$ /* Ill',
a:4
RF.SUL r I=HXL
TEST S'fAR TED
TWST TFiK't Ell 08 1$!21011
FS t_I^ :E JrL 1.r15 •iN
L!y0 TTME 1:27' Pt1
END DATE 0B/18/2a
qD _tUFL :..4277 1N
LEAK THREHOLD a.00 Ih
i r=A1LL' t?
SB989 TESTING FAILURE REPORT
SITE NAME: ONE STOP MOBIL DATE: 8/18/11
THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE
TESTING.
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 AB IFABOVELISTEDPROBLEMSANDNOTYING RICH ENVIRONMA.NTAL 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.