HomeMy WebLinkAbout3221 H STREET (6)Secondary Containment Testing Report Form
Thisform is intendedfor use by contractors peiforniiiig periodic testing of USTsecondary containment s,vstems. Use the
appropriate pages ofthis form to report resultsfor all components tested The completedform, written test procedures, and
printouts from tests (ifopplicable), should beprovided to the facility owner/operatorforsubmittal to the local regulatory agency.
1. FACILITY INFORMATION Facilitv ID: SA098
Facility Name: Pacific Bell Telephone Co. dba AT &T California Date of Testing: 3/2/2012
Facility Address: 3221 S. H STREET, Bakersfield, CA 93304
Facility Contact: Grant Armstrong Phone: (661) 327 -6903 r Initial P Repair Test
Date Local Agency Was Notified Of Testing: 2/24/2012 r 6 Month r Other
Name of Local Agency Inspector (if present during testing): Esther Duran r Triennial
2. TESTING CONTRACTOR INFORMATION
Company Name: Tait Environmental Services
Technician Conducting Test: Adolfo Aguilar
Credentials: F- CSLB Licensed Contractor r SW RC13 Licensed Tank Tester r-' ICC UST Service Technician
License Type: A B ASB C -10 HAZ License Number: 588098
Manufacturer Training
Manufacturer Component(s) Date Training Expires
ICC Technician 5238610 2/7/2013
r r r r. r r r
SA0980001 Return Secondary
3. SUMMARY OF TEST RESU LTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
SA0980001 Supply Secondary r r r r r. r r r
SA0980001 Return Secondary Fo- r" r- r r" r r- r
r r r r r r r r
r r r r r r r r
r r r r r r r r
r r r r r r r
r r rr r r r r F-
r- r r r r r r
F- r r r r r r r
If hydrostatic testing was performed, describe what was done with the water after completion of tests:
For any equipment capable of generating a print out of test results, you must attach a copy ofthe test report to this
certification r System printout attached.
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best ofmy knowledge, thefacts stated in this documen tare accurate and infull compliance with legal requirements
Technician's Signature: 1-17 ' Date: 3/2/2012
5. SECONDARY PIPE TESTING
Test Method Developed By: r Piping Manufacturer 1 Industry Standard r Professional Engineer
F Other(Specify)
Test Method Used: r Pressure r Vacuum r Hydrostatic
F Other(Specify)
Test Equipment Used: 4" Dial Gauge I Equipment Resolution: .1
W
Piping Run
SA098000I Supply
Piping Run
SA098000I Reuim
Piping Run Piping Run
Piping Material: Poly Poly
Piping Manufacturer: Western Fiberglass Western Fiberglass
Piping Diameter: 1" 1 1/2"
Length of Piping Run: Approx. 35' Approx. 35'
Product Stored: Diesel Diesel
Method and location of piping -run
isolation: Test Boot In Sump Kest Boot In Sump
Wait time between applying
pressure/vacuum/water and
starting test:
15 Minutes 15 Minutes
Test Start Time: 9:15 AM 9:15 AM
Initial Reading (Rt): 5 PSI 5 PSI
Test End Time: 10:15 A M 10:15 A M
Final Reading (R r): 5 PSI 5 PSI
Test Duration: 1 I -lour 1 1 -lour
Change in Reading (Rt.R,): 0 0
Pass/Fail Threshold or Criteria: 0 0
Test Result: F Pass r Fail r Pass r Fail r Pass r Fail r Pass r Fail
01nmen4S — (include injorniatron on repairs made prior to testing, and recommenaeajoltow -up jorjailect tests)