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Home My WebLink About3460 SILLECT AVENUESWRCB January 2002 Page of Secondary Containment Testing Report Form Thisform is intendedfor use by contractors performing periodic testing of USTsecondary containment systems. Use the appropriate pages ofthisform to report resultsfor all components tested The completedform, written testprocedures, and printoutsfrom tests (ifapplicable), should beprovided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION 2. TESTING CONTRACTOR INFORMATION Company Name: Rich Environmental Technician Conducting Test: JAMES J RICH Credentials: X CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester License Type: C6 iD40 A HAZ License Number: 809850 Manufacturer Training Manufacturer Component(s) Date Training Expires INCON TS -STS 6/25/2014 3. SUMMARY OF TEST RESULTS Component Facility Name: ORANGE BELT STAGES I Date ofTesting: 6/25/12 Facility Address: 3640 SILLECT AVENUE, BAKERSFIELD Facility Contact: Phone: Date Local Agency Was Notified of Testing: Name ofLocal Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Rich Environmental Technician Conducting Test: JAMES J RICH Credentials: X CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester License Type: C6 iD40 A HAZ License Number: 809850 Manufacturer Training Manufacturer Component(s) Date Training Expires INCON TS -STS 6/25/2014 3. SUMMARY OF TEST RESULTS Component UP111A NI 0000; nninnn SECONDARY nuo noon nnn n; aoAO nno nnn nnmo ninnnn r.nnntn mom If hydrostatic testing was performed, describe what was done with the water after completion oftests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best ofmy knowledge, thefacts stated in this document are accurate and infull compliance with legal requirements Technician's Signature: Date: 6/25/12 7 / SWRCB, January 2002 4. TANK ANNULAR TESTING 06x54 J Page 1Yof I Test Method Developed By: Tank Manufacturer X Industry Standard Professional Engineer Other (Sped) Test Method Used: Pressure X Vacuum Hydrostatic Other (Sped) Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: Tank # DIESEL Is Tank Exempt From Testing ?` X Yes No Tank # Tank # Tank # Yes No Yes No Yes No Tank Capacity: Tank Material: Tank Manufacturer: Product Stored: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (Rj): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF -Rj): Pass/Fail Threshold or Criteria: Test Result: Pass Fail Pass Fail Pass Fail Pass Fail Was sensor removed for testing? Yes No NA Yes No NA Yes No NA Yes No NA Was sensor properly replaced and verified functional after testing? yes No NA rOYes No NA Yes No NA Yes No NA Comments — (include information on repairs made prior to testing, and recommendedfollow -upfor failed 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)1 SWRCB, January 2002 5. SECONDARY PIPE TESTING 4b95q // Page 3 of I Test Method Developed By: Piping Manufacturer X Industry Standard Professional Engineer Other (Spec) Test Method Used: X Pressure 0 Vacuum Hydrostatic Other (Sped) Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: .5% Piping Run # DSL Piping Material: FIBERGLASS Piping Run # Piping Run # Piping Run # Piping Manufacturer: AO SMITH Piping Diameter. 2" Length ofPiping Run: 20' Product Stored: DIESEL Method and location of i in -run isolation: TEST BOOT rN STP Wait time between applying pressure/vacuum/water and starting test: 30 MIN Test Start Time: 10:00 Initial Reading (Rz): 5 Test End Time: 11:00 Final Reading (RF): 5 Test Duration: 60 MIN Change in Reading (RF -R,): 0 Pass/Fail Threshold or Criteria: 0 Test Result: X Pass 0 Fail Pass Fall. 0 Pass 0 Fail Q Pass 0 Fail COMMentS — (include information on repairs made prior to testing, andrecommendedfollow -upforfailed tests) SWRCB, January 2002 6_ PIPING SITMP TF.9T1NG 4b0v5q Page q ^ / of L Test Method Developed By: Sump Manufacturer X Industry Standard Professional Engineer 0 Other (Spec) Test Method Used: Pressure D Vacuum X Hydrostatic Other (Spec) Test Equipment Used: INCON TS -STS Equipment Resolution: Sump # DSL Sump # Sump # Sump 4 Sump Diameter. 36" Sump Depth: 36" Sump Material: FIBERGLASS Height from Tank Top to Top of Highest Piping Penetration: 20" Height from Tank Top to Lowest Electrical Penetration: 36" Condition ofsump prior to testing: CLEAN Portion of Sump Tested' 50% Does turbine shut down when sump sensor detects liquid (both product and water) ?* X Yes 0 No NA Yes No D NA Yes D No NA Yes No NA Turbine shutdown response time 2SEC Is system programmed for fail -safe shutdown? X Yes D No DNA Yes No NA 0 Yes D No NA D Yes 0 No DNA Was fail -safe verified to be operational?* X Yes No NA D Yes No NA D Yes D No NA 0 Yes No NA Wait time between applying pressure/vacuum /water and starting test: 30 MIN Test Start Time: 10:47 11:04 Initial Reading (Rj): 2.491 2.491 Test End Time: 11:02 11:19 Final Reading (RF): 2.491 2.492 Test Duration: 15MIN 15MIN Change in Reading (RF -RI): 000 001 Pass/FaiI Threshold or Criteria: 002 002 Test Result: X Pass D Fail l Pass Fail Pass Fail Pass Fail Was sensor removed for testing? X Yes No D NA D Yes D No D NA D Yes D No D NA D Yes No NA Was sensor properly replaced and verified functional after testing? X Yes No NA C1 Yes No 0 NA D Yes =No(] D Yes D No NA Comments — (include information on repairs madeprior to testing, and recommendedfollow -upforfailed tests) Ifthe entire depth of the sump is not tested, specify how much was tested. Ifthe answer to any ofthe questions indicated with an asterisk ( *) is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160) SWRCB, January Page2002 of lg 7. UNDER-DISPENSER CONTAINMENT C TESTING Test Method Developed By: UDC Manufacturer X Industry Standard D Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum X Hydrostatic Q Other (Spec) Test Equipment Used: INCON TS -STS Equipment Resolution: UDC # DSL UDC Manufacturer: UNKNOWN UDC # UDC # UDC # UDC Material: FIBERGLASS UDC De the 36" Height from UDC Bottom to Top of Highest Pi2ing Penetration: 20" Height from UDC Bottom to Lowest Electrical Penetration: 30" Condition of UDC prior to testing: GOOD Portion ofUDC Tested 90% Does turbine shut down when UDC sensor detects liquid (both product and water)?* Yes D No X NA Yes No NA 0 Yes No DNA Yes 0 No D NA Turbine shutdown response time N/A Is system programmed for fail- safe shutdown ?* D Yes No XNA D Yes No DNA D Yes No NA Yes No DNA Was fail -safe verified to be operational?' Yes No XNA D Yes DNo DNA Yes No NA Yes No D NA Wait time between applying pressure /vacuum/water and starting test 30MIN Test Start Time: 11:33 12 :08 Initial Reading (R1): 2.606 2.600 Test End Time: 11:48 12:23 Final Reading (Rr): 2.604 2.599 Test Duration: 15MIN 15MIN Change in Reading RF-Ri : 002 001 PassNail Threshold or Criteria: 002 002 Test Result: X Pass Fail Pass Fail Pass Fail Pass Fail Was sensor removed for testing? X Yes 0 No NJAYesCNo NA Yes No NA Yes No NA Was sensor properly replaced and verified functional after testing? X Yes No D N Yes D No DNA D Yes D No NA Yes D No D NA Comments — (include information on repairs madeprior to testing, andrecommendedfollow -upforfailedtests) 1 Ifthe entire depth ofthe 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 e2002Pa ofPage 8. FELL RISER CONTAINMENT SUMP TESTING Facility is Not Equipped With Fill Riser Containment Sumps D Fill Riser Containment Sumps are Present, but were Not Tested Test Method Developed By: Sump Manufacturer X Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum X Hydrostatic Other (Spec) Test Equipment Used: INCON TS -STS Equipment Resolution: Fill Sum # Fill Sump # Fill Sump # 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 pressurelvacuum/water and starting test: Test Start Time: Initial Reading (Rj): Test End Time: Final Reading (RF): Test Duration: Change in Reading- (RF-R,): Pass/Fail Threshold or Criteria: Test Result: Pass Fail Pass Fail Pass Fail D Pass Fail Is there a sensor in the sump? Yes No Yes No Yes No Yes No Does the sensor alarm when either product or water is detected? Yes D No NA D Yes No DNA Yes No NA Yes No NA Was sensor removed for testing? Yes No NA Yes No DNA Yes No NA D Yes D No NA Was sensor properly replaced and verified functional after testing? Yes No D NA Yes []No NA Yes DNo NA Yes No DNA Comments — (include information on repairs made prior to testing and recommendedfollow -upforfailed tests) NO FILL SUMPS SWRCB, January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page 7 of 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 Other (Spec) Test Method Used: Pressure Vacuum X Hydrostatic Other (Spec) Test Equipment Used: INCON TS -STS Equipment Resolution: Spill Box # Bucket Diameter. Spill Box # Spill Box # Spill Box # Bucket Depth: Wait time between applying pressure/vacuum /water and starting test: NOT TESTED Test Start Time: Initial Reading (R,): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF -R4): Pass/Fail Threshold or Criteria: Test Result: Pass Fail Pass Fail Pass Fail Pass Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -upfor ailed tests) TESTED WITH MONITOR CERTIFICATION q6`"4 ANr,E 3 SELT STAG S540SILLECTAO 1WERSFIELD CA ORANGE BELT STAGES ORANGE BELT STAGES1- 800 - 984`6266 7640 SILLECT AVE 3649 SILLECT AVE 06/25x2012 11: @? AM 1-800-984-6266 CA !3AKERSFIFLD CA 1- 800 -984 -6266 1- 800 - 984 -6266 SUMP LEAK TEST REPORT 06/25/2012 12:04 PM 06/25/2012 11:48 AM DSL -1TP SUMP LEAK TEST REPORT SUMP Z f 7-ST ORT TEST STARTED 10:47 AM AIL -BKT TEST STAR. TECG 06/25/2012 BEGIN LEVEL 2.4915 IN TEST STARTED 11:49 AM TEST,.STARTED .11:.33 AM . END TIME 11:02 AM TEST 'STARTED 06/25/2012 TEST SthKYED '6i25f 612ENDDATE06/25/2012 BEGIN LEVEL 2.2986 IN BEGIN LEVEL 2.2983 INENDLEVEL2.4914 IN END TIME 12:04 PM END TIME 11:48 AMLEAKTHRESHOLD0.002 IN END DATE 06/25/2012 END'DATE 06/25/2012TESTRESULTPASSEDENDLEVEL2.29:36 IN END LEVEL 2.2987 IN LEAK. THRESHOLD 0.002 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED TEST RESULT PASSED DSL -UDC DSL -UGC TES STARTED 11 :49 TEST STARTED 11 :33 AM TEST RTED 06/7 2012 TEST STARTED 06/25/2012 BEGIN LE '.6037 IN BEGIN LEVEL 2.6062 IN ORANGE BELT STAGE:? END TIME 11:04 PM END TIME 1I:48 AM 64@ SILLECT AVE END DA /25/2012 END DATE 06/25/2012 BAKERSFIELD GA END UEL 12 IN END LEVEL 2.6046 IN 1- 30t - °P4 -6266 LEA THRESHOLD @. I LEAK THRESHOLD 0.002 IN TEST RESULT FAIL TEST RESULT PASSED 06/25/2012 11 :19 AM SUMP LEAK TEST REPORT DSL -STP TEST STARTED 11:04 AM TEST STARTED 06/25/2012 BEGIN LEVEL 2:4916 IN - END TIME 11:19 AM END DATE 96/25/2012 END LEVEL 2.4920 IN LEAK THRESHOLD 0.002 IN ORANGE BELT STAGESTESTRESULTPASSED3640SILLECTAVE BAKERSFIELD CA 1- 800 - 984 -6266 06/25/2012 12:23 PM SUMP LEAK TEST REPORT FIL -BKT ST STARTED 12:0 TES ,TARTED 06/ 012 BEGIN EL UME ERP. END TIME^ 12:09 PM END DAT 06/25/2012 END L L 4E ERR LF THRESHOLD 0. IN ST RESULT ERROR DSL -UDC TEST STARTED TEST STARTED BEGIN LEVEL END TIME END DATE END LEVEL LEAK THRESHOL TEST RESULT 12:08 PM 06/25/20!2 2.6009 IN 12:23 PM 06/25/2012 2.5991 IN D 0.002 IN PASSED SB989 TESTING FAILURE REPORT SITE NAME: ORANGE BELT STAGES DATE: 6/25/12 ADDRESS: 3640 SILLECT AVENUE TECHNICIAN: JAMES RICH CITY: BAKERSFIELD SIGNATURE: THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS: NONE LABOR: NONE PARTS INSTALLED: NONE 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.