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HomeMy WebLinkAbout3711 MT. VERNON AVENUESWRCB, January 2002 Page -{--- of Secondary Containment Testing Report Form Thisform is intendedfor use by contractors performing periodic testing ofUSTsecondary containment systems. Use the appropriate pages ofthis form to report resultsfor all components tested The completedform, written testprocedures, and printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACII.ITY INFORMATION Facility Name: HUNGRY'S MARKET Date of Testing: 3/12/12 Facility Address: 3711 MT VERNON AVENUE, BAKERSFIELD Facility Contact: I Phone: Date Local Agency Was Notified of Testing: 1/11/12 Name of Local Agency Inspector (fpresent during testing): 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: C61 /D40 A HAZ License Number: 809850 Manufacturer Manufacturer Training Component(s) Date Training Expires INCON TS -STS 6/11/2012 X UCD #3/4 X 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made 87 ANNULAR X UCD #3/4 X 91 ANNULAR X 87 FILL SUMP X DIESEL ANNULAR X 91 FILL SUMP X 87 #1 SECONDARY X DIESEL FILL SUMP X 87 #2 SECONDARY X 87 VAPOR BUCKET X 91 #1 SECONDARY X o 91 VAPOR BUCKET X 91 #2 SECONDARY X 0 DIESEL SECONDARY X p 0 0 0 87 STP X 91STP X 0 0 0 0 DIESEL STP X 0 0 0 UDC #1/2 X1 p 1 []--1 1 0 Ifhydrostatic testing was performed, describe what was done with the water after completion oftests: CERTIFICATION OF TECHNVIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best ofmy knowledge, thefacts state this document are accurate and infull compliance with legal requirements Technician's Signature: Date: 3/12/12 SWRCB, January 2002 CIi a 17 1mn- 1 l 1 - :71ii ` 1ii`7'eJ Page of Test Method Developed By: 0 Tank Manufacturer X Industry Standard 0 Professional Engineer Other (Specify) Test Method Used: Pressure X Vacuum 0 Hydrostatic Other (Specify) GAUGE Equipment Resolution: oTestEquipment O4"DIAL Tank # Tank # Tank # Tank # t 0 Yes 0 No Yes No 0 Yes No 0 Yes No Tank Capacity: Tank Material: Tank Manufacturer: Product Stored: 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: 60 MIN 60 MIN 60 MIN 60MIN Change in Reading (RF-R,): Pass/Fail Threshold or Criteria: Test Result: Pass Fait 0 Pass Fait 0 Pass Fail Pass 0 Fail Was sensor removed for testing? 0 Yes No 0 NA Yes 0 No NA Yes No 0NA Yes 0 No NA Was sensor properly replaced and verified functional after testing? 0 Yes No 0 NA 0 Yes 0 No 0 NA 0 Yes 0No NA 0 Yes 0 No NA Comments -- (include information on repairs made prior to testing and recommended follow -up forfailed tests) NOT TESTED "SINGLE WALL SITE" 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)) SWRCB, January 2002 5. SECONDARY PIPE TESTING Page of Test Method Developed By: Piping Manufacturer X Industry Standard Professional Engineer Other (Spec) Pest Method Used: X Pressure Vacuum 0 Hydrostatic Other (Spec) Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: .5% Piping Run #87 #1 Piping Run #87 #2 Piping Run #91 #1 Piping Run #91 #2 Piping Material: PLASTIC PLASTIC PLASTIC PLASTIC Piping Manufacturer: TCI TCI TCI TCI Piping Diameter: 2" 2" 2" 2" Length ofPiping Run: 50' S0' 50' 50' Product Stored: 87REG 87REG 91PREM 91 PREM Method and location of piping-run isolation: BOOT IN SUMP BOOT IN SUMP BOOT IN SUMP BOOT IN SUMP Wait time between applying pressure/vacuunVwater and s=ing test: 30 MIN 30 MIN 30 MIN 30 MIN Test Start Time: 9:45 9:45 10:20 10:20 Initial Reading (R,): 6.5 6.5 7.0 6.5 Test End Time: 10:45 10:45 11:20 11:20 Final Reading (RF): 6.5 6.5 7.0 6.5 Test Duration: 60 MIN 60 MIN 60 MIN 60 MIN Change in Reading (RF -RO: 0 0 0 0 Pass/Fail Threshold or Criteria: 0 0 0 0 Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail COMMents — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) SWRCB, January 2002 5. SECONDARY PIPE TESTING P'. 1U Lf Page A_ of Test Method Developed By: Piping Manufacturer X Industry Standard Professional Engineer Other (Spec) Test Method Used: X Pressure 0 Vacuum Hydrostatic Other (Specify) Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: .5% Piping Run #DSL Piping Run # Piping Run # Piping Run # Piping Material: PLASTIC Piping Manufacturer: TCI Piping Diameter: 2" Length of Piping Run: 65' Product Stored: DIESEL Method and location of piping-run isolation: BOOT IN SUMP Wait time between applying pressure/vacuum /water and starting test: 30 MIN Test Start Time: 12:00 Initial Reading (R,): 6.5 Test End Time: 1:00 Final Reading (RF): 6.5 Test Duration: 60 MIN Change in Reading (RF -R,): 0 Pass /Fail Threshold or Criteria: 0 L.Test Result: X Pass Fail Pass Fail Pass Fail Pass 0 Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -up forfailed tests) SWRCB, January 2002 6. PIPING SUMP TESTING LiVcuw Page _J of 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: Sump #87 Sump #DSL Sump # Sump #91 Sump Diameter: 37" 37' 3T' Sump Depth: 46" 46" 46" Sump Material: FIBERGLASS FIBERGLASS FIBERGLASS Height from Tank Top to Top of Highest Piping Penetration: 18" 14" 14" Height from Tank Top to Lowest Electrical Penetration: 8" 8" 8" Condition of sump prior to testing: GOOD GOOD GOOD Portion of Sump Tested' 20" 16" 16" Does turbine shut down when sump sensor detects liquid (both product and water)?' Yes No X NA Yes 0N XNA Yes No XNA Yes 0 No 0N Turbine shutdown response time Is system programmed for fail- safe shutdown ?* Yes No XNA 0 Yes No XNA 0 Yes No XNA Yes 0 No NA Was fail -safe verified to be operational?* Yes No X NA 0 Yes No X NA Yes No X NA Yes No NA Wait time between applying pressure/vacuum/water and starting test 30 MIN 30 MIN 30 MIN Test Start Time: 10:54 11:11 1 10:54 11:11 10:53 12:14 Initial Reading (110: 3.917 3.917 3.355 3.354 3.809 3.809 Test End Time: 11:09 11:26 11:00 11:26 12:08 12:29 Final Reading (RF): 3.917 3.917 3.355 3.354 3.807 3.807 Test Duration, 15MIN 15NIIN 15MIN 15MIN 15MIN 15MIN Change in Reading (RF -Ri): 000 000 000 000 000 002 Pass/Fail Threshold or Criteria: 002 002 002 002 002 002 Test Result: X Pass 0 Fail X Pass Fail X Pass Fail Pass Fail Was sensor removed for testing? X Yes No NA X Yes No NA X Yes 0 No NA Yes No NA Was sensor properly replaced and verified functional after testing? X Yes No NA X Yes No NA X Yes No NA Yes No 0 NA COM M U — (include information on repairs made prior to testing, andrecommendedfollow -upforfailed tests) Ifthe entire depth ofthe sump is not tested, specify how much was tested. If the answer to any ofthe questions indicated with an asterisk M is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160) SWRCB, January 2002 7. UNDER- DISPENSER CONTAINMENT (UD0 TESTING Lo v I Page of Test Method Developed By: UDC Manufacturer X Industry Standard 0 Professional Engineer 0 Other (Specify) Test Method Used: Pressure Vacuum X Hydrostatic Other (Spec) Test Equipment Used: INCON TS -STS Equipment Resolution: UDC #1/2 UDC #3/4 UDC 4 UDC # UDC Manufacturer: UNKNOWN UNKNOWN UDC Material: PLASTIC PLASTIC UDC Depth: 20" 20" Height from UDC Bottom to Top of Highest Piping Penetration: 12" 12" Height from UDC Bottom to Lowest Electrical Penetration: 6" 6" Condition of UDC prior to testing: GOOD GOOD Portion ofUDC Tested 14" 14" Does turbine shut down when UDC sensor detects liquid (both and water)?* Yes No X NA 0 Yes No X NA Yes 0 No NA Yes 0No NA product Turbine shutdown response time Is system programmed for fail- safe shutdown ?' 0 Yes 0 No X NA Yes No X NA Yes 0 No NA Yes No NA Was fail -safe verified to be Yes No X NA Yes No XNA Yes 0 No NA Yes 0 No NA operational?* Wait time between applying pressure/vacuum /water and starting test 30MIN 30MIN Test Start Time: 1:05 1:24 1:24 1:43 Initial Reading (Rj): 1.833 1.833 1.713 1.713 Test End Time: 1:20 1:39 1:39 1:58 Final Reading (RF): 1.833 1.833 1.713 1.713 Test Duration: 15MIN 15MIN 15MIN 15MIN Change in Reading (RF -R,): 000 000 000 000 Pass/Fail Threshold or Criteria: 002 002 002 7 002 Test Result, X Pass Fail X Pass Fail Pass 0 Fail Pass Fail Was sensor removed for testing? X Yes No NA X Yes No 0 NA Yes 0 No [DNA Yes 0 No NA Was sensor properly replaced and verified functional after testing? X Yes 0 No NA X Yes No NA Yes 0 No NA Yes 0 No NA Comments — (include information on repairs made prior to testing and recommendedfollow -upforfarted tests) If the entire depth of the UDC is not tested, specify how much was tested. If the answer to My of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) SWRCB, January 2002 R. FILL RISER CONTAINMENT SUMP TESTING 457)T Page I of Facility is Not Equipped With Fill Riser Containment Sums Fill Riser Containment Sumps are Present, but were Not Tested Test Method Developed By: 0 Sump Manufacturer X Industry Standard Professional Engineer Other (Spec) Test Method Used: 0 Pressure 0 Vacuum X Hydrostatic 0 Other (Spec) Test Equipment Used: INCON TS -STS Equipment Resolution: Fill Sump # Fill Sump # Fill Sump # Fill Sum # Sum Diameter. Sum De the 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: NOT TESTED Test Start Time: Initial Reading (R,): Test End Time: Final Reading Test Duration: 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN Change in Reading (RF-R : Pass/Fail Threshold or Criteria: Test Result: 0 Pass Fail Pass 0 Fail Pass 0 Fail Pass 0 Fail Is there a sensor in the sump? Yes 0 No 0 Yes 0 No Yes 0 No Yes 0 No Does the sensor alarm when either product or water is detected? Yes No NA 0 Yes 0 No 0NA Yes No 0 NA 0 Yes 0No NA Was sensor removed for testing? 0 Yes No NA 0 Yes No NA 0 Yes No 0 NA 0 Yes No 0 NA Was sensor properly replaced and verified functional after testing? 0 Yes No 0 NA 0 Yes 0 No NA C Yes No NA Yes No NA Comments — (include information on repairs made prior to testing, andrecommendedfollow -upforfailed tests) NO FILL SUMPS. BUCKETS ARE DIRECT BURIED SWRCB, January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES q, /Dr(' // Page —I— of b 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 987 VPR Spill Box #91 VPR Spill Box # Spill Box # Bucket Diameter: 12" 12" Bucket Depth: 16" 16" Wait time between applying pressure/vacuum /water and starting test: 30MIN 30MrN Test Start Time: 10:54 11:11 10:54 11 :11 Initial Reading (R,): 2.856 2.856 2.436 2.439 Test End Time: 11:09 11:26 11:09 11:26 Final Reading (RF): 2.856 2.855 2.429 2.428 Test Duration: 15MIN 15MIN 15MIN 15MIN Change in Reading (RF -Ri): 000 001 001 001 Pass/Fail Threshold or Criteria: 002 002 002 002 Test Result: X Pass Fail X Pass Fail Pass Fail Pass Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) HUNGRY MARKET 3711 NT VERON BAKERSFIELD CA 03/12/2012 11:09 AM SUMP LEAK TEST REPORT S7UPR TEST STARTED 10:54 AMTESTSTARTED03/12/2012BEGINLEVEL2.8569 INENDTIME11:09 AMENDDATE03/12./2012ENDLEVEL • 2,8564 INLEAK. THRESHOLD' 0.002 INTESTRESULTPASSED 7STP TEST STARTED 10:54 AMTESTSTARTED03/12/2012BEGINLEVEL3.9178 INENDTIME11:09 AMENDDATE03/12/2012END -177 INLEAK LEVEL 309002 INTESTRESULTPASSED 91VPR TEST STARTED 1@ :54 AMTESTSTARTED03/12/2012BEGINLEVEL2.4304 INENDTIME11109AMENDDATE03/12/2012ENDLEVEL2.4297 INLEAKTHRESHOLD0.002 INTESTRESULTPASSED 91STP TEST STARTED 10:54 AM TEST STARTED03.13952BEGINLLEVEL INENDTIME11:09 AMENDDATE03/12/2012ENDLEVEL3.3550 INLEAKTHRESHOLD0.002 INTESTRESULTPASSED ritlnr y MARk T - -- _ I1 MT WEk.ONSRKEkSFIF CR@3/11012 SUMP LEAK rfSr R pt, EPpk 11 :11 AM TEST STARTED UDr1 _2 TEST STRk7TeST DIr 11 eVEI F'ENND PATE 2g 012 1:24 N LzRK Lek L r Sr k LZ 883319121 0, T eel IN LEAK THRESHOLD 0.002 IN Pft* HUNGRY MARKET 3711 MT UERON SAKERSFIELD CA 03/12/2012 11:26 AM SUMP LEAK TEST REPORT 87VPR TEST STARTED 11:11 AM TEST STARTED 03/12/2012 BEGIN LEVEL 2.8561 IN END TIME 11:26 AM END DATE 03/12/2012 END LEVEL 2.1551 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 87STP TEST STARTED 11-11 AM TEST STARTED 03/12/2012 BEGIN LEVEL 3.9177 IN END TIME 11:26 AM END DATE 03/12/2012 END LEVEL 3.9175 IN, LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 91VPR TEST STARTED TEST STARTED BEGIN LEVEL END TIME END DATE t END LEVEL LEAK THRESHOI TEST RESULT 11:11 AM. 03/12/2012 2.4296 IN 11:26 AM 03/12/2012 2.4285 IN D 0.002 IN PASSED 91STP TEST STARTED 11 :11 AM TEST STARTED 03/12 /2012 BEGIN LEVEL 3.3549 IN END TIME 11:26 AM END DATE 03/12/2012 END LEVEL 3.3548 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED UDC3 -4 TEST STARTED 1:43 PM TEST STARTED 03/12/2012 BEGIN LEVEL 1.7137 IN END TIME 1:58 PM END DATE 03/12/2012 END LEVEL 1.7138 IN LEAK THRESHOLD 0.002 INTESTRESULTPASSED HUNGRY MARKET 3711 MT VERON BAKERSFIELD CA 03/12/2012 12:08'k SUMP LEAK TEST REPORT DSLSTP TEST STARTED 11:53 AM TEST STARTED 03/12/2012 BEGIN LEVEL 3.8094 IN END TIME 12:08 PM END DATE 03/12/2012 END LEVEL 3.8096 IN LEAK-THRESHOLD 0.002 IN TEST RESULT PASSED HUNGRY MARKET 3711 MT UERON BAKERSFIELD CA 03/12/2012 12 :29 PM SUMP LEAK TEST REPORT DSLSTP TEST STARTED 12 :14 PM TEST STARTED 03/12/2012 BEGIN LEVEL 3.8095 IN END TIME 12%29 PM END DATE 03/12/2012 END LEVEL 3.8075 IN LEAK THRESHOLD 0.002 IN TEST RESULT im HUNGRY MARKET 3711 MT VERON BAKERSFIELD CA 03/12/2012 1:39 PM SUMP LEAK TEST REPORT UDC1-2 TEST STARTED 1 :24 PM TEST STARTED 03/12/2012 BEGIN LEVEL 1.8335 IN END TIME 1:39 PM END DATE 03/12/2012 END LEVEL 1.8336 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED UDC3 -4 TEST STARTED 1:24 PM TEST STARTED 03/12/2012 BEGIN LEVEL 1.7136 IN END TIME 1:39 PM END DATE 03/12/2012 END LEVEL 1.7137 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED y57o`i f, j" l' SB989 TESTING FAILURE REPORT SITE NAME: HUNGRY'S MARKET DATE: 3/12/12 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.