HomeMy WebLinkAboutPREMIUM SPILL BUCKET RE-TEST 10-2319SPILL BUCKET TEST
11000 N. MoPac Expressway, Suite 500
Austin, Texas 78759
Phone: (512) 451-6334
Fax: (512) 459-1459 Date Printed and Mailed: 10/30/2019
BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
INSPECTOR KRIS KARNS
1501 TRUXTUN AVE.
BAKERSFIELD, CA 93301
Test Date: 10/23/2019
Order Number: 3448456
Dear Regulator,
Enclosed are the results of recent testing performed at the following facility:
7-ELEVEN #32241, MKT 2368
4101 CALLOWAY DRIVE
BAKERSFIELD, CA 93312
In an effort to keep all our record keeping and reporting requirements as current as possible,
Tanknology kindly requests you notify Dawn Kohlmeyer in writing at dkohlmeyer@tanknology.com
when your CUPA requires all records to be submitted electronically via the CERS database. Your
assistance in this endeavor is greatly appreciated.
Testing performed:
Sincerely,
Dawn Kohlmeyer
Manager, Field Reporting
SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and
printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: 7-ELEVEN #32241, MKT 2368 Date of Testing: 10/23/2019
Facility Address: 4101 CALLOWAY DRIVE , BAKERSFIELD, CA 93312
Facility Contact: Iman 5/18/16 Phone: 661-379-5911
Date Local Agency Was Notified of Testing:
Name of Local Agency Inspector (if present during testing): None.
2. TESTING CONTRACTOR INFORMATION
Company Name: TANKNOLOGY INC.
Technician Conducting Test: Luis Navarro
Credentials1: CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Specify)
License Number(s): 743160 / 8171123
3. SPILL BUCKET TESTING INFORMATION
Test Method Used By: Hydrostatic Vacuum Other
Test Equipment Used: LAKE TEST Equipment Resolution: 0.0625 in.
Identify Spill Bucket (By Tank
Number, Stored Product, etc.)
Bucket Installation Type:
Bucket Diameter:
Bucket Depth:
Wait time between applying
vacuum/water and start of test
Test Start Time (TI):
Initial Reading (RI):
Test End Time(TF):
Final Reading (RF):
Test Duration(TF–TI):
Change in Reading (RF–RI) :
Pass/Fail Threshold or Criteria:
Test Result:
Spill Box # Tank T5 PUL
PUL - Fill 1 - Direct - Below
Grade in containment sump
Direct Bury
Contained in Sump
11.00
13.00
15 min
02:45:00
12.00 in. H20
03:45:00
12.00 in. H20
1 hr
0.00 in. H20
+/- 0.00
Pass
Spill Box #
Direct Bury
Contained in Sump
min
+/-
Spill Box #
Direct Bury
Contained in Sump
min
+/-
Spill Box #
Direct Bury
Contained in Sump
min
+/-
Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician's Signature:Date:10/23/2019
1State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.
WO: 3448456
UNDERGROUND STORAGE TANK
SPILL CONTAINER TESTING REPORT FORM (Page 1 of 1)
Type of Action Installation Test Repair Test 12 Month Test
I. FACILITY INFORMATION
CERS ID
10024393
Date of Spill Container Test:
10/23/2019
Business Name (Same as Facility Name or DBA-Doing Business As.)
7-ELEVEN #32241, MKT 2368
Business Site Address
4101 CALLOWAY DRIVE
City:
BAKERSFIELD
Zip:
93312
II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION
Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification.)
Luis Navarro
Phone #
(800) 800-4633
Contractor/Tank Tester License #
Class A General Engineering 743160
ICC Certification #
8171123
ICC Certification Expiration Date
1/5/2021
Spill Container Testing Training and Certifications (List applicable certifications.)
OPW - EVR Phase 1 101183 07/07/2020
III. SPILL CONTAINER TESTING INFORMATION
Test Method Used: Manufacturer Guidelines: (Specify)
Industry Code or Engineering Standard: (Specify) PEI RP 1200
Engineered Method: (Specify)
Attach the testing procedures and all documentation required to determine the results. # of Attached Pages
2
Tank ID: (By tank number, stored product, etc.)
Spill Container Manufacturer:
Method of Cathodic Protection
Inside Diameter of Spill Container: (Inches)
Depth of Spill Container: (Inches)
Does the spill container have a 5 gallon capacity?
Method to Keep Spill Container Empty
IV.
Spill Container Test Results
Fill T5 PUL
PUL
OPW
Non-Metallic
Isolation
Other
(Specify in section V)
11
13
Yes No
Drain Valve
Onsite Pump
Other
(Specify in section V)
Non-Metallic
Isolation
Other
(Specify in section V)
Yes No
Drain Valve
Onsite Pump
Other
(Specify in section V)
Non-Metallic
Isolation
Other
(Specify in section V)
Yes No
Drain Valve
Onsite Pump
Other
(Specify in section V)
Non-Metallic
Isolation
Other
(Specify in section V)
Yes No
Drain Valve
Onsite Pump
Other
(Specify in section V)
SUMMARY OF TESTING RESULTS
Pass Fail Pass Fail Pass Fail Pass Fail
V. COMMENTS
All items marked failed above must be explained in this section. Any additional comments may also be provided here.
VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS
I hereby certify that the spill containers were tested in accordance with California Code of Regulations, title 23, division 3, chapter 16, section
2637.1 and all the information contained herein is accurate.
UST Service Technician Signature
If the facility has more components than this form accommodates, additional copies of this page may be attached.
CERS=California Environmental Reporting System, ID=Identification, UST=Underground storage tank, ICC=International Code Council
Site Diagram
(This site diagram is for reference only and is not drawn to scale)
Work Order:3448456
Site ID / Name:32241 / 7-ELEVEN #32241, MKT 2368
Address:4101 CALLOWAY DRIVE
City:BAKERSFIELD State:CA Zip:93312
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