HomeMy WebLinkAboutSB989 2020Appendix VII
Underground Storage Tank
Secondary Containment Testing Report Form
CERS = California Environmental Reporting System, ICC = International Code Council,
ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment,
Page 1 of 5
TYPE OF ACTION ܆ Installation ܆ Repair ܆ 6 Month ܈ 36 Month
CERS ID
10022425
Test Date
10-30-2020
Facility Name
Sprint - Bakersfield
Facility Address
715 E. Sumner St.
City
Bakersfield
ZIP Code
93305
Company Performing the Test
Jauregui & Culver Inc.
Phone
760-743-0518
Mailing Address
959 W. Mission Ave. Escondido, CA. 92025
Service Technician Performing Test
John Culver II
Contractor/Tank Tester License Number
780231
ICC Number
8182417
ICC Expiration Date
4-16-21
Manufacturer and Test Equipment Training Certifications Expiration Date
Incon - 1004353708 9-15-22
Test Procedures Used Components Tested
I hereby certify that the secondary containment was tested in accordance with California
Code of Regulations, title 23, division 3, chapter 16, section 2637; that required supporting
documentation is attached; and all information contained herein is accurate. I understand
that test procedures shall be made available upon request by the governing authority.
Service Technician Signature Date
10-30-2020
Total # of Pages
1. FACILITY INFORMATION
2. SERVICE TECHNICIAN INFORMATION
3. TRAINING AND CERTIFICATIONS
4. TEST PROCEDURE INFORMATION
5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST
Underground Storage Tank
Secondary Containment Testing Report Form
All tests marked “Fail” and any repairs made before or during the tightness test must be described in
the COMMENTS section.
Page 2 of 5
Test Method Developed by ܆ Manufacturer ܈ Industry Standard ܆ Professional Engineer
Test Type ܆ Pressure ܈ Vacuum ܆ Hydrostatic
Test Equipment Used: Vacuum and gauges
Tank ID Diesel
Tank Manufacturer O/C
Tank Capacity 550
Test Start Time 10:00am
Initial Reading 10 inHg
Test End Time 11:am
Final Reading 10 inHg
Change in Reading 0
Pass/Fail Criteria 0 Loss
Tightness Test Results ܈ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail
Test Method Developed by ܆ Manufacturer ܈ Industry Standard ܆ Professional Engineer
Test Type ܈ Pressure ܆ Vacuum ܆ Hydrostatic
Test Equipment Used: Nitrogen and gauges
Pipe Run ID Supply Return
Pipe Manufacturer Smith Smith
Test Start Time 10:00am 10:00am
Initial Reading 5 psi 5 psi
Test End Time 11:00am 11:00am
Final Reading 5 psi 5 psi
Change in Reading 00
Pass/Fail Criteria 0 Loss 0 Loss
Tightness Test Results ܈ Pass ܆ Fail ܈ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail
Pipe Run ID
Pipe Manufacturer
Test Start Time
Initial Reading
Test End Time
Final Reading
Change in Reading
Pass/Fail Criteria
Tightness Test Results ܆ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail
Additional copies of this page may be attached.
6. TANK SECONDARY CONTAINMENT TEST
7. PIPE SECONDARY CONTAINMENT TEST
Underground Storage Tank
Secondary Containment Testing Report Form
All tests marked “Fail” and any repairs made before or during the tightness test must be described in
the COMMENTS section.
Page 3 of 5
Test Method Developed by ܆ Manufacturer ܈ Industry Standard ܆ Professional Engineer
Test Type ܆ Pressure ܆ Vacuum ܈ Hydrostatic
Test Equipment Used: Incon
Sump/UDC ID Diesel
Sump Manufacturer O/C
Sump Depth (inches) 36"
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
21"
Test Start Time 10:56am
Initial Reading 5.9457
Test End Time 11:11am
Final Reading 5.9440
Change in Reading 0.0017
Pass/Fail Criteria +or-0.002
Tightness Test Results ܈ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail
Sump/UDC ID
Sump Manufacturer
Sump Depth (inches)
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
Test Start Time
Initial Reading
Test End Time
Final Reading
Change in Reading
Pass/Fail Criteria
Tightness Test Results ܆ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail
Additional copies of this page may be attached.
8. SUMP/UDC TEST
Underground Storage Tank
Secondary Containment Testing Report Form
All tests marked “Fail” and any repairs made before or during the tightness test must be described in
the COMMENTS section.
Page 4 of 5
Test Method Developed by ܆ Manufacturer ܆ Industry Standard ܆ Professional Engineer
Test Type ܆ Pressure ܆ Vacuum ܆ Hydrostatic
Test Equipment Used:
Sump/UDC ID
Sump Manufacturer
Sump Depth (inches)
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
Test Start Time
Initial Reading
Test End Time
Final Reading
Change in Reading
Pass/Fail Criteria
Tightness Test Results ܆ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail
Sump/UDC ID
Sump Manufacturer
Sump Depth (inches)
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
Test Start Time
Initial Reading
Test End Time
Final Reading
Change in Reading
Pass/Fail Criteria
Tightness Test Results ܆ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail ܆ Pass ܆ Fail
Additional copies of this page may be attached.
8. SUMP/UDC TEST (continued)
Underground Storage Tank
Secondary Containment Testing Report Form
All tests marked “Fail” and any repairs made before or during the tightness test must be described in
the COMMENTS section.
Page 5 of 5
9. COMMENTS