HomeMy WebLinkAboutSB989 2020
Appendix 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 X 36 Month
CERS ID
10129798
Test Date
12/8/2020
Facility Name
Panam Buena Vista School District
Facility Address
4200 Ashe Rd
City
Bakersfield Ca
ZIP Code
93313
Company Performing the Test
Advanced Compliance
Phone
6617064321
Mailing Address
4007 Brae Burn Dr Bakersfield Ca 93306
Service Technician Performing Test
Bradley Hinsley
Contractor/Tank Tester License Number
971259
ICC Number
8373948
ICC Expiration Date
8/10/2021
Manufacturer and Test Equipment Training Certifications Expiration Date
ICC Service Techican 8/10/2021
INCON STS 10/9/2021
Test Procedures Used Components Tested
PEI/RP1200-19 Sect. 4. Tank Annular
PEI/RP1200-19 Sect. 5. Line Secondary
PEI/RP1200-19 Sect. 6. Containment Sump
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
12/8/2020
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
6. TANK 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 2 of 5
Test Method Developed by ☐ Manufacturer X Industry Standard ☐ Professional Engineer
Test Type ☐ Pressure X Vacuum ☐ Hydrostatic
Test Equipment Used: Tank Annular Testing Set-Up
Tank ID 87 Diesel Waste Oil
Tank Manufacturer Unknown Unknown Unknown
Tank Capacity 12,153 12,153 550
Test Start Time 08:50 10:00 11:30
Initial Reading -10 -10 -10
Test End Time 09:50 11:00 12:30
Final Reading -10 -10 -10
Change in Reading 0 0 0
Pass/Fail Criteria 2 2 2
Tightness Test Results X Pass ☐ Fail X Pass ☐ Fail X Pass ☐ Fail ☐ Pass ☐ Fail
Test Method Developed by ☐ Manufacturer X Industry Standard ☐ Professional Engineer
Test Type X Pressure ☐ Vacuum ☐ Hydrostatic
Test Equipment Used: Secondary line test set-up
Pipe Run ID 87 Diesel
Pipe Manufacturer Unknown Unknown
Test Start Time 08:30 08:50
Initial Reading 5 5
Test End Time 09:30 09:50
Final Reading 5 5
Change in Reading 0 0
Pass/Fail Criteria 0 0
Tightness Test Results X Pass ☐ Fail X 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.
7. PIPE SECONDARY CONTAINMENT TEST
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 3 of 5
Test Method Developed by ☐ Manufacturer X Industry Standard ☐ Professional Engineer
Test Type ☐ Pressure ☐ Vacuum X Hydrostatic
Test Equipment Used: Incon STS
Sump/UDC ID 87 STP 87 UDC Diesel STP Diesel UDC
Sump Manufacturer Unknown Unknown Unknown Unknown
Sump Depth (inches) 42 40 42 40
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
20 25 20 25
Test Start Time 08:35 09:39 08:16 09:39
Initial Reading 7.4497 3.1679 6.0161 7.1957
Test End Time 08:50 09:54 08:31 09:54
Final Reading 7.4517 2.8976 6.0165 7.1969
Change in Reading 0.0020 0.2703 0.0004 0.0012
Pass/Fail Criteria 0.0020 0.0020 0.0020 0.0020
Tightness Test Results X Pass ☐ Fail ☐ Pass X Fail X Pass ☐ Fail X 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.
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
87 UDC Failed Hydrostatic testing. Must be repaired and retested.
9. COMMENTS