Loading...
HomeMy WebLinkAboutSB-989 2018 &(56 &DOLIRUQLD(QYLURQPHQWDO5HSRUWLQJ6\VWHP,' ,GHQWLILFDWLRQ867 8QGHUJURXQG6WRUDJH7DQN,&& ,QWHUQDWLRQDO&RGH&RXQFLO1$ 1RW$SSOLFDEOH8'& 8QGHU 'LVSHQVHU&RQWDLQPHQW 81 ZZZXQLGRFVRUJ 5HY 81'(5*5281'6725$*(7$1. 6(&21'$5<&217$,10(177(67,1*5(3257)250 3DJHRI  7\SHRI$FWLRQ,QVWDOODWLRQ7HVW5HSDLU7HVW6L[0RQWK7HVW0RQWK7HVW , )$&,/,7<,1)250$7,21 &(56,'  'DWHRI6HFRQGDU\&RQWDLQPHQW7HVW  %XVLQHVV1DPH(Same as Facility Name or DBA-Doing Business As)  %XVLQHVV6LWH$GGUHVV  &LW\  =,3&RGH  ,, 81'(5*5281'6725$*(7$1.6(59,&(7(&+1,&,$1,1)250$7,21 1DPHRI8676HUYLFH7HFKQLFLDQ3HUIRUPLQJWKH7HVW(Print as shown on the ICC Certification)  3KRQH  &RQWUDFWRU7DQN7HVWHU/LFHQVH  ,&&&HUWLILFDWLRQ  ,&&&HUWLILFDWLRQ([SLUDWLRQ'DWH  ,,, 6800$5<2)6(&21'$5<&217$,10(177(67,1*5(68/76 7$1.,'(By tank number, stored product, etc.)$ % & ' 7DQN&RQWDLQPHQW 7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ 3URGXFW3LSLQJ&RQWDLQPHQW 7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ &RPPXQLFDWLRQ7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ 5HPRWH)LOO3LSLQJ&RQWDLQPHQW 7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ &RPPXQLFDWLRQ7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ 9HQW3LSLQJ&RQWDLQPHQW 7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ &RPPXQLFDWLRQ7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ 9DSRU5HFRYHU\3LSLQJ&RQWDLQPHQW 7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ &RPPXQLFDWLRQ7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ 7XUELQH3URGXFW3LSLQJ6XPS 7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ )LOO5LVHU6XPS 7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ 9(1775$16,7,216803,'D E F G 7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ 8'&,'    7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ 8'&,'    7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ 8'&,'    7LJKWQHVV7HVW5HVXOW3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$3DVV)DLO1$ All items marked “Fail” or “NA” must be explained in their respective “COMMENTS” section. ,9 &(57,),&$7,21%<8676(59,&(7(&+1,&,$1&21'8&7,1*7+,67(67,1* ,KHUHE\FHUWLI\WKDWWKHVHFRQGDU\FRQWDLQPHQWZDVWHVWHGLQDFFRUGDQFHZLWK&DOLIRUQLD&RGHRI5HJXODWLRQV7LWOH'LYLVLRQ &KDSWHU6HFWLRQDQGDOOWKHLQIRUPDWLRQFRQWDLQHGKHUHLQLVDFFXUDWH 8676HUYLFH7HFKQLFLDQ6LJQDWXUH   10125616 11/13/2018 Express Gas 928 Flower Street Bakersfield 93305 Frank Amestoy (800) 339-9930 804904 8374998 11/14/2019 T1: 87 12,000 T2: 91 8,000 1/2 3/4 5/6 7/8 9/10 11/12 ,' ,GHQWLILFDWLRQ 81 ZZZXQLGRFVRUJ 5HY 81'(5*5281'6725$*(7$1. 6(&21'$5<&217$,10(177(67,1*5(3257)250 3DJHRI  9 7$1.6(&21'$5<&217$,10(17,1)250$7,21 0DQXIDFWXUHU,GHQWLI\7DQN,'IURP6HFWLRQ,,,IRUHDFK0DQXIDFWXUHU $%&' $%&' 7HVW0HWKRG8VHG0DQXIDFWXUHU*XLGHOLQHV(Specify)  ,QGXVWU\&RGHRU(QJLQHHULQJ6WDQGDUG (Specify)  (QJLQHHUHG0HWKRG(Specify)  Attach the testing procedures and all documentation required to determine the results.RI$WWDFKHG3DJHV  7DQN&RQWDLQPHQW7HVWLQJ7UDLQLQJDQG&HUWLILFDWLRQV(List applicable certifications.) ([SLUDWLRQ'DWH    9, &200(176 Provide any additional comments here.  9,, 352'8&73,3,1*&217$,10(177(67,1*,1)250$7,21 0DQXIDFWXUHU,GHQWLI\7DQN,'IURP6HFWLRQ,,,IRUHDFK0DQXIDFWXUHU $%&' $%&' 7HVW0HWKRG8VHG0DQXIDFWXUHU*XLGHOLQHV(Specify)  ,QGXVWU\&RGHRU(QJLQHHULQJ6WDQGDUG (Specify)  (QJLQHHUHG0HWKRG(Specify)  Attach the testing procedures and all documentation required to determine the results.RI$WWDFKHG3DJHV  3URGXFW3LSLQJ&RQWDLQPHQW7HVWLQJ7UDLQLQJDQG&HUWLILFDWLRQV(List applicable certifications.)([SLUDWLRQ'DWH    ,QWHUVWLWLDO&RPPXQLFDWLRQ9HULILFDWLRQ0HWKRG8VHG  9,,, &200(176 Provide any additional comments here.  EPS PEI-1200 1 ICC 8374998 11/14/2019 Split tank Smith PEI-1200 1 ICC 8374998 11/14/2019 Check communication from furthest point. SWRCB, January 2002 4. TANK ANNULAR TESTING Test Method Developed By: Tank Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: Tank # Tank # Tank # Tank # Is Tank Exempt From Testing?1 Yes No 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 (RI): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-RI): 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 Yes No NA Yes No NA Yes No NA Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests) 1 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)} ✔ ✔ Percision mechanical test Gage 0.10” 87/91 ✔ 12k/8k= 20,000 Fiberglass EPS Gasoline 30 minutes 9:45am 10Hg 11:45am 10Hg 120 minutes 0.00” 0.00” ✔ ✔ ✔ SWRCB, January 2002 5. SECONDARY PIPE TESTING Test Method Developed By: Piping Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: Piping Run # Piping Run # Piping Run # Piping Run # Piping Material: Piping Manufacturer: Piping Diameter: Length of Piping Run: Product Stored: Method and location of piping-run isolation: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-RI): 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 recommended follow-up for failed tests) ✔ ✔✔ Precision mechanical test gauge 0.10” 87 91 Vapor 87 vent Fiberglass Fiberglass Fiberglass Fiberglass Smith Smith Smith Smith 3.50”3.50”4.50”3.50” 225’225’225’40’ Gasoline Gasoline Gasoline Gasoline Boot in Sump Boot in Sump Boot in Sump Boot in Sump 30 minutes 30 minutes 30 minutes 30 minutes 11:30am 11:30am 11:30am 11:30am 5.00”5.00”5.00”5.00” 12:30pm 12:30pm 12:30pm 12:30pm 5.00”5.00” 5.00”5.00” 60 minutes 60 minutes 60 minutes 60 minutes 0.00” 0.00”0.00”0.00” 0.00”0.00”0.00”0.00” ✔✔✔✔  ,' ,GHQWLILFDWLRQ 81 ZZZXQLGRFVRUJ 5HY 81'(5*5281'6725$*(7$1. 6(&21'$5<&217$,10(177(67,1*5(3257)250 3DJHRI  ,; 5(027(),//3,3,1*&217$,10(177(67,1*,1)250$7,21 0DQXIDFWXUHU,GHQWLI\7DQN,'IURP6HFWLRQ,,,IRUHDFK0DQXIDFWXUHU $%&' $%&' 7HVW0HWKRG8VHG0DQXIDFWXUHU*XLGHOLQHV(Specify)  ,QGXVWU\&RGHRU(QJLQHHULQJ6WDQGDUG (Specify)  (QJLQHHUHG0HWKRG(Specify)  Attach the testing procedures and all documentation required to determine the results.RI$WWDFKHG3DJHV  5HPRWH)LOO3LSLQJ&RQWDLQPHQW7HVWLQJ7UDLQLQJDQG&HUWLILFDWLRQV(List applicable certifications.)([SLUDWLRQ'DWH    ,QWHUVWLWLDO&RPPXQLFDWLRQ9HULILFDWLRQ0HWKRG8VHG  ; &200(176 Provide any additional comments here.  ;, 9(173,3,1*&217$,10(177(67,1*,1)250$7,21 0DQXIDFWXUHU,GHQWLI\7DQN,'IURP6HFWLRQ,,,IRUHDFK0DQXIDFWXUHU $%&' $%&' 7HVW0HWKRG8VHG0DQXIDFWXUHU*XLGHOLQHV(Specify)  ,QGXVWU\&RGHRU(QJLQHHULQJ6WDQGDUG (Specify)  (QJLQHHUHG0HWKRG(Specify)  Attach the testing procedures and all documentation required to determine the results.RI$WWDFKHG3DJHV  9HQW3LSLQJ&RQWDLQPHQW7HVWLQJ7UDLQLQJDQG&HUWLILFDWLRQV(List applicable certifications.)([SLUDWLRQ'DWH    ,QWHUVWLWLDO&RPPXQLFDWLRQ9HULILFDWLRQ0HWKRG8VHG  ;,, &200(176 Provide any additional comments here.   PEI-1200 Check communication from furthest point. N/A Smith PEI-1200 1 ICC 8374998 11/14/2019 SWRCB, January 2002 5. SECONDARY PIPE TESTING Test Method Developed By: Piping Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used:Equipment Resolution: Piping Run # Piping Run # Piping Run # Piping Run # Piping Material: Piping Manufacturer: Piping Diameter: Length of Piping Run: Product Stored: Method and location of piping-run isolation: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-RI): 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 recommended follow-up for failed tests) ✔ ✔✔ Precision mechanical test gauge 0.10” 91 vent Fiberglass Smith 3.50” 25’ Gasoline Boot in Sump 30 minutes 11:30am 5.00” 12:30pm 5.00” 60 minutes 0.00” 0.00” ✔ ,' ,GHQWLILFDWLRQ 81 ZZZXQLGRFVRUJ 5HY 81'(5*5281'6725$*(7$1. 6(&21'$5<&217$,10(177(67,1*5(3257)250 3DJHRI  ;,,,9$3255(&29(5<3,3,1*&217$,10(177(67,1*,1)250$7,21 0DQXIDFWXUHU,GHQWLI\7DQN,'IURP6HFWLRQ,,,IRUHDFK0DQXIDFWXUHU $%&' $%&' 7HVW0HWKRG8VHG0DQXIDFWXUHU*XLGHOLQHV(Specify) ,QGXVWU\&RGHRU(QJLQHHULQJ6WDQGDUG (Specify) (QJLQHHUHG0HWKRG(Specify) Attach the testing procedures and all documentation required to determine the results.RI$WWDFKHG3DJHV 9DSRU5HFRYHU\3LSLQJ&RQWDLQPHQW7HVWLQJ7UDLQLQJDQG&HUWLILFDWLRQV(List applicable certifications.)([SLUDWLRQ'DWH ,QWHUVWLWLDO&RPPXQLFDWLRQ9HULILFDWLRQ0HWKRG8VHG ;,9 &200(176 Provide any additional comments here. ;9 785%,1(352'8&73,3,1*68037(67,1*,1)250$7,21 0DQXIDFWXUHU,GHQWLI\7DQN,'IURP6HFWLRQ,,,IRUHDFK0DQXIDFWXUHU $%&' $%&' 7HVW0HWKRG8VHG0DQXIDFWXUHU*XLGHOLQHV(Specify) ,QGXVWU\&RGHRU(QJLQHHULQJ6WDQGDUG (Specify) (QJLQHHUHG0HWKRG(Specify) Attach the testing procedures and all documentation required to determine the results.RI$WWDFKHG3DJHV 7XUELQH3URGXFW3LSLQJ6XPS7HVWLQJ7UDLQLQJDQG&HUWLILFDWLRQV(List applicable certifications.)([SLUDWLRQ'DWH ;9, &200(176 Provide any additional comments here. Smith PEI-1200 ICC 8374998 11/14/2019 Check communication from furthest point. Unknown PEI-1200 ICC 8374998 11/14/2019 Franklin fueling 1008973709 4/12/2019 SWRCB, January 2002 6. PIPING SUMP TESTING Test Method Developed By: Sump Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: Sump # Sump # Sump # Sump # Sump Diameter: Sump Depth: Sump Material: 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 Tested1 Does turbine shut down when sump sensor detects liquid (both product and water)?* Yes No NA Yes No NA Yes No NA Yes No NA Turbine shutdown response time Is system programmed for fail-safe shutdown?* Yes No NA Yes No NA Yes No NA Yes No NA Was fail-safe verified to be operational?* Yes No NA Yes No NA Yes No NA Yes No NA Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-RI): 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 Yes No NA Yes No NA Yes No NA Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests) 1 If the entire depth of the sump is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is “NO” or “NA”, the entire sump must be tested. (See SWRCB LG-160) ✔ ✔ INCON 0.002” 87 91 42.00”42.00” 80.00”80.00” Fiberglass Fiberglass 20.00”20.00” 12.00”12.00” Clean Clean 24.00”24.00” ✔ ✔ N/A N/A N/A N/A ✔ ✔ ✔ ✔ 30 minutes 30 minutes 0.002” 0.002” ✔✔ ✔ ✔ ✔ ✔ See incon strips for test results  ,' ,GHQWLILFDWLRQ 81 ZZZXQLGRFVRUJ 5HY 81'(5*5281'6725$*(7$1. 6(&21'$5<&217$,10(177(67,1*5(3257)250 3DJHRI  ;9,, ),//5,6(568037(67,1*,1)250$7,21 0DQXIDFWXUHU,GHQWLI\7DQN,'IURP6HFWLRQ,,,IRUHDFK0DQXIDFWXUHU $%&' $%&' 7HVW0HWKRG8VHG0DQXIDFWXUHU*XLGHOLQHV(Specify)  ,QGXVWU\&RGHRU(QJLQHHULQJ6WDQGDUG (Specify)  (QJLQHHUHG0HWKRG(Specify)  Attach the testing procedures and all documentation required to determine the results.RI$WWDFKHG3DJHV  )LOO5LVHU6XPS7HVWLQJ7UDLQLQJDQG&HUWLILFDWLRQV(List applicable certifications.)([SLUDWLRQ'DWH    ;9,,, &200(176 Provide any additional comments here.  ;,; 9(1775$16,7,2168037(67,1*,1)250$7,21 0DQXIDFWXUHU,GHQWLI\9HQW7UDQVLWLRQ6XPS,'IURP6HFWLRQ,,,IRUHDFK0DQXIDFWXUHU DEFG DEFG 7HVW0HWKRG8VHG0DQXIDFWXUHU*XLGHOLQHV(Specify)  ,QGXVWU\&RGHRU(QJLQHHULQJ6WDQGDUG (Specify)  (QJLQHHUHG0HWKRG(Specify)  Attach the testing procedures and all documentation required to determine the results.RI$WWDFKHG3DJHV  9HQW7UDQVLWLRQ6XPS7HVWLQJ7UDLQLQJDQG&HUWLILFDWLRQV(List applicable certifications.)([SLUDWLRQ'DWH    ;; &200(176 Provide any additional comments here.   PEI-1200 N/A Bakersfield city fire department inspector Kris Karns said no test necessary no piping and fill Sumps PEI-1200 N/A  8'& 8QGHU'LVSHQVHU&RQWDLQPHQW,' ,GHQWLILFDWLRQ 81 ZZZXQLGRFVRUJ 5HY 81'(5*5281'6725$*(7$1. 6(&21'$5<&217$,10(177(67,1*5(3257)250 3DJHRI  ;;, 81'(5',63(16(5&217$,10(177(67,1*,1)250$7,21 0DQXIDFWXUHU V ,GHQWLI\8'&,'IURP6HFWLRQ,,,IRUHDFK0DQXIDFWXUHU     7HVW0HWKRG8VHG0DQXIDFWXUHU*XLGHOLQHV(Specify)  ,QGXVWU\&RGHRU(QJLQHHULQJ6WDQGDUG (Specify)  (QJLQHHUHG0HWKRG(Specify)  Attach the testing procedures and all documentation required to determine the results.RI$WWDFKHG3DJHV  8'&7HVWLQJ7UDLQLQJDQG&HUWLILFDWLRQV(List applicable certifications.)([SLUDWLRQ'DWH    ;;,, &200(176 Provide any additional comments here.  If the facility has more components than this form accommodates, additional copies of these pages may be attached. Unknown PEI-1200 2 ICC 8374998 11/14/2019 Franklin fueling 1008973709 4/12/2019 SWRCB, January 2002 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: UDC Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: UDC # UDC # UDC # UDC # UDC Manufacturer: UDC Material: UDC Depth: Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested1 Does turbine shut down when UDC sensor detects liquid (both product and water)?* Yes No NA Yes No NA Yes No NA Yes No NA Turbine shutdown response time Is system programmed for fail- safe shutdown?* Yes No NA Yes No NA Yes No NA Yes No NA Was fail-safe verified to be operational?* Yes No NA Yes No NA Yes No NA Yes No NA Wait time between applying pressure/vacuum/water and starting test Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-RI): 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 Yes No NA Yes No NA Yes No NA Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests) 1 If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is “NO” or “NA”, the entire UDC must be tested. (See SWRCB LG-160) ✔ ✔ INCON 0.002” 1/2 3/4 5/6 7/8 Unknown Unknown Unknown Unknown Fiberglass Fiberglass Fiberglass Fiberglass 32.00”32.00”32.00”32.00” 8.00”8.00”8.00”8.00” 2.00”2.00”2.00”2.00” Clean Clean Clean Clean 12.00”12.00”12.00”12.00” ✔ ✔✔✔ N/A N/A N/A N/A ✔ ✔✔✔ ✔ ✔✔✔ 30 minutes 30 minutes 30 minutes 30 minutes 0.002” 0.002” 0.002” 0.002” ✔✔✔✔ ✔✔✔✔ ✔ ✔✔✔ See incon strips for test results SWRCB, January 2002 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: UDC Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: UDC # UDC # UDC # UDC # UDC Manufacturer: UDC Material: UDC Depth: Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested1 Does turbine shut down when UDC sensor detects liquid (both product and water)?* Yes No NA Yes No NA Yes No NA Yes No NA Turbine shutdown response time Is system programmed for fail- safe shutdown?* Yes No NA Yes No NA Yes No NA Yes No NA Was fail-safe verified to be operational?* Yes No NA Yes No NA Yes No NA Yes No NA Wait time between applying pressure/vacuum/water and starting test Test Start Time: Initial Reading (RI): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-RI): 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 Yes No NA Yes No NA Yes No NA Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests) 1 If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is “NO” or “NA”, the entire UDC must be tested. (See SWRCB LG-160) ✔ ✔ INCON 0.002” 9/10 11/12 Unknown Unknown Fiberglass Fiberglass 32.00”32.00” 8.00”8.00” 2.00”2.00” Clean Clean 12.00”12.00” ✔ ✔✔ N/A N/A ✔ ✔ ✔ ✔ 30 minutes 30 minutes 0.002” 0.002” ✔✔ ✔✔ ✔ ✔ See incon strips for test results