HomeMy WebLinkAbout2021-10-08-2708606-SBI Appendix VIII Underground Storage Tank Spill Container Testing Report Form
CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council Page 1 of 2
TYPE OF ACTION ☐ Installation ☐ Repair ☒ 12 Month
1. FACILITY INFORMATION
CERS ID
10023799
Test Date
10/8/2021
Facility Name
Circle k
Facility Address
1030 Oak st
City
Bakersfield
ZIP Code
93304
2. SERVICE TECHNICIAN INFORMATION
Company Performing the Test
B&T Service Station Contractors
Phone
805-929-8944
Mailing Address
630 S. Frontage rd Nipomo Service Technician Performing Test
Rick Binger Contractor/Tank Tester License Number
902034
ICC Number
8452629
ICC Expiration Date
3/31/2023
3. TRAINING AND CERTIFICATIONS
Manufacturer and Test Equipment Training Certifications Expiration Date
OPW 1192309 7/2/2023
4. TEST PROCEDURE INFORMATION
Test Procedures Used Components Tested
RP1200
5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST
I hereby certify that each spill container was tested in accordance with California Code of
Regulations, title 23, division 3, chapter 16, section 2637.1; 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
10/8/2021
Total # of Pages
Underground Storage Tank Spill Container Testing Report Form
Additional copies of this page may be attached. Page 2 of 2
6. SPILL CONTAINER DETAILS
Test Method Developed by ☐ Manufacturer ☒ Industry Standard ☐ Professional Engineer
Test Type ☐ Pressure ☐ Vacuum ☒ Hydrostatic
Tank ID Tank 1 87 Tank 2 91 Tank 89 DSL
Spill Container Manufacturer: OPW OPW OPW
Method of Cathodic Protection ☒ Nonmetallic
☐ Other
☒ Nonmetallic
☐ Other
☒ Nonmetallic
☐ Other
☐ Nonmetallic
☐ Other
Is the spill container minimum capacity five gallons excluding
riser volume?
☒ Yes
☐ No*
☒ Yes
☐ No*
☒ Yes
☐ No*
☐ Yes
☐ No*
Method to keep spill container empty
☒ Drain
☐ Pump
☐ Other
☒ Drain
☐ Pump
☐ Other
☒ Drain
☐ Pump
☐ Other
☐ Drain
☐ Pump
☐ Other
Spill Container Test Results ☒ Pass
☐ Fail
☒ Pass
☐ Fail
☒ Pass
☐ Fail
☐ Pass
☐ Fail
Tank ID
Spill Container Manufacturer:
Method of Cathodic Protection ☐ Nonmetallic
☐ Other
☐ Nonmetallic
☐ Other
☐ Nonmetallic
☐ Other
☐ Nonmetallic
☐ Other
Is the spill container minimum
capacity five gallons excluding
riser volume?
☐ Yes
☐ No*
☐ Yes
☐ No*
☐ Yes
☐ No*
☐ Yes
☐ No*
Method to keep spill container empty
☐ Drain
☐ Pump
☐ Other
☐ Drain
☐ Pump
☐ Other
☐ Drain
☐ Pump
☐ Other
☐ Drain
☐ Pump
☐ Other
Spill Container Test Results ☐ Pass
☐ Fail
☐ Pass
☐ Fail
☐ Pass
☐ Fail
☐ Pass
☐ Fail
1 8. COMMENTS
Describe all answers marked “Other,” “No,” or “Fail” and each proposed remedy.
* Mark here if:
Spill containers do not have a minimum capacity of five gallons and require replacement.