HomeMy WebLinkAboutSPILL BUCKETS 2022Appendix VIII Underground Storage Tank Spill Container Testing Report Form
CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council
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TYPE OF ACTION ☐Installation ☐Repair ☒12 Month
1. FACILITY INFORMATION
CERS ID
10022869
Test Date
10-12-2022
Facility Name
Circle k
Facility Address
5634 Stine rd
City
Bakersfield
ZIP Code
2. SERVICE TECHNICIAN INFORMATION
Company Performing the Test
B&T SERVICE STATION CONTRACTORS
Phone
805.929.8944
Mailing Address
630 S FRONTAGE RD, NIPOMO, CA 93444 Service Technician Performing Test
RYAN WITTENBERG Contractor/Tank Tester License Number
902034
ICC Number
10167080
ICC Expiration Date
5-18-2024
3.TRAINING AND CERTIFICATIONS
Manufacturer and Test Equipment Training Certifications Expiration Date
FFS PRO STAGE II 1026443711 7-29-2024
4.TEST PROCEDURE INFORMATION
Test Procedures Used Components Tested
1 HR HYDRO 87 FILL
1 HR HYDRO 91 FILL
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
10-12-2022
Total # of Pages
93313
Underground Storage Tank Spill Container Testing Report Form
Additional copies of this page may be attached.
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6.SPILL CONTAINER DETAILS
Test Method Developed by ☒ Manufacturer ☐ Industry Standard ☐ Professional Engineer
Test Type ☐Pressure ☐Vacuum ☒Hydrostatic
Tank ID 87 91
Spill Container Manufacturer: 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.
87 SPILL BUCKET FAILED HYDROSTATIC TEST. WILL NEED TO REPLACE AND RETEST.