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Home My WebLink AboutFMC 2023 Repair 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 X Repair ☐ 12 Month 1. FACILITY INFORMATION CERS ID 10023058 Test Date 4/28/2023 Facility Name ARCO Facility Address 6450 White Lane City Bakersfield ZIP Code 93309 2. SERVICE TECHNICIAN INFORMATION Company Performing the Test Advanced Compliance Phone 661-706-4321 Mailing Address 4007 Brae Burn Dr Bakersfield Ca. 93306 Service Technician Performing Test Bruce W. Hinsley Contractor/Tank Tester License Number 971259 ICC Number 8032698 ICC Expiration Date 6/23/2023 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date ICC Service Techican 6/23/2023 4. TEST PROCEDURE INFORMATION Test Procedures Used Components Tested Industry Standard 91 Spill Bucket. 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 4/28/2023 Total # of Pages 2 6. SPILL CONTAINER DETAILS Test Method Developed by ☐ Manufacturer X Industry Standard ☐ Professional Engineer Underground Storage Tank Spill Container Testing Report Form Additional copies of this page may be attached. Page 2 of 2 Test Type ☐ Pressure ☐ Vacuum X Hydrostatic Tank ID 91 Spill Container Manufacturer: OPW Method of Cathodic Protection ☐ Nonmetallic X Other ☐ Nonmetallic ☐ Other ☐ Nonmetallic ☐ Other ☐ Nonmetallic ☐ Other Is the spill container minimum capacity five gallons excluding riser volume? X Yes ☐ No* ☐ Yes ☐ No* ☐ Yes ☐ No* ☐ Yes ☐ No* Method to keep spill container empty X Drain ☐ Pump ☐ Other ☐ Drain ☐ Pump ☐ Other ☐ Drain ☐ Pump ☐ Other ☐ Drain ☐ Pump ☐ Other Spill Container Test Results X 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.