HomeMy WebLinkAboutSB989 2023
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
10120489
Test Date
6/8/2023
Facility Name
Samco Oak
Facility Address
1131 Oak St
City
Bakersfield
ZIP Code
93304
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
8/9/2023
Manufacturer and Test Equipment Training Certifications Expiration Date
ICC Service Techican 8/9/2023
INCON STS 10/5/2023
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
6/8/2023
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
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 ☐ Industry Standard X Professional Engineer
Test Type ☐ Pressure X Vacuum ☐ Hydrostatic
Test Equipment Used: Tank Annular Testing Setup
Tank ID 871 872 91 Diesel
Tank Manufacturer Unknown Unknown Unknown Unknown
Tank Capacity 9,842 9,842 9,842 9,842
Test Start Time 08:35 09:45 10:50 13:00
Initial Reading -10.00 InHg -10.00 InHg -10.00 InHg -10.00 InHg
Test End Time 09:35 10:45 11:50 14:00
Final Reading -10.00 InHg -10.00 InHg -10.00 InHg -10.00 InHg
Change in Reading 0.0 InHg 0.0 InHg 0.0 InHg 0.0 InHg
Pass/Fail Criteria +/- 0.0 InHg +/- 0.0 InHg +/- 0.0 InHg +/- 0.0 InHg
Tightness Test Results X Pass ☐ Fail X Pass ☐ Fail X Pass ☐ Fail X Pass ☐ Fail
Test Method Developed by ☐ Manufacturer ☐ Industry Standard X Professional Engineer
Test Type X Pressure ☐ Vacuum ☐ Hydrostatic
Test Equipment Used: Piping Secondary Testing Setup
Pipe Run ID 871 Product 872 Product 91 Product Diesel Prod.
Pipe Manufacturer Unknown Unknown Unknown Unknown
Test Start Time Line 08:40 Line 08:40
Initial Reading Would 5.0 PSI Would 5.0 PSI
Test End Time Not 09:40 Not 09:40
Final Reading Hold 5.0 PSI Hold 5.0 PSI
Change in Reading Pressure 0.0 PSI Pressure 0.0 PSI
Pass/Fail Criteria +/- 0.0 PSI +/- 0.0 PSI +/- 0.0 PSI +/- 0.0 PSI
Tightness Test Results ☐ Pass X Fail X Pass ☐ Fail ☐ Pass X Fail X 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.
6. TANK SECONDARY CONTAINMENT TEST
7. PIPE 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 3 of 5
Test Method Developed by ☐ Manufacturer ☐ Industry Standard X Professional Engineer
Test Type ☐ Pressure ☐ Vacuum X Hydrostatic
Test Equipment Used: Incon STS
Sump/UDC ID 871 Fill 872 Fill 91 Fill Diesel Fill
Sump Manufacturer Unknown Unknown Unknown Unknown
Sump Depth (inches) 68 68 68 68
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
34 34 34 34
Test Start Time 09:18 09:55 11:11 12:18
Initial Reading 4.5250 3.8176 5.1638 3.2064
Test End Time 09:33 10:10 11:26 12:33
Final Reading 4.5240 3.8162 5.1630 3.2084
Change in Reading 0.0010 0.0014 0.0008 0.0020
Pass/Fail Criteria +/- 0.0020 +/- 0.0020 +/- 0.0020 +/- 0.0020
Tightness Test Results X Pass ☐ Fail X Pass ☐ Fail X Pass ☐ Fail X Pass ☐ Fail
Sump/UDC ID 871 STP 872 STP 91 STP Diesel STP
Sump Manufacturer Unknown Unknown Unknown Unknown
Sump Depth (inches) 68 68 68 68
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
25 25 25 25
Test Start Time 15:28 14:38 13:06 12:00
Initial Reading 3.6016 3.0143 3.9945 4.2861
Test End Time 15:43 14:53 13:21 12:15
Final Reading 3.6001 3.0124 3.9945 4.2848
Change in Reading 0.0015 0.0019 0.0000 0.0013
Pass/Fail Criteria +/- 0.0020 +/- 0.0020 +/- 0.0020 +/- 0.0020
Tightness Test Results X Pass ☐ Fail X Pass ☐ Fail X Pass ☐ Fail X Pass ☐ Fail
Additional copies of this page may be attached.
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 4 of 5
Test Method Developed by ☐ Manufacturer ☐ Industry Standard X Professional Engineer
Test Type ☐ Pressure ☐ Vacuum X Hydrostatic
Test Equipment Used: Incon STS
Sump/UDC ID UDC 1/2 UDC 3/4 UDC 5/6 UDC 7/8
Sump Manufacturer Unknown Unknown Unknown Unknown
Sump Depth (inches) 40 40 40 40
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
21 21 21 21
Test Start Time 16:09 16:27 17:39 17:39
Initial Reading 3.4530 5.8264 2.6858 4.0664
Test End Time 16:24 16:42 17:54 17:54
Final Reading 3.4537 5.8265 2.6183 4.0666
Change in Reading 0.0007 0.0001 0.0675 0.0002
Pass/Fail Criteria +/- 0.0020 +/- 0.0020 +/- 0.0020 +/- 0.0020
Tightness Test Results X Pass ☐ Fail X Pass ☐ Fail ☐ Pass X Fail X Pass ☐ Fail
Sump/UDC ID UDC 9/10
Sump Manufacturer Unknown
Sump Depth (inches) 40
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
21
Test Start Time 18:07
Initial Reading 5.3775
Test End Time 18:22
Final Reading 5.3759
Change in Reading 0.0016
Pass/Fail Criteria +/- 0.0020
Tightness Test Results X 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
91 Line failed due to leaking boot in Disp 9/10. 871 Line failure point could not be found. Disp 5/6
failed, must be repaired and retested.
9. COMMENTS