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Home My WebLink AboutSB989 2024Appendix 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 ܆ 36 Month CERS ID Test Date Facility Name Facility Address City ZIP Code Company Performing the Test Phone Mailing Address Service Technician Performing Test Contractor/Tank Tester License Number ICC Number ICC Expiration Date Manufacturer and Test Equipment Training Certifications Expiration Date Test Procedures Used Components Tested 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 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 10137943 03/19/2024 Jaco #3367 Fastrip #640 (West) 8001 White Lane Bakersfield 93309 Nwestco LLC (800) 339-9930 2209 Zeus Court, Bakersfield, CA 93308 Billy Lane 1073967 10281488 03/15/2025 INCON 1022163714 11/8/2024 Incon Sumps and UDC’s Precision mechanical test gauge Tank annular’s and line secondaries 03/19/2024 5Billy Lane 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 ܆܆ Professional Engineer Test Type ܆܆ Pressure ܆܆ Vacuum ܆܆ Hydrostatic Test Equipment Used: Tank ID Tank Manufacturer Tank Capacity 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 Test Method Developed by ܆܆ Manufacturer ܆܆ Industry Standard ܆܆ Professional Engineer Test Type ܆܆ Pressure ܆܆ Vacuum ܆܆ Hydrostatic Test Equipment Used: 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 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 91 ANN UNKNOWN 12,000 1300 -7.00" HG 1400 -7.00" HG 0.00" HG 0.00" HG 91 PRODUCT SMITH 1000 5.00 PSI 1100 5.00 PSI 0.00 PSI 0.00 PSI DSL ANN UNKNOWN 12,000 1300 -7.00" HG 1400 -7.00" HG 0.00" HG 0.00" HG DSL PRODUCT SMITH 1130 5.00 PSI 1230 2.50 PSI 2.50 PSI 0.00 PSI 91 VENT SMITH 0930 5.00 PSI 1030 5.00 PSI 0.00 PSI 0.00 PSI DSL VENT SMITH 0930 5.00 PSI 1030 5.00 PSI 0.00 PSI 0.00 PSI 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 ܆ Professional Engineer Test Type ܆ Pressure ܆ Vacuum ܆ Hydrostatic Test Equipment Used: Sump/UDC ID Sump Manufacturer Sump Depth (inches) Sump Bottom to Top of Highest Pipe Penetration (inches) 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 Sump/UDC ID Sump Manufacturer Sump Depth (inches) Sump Bottom to Top of Highest Pipe Penetration (inches) 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. 8. SUMP/UDC TEST 91 STP UNKNOWN 60.00" 36.00" SEE INCON RESULTS UDC 13-14 GVR 33.00" 13.00" SEE INCON RESULTS 91 FILL UNKNOWN 60.00" 36.00" SEE INCON RESULTS DSL STP UNKNOWN 60.00" 36.00" SEE INCON RESULTS DSL FILL UNKNOWN 60.00" 36.00" SEE INCON RESULTS UDC 15-16 GVR 33.00" 13.00" SEE INCON RESULTS UDC 17-18 GVR 33.00" 13.00" SEE INCON RESULTS UDC19-20 GVR 33.00" 13.00" SEE INCON RESULTS 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 ܆ Professional Engineer Test Type ܆ Pressure ܆ Vacuum ܆ Hydrostatic Test Equipment Used: Sump/UDC ID Sump Manufacturer Sump Depth (inches) Sump Bottom to Top of Highest Pipe Penetration (inches) 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 Sump/UDC ID Sump Manufacturer Sump Depth (inches) Sump Bottom to Top of Highest Pipe Penetration (inches) 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 Additional copies of this page may be attached. 8. SUMP/UDC TEST (continued) ܆ Pass ܆ Fail UDC 21-22 GVR 33.00" 13.00" SEE INCON RESULTS UDC 23-24 GVR 33.00" 13.00" SEE INCON RESULTS 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 9. COMMENTS