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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 03/05/2024 Jaco #3366 Fastrip #640 (WEST) 8001 White Lane Bakersfield 93309 Nwestco LLC (800) 339-9930 2209 Zeus Court, Bakersfield, CA 93308 Billy Lane 1073967 10481488 03/5/2025 OPW-1193586 06/09/2025 INCON-1022163714 11/08/2024 Incon Sumps and UDC’s Precision mechanical test gauge Tank annular’s and line secondaries 03/05/2024 8Billy 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 87 MAIN MW 12,000 0900 -7.00 HG" 1000 -7.00 HG" 0.00 HG" 0.00 HG" 87 MAIN PRODUCT SMITH 0900 5.00 PSI 1000 5.00 PSI 0.00 PSI 0.00 PSI 87 SIPHON PRODUCT SMITH 0930 5.00 PSI 1030 5.00 PSI 0.00 PSI 0.00 PSI 87 SIPHON MW 12,000 0915 -7.00 HG" 1015 -7.00 HG' 0.00 HG" 0.00 HG" 91 MW 12,000 1000 -7.00 HG" 1100 -7.00 HG" 0.00 HG" 0.00 HG" DSL MW 12,000 1100 -7.00 HG" 1200 -7.00 HG" 0.00 HG" 0.00 HG" 87 MAIN SIPHON SMITH 1200 5.00 PSI 1300 5.00 PSI 0.00 PSI 0.00 PSI 87 MAIN VENT SMITH 1200 5.00 PSI 1300 5.00 PSI 0.00 PSI 0.00 PSI 87 MAIN VAPOR SMITH 1230 5.00 PSI 1330 5.00 PSI 0.00 PSI 0.00 PSI 87 SIPHON SIPHON SMITH 0930 5.00 PSI 1030 5.00 PSI 0.00 PSI 0.00 PSI 87 SIPHON VENT SMITH 0930 5.00 PSI 1030 5.00 PSI 0.00 PSI 0.00 PSI 91 PRODUCT SMITH 1030 5.00 PSI 1130 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 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 VAPOR SMITH 1030 5.00 PSI 1130 5.00 PSI 0.00 PSI 0.00 PSI 91 VENT SMITH 1030 5.00 PSI 1130 5.00 PSI 0.00 PSI 0.00 PSI DSL PRODUCT SMITH 1330 5.00 PSI 1430 5.00 PSI 0.00 PSI 0.00 PSI DSL VENT SMITH 1330 5.00 PSI 1430 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 87 MAIN FILL WF 77.00" 12.00" SEE INCON RESULTS 91 FILL WF 77.00" 12.00" SEE INCON RESULTS 87 MAIN STP WF 77.00" 36.00" SEE INCON RESULTS 87 SIPHON FILL WF 77.00" 12.00" SEE INCON RESULTS 87 SIPHON STP WF 77.00" 38.00" SEE INCON RESULTS 91 STP WF 77.00" 18.00" SEE INCON RESULTS DSL FILL WF 77.00" 12.00" SEE INCON RESULTS DSL STP WF 77.00" 18.00" 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 1-2 GVR 33.00" 13.00" SEE INCON RESULTS UDC 9-10 GVR 33.00" 13.00" SEE INCON RESULTS UDC 3-4 GVR 33.00" 13.00" SEE INCON RESULTS UDC 5-6 GVR 33.00" 13.00" SEE INCON RESULTS UDC 7-8 GVR 33.00" 13.00" SEE INCON RESULTS UDC 11-12 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