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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
10023058
Test Date
6/6/2024
Facility Name
ARCO White Ln
Facility Address
6450 White Ln
City
Bakersfield, Ca
ZIP Code
93309
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
8835007
ICC Expiration Date
8/8/2025
Manufacturer and Test Equipment Training Certifications Expiration Date
ICC Service Techican 8/8/2025
INCON STS 10/20/2025
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
6/6/2024
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 Setups
Tank ID 87S 87M 91
Tank Manufacturer Unknown Unknown Unknown
Tank Capacity 11,627 11,627 11,627
Test Start Time 09:15 07:55 10:40
Initial Reading -10.00 InHg -10.00 InHg -10.00 InHg
Test End Time 10:15 08:55 11:40
Final Reading -10.00 InHg -10.00 InHg -10.00 InHg
Change in Reading 0.0 InHg 0.0 InHg 0.0 InHg
Pass/Fail Criteria +/- 0.0 InHg +/- 0.0 InHg +/- 0.0 InHg
Tightness Test Results X Pass ☐ Fail X Pass ☐ Fail X Pass ☐ Fail ☐ Pass ☐ Fail
Test Method Developed by ☐ Manufacturer ☐ Industry Standard X Professional Engineer
Test Type X Pressure ☐ Vacuum ☐ Hydrostatic
Test Equipment Used: Line Secondary Testing Setup
Pipe Run ID 87S Line 87M Line 91 Line
Pipe Manufacturer Unknown Unknown Unknown
Test Start Time 07:50 07:45 08:10
Initial Reading 5.0 PSI 5.0 PSI 5.0 PSI
Test End Time 08:50 08:45 09:10
Final Reading 5.0 PSI 5.0 PSI 5.0 PSI
Change in Reading 0.0 PSI 0.0 PSI 0.0 PSI
Pass/Fail Criteria +/- 0.0 PSI +/- 0.0 PSI +/- 0.0 PSI
Tightness Test Results X Pass ☐ Fail X Pass ☐ Fail X 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
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 87S FS 87M FS 91 FS 87S STP
Sump Manufacturer Unknown Unknown Unknown Unknown
Sump Depth (inches) 45 45 45 40
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
10 10 10 30
Test Start Time 12:46 12:19 11:20 10:30
Initial Reading 2.2773 2.9664 2.7324 4.7637
Test End Time 13:01 12:34 11:35 10:45
Final Reading 2.2781 2.9682 2.7339 4.7633
Change in Reading 0.0008 0.0018 0.0015 0.0004
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 87M STP 91 STP UDC 1/2 UDC 3/4
Sump Manufacturer Unknown Unknown Unknown Unknown
Sump Depth (inches) 40 40 13 13
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
30 30 4 4
Test Start Time 09:52 10:53 14:09 14:27
Initial Reading 5.0077 4.2690 0.2288 0.9510
Test End Time 10:07 11:08 14:24 14:42
Final Reading 5.0081 4.2687 0.2285 0.9493
Change in Reading 0.0004 0.0003 0.0003 0.0017
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 5/6 UDC 7/8 UDC 9/10 UDC 11/12
Sump Manufacturer Unknown Unknown Unknown Unknown
Sump Depth (inches) 40 13 13 40
Sump Bottom to Top of
Highest Pipe Penetration
(inches)
28 4 4 28
Test Start Time 15:05 12:46 13:14 14:27
Initial Reading 4.9725 1.0318 0.9406 6.1007
Test End Time 15:20 13:01 13:30 14:42
Final Reading 4.9735 1.0315 0.9405 6.1013
Change in Reading 0.0010 0.0003 0.0001 0.0006
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
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 (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
All Passed.
9. COMMENTS