HomeMy WebLinkAboutSB989 2025Appendix 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
10134226 1/28/25
Jaco #3346 Fastrip #621
805 34th St Bakersfield 93301
Nwestco LLC (800) 339-9930
2209 Zeus Court, Bakersfield, CA 93308
Zachary Elder
1073967
10381559 05/06/26
INCON 4528403716 06/17/2026
Incon Sumps and UDC’s
Precision mechanical test gauge Tank annular’s and line secondaries
1/28/25 6
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
Vacuum gauges
T1 87
Modern welding
12,000
1pm
10Hg
2pm
10Hg
0
0
Pressure gauges
87-1
Unknown
1pm
5psi
2pm
5psi
0
0
T2 87-2
Modern welding
12,000
1pm
10Hg
2pm
10Hg
0
0
91
Modern welding
12,000
1pm
10Hg
2pm
10Hg
0
0
DSL
Modern welding
12,000
1pm
10Hg
2pm
10Hg
0
0
87-2
Unknown
1pm
5psi
2pm
5psi
0
0
91
Unknown
1pm
5psi
2pm
5psi
0
0
DSL
Unknown
1pm
5psi
2pm
5psi
0
0
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
87-1
Unknown
60”
24”
12:58
1.1339
1:13
1.1335
.000
.002
1-2
Unknown
36”
12”
2:51
3.1120
3:06
3.1120
.000
.002
87-2
Unknown
60”
24”
12:09
2.0938
12:24
2.0941
.002
.002
91
Unknown
60”
24”
12:09
3.0109
12:24
3.0109
.000
.002
DSL
Unknown
60”
24”
12:58
3.0133
1:13
3.0132
.002
.002
3-4
Unknown
36”
12”
12:53
2.7673
1:09
2.7675
.002
.002
5-6
Unknown
36”
12”
12:53
1.4673
1:09
1.4675
.002
.002
7-8
Unknown
36”
12”
2:27
4.2853
2:42
4.2855
.002
.002
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
Trans East
Unknown
36”
12”
2:27
2.7531
2:42
2.7525
.002
.002
Trans West
Unknown
36”
12”
12:53
1.6589
1:09
1.7086
.002
.002
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
INCON F,ASTRI IP 805 34ST BAKERSFIELD CA 93301 1-800-984-6266
05/21/2007 1:13 AM
SUMP LEAK TEST REPORT
87-lSTP
TEST STARTED 12:58 AM TEST STARTED 06/21/2007 BEGIN LEVEL 1.1339 IN END TIME 1:13 AM END DATE 06/21/2007 END LEVEL 1.1335 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED
DSL STP
TEST STARTED 12:58 AM TEST STARTED 06/21/2007 BEGIN LEVEL 3.0133 IN END TIME 1:13 AM END DATE 06/21/2007 END LEVEL 3.0132 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED
INCON tiSTRIIP 805 34ST BA�ERSFIELD CA 93301 1-800-984-6266
06/21/2007 12:24 AM
SUMP LEAK TEST REPORT
87-2STP
TEST STARTED 12:09 AM TEST STARTED 06/21/2007 BEGIN LEVEL 2.0938 IN END TIME 12:24 AM END DATE 06/21/2007 END LEVEL 2.0941 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED
91 STP
TEST STARTED TEST STARTED BEGIN LEVEL END TIME END DATE END LEVEL LEAK THRESHOLD TEST RESULT
12:09 AM 06/21/2007 3. 0109 IN12:24 AM06/21/2007 3.0101 IN0.002 INPASSED
TEST PERFORMED ON 1/28/2025, INCON DATE AND TIME WAS INCORRECT