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S tti'i2CB, January 20o2 - - `- -- - - Page ~ of
SecondaT~y containment Testing Report Form
Tl,is form is intandadfor rrsa by contracr~rs performing pvrtodic tasting of UST secondary co»ralnmant .cystams. CJse tha
aiaproprlate pages of this form Jo report ~•esul4r for all components Jested. The completed form, written test procedures, and
prinroutsfrom tests ({f applicable), shoo?t(be provided to thefacility owner/operator for submittal to the local regulalory age»cy.
t F`ef`iY.TTViNFt)RMA?'T(1N
Facility Name: Date ofTestin ~ ^ ' O
F'aciliry Address: ~ ~ ~yrl,
Facility Contact: Phone:
Date Local Agency Was Notified of Tcstutg
Pdame of Local Agency Inspector (jpresenl during testln~:
2. T~C1'T3VC: C(1NTRAf'T17R INR()RMATTON
Company Name: RTCH ENVIRONMENTAL
7'cchnician Conducting Test: ~„3
Credentials: ~ CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester
License Type. C611D90 License Number: 809850
_ Manu&ecturer nufacty,,rer TraEnine
Com onen s DateTrainin E lies
ZNCON INCON TS-STS
3. SiTMMARV nF TFCT RTi'Ci'TI.TC ,';. .
Component
_ Pass FaiE Not
Tested Repafry
Made Component Vasa FaE1 -Not
Tested Repairs
Made
nG. ~ D ^ ^ 0 ^ ^ 0
~(,,,~~ D
~ D
^ C7
^ ^
0 D
^ 0
^ D
0
^ D D ^ ^ ^ ^ CE
o a D D ^ ^ ^ ^
^ D D U D D D ^
D ^ a ^ ^ ^ ^ f
~. D 0 D D ^ ^ ^ 0
n a a a ^ ^ ^ r
^ o D a ^ ^ D a
~, nyuros~atic testing was pertormeU, describe what was done with the water after completion of tests:
RECYCLE AND REUSRD
CERTTFICATIUIV OF TECHIVTCIAN RESPONSIBLE FUR COAlDUCTING TIII5 TESTING
I'v the hesr of my knowledge, t/re jams stared in thls doc/u~ment are accurate and !n fu!! co»rpliance with legs! requtrerrrents
Technician's Signature: /V~ ~' _ -{,~ Date: l~ ,~ v?- 6
~'
~~~
r
~yg~g ~
SW'RCB, January 2002 Page ~ of~
~ T+T7)77Vf! C7'TkAD TF.QT7Mf_
Test Method Developed By: ^ Sump Manufacturer ~ ladustry Standard ^ Professional Engineer
^ Other (Spec~J
Test Method Used: U Pressure D Vacuum iC7 Hydrostatic
0 Other (Sped)
Test Equipment Used: INCON TS -STS Equipment Resolution:,oooin.
Sump # ~ Sump # Sump # Sump #
Sump Diameter,
Sump Depth: t' ~~
Swnp Material:
-Haight from Tank Top to Top of
1-li hest Pi in Penetration: +
r_! / ~ /~'•
Height from Tank Top to Lowest
Electrical Penetration; }r ,
ti> ~~' ~ ~ r1~'
•~G
Condition of sump prior to testing: C~ ~,Y1r C Y1
Ponion of Sump Tested' ~' ;74 ~'
Does turbine shut down when
sump sensor detects liquid (both
roduct and water ?~
^Yes ^No~JA
DYes ^No~'~[A
DYes ^No~IA
QYcs DNo DNA
Turbine shutdown response tune ,~y~ v n~»pttily~ nknUw L
!s system programmed for fail-safe
shutdown?' DYes ^ No A
~ 0 Yes Q No
~fNA
0 Yes D N~NA
DYes DNo DNA
Was ail-safe verified to be
0 eratiorial? p yes Q No ~QJA DYes DNo `,~IA DYes 0 No `f~NA Q Yes Q No Q NA
Wait time between applying
pressureJvacuum/water and starting
test:
M+n
,
~ Mt
Mt n
Test Start Time: ~. p ;l :~Ar 51AIr~ .}~pM gun
Initial Reading (R~: .7 rj.n 7,r~ ,f1 .~ to
Test End Time: ;lay,pt ' ~ ;~~ t~
Finat Reading (RF): .7~n ,n 3~•n ,,,~j,n „"t ~n
Tes[Dtuation: ~5mip }rjp~irl ~JN1~ 5 i , m.
Change in Reading (RF•Rt): -tt1 ,~?~rl~ tta(3~,n .00).t1 .c>ol, r• ,LXp'~h
Pass/Fail Threshold or Criteria: QQ~j1;n . pQq'1; ~ x. ~ '+ ~ , ~ , (~a;t.,
Test Resulh ~ Pass ^ Fail ~"iS:PaSS Q Fall .Pass ^ Fail D Pass D Fait
Was sensor removed for testing? es ^ No ^ NA es DNo ^ NA `DYes DNo ^ NA DYes ^ No ^ NA
Was sensor properly replaced and
verified functional after testin T es DNo ^ NA es DNo Q NA
'~ es DNo Q NA
'~' q Yes DNo ^ NA
CUmments - (include information on repairs mode prior to feeling and recommended follow apforfoiled lesl~
t If the entire depth of the sump is not tested, specify how much was tested. If the answer to ~ of the questions indicatt;ti with an
asterisk (•) is "NO" or "NA", the enure sump must be tested. (See SWRCB LG-160)
I
:. . • ,z.
`~l $~ /
~..~
TEST '=,TARTECi. R. }`, ~ TE~,T STARTED ?:57 Ai't
/
2r
005
i'
"SST STfiRTEG 11/22/200E 1-rST STARTED i
c
'
U
r85'
I
BEGIN LEVEL 5.7850 IF BEGIN LEI.~EL ._.
'
u:12 AM
F.NG TIME c;: 30 AM c~.aD TTME i1J22/•~806
ENn Dr.TE 11r22f2005 END bRTE
5
IN
r END '_~:VEi_
LEAK THRESHOLD 5.7848 IN:
0.902 IN, Ei3D LEVEL
LEflK, THRESHOL ~ ~ ~
D PASc;ED
TEST RESULT °A'SSED' TFBT RESULT
41STP
TEST 4~TARTr Ci 3:15 RM ~'.
TEST STAP.TF_D llr2?./2006 '.
BEGIN LEVEL 3.56b4 IN
END TIME 8:30 AM .
END i~ATE iir22r2006 ;
END LEVEL 3.5659 IN
LEHK THRESHOLD 0.002 IN
TEST RESULT PASSED ~~
D:LSTP
TEST STARTED 8:15 AM
TEST STARTED 11r2?/2006
BEr,IN LEVEL 5.3056 IN
END TIME 8:30 At^
END DATE i i %22.2006
END i_EVEL 5.3041 TN
LEAK THRESHOLD 0.00'? IN
TEST RESULT PASSED
9.1 •'~TP -
Ti,ST :; i ARTEU 7:57 AM
TEST STARTED 11i22/200~
BEGIN LEJt'4 3.5671 TN
g: i2 AC4
END TIME 11/G2•~2006
END DATE 3.5667 IN
ENU LEVEL
LEAK THRESHOLD O'PASSED
TEST P.ESULT , _.
DSLSTP
TEST STARTED 8:32 RM
TEST STARTED 11/22/2006
grr,IN LEVEL 5.3038 IN
END TIME 8:47 Ai~i
END DATF_ xi/22~2806
END I_F.l1EL 5.3035 IN
LEAK THRESHOLD 0.002 IN
'i E ST RESUI_1' PASSED