HomeMy WebLinkAboutSB989 2008 IIIIIIIIIIIIIIII�II 35 >xx
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SWRCB,January 2002 Page_L of
Secondary COntain.ment Testing Report Form
7'h Is form is intended for use by contractors performing periodic testing of UST secondary containment systems, Use the
appropriate pages of tha form to report results for all componenis tested. Ae completed form,written test procedures,and
printouts fmm testa rf applicable),should be provided to thefacility owner/operator for.submitral to the local regulatory agency,
I. FACILI'T'Y INFORMATION
Facility Name: Date of Tes' _j
Facility Address:
Facility Contact; fa Phone:
Date Local Agency Was Notified of Testing:
Nanw of Local Agency Inspector(ifpresent during testing):
2. 'TESTING CONTRACTOR INFORMATION
Company Name:
Tcchniclan Conduetin Test
Credentials: 9<8LB Lio=td Contractor 0 SWRCS Liocnsed Tank Tester
License Type: C Lt, 4 License Nutnber. 7,?c//7'D
MamtFaetarer Training;
Manufacturer Cote ens Date Training-Expires
3. SUMMARY OF TEST RESULTS
Component pass Fail Not Repalm Component Pau Pall Not Repairs
Tested Made Tested Rude
❑ ❑ ❑ ❑ n o ❑
❑ 0 ❑ U ❑ 0 ❑
0 ❑ 0 ❑ D ❑ D
G 0 ❑ 0 ❑ rJ ❑
L7 0 ❑ C7 ❑ n 0 D
0 ❑ D ❑ 0 ❑ 0 ❑
❑ ❑ 0 ❑ 0 0 ❑ 0
D n ❑ u ❑ n n ❑
0 ❑ 0 ❑ ❑ ❑ n ❑
00 0 n fl f ❑ 0 0
❑ ❑ a ❑ ❑ ❑ 0 0
❑ G rJ ❑ [1 1. ❑ ❑ ❑
If bydrostadc testing was performed,describe what was done with the water after completion of tests:
W f 0,s—
CER'[WICATION OF TEC>i NICTAN RESPONSJULE FOR CONDUCTING TIUS TESTING
ro the bc_rI of tity km7Wedge;ibefacts.W.Y in this document are aecurata and in full compliance with legdl requirements
Technician's Signature: It Date:�l/ya
IIIIIII IIIII III IIII 36
1 E
SWRCR.January 20Q2 page �—of-7
4. TANK ANNULAR TESTING
Test Method Developed By: 0 T�anis Manufacturer F1 industry Standard 0 Professional Engineer
Pc er(Speooy)
Test Method Used: 0 Pressure ❑Vacuum ❑Hydrostatic
❑Other(Speci
Test Equipment Used: Equipment Resolution:
7Tatik# Tank# Tank# Tank#
is Tank Exempt From Tcstirtg?' n No O Yes O No rJ Yes 0 No 0 Yes ❑No
Tank Capacity:
Tank Material:
Tank Manufacturer:
Product Stored:
Wait time between applying
pressure/vacuum/water and
starting teat:
Test Start Time:
Initial Reading
Test End Time:
Final Reading(Rp):
Test Duration:
Change in Reading(RrR�:
Pass/Fail Threshold or Criteria
Test Result: ❑ miss ❑FAU 17 Pass I?VAH. 0 Pass 13#44. 0 Pass ❑Fiiil
Was sensor removed for test ne. 0 Ycs C No O NA O Yes O No DNA n Yes O No O NA ❑Yes 0 No 0 NA
Was sensor properly replaced and D Yes O No 0 NA C7 Yes 0 No 0 NA O Yes O No O NA D Yes 0 No 0 NA
verified functional after testin ?
Comments—(1w1ude information tin repairs made prior to resting,and recommendedfollow-upforfailed tests}
Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary
containment,such as systems that are hydrostatically monitored or under constant vacuum,are exempt from periodic containment
testing_ {California Codc of Regulations,Title 23,Section 2637(x)(6)}
SWRCB,January 2002 rage of 7
S. SECONDARY PIPE TESTING
Test Method Developed By: p Piping Manufacturer WfhQustry Standard ❑Professional Zngincer
Other(Sped
Tect Method Used: sum 0 Vacuum D Hydrostatic
Q Other(S ecjfy
Test Equipment Used; rr- Equipment Resolution:
Piping Run 0 Piping Run N Plping Run# Piping Ran#
Piping Material:
Piping Manufacturer:
Piping Diameter.
Length of Piping Run; Men
Product Stored
Method and location of
piping-run isolation:
Wait time between applying
prossure/vacuum/watcr and
starting test:
Test Start Time:
Initial Reading(Rt):
Test End Time: t
Final Reading(RF): '
Test Duration:
Change in Reading
Pass/Fail Threshold or
Criteria: 0.2
Test Result: Pass U PAR, El Pass 0 I$ni1 D Pass ❑1r5i31 A p Pan d Fell
Co11 MCnts—(inc Jude!hCa maaor7 on repairs made prior to eesli ,and reET ndedfollow-u2&failed wts)
S WRCB,January 2002 page-5 of
6. PIPING SUMP TESTING
Test Method Developed By: 0 Sump Manufacturer 10dustry Standard ❑Professional Engineer
0 Other('Specify
Test Method Used: 0 Pressure U Vacuum ydrostatic
0 0tbor(SpeC.ify)
Te.4t Equipment Used: Equipment Resolution:
MIN
Snmp i's{ Sump# 5amp ii Sump#
Sump Diameter:
Sump Depth:
Sump Material:
Height from Tank Top to"fop of
Hfghosrt Piping Penetration.-
Height from Tank Top to lowest
Electrical Penetration:
Condition of sump prior to testing: C 1
Portion of Sump Tested' C'
Does turbine shut down when ees 0 No 0 NA
sump sensor detects liquid(both ❑Yee 0 No 0 NA 0 Yes n No 0 NA 0 Yes 0 No 0 NA
product and water)?'
Turbine shutdown response time
Is system programmed for fail-safe des ❑No CJ NA 0 Yes C No ❑NA, 0 Yes C No n NA n Yts ❑No O NA
shutdown?
Was fail-safe verified to be Q'!cs J No DNA 0 Yes n No D NA 0 Yes 0 No 0 NA 0 Yes 0 No 0 NA
operational?*
Wait time between applying
pressure/vacuum/water and starting
test:
Test Start Tirane:
Initial Reading(Q.,
Test End Time: j
Final Reading('Rf):
Test Duration:
'AN PACIFIC; PETROLEUM
le5O COFFEE RD
SAKERSPIELD CA
9;,3@8
11/14/2088 11:37 AM
?AN 1850FCOFFEERRDEUM
Sr�1P LEAK TEST P,EFORT
BAKERSFIELD CA
93308
DSL. STP
^1/14/21908 19:19 A0 TEST STARTED 11:22 AM
TEST STARTED 11/14/2508
SUMP LEAK TEST REPORT BEGIN LEVEL 5.9998 IN
END TIME 11:37 Aft
UDC 1-2 END DATE 11/14/2098
END LEVEL 5.0986 IN
TEST STARTED 10°02. AN LEAK 'THRESHOLD 0.892 IN
TCST STARTED 11/14•/2008 TEST RESULT PASSED
BEGIN LEVEL S.A
LS D DATE IJr14/200JB DSL STP
END LEVEL
LEAK. THRESHOLD 0.002 IN TES ARTEO 11:22 AM
TES; REGULT TEST BTA 11/14/2998
FIEGIN �_F'�1E.
IN
END TIME 7 Ail
DSL Fa END DA 11/14/
END L ¢.1853 IH
•�$T STARTED 18 82 AM THRESHOLD 0.092 IN
TEST STAP,TED 11Ila 02 AM _ ST RESULT 1WREASED
SECIN LEVEL
END TIME 10, 6 AM
END DATE 11/114/2008
END LEVEL 4.9517 IN
LEAK THRESHOLD 8.002 IN
TEST RESULT PASSED
DSL F8
TEST STARTED 18 62 AM DAN °ACIFIC PETROLEUM
TEST STARTED 11/14/280$ 1850 COFFEE RD
BEGIN LEVEL 3.5753 IN SAIKERSFIELD CA
END TIME • 1 i�4i200�1 9330£
A's
END D
EHD LEVEL 3.5757 IN 11,114/2F$ 11:56 AM}
LEAK THRESHOLD 8,002 It'
TEST RESULT SUMP LEAK TEST REF15RT
�JSL STP
TEST STARTED 11:41 AM
TEST STARTED 11/14/2808
BEGIN LEUEL 5.09$2 IN
END TIME 11:56 HM
END DOTE 1:1114/2 068
END LEVEL 5.0982 IN
LEAK THRESHOLD @.082 IN
TEST RESULT PASSED
DSL STP
TEST STARTED :41 AM
>TIMED /14/26@8
L 4.1882 IN
11:56 AM
11/14/2008
19;15 IN
HOL ID 0.T 14MASED
CAL-VALLEY EQUIPMENT
3500 GILMORE AVE.
BAKERSFIELD, CA 93308 CAL-VALLEY
(661)327-9341 FAX (661)325-2529 EQUIPMENT
CONTRACTOR'S LIC.#784170 A HAZ
Fax
Ta Frorrc 46622
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