HomeMy WebLinkAboutSB989 2011 SWRCB,January 2002 I IIIIIII VIII III IIII 39 Page of
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Secondary Containment Testing Report Form
This form is intended for use by contractors performing periodic testing of UST secondary containment systems Use the
appropriate pages of this form to report results for all components tested The completed form,written test procedures, and
printouts from tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACII..TTY INFORMATION
Facility Name: D&G 223 Date of Testing: — 3/15/11
Facility Address: 2732 Brundage Ln.Bakersfield,CA
Facility Contact: Jaco Hill Phone: 661-393-7000
Date Local Agency Was Notified of Testing: 3/9/11
Name of Local Agency Inspector(fpresent during testing):
2. TESTING CONTRACTOR INFORMATION
Company Name: Sunset Mechanical
Technician Condu Test: Scott Olinger
Credentials: WCSLB Licensed Contractor ❑SWRCB Licensed Tank Tester
License Type: C-36 C-10 License Number: 589517
Manufacturer Traininn _
Manufacturer Co netts Date Training Expires
Incon TS-STS hispection E ui merit 1/18/13
Veeder Root Monitorin System 1/15/12
ICC Cal UST Service Tech 1/18/13
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not Repairs Component P� Fail Not Repairs
Tested Made Tested Made
UDC#1-2 ET ❑ ❑ ❑ ❑ ❑ ❑ ❑
SPILL#1 0 ❑ 0 ❑ ❑ ❑ ❑
SPILL#2 ❑ ❑ ❑ ❑ 1 ❑ 1 ❑ ❑
SPILL#3 ❑ ❑ ❑ ❑ ❑ ❑ ❑
V SPILL#1 E ❑ ❑ ❑ ❑ ❑ ❑ ❑
V SPILL#2 ❑ ❑ ❑ ❑ ❑ ❑ ❑
V SPILL 43 ❑ ❑ ❑ ❑ ❑ ❑ ❑
❑ 0 0 ❑ 0 0 0 0
❑ ❑ ❑ ❑ 0 ❑ 0 ❑
❑ ❑ 0 0 ❑ 0 ❑ ❑
❑ ❑ ❑ 0 0 0 0 ❑
❑ ❑ 0 0 0 ❑ 0 ❑
If hydrostatic testing was performed,describe what was done with the water after completion of tests:
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best of my knowledge, a ads stated in this document are accurate and in fuA compliance with legal requirements
Technician's Sign Date:-3/15/1
IIIIIII VIII III IIII 40
IE
SWRCB,January 2002 Page_of
4. TANK ANNULAR TESTING—
Test Method Developed By- ❑Tank Manufacturer ❑industry Standard ❑Profmional Engineer
❑Other(Specify)
Test Method Used: 0 Pressure ❑Vacuum ❑Hydrostatic
❑Other(Specify)
Test Equipment Used: Equipment Resolution:
U,o"
Tank#1 Tank#2 Tank#3 Tank#
Is Tank Exempt From Testing?' G(Yes ❑No D(Yes ❑No dYes ❑No ❑Yes ❑No
Tank Capacity:
Tank Material:
Tank Manufacturer:
Product Stored:
Wait time between applying
pressure/vacuum/water and
starting test:
Test Start Time:
Initial Reading(RO:
Test End Time:
Final Reading(R.F):
Test Duration:
Change in Reading(RF-R4):
Pass/Fail Threshold or Criteria:
Test Result 0.Pass OFatif 0:Pass 6 Fad: ..O--PBSS-. 0,ftil ❑-;Pass- OTAH
Was sensor removed for testing? ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA
Was sensor properly replaced and
es ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No DNA
verified functional after testing? F—OY4 I I I I
Comments—(include it formation on repairs made prior to testing, and recommended follow-up for failed 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 Code of Regulations,Tide 23,Section 2637(a)(6))
SWRCB,January 2002 -F Page_of
5. SECONDARY PIPE TESTING
Test Method Developed By: 0 Piping Manufacturer 0 Industry Standard 0 Professional Engineer
0 Other(Specify)
Test Method Used: 0 Pressure 0 Vacuum 0 Hydrostatic
D Other(Specify)
Test Equipment Used: Equipment Resolution:
Piping Run# Piping Run#
Piping Run# Piping Run#
Piping Material:
Piping Manufacturer:
Piping Diameter.
Length of Piping Run:
Product Stored:
Method and location of
Pipt -run isolation:
Wait time between applying
presstuWvacuum/water and
starting test.-
Test Start Time:
Initial Reading(R):
Test End Time:
Final Reading(Rf):
Test Duration:
Change in Reading(Rr.-R4):
Pass/Fail.Threshold or
Criteria:
Test it it: O :Pass 0 Fail: b-Pass 0 0-Pass ..01aff. D Pass 0: ail
Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests)
SWRCB,January 2002 Page_of
6. PIPING SUMP TESTING
Test Method Developed By. 0 Sump Manufacturer 0 Industry Standard 0 Professional Engineer
0 Other(Specify)
Test Method Used: 0 Pressure 0 Vacuum 0 Hydrostatic
0 Other(Specify)
Test Equipment Used: Equipment Resolution:
Sump# Sump# Sump# Sump#
Sump Diameter.
.Sump Depth:
Sump Material:
Height from Tank Top to Top of
Highest Piping Penetration:
Height from Tank Top to Lowest
Electrical Penetration:
Condition of sump prior to testing:
Portion of Sump Tested'
Does turbine shut down when
sump sensor detects liquid(both OYes ONo DNA OYes ONo DNA OYes ONo OKA OYes ONo DNA
product and water)?*
Turbine shutdown response time
Is system programmed for fail-safe
shutdown'?* OYes ONo DNA DYes ONo DNA OYes ONo DNA DYes ONo DNA
Was fail-safe verified to be OYes ONo, DNA OYes DNo DNA OYes ONo DNA 0 Yes 0 No 0 NA
2perationalf
Wait time between applying
press=/vacuum/water and starting
test:
Test Start Time:
Initial Reading W:
Test End Time:
Final Reading(RF):
Test Duration:
Change in Reading(RF-RO:
Pass/Fail Threshold or Criteria:
Test Result: 0 0 Faq :0 Fail.--. .'D Paw,::1 Fail 0,Pgw: 0fail
Was sensor removed for testing? 0 Yes 0 No 0 NA 0 Yes D No 0 NA 0 Yes 0 No 0 NA OYes DNo DNA
Was sensor properly replaced and 0 Yes 0 No 0 NA 0 Yes 0 No 0 NA 0 Yes 0 No DNA OYes ON6 DNA
verified functional after testis ?
Comments—(include it formation on repairs made prior to testing; and recommended follow-up forfailed lesls)
If the entire depth of the sump is not tested,specify how much was tested. If the answer to any of the questions indicated with an
asterisk(*)is"140"or"NA",the entire sump must be tested. (See SWRCB LG-160)
SWRCB,January 2002 Page of
7. UNDER ISPENSER CONTAINMENT C TESTING
Test Method Developed By: 14 UDC Manufacturer ❑Industry Standard ❑Professional Engineer
❑Other(Specify)
Test Method Used: ❑Pressure ❑Vacuum Aydrostatic
❑Other(Specify)
Test Equipment Used:INCON TS-STS Equipment Resolution:
UDC#1-2 UDC#3-4 UDC# UDC#
UDC Manufacturer. WESTERN
UDC Material: FIGERGLASS
UDC Depth: 12"
Height from UDC Bottom to Top 0"
of Highest Piping Penetration:
Height from UDC Bottom to 0"
Lowest Electrical Penetration:
Condition of UDC prior to DRY
testing:
Portion of UDC Tested 9"
Does turbine shut down when /
UDC sensor detects liquid(both tq Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA
product and water)?*
Turbine shutdown response time
Is system programmed for fail- Sp Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA
safe shutdown?*
Was fail-safe verified to be 91yes ❑No 0 NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA
operational?*
Wait time between applying 10 MIN
pressure/vacuum/water and
starting test
Test Start Time: 221
Initial Reading K): 3.8748
Test End Time: 2:36
Final Reading 3.8761
Test Duration: 15 MIN
Change in Reading(Rf .0013
Pass/Fail Threshold or Criteria: 002
.Test Result: Pass ❑Fail ❑:Pass" ❑Fail i7 Pass rj Evil ❑'Pass `' :Fail '
Was sensor removed for testing? 46 Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA
Was sensor properly replaced and Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA
verified functional after testing?
Comments—(include it formation on repairs made prior to testing and recommended follow-up for failed tests)
'If the entire depth of the UDC is not tested,specify how much was tested If the answer to M of the questions indicated with an
asterisk(*)is"NO"or"NA",the entire UDC must be tested (See SWRCB LG-160)
SWRCB,January 2002 Page_of
8. FILL RISER CONT SUMP TESTING
Fac'q is Not Equipped With Fill Riser Containment Sumps S(
Fill Riser Containment Sumps are Present,but were Not Tested ❑
Test Method Developed By: 0 Sump Manufacturer 0 Industry Standard 0 Professional Engineer
0 Other(Specify)
Test Method Used: 0 Pressure 0 Vacuum ❑Hydrostatic
0 Other(Specify)
Test Equipment Used- Equipment Resolution:
...........
kd
0
Fin sump me# III SUME#
# Fill Sump# Fill Su F
Sump Diameter.
Sump Depth-
Height from Tank Top to Top of
Highest Piping Penetration:
Height from Tank Top to Lowest
Electrical Penetration:
Condition of sump prior to
testing-
Portion of Sump Tested
Sump Material:
Wait time between applying
pressure/vacuum/water and
starting test:
Test Start Time:___
Initial Reading(Rj:
Test End Time:
Final Reading(RF):
Test Duration:
Change in Reading
Pass/Fail Threshold or Criteria:
-. 0 ' 'O .P O-ft � 0. fl . .
is there a sensor in the sump? ❑Yes ONo 0 Yes 0 No 0 Yes ❑No 0 Yes 0 No
Does the sensor alarm when
either product or water Is OYes 0 N DNA O Yes ONo DNA 0 Yes ❑No 0 NA OYes ONO LINA
detected?
Was sensor removed for testing? 0 Yes 0 No ❑NA ❑Yes ❑No 0 NA 0 Yes 0 No 0 NA ❑Yes 0 No 0 NA
Was sensor properly replaced and 2=1 1
verified functional after!E!�M? D Yes ❑No ❑NA 0 Yes ❑No DNA OYes ONo DNA D Yes ❑No ❑NA
Comments—(include reformation on repairs made prior to testing and recommended follow-up for failed tests)
SWRCB,January 2002 page—Of
9. SPILL/OVERFILL CONTAINMENT BOXES
Facilit
y is Not Equipped With Spill/Overfill Containment Boxes ❑
Spill/Overfill Containment Boxes are PT-gent,but were Not Tested ❑
Test Method Developed By 9 Spill Bucket Manufacturer ❑Industry Standard ❑Professional Engineer
❑Other(Specify)
Test Method Used: ❑Pressure ❑Vacuum IYHydrostatic
❑Other(Specify)
Test Equipment Used.INCON TS-STS Equipment Resolution:
-g
Spill Box#1 Spill Box#V1 SpiH Box#2 Spill Bog;ffv2
=0
Bucket Diameter. 12" 12" 12 12"
Bucket Depth: 12" 12" 12" 12"
Wait time between applying
pressure/vacuum/water and 10 MIN 10 MIN 10 MIN 10 MIN
starting test
Test Start Time: 2:21 2:21 2:21 3:00
Initial Reading(Pq): 5.0963 7.0579 4.4369 5.3044
Test End Time: 2:36 2:36 2:36 3:15
Final Reading(RF): 5.0973 7.0581 4.4377 5.3045
Test Duration: 15 N41N 15 MIN 15 MIN 15 N41N
Change in Reading(RfAj: .001 .002 .0008 .0001
Pass/Fail Threshold or .002 .002 .002 .002
Criteria: 4
On
'Test 1p* 01iff il Pass dpais 0
Pass-: Fall
COMMentS—(include information on repairs made prior to testing and recommended follow-upfor failed tests)
SWRCB,January 2002 Page_of
9. SPILUOVERFUL CONTAINMENT BOXES
Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ *
Spill/Overfill Containment Boxes are Prpsent,but were Not Tested ❑
Test Method Developed By: dSpill Bucket Manufacturer ❑Industry Standard ❑Professional Engineer
❑Other(Spec)
Test Method Used: ❑Pressure ❑Vacuum ydrostatic
❑Other(Specify)
Test Equipment Used:INCON TS-STS Equipment Resolution:
�2!,z
Spill Box#3 Spill Box W3 Spill 8
Bucket Diameter: 12" 12"
Bucket Depth. 12" 12"
Wait time between applying
pressure/vacuum/water and 10 NUN 10 MIN
starting test:
Test Start Time: 3:00 3:00
Initial Reading(R4)- 5.0289 6.0877
Test End Time: 3:15 3:15
Final Reading(RF): 5.0300 6.0877
Test Duration: 15 MIN 15 MIN
Change in Reading(RF-R�: .0011 0
Pass/Fail Threshold or .002 .002
Criteria-
Test Result' irPass' u Fail C(:Pass,` ❑Fail- D -Pass; 11 ikit ❑ 0 t Fa!I
Comments—flinclude information on repairs made prior to testing; and recommended follow-up for f
ailed tests)
U AND G 223 D AND G 223 D AND G 223
2732 SFIELDGC LN 2732 BRUNDAGE LN 2732 BRUNDAGE LN
B SUNSET CO CA BAKE'SFIELD CA BAKERSFIELD CA
5'800-9 CONST SUNSET CONST SUNSET CONST
1-800-984-6266 1-800-984-6266 1-800-984-6266
03/15/2011 2:59 PM 33/15/2011 2:36 PN 03/15/2011 2:20 PM .
SUMP LEAK TEST REPORT Sly LEAK TEST REPORT SUMP LEAK TEST REPORT
USPILL2 SPILLI SPILLI
TEST STARTED 2:44 PM TEST STARTED 2:21 PM TEST STARTED 2:05 PM
TEST STARTED 03/15/2011 TEST STARTED 03/15/2011 TEST STARTED 03/15/2011
BEGIN LEVEL 5.3044 IN BEGIN LEVEL 5.0963 IN BEGIN LEVEL 5:0953 IN
END TIME 2:59 PM END TIME 2:36 PM END TIME 2:20 PM
END DATE 03/15/2011 END DATE 03/15/2011 END DATE 03/15/2011 -
END LEVEL 5.3044 IN END LEVEL 5.0973 IN END LEVEL 5.0957 IN
LEAK THRESHOLD 0,002 IN LEAK THRESHOLD 0,002 IN LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED TEST RESULT PASSED TEST RESULT PASSED
. SPILL3 VSPILLI VSPILLI
TEST STARTED 2:44 PM TEST STARTED. 2:21 PM TEST STARTED 2:05 PM
TEST STARTED 03/15/2011 TEST STARTED 03/15/2011 TEST STARTED 03/15/2011
BEGIN LEVEL 5.0281 IN BEGIN LEVEL 7.0579 IN BEGIN LEVEL 7,0579 IN
END TIME 2:59 PM END TIME 2:36 PM END TIME 2:20 PM
END DATE 03/15/2011 END DATE 03/15/2011 END DATE 03/15/2011
END LEVEL 5.0289 IN END LEVEL - 7,0581 IN END LEVEL 7.0580 IN
LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED TEST RESULT PASSED TEST RESULT PASSED
VSPILL3 SPILL2 SPILL2
TEST STARTED 2:44 PM TEST STARTED 2:21 PM TEST STARTED 2:05 PM
TEST STARTED 03/15/2011 TEST STARTED 03/15/2011 TEST STARTED 03/15/2011
BEGIN LEVEL 6.0875 IN BEGIN LEVEL 4,4369 IN BEGIN LEVEL 4,4363 IN
END TIME 2:59 PM END TIME 2:36 PM END TIME 2:20 PM
END DATE 03/15/2011 END DATE 03/15/2011 END DATE 03/15/2011
END LEVEL 6,0876 IN END LEVEL 4,4377 IN END LEVEL 4.4366 IN
LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0,002 IN LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED TEST RESULT PASSED TEST RESULT PASSED
. -- ..............:. . . UDCI-2 UDCI-2
TEST STARTED 2:21 PM TEST STARTED 2:05 PM
TEST STARTED 03/15/2011 TEST STARTED 03/15/2011
BEGIN LEVEL 3,8748 IN BEGIN LEVEL 3.8733 IN
END TIME 2:36 PM END TIME 2:20 PM
END DATE 03/15/2011 END DATE 03/15/2011
END LEVEL 3.8761 IN END LEVEL 3.8750 IN
LEAK THRESHOLD 0,002 IN LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED TEST RESULT PASSED
D AtUG 223
2732 BRUNDAGE LN
BAKERSFIELD CA
SUNSET CONST
1-800-984-6266
03/15/2011 3:15 PM
SUMP LEAK TEST REPORT
VSPILL2
TEST STARTED 3:00 PM
TEST STARTED 03/15/2011
BEGIN LEVEL 5,3044 IN
END TIME 3:15 PM
END DATE 03/15/2011
END LEVEL 5,3045 IN
LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED
SPILL3
TEST STARTED 3:00 PM
TEST STARTED 03/15/2011
BEGIN LEVEL 5,0289 IN
END TIME 3:15 PM
END DATE 03/15/2011
END LEVEL 5.0300 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED
VSPILL3
TEST STARTED 3:00 PM
TEST STARTED 03/15/2011
BEGIN LEVEL 6.0877 IN
END TIME 3:15 PM
END DATE 03/15/2011
END LEVEL 6.0877 IN
LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED