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SWRCB, lanuarv?006 <br />• SPW Bucket Testing Report Form <br />Tx:S !-,7 IS :mended for t45e 7r CoMiravors pet -forming annual' :esrng of i 317 sttui G7rvaiw.ment struc'vras T ?e fdmD Rtod fnn.. <br />pili*toMcs vnr testi %ii applic� ie;. Should be prided to the,cciirtr Jwncr!0.0�r�:r,, for su�mr ra: tc :' a : tai r!g�liarnn agent. <br />I. FACnXrY WORIM .TION <br />u r aZi1i-- ' Na.^•ea: rr -11if 640k <br />Ai# ! Date of Testing. <br />Facdity Aodres5:0 Ire dAg&&AV lz"z <br />Facility Contact, ETA'T- <br />Pl ahs: <br />Datt Hca] Agcncv Was Notified ofi•mmg <br />�' Satre of Locar Agencv InepeCtor ltfpresext dttrrn¢ tesrrn�/' � t,.,`y <br />a. 77SM, C CONMACTOR INFOkMATIOr <br />d ro m-par,v Nave - <br />�i trchnieian �onduciing � est: � <br />r r*dEntials' :.B erv�t SW-RL3 Tanis Tester OtheT �pa.t's•} <br />Liocme Numbcr(s): 4;76-53SW- UT <br />3. SPILL BUCXZT TESTRiG P'F'ORPKA7101ti <br />Tc- Me:Itod Used: VaGuirrtt Other i <br />Test Equipmera Used. 11 Efluiinment Resolucatt: <br />:dt*tt!w Spill Bucket (Bv Ta»k 4 I !' y df* poR i r r i fO� <br />'Vu.mber Stared Product, etc.; gi Ft"3 �/ /� ct ' r ' <br />Direct Bury Direct Bury Direct i Direct ENIx <br />Bucket in-itallatian Tvpe: <br />5 ntaiMLed Su I oatatn <br />amed in Su B ne to <br />Backe D,ame=:/o%a <br />/a %y <br />y <br />/arsl <br />guckm Dcpth-. a <br />FW -aft time between appiving <br />vacuwwwat ar and m= of ,=t' <br />Ps M t A2 <br />/ S N4 ( A+ <br />�im (A <br />- <br />%=Test <br />Test Start Time (TO. <br />S-7 PAitriTiai <br />Readine MI. <br />11 In <br />�, <br />iy <br />Test ZYltl 'MimeiF%. <br />:4Y <br />I � <br />'i Final Read•.ng lit. j' <br />` <br />$ � <br />/ r <br />PAY <br />Test Duration (?r - T,}: <br />�61C <br />! 94Z_ <br />E Grange Reading tRr R )- <br />4 <br />-B' ,! <br />.rt <br />3 ?asiwFali 7 4 reshold or <br />Tit k?�uit <br />Pass ❑ F' <br />Pass C Fail <br />k'Pass <br />C Fail Pass —fail i <br />I <br />ivu1t71�DtS -- (ncludc information on repairs made prior cc teMn-, and r=ecvnrme:t�::u <br />lallo.v-�;or;wiled <br />tesL�J <br />CI?R I t�3�1si?D 'l t? T l� �u=`r RESPOtYSLUi.E FOR CON-DUC"TPtG THIS 'TESTING <br />hC"bv csrtift. tha-, au rata iS(arpvador ra>tra ned & this red i3 true, accurcam, and u fie1L rareMtiaxee whit isoai reauirer et>vs. <br />. �C...ti:t:af.S jpeTlt 3T-.LIFC" <br />nakE dC�0 <br />S*atc laws end rtgu at -.0M do nct r-urr"tly ;eauire tcst/ma to btC;d"'+0/��1ed 7v cttairneti conrractar. tioue,e-_. iucai rzcjulrett7c tits <br />a« h �r+are _tri^Qt^t. / tS� <br />6 e <br />