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SWRCB,January 2006 <br /> 9. S-b„11 Bucket Testing Repor�iw orm <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(ifapplicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> FacilityName: TRACY PETRO I Dateof Testing: 02/26/2010 <br /> Facility Address: 3400 N. MACARTHUR DR TRACY, CA, 95376 <br /> Facility Contact: KARAM SINGH Phone: (209) 814-8581 <br /> Date Local Agency Was Notified of Testing <br /> Name of Local Agency Inspector(if present during testing): STACEY RI VERA <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: DANIEL ROLLINS <br /> Credentials 1: F]CSLB Contractor [T]ICC Service Tech. F]SWRCB Tank Tester E Other(Specify) ICC <br /> License Number: 8011610 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: E Hydrostatic Vacuum D Other <br /> Test Equipment Used:TEST WATER Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 PRE FILL 2 2 REG FILL 3 3 DIE FILL J 3 DIE FILL <br /> Number,Stored Product, etc) <br /> Bucket Installation Type: Ej Direct Bury ❑Direct Bury ❑Direct Bury L]Direct Bury <br /> X❑Contained in Sump XQ Contained in Sump ❑X Contained in Sump ❑X Contained in Sump <br /> Bucket Diameter: 11 1/2 11 1/2 11 /12 11 /12 <br /> Bucket Depth: 13 14 /12 13 1/2 13 1/2 <br /> Wait time between applying 5 MIN 5 MIN 5 MIN 5 MIN <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 0915 0915 0915 1025 <br /> Initial Reading(RI ): 12 1/2 14 13 13 1/4 <br /> Test End Time(TF ): 1015 1015 1015 1125 <br /> Final Reading(RF ): 12 1/2 14 12 1/2 13 1/4 <br /> Test Duration: 1 HR 1 HR 1 HR 1 HR <br /> Chane in Reading(R F-RI ): 0 0 -1/2 0 <br /> Pass/Fail Threshold or 0 0 0 0 <br /> Criteria: <br /> X❑ Pass ❑ Fail x❑Pass ❑ Fail i ❑P Fail [K] Pass [] Fail <br /> Comments - (include information on repairs made prior to testing, and recommended follow-up forfailed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: �. �ul�l'�S Date: 02/26/2010 <br /> 1 State laws and regulations do notcurrently require testing to be performed by a qualified contractor.However,local requirements <br />