COMPLIANCE INFO 2008 - 2012 - Laserfiche WebLink

Home Browse Search

Spill Bucket Testing Report Form r�v� err Awa This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Valley ARCO Date of Testing: 04/29/2009 Facility Address: 16 E. Harding Way Facility Contact: Abraham Phone: (209) 466-9515 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): N/A 2. TESTING CONTRACTOR INFORMATION Company Name: EPIC Compliance Systems, Inc. Technician Conducting Test: Keith Huston Credentials: R1 CSLB Contractor ❑ ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Spec) License Number(s): 880430 3. SPILL BUCKET TESTING INFORMATION Test Method Used: El Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: 1 Hour LAKE Test Equipment Resolution: Identify Spill Bucket (By Tank Number, Stored Product, etc.) 1 Regular 2 Regular 3 Premium 4 Mid -Grade Bucket Installation Type: ❑ Direct Bury i] Contained in Sum ❑ Direct Bury D Contained in Sum ❑ Direct Bury ❑x Contained in Sump ❑ Direct Bury ❑x Contained in Sum Bucket Diameter: 12" 12" 12" 12" Bucket Depth: 14" 14" 14" 14" Wait time between applying vacuum/water and start of test: 5 minutes 5 minutes 5 minutes 5 minutes Test Start Time (Ti): 4:40 PM 4:40 PM 4:40 PM 4:40 PM Initial Reading (Rt): 13 1/4" 13" 13 1/8" 12 5/8" Test End Time (TF): 5:40 PM 5:40 PM 5:40 PM 5:40 PM Final Reading (RF): 11 1/2" 11 3/4" 13 1/8" 12 5/8" Test Duration (TF —T,): 1 hour 1 hour 1 hour 1 hour Change in Reading (RF - Ri): 1 3/4" 1 t/4" 0 0 Pass/Fail Threshold or Criteria: 1/16" hr. 1/16"hr. 1/16"hr. 1/16"hr. Test Result: ❑ Pass OO Fail ❑ Pass OO Fail 0 Pass ❑ Fail ❑x Pass ❑ Fail Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) Spill buckets for regular fill sump leaked into fill sump set off sensor and shut down station. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: Date: 04/29/2009 t State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.