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Ij� DD� <br /> r <br /> El <br /> Spill Bucket Testing Report Fortel Nab <br /> ;EALTN <br /> This form is intended for use by contractors performing annual testing of UST spill corinznent structz�rea completed form and <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for s0knittal to the lolc-al regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Valley Arco I Date of Testing: 05/20/08 <br /> Facility Address: 16 E Harding Way, Stockton, CA, 95204 <br /> Facility Contact: Paul I Phone: (209) 606-3551 <br /> Date Local Agency Was Notified of Testing: 05/16/08 <br /> Name of Local Agency Inspector(if present during testing): Garrett Backus <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: EPIC Compliance Systems, Inc. <br /> Technician Conducting Test: Alvin L. Milburn <br /> CredentialsEl CSLB Contractor ❑x ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other(Specify) <br /> License Number(s): 880430 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: M Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: 1 hr Lake Test Equipment Resolution: <br /> Identify Spill Bucket(lay Tank 1 2 3 d <br /> Number,Stored Product, etc.) 87 West 89 91 <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑Direct Bury ❑Direct Bury <br /> ❑x Contained in Sump 0 Contained in Sump ❑x Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 13" 14" 14" <br /> Wait time between applying <br /> vacuum/water and start of test: 5min 5min 5 m i n <br /> Test Start Time(Tj): 13:20 13:20 13:20 <br /> Initial Reading(Ri): 10.5" 11.5" 11.75" <br /> Test End Time(TF): 14:20 14:20 14:20 <br /> Final Reading(RF): 10.5" 11.5" 11.75" <br /> Test Duration(TF—Tj): 1 hr 1 hr 1 hr <br /> Change in Reading(RF-RI): 0 0 0 <br /> Pass/Fail Threshold or 0 0 0 <br /> Criteria: _ <br /> Test Result: 1--al Pass ❑Fail El Pass ❑ Fail I IE Pass ❑ Fail ❑Pass ❑ Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Retest of buckets that previously failed due to damaged swivel adapters. The adaptors were replaced <br /> and buckets retested — Passed. <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: Date: 05/20/08 <br /> ' State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br /> may be more stringent. <br />