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Spill Bucket Testing Report Form SWRCB,January 2016 <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(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: A.G. Spanos Aviatiot; Date of Testing: 02/21108 <br /> Facility Address: 4800 S.Airport Way <br /> Facility Contact: Thomas Phone: (209)982-1550 <br /> Date Local Agency Was Notified of Testing: 02/19/08 <br /> Name of Local Agency Inspector(if present during testing): Muniappa Naidu <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Compairy Name: Reliable Petroleum Services, Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials': X CSLB Contractor X ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s�: 883706 <br /> 3. SPILL BUCKET TESTING_ INFORMATION <br /> Test Method Used: X Hydrostatic ❑Vactiv.,n ❑Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 T1: Jet Fuel West 2 T2: Jet Fuel East 3 T3: Jet Fuel East2 4 <br /> Number, Stored Product, etc.) Fill Bucket Fill Bucket Fill Bucket <br /> Bury X Direct Bu <br /> Bucket Installation Type: X Direct BuD' X Direct Bury ❑Direct Bury <br /> ❑Contained in Symp ❑Contained in Sum U Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 1211 14+1 <br /> 14„ <br /> Wait time between applying <br /> vacuum/wtiter and start of test: 1 mm. 1mm• 1 min. <br /> Test Start Time(Ti): 9:14 am 9:13 am 9:12 am. <br /> Initial Reading(RI): 8-7/8" 8-114" 8-1/4" <br /> Test End Time(TF)= 1046 am 10:46 am 10:46 am <br /> Final Reading(RF). 8-718" 8-1/4" 8-1/4" <br /> Pest Duration(TF--Tj): I hr.32min. 1 hr.33min. l hr.34 min. <br /> Change in Reading(RF-Rj): 0 0 0 <br /> PassiJFail Threshold or <br /> CrkL�: 1116" 1/16" 1/16" <br /> Test Result: X Pass ❑Fail X Pass ❑ Fail X Pass D Fail ❑ Pass ❑ Fail <br /> COmMCnts— (include information on repairs made prior to testing and recommendedfollow-u for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I Hereby cerito that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: , <br /> I/5 <br /> ,`e Date: 2/21/08 <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 />