Laserfiche WebLink
SWRCB,January 2006 <br /> Spill Bucket Testing Report ForuiP 2. 8 Z017 <br /> This form is intendedfor use by contractors performing annual testing of UST spill containment str J, red rT�coletedform and <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for submitta rth �1,o f regulatory agency. <br /> 1. FACILITY INFORMATION 77 <br /> Facility Name: LATHROP GAS-&FOOD - CHEVRON Date of Testing: 12/12/2016 <br /> Facility Address: 140 E. LATHROP RD. LATHROP, CA 95330 <br /> Facility Contact: Jesse I Phone: 209-982-5005 <br /> Date Local Agency Was Notified of Testing:11/21/2016 <br /> Name of Local Agency Inspector(fpresent during testing): VICKY <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2n1 Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ❑ Lyle D.Nimmo ® Zane A.Nimmo ❑ David A. Winkler ❑ Felix G.Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials': E ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: TAPE MEASURE, H2O Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 87 2 3 91 4 DIESEL <br /> Number,Stored Product, etc.) <br /> M Direct Bury ❑ Direct Bury ® Direct Bury Direct Bury <br /> Bucket Installation Type: ❑ Contained in El Contained in <br /> El Contained in Sump El in Sump Sump Sum <br /> Bucket Diameter: 11 11 11 <br /> Bucket Depth: 14 1/4 13 1/2 14 1/4 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 0915 0915 0915 <br /> Initial Reading(Rt): 13 1/4 12 1/2 13 1/4 <br /> Test End Time(TF): 1015 1015 1015 <br /> Final Reading(RF): 13 1/4 12 1/2 13 1/4 <br /> Test Duration(TF—Tj): HR HR HR HR <br /> Change in Reading(RF-Ri): 0 0 0 <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ❑ Pass ❑ Fail 0 Pass ❑ Fail ® Pass ❑ Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up far failed tests) <br /> ALL BUCKETS MEASURED 5 GALLONS PLUS <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:-12-12-16— <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 />