Laserfiche WebLink
• • SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> Thin fibrin is intended for are by contractors perfbrming annual lesling of USTspill containment structures. The completed farm and <br /> printours fi ofn teats(if applicoh/e), should he provided to the facility owner/operator,for submittal to the local regulatory apensv. <br /> _ L FACILITY INFORMATION <br /> Facility Name: Son Joaquin RTD — Date or Testing: _ 6130/10 <br /> Facility Address: 1533 E.Lindsay St.,Stockton,Ca 95205 <br /> Facility Contact: Dong Smith Phone: 209.948.5566 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector((fpresenl dVHntg lesling): left Wong <br /> 2. TESTING CONTRACTOR.TNFORMATION <br /> Cnmpany Name: STOCKTON SERVICE,STATION EQUIPMENT CO. INC. <br /> Technician Conducting Tcse Eric Molgaard _ _ <br /> Credentials': D CSLB Contractor x ICC Service Tech, ❑SWRCB Tank Tester la Other(Sped) <br /> License Number(s): _ NCC California UST Service Tech 952.50200-UT <br /> 3. SPILL BUCKET TF,STIING INFORMATION <br /> Test Method Used: x Hydrostatic ❑Vactu_im_ I I Other <br /> Test Equipment Used: - uquipmem Resolution: 1/32 <br /> Identify Spill Bttcket (13y Tank Diesel Tank I Diesel Tank 2 Diesel Tank 3 Diesel Tank 4 <br /> Number,Stored Product, eta:. <br /> Bucket Installation Type: x Direct Bury x Direct Bury x Direct Bury x Direct Bury <br /> 171 Contained in Sump n Contained in Sump D Contained in Sump I I Contained in Sum <br /> Bucket Diameter:' 12" 12" 12" 12" <br /> Bucket Depth: — 13" 13-112" 12-1/21" 13" <br /> Wait time between applying 1 30 min. 30 min. 30 min. 30 min. <br /> vacuum/water and start of test: _ _ <br /> Test Start Time(Ti): 10:45 am 10:45 am 10:45 pm 10:45 pan -" <br /> Initial Reading(Rt): 12" 12-1/4" 11-318_ 11-3/4 <br /> Test End Time(T„): 11:45 am 11:45 am 11:45 pm T 11:45 pm <br /> Final Reading MI.): 1201 12-1/4" <br /> Test Duration (Tv-Ti): 1 hour 1 hour T 1 hour 1 hour <br /> Chnnge in Reading(Rr-R,): -0-- -0 ry -0- -0- <br /> Pass/Fail Threshold or Less then 1/16 <br /> Criteria: <br /> Test Result: x Pass D Fail x Pass Fail x Pass ❑ Fail x Pass ❑ Fail V <br /> Comments-(include information on repairs made prior to testing and recommended fb low- fb oiled tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDIJCTINC THIS TESTING <br /> I hereby eertifv that all the Injbrneallon contained in this report is true, accurate,and Infill compliance with legal requirements. <br /> Technician's 5ignature: 'L•rfc N LQI arca Date; 6/30/10 <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 />