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• SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended,for tcse hD contractors performing antral testing of UST spill containment structures. The completed form and <br /> printouts fi•Wn tests (tf applicable), should Ge provided to the,facility owner/aperator,for submittal to the local regulato+y agency. <br /> 1. .FACILITY INFORMA'ITON <br /> Facility Name: San.loaquln RTD Date of'festing: 7/7/l0 <br /> n <br /> Facility Address: 1.533 E. Lindsay ,Ca 95205 <br /> Sl.,Stockton -,,.. <br /> Facility Contact: Doug Smith Phone: — 209.948.5566 <br /> Date Local Agency Was Notified of Testing <br /> Name of Local Agency Inspector(ifpresent during testing,) ,Teff Wong <br /> 2. TESTING CONTRACTOR IN.FC>RMATION <br /> UIPO. INC. <br /> Company Namc: STOCICTON SERVICE STATION F,QMENTC_., <br /> Technician Conducting'I'est: Eric Molgoard <br /> Credentlals'; ❑CSLB Contractor x ICC Service Tech. 17 SWRCB Tank Tester .1 Other(Specify) <br /> License Num her(s): ICC California US'r Service Tech#5250200-UT <br /> _ 3. SPILL DUCKET TESTING INFORMATION <br /> Test Method Used: 0 Hydrostatic I:I Vacuum I.1 Other <br /> 'rest Bquipmunt Used: F m m q p ent Resolution: <br /> Identify SpillBuckcl(Uy Tank 1 NORTH 2CENT R 3SOUTH 4 <br /> Number, Stared product, etc. WASTFOIL WASTEOIL WASTEOIL <br /> x Direct Bury x Direct Bury x Direct Bury Direct Bury <br /> Bucket Installation'r'ype: 1:I Contained in Sump I I Contained in Sum U Contained in Sump 71 Contained in Sump <br /> Bucket Diameter: 12" 12" <br /> Bucket Depth; <br /> Wait time between applying Y 45 min. 45 min. 45 min. <br /> vacuum/water and start of test: <br /> Test Start'mile(Ti): 9:15 am 9:15 am 9:15 Pro <br /> Initial Rcading(RI); 11-1/2" I1-1I8"^ 11-3/8" <br /> Test F,nd Time(I}:): 10:20 am 10:20 am 10:20 am <br /> Final Reading(RO: 11-1/2" 11-1/8" — 11-3/S" <br /> Test Duration(rt:—Ti): 1 hour I hour _ 1 hour ..,,......... <br /> n <br /> Change iReading(Ri:-Ri): 0 0 <br /> Pass/Fail Threshold or Less then 1/16 Less then 1/16 Less then 1/16 <br /> Criteria: -_ �. .• <br /> Test Result _ x Pass 0 Fail I x Pass Fall x Pass ❑ Fail Pass 0 Fail <br /> Comments— (include information nn repairs made print,to tG!Yy, and recommended allow-up for failed tests) <br /> CERTIFICATION OF TECHINiCIAN RESPONSIBLE. FOR CONDUCTING THIS TESTING <br /> 1 hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> 'Pcchnician's Signature: 2=1'tiC„7Tt_o aard _ <br /> ' Date: 717110 <br /> State laws and regulations tlo not currently require testing to be performed by a qualified contractor.However, local requirements <br /> may be more stringent. <br />