Laserfiche WebLink
0 4k <br />Spill Bucket Testing Report Form RECEIVE <br />1. FACILITY INFORMATION <br />Facility Name: FAST AND EASY Date of Testing: 4/2212015 <br />Facility Address: 10878 N. HN" 99 STOCTON CA, <br />Facility Contact: MIKE ALE Phone: ENWRnNMF <br />Date Local Agency was notified of Testing: 4!4/2014 1-lFA6TN rWPAR IUFNT <br />Name of Local Agency Inspector (if present during testing:) Aris Cacapit <br />2.TESTING CONTRACTOR INFRUMNYM N <br />Company Name: Mid Valley Consulting & General Engineering <br />Technician Conducting Test: JASON HAASE <br />Credentials: CSLB Contractor ICC Service Tech. SWRCB Tank tester <br />License Number(s): 920985 8165409 -UC <br />1. SPILL BUCKET TESTING INFORMATION <br />Test Method Use: x Hydrostatic Vacuum Other <br />Test Equipment Used: Pump Equipment Resolution: <br />Identify Spill Bucket (By Tank <br />Number, Stored Product) <br />LPREMIUM #1 <br />2. PREMIUM #2 <br />3. UNLEADED <br />4. DIESEL <br />Bucket Installation Type: <br />X Direct Bury <br />X Direct Bury <br />X Direct Bury <br />X Direct Bury <br />Contained in Sump <br />Contained in Sump <br />Contained in Sump <br />Contained in Sump <br />Bucket Diameter: <br />12" <br />12" <br />12" <br />12" <br />Bucket Depth: <br />12" <br />12.75" <br />12.50" <br />16" <br />Wait time between applying <br />5 MIN <br />5 MIN <br />5 MIN <br />5 MIN <br />vacuum/water and start of test: <br />Test Start Time (Ti): <br />9:00 AM <br />9:00 AM <br />9:00 AM <br />9:00 AM <br />Initial Reading (Rl): <br />11" <br />11.75" <br />1150" <br />15" <br />Test End Time (Tf): <br />10:00 AM <br />10:00 AM <br />10:00 AM <br />10:00 AM <br />Final Reading (110: <br />1l" <br />11.75" <br />12.50" <br />15" <br />Test Duration (Tf—TI): <br />1 HR <br />I HR <br />I HR <br />1 HR <br />Change in Reading (Rf-R1): <br />0 <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or Criteria: <br />.025" <br />.025" <br />025 <br />025" <br />Test Results: <br />X Pass Fail <br />X Pass Fail <br />X Pass Fail <br />X Pass Fail <br />Comments: — include information <br />on repairs made prior to <br />testing. and recommended follow -ug for failed tests <br />I hereby certify that t information in this report is true, and in full compliance with legal requirements. <br />Technician's Signa --e. Date: 412212015 <br />