Laserfiche WebLink
0 <br /> Spill Bucket Testing Report Form S WRCB,January 2006 <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The comple;4E <br /> d% <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regular E I V <br /> ELL FACILITY INFORMATIONvvv <br /> Facility Name:7-ELEVEN#32190,MKT 2368 Date of Testing:5/l/2015 <br /> Facility Address:4943 S.KINGSLEY(FRONTAGE RD)HWY 99 @ ARCH AIRPORT RD,STOCKTON,CA 95206 <br /> Facility Contact:MGR-LORENA Phone:209-939-0679 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(if present during testing):Elena Manzo <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TANKNOLOGY INC. <br /> Technician Conducting Test:Darren Sciume <br /> Credentials[: 7; CSLB Contractor ICC Service Tech. S01 SWRCB Tank Tester r Other(Specify) <br /> License Number(s):09-1733 <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used By: r hydrostatic r Vacuum r Other <br /> 'T'est Equipment Used:LAKE TEST Equipment Resolution:0.0625 in. <br /> Identify Spill Bucket(By Tank Spill Box#Wank T4 RUL- Spill Bax#Tank T5 MUL- Spill Box#Tank T6 PUL- <br /> Number, Stored Product, etc.) Fill 1-Direct-Grade level Fill 1-Direct-Grade level Fill I-Direct-Grade level Spill Bax# <br /> in containment sump in containment sump in containment sump <br /> f- Direct Bury r Direct Bury 1, Direct Bury CT Direct Bury <br /> Bucket Installation Type: (; Contained in Sump Contained in Sump C Contained in Sump f, Contained in Sump <br /> Bucket Diameter: 10.00 10.00 10.00 <br /> Bucket Depth: 17.50 17.50 18.00 <br /> Wait time between applying 15 min 15 min 15 min min <br /> vacuum/water and start of test <br /> Test Start Time(Tl): 12:36:00 08:51:00 10:04:00 <br /> Initial Reading(Rl): 16.00 in. 16.00 in. 16.50 in. <br /> Test End Time(TF): 13:36:00 09:51:00 11:04:00 <br /> Final Reading(RF): 16.00 in. 16.00 in. 16.50 in. <br /> 'fest Duration(TF—TI): 1 hr I hr 1 hr <br /> Change in Reading(RF—Rt): 0.00 in. 0.00 in. 0.00 in. <br /> PassiFail Threshold or Criteria: +/-0.00 +/-0.00 ''-0.00 <br /> Test Result: Pass Pass Pass <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Replaced all three fill caps and the 87 fill swivel adaptor. <br /> CERTIFICATION OF TECBMCIAN RESPONSIBLE FOR CONDUCI`ING TRIS TESTING <br /> thereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: SP Date: 5/1/2015 <br /> [State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent. <br /> WO:2322424 <br />