Laserfiche WebLink
`I <br /> AWL ' `�"&,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill contdilment structures. The complet&form and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> I. FACILITY INFORMATION <br /> Facility Name: Fast Lane Central Valley (Truck Side) Date of Testing: 6/20/2.017 <br /> Facility Address: 116 East Roth Road, Lathrop, CA 95330 <br /> Facility Contact: Hardeep Gill Phone: 707- 326-0369 <br /> Date Local Agency Was Notified of Testing: 4/18/2017 <br /> Name of Local Agency Inspector Ofpresent during testing): Vicki McCartney <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: ELIC Environmental Compliance Systems Inc. <br /> Technician Conducting Test: Brian Dunahay <br /> Credentials]: 0 CSLB Contractor Q ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other(Spec) <br /> License Number(s): 956593 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ? Hydrostatic ❑Vacuum Other <br /> Test Equipment Used: 1 hr lake test Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank t Diesel South 2 Diesel North 3 4 <br /> Number,Stored Product, etc.) <br /> Bucket Installation Type: ❑ Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> ❑ Contained in Sump 0 Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 12" 12" <br /> Bucket Depth: 15" 15" <br /> Wait time between applying <br /> vacuum/water and start of test: S m i n S m i n <br /> Test Start Time(T]): 1100 1230 <br /> Initial Reading(R]): 14" 13.5" <br /> Test End Time(TF): 1200 1330 <br /> Final Reading(RF): 14" 13.5" <br /> Test Duration(TF—TI): 1 hr 1 hr <br /> Change in Reading(RF-R]): 0 0 <br /> Pass/Fail Threshold or 0 0 <br /> Criteria: <br /> Test Result: 2 Pass ❑Fail 0 Pass ❑Fail ❑ Pass ❑ Fail ❑ Pass ❑Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for fulled tests) <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: 6/20/2017 <br /> State laws and regutations do not currently require testing to be performed by a qualified contractor.However, local requirements <br /> may be more stringent. <br />