COMPLIANCE INFO_2006 - 2010 - Laserfiche WebLink

Home Browse Search

+ • SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: JAHANT FOOD AND FUEL I Date of Testing: April 9, 2009 Facility Address: 24323 NORTH HIGHWAY 99 ACAMPO CALIFORNIA 95240 Facility Contact: SINGH Phone: 209-333-6000 Date Local Agency Was Notified of Testing :3-10-09 Name of Local Agency Inspector ('(present during testing): SAN JOAQUIN CO 2. TESTING CONTRACTOR INFORMATION Company Name: AFFORDA TEST 4162 nd Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 Technician Conducting Test: ❑ Lyle D. Nimmo ❑ Zane A. Nimmo ❑ David A. Winkler ® Felix G. Ramirez 5249115 -UT 5263322 -UT 5263373 -UT 5273934 -UT II Credentials: ® ICC Service Tech. ® SWRCB Tank Tester 9 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: TAPE H2O Equipment Resolution: V16 Identify Spill Bucket (By Tartk Number, Stored Product, etc. 1 87 2 89 3 91 4 DIESEL Bucket Installation Type: ® Direct B ❑ Contained in Sump ®Direct Bury ❑ Contained in Sump ® Direct Bury ❑ Contained in SumpSum ® Direct Bury ❑ Contained in Bucket Diameter: 11 11 11 11 Bucket Depth: 14 14 14 12 Wait time between applying vacuum/water and start of test: 0 0 0 0 Test Start Time (Tj): 945 945 945 1100 Initial Reading (111): 121/2 13 13 11 1/2 Test End Time (TF): 1045 1045 1045 1200 Final Reading (RF): 121/2 13 13 11 1/2 Test Duration (TF — Tj): 1 HOUR 1 HOUR I HOUR 1 HOUR Change in Reading (RF - Rj): 0 0 0 0 Pass/Fail Threshold or Criteria: Test Result: 0 Pass ❑ Fail ®Pass ❑ Fail j ❑ Pass ❑Fail ❑ Pass ❑ Fail Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature:�r—� Date: 4-9-09 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.