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SWRCB,January 2006 <br /> 9. So Bucket Testing Report_ 'orm <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> FacilityName: YRC 813 1 Date of Testing: 04/13/2010 <br /> Facility Address: 1535 E PESCADERO AVE TRACY, CA, 95304 <br /> Facility Contact: CHRIS ROY Phone: (209) 993-7946 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(if present during testing): Stacy and ray <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: STEVEN WILLEMS <br /> Credentials t: ❑x CSLB Contractor [fl ICC Service Tech. ❑SWRCB Tank Tester E Other(Specify) icc <br /> License Number: 8016974 ut <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: El Hydrostatic Vacuum ❑ Other <br /> Test Equipment Used: tape measure Equipment Resolution:1/8 inch <br /> Identify Spill Bucket(By Tank 1 WAS FILL 2 1 WAS FILL 3 Others FILL 4 Others FILL <br /> Number,Stored Product, etc) <br /> ❑x Direct Bury x❑Direct Bury ❑x Direct Bury ❑x Direct Bury <br /> Bucket Installation Type: <br /> ❑ Contained in Sump ❑ Contained in Sump ❑Contained in Sump ❑ Contained in Sump <br /> Bucket Diameter: 15 15 15 15 <br /> Bucket Depth: 22.25 22.25 22.875 22.875 <br /> Wait time between applying 5 mins 5 mins 5 mins 5 mins <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 1051 1144 1042 1118 <br /> Initial Reading(R1 ): 21.25 21.25 21.5 21.875 <br /> Test End Time(TF ): 11.21 1244 1112 1218 <br /> Final Reading(R F ): 19.0 21.25 21.0 21.875 <br /> Test Duration: 30 mins 1 hour 30 mins 1 hour <br /> Change in Reading(R F-Ri ): 2.25 0 .5 0 <br /> Pass/Fail Threshold or visual visual visual visual <br /> Criteria: <br /> Test Resul Pass [T] Fail Fail <br /> Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the infoorrm}a-tion clontained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: �C - V�J Date: 04/13/2010 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br />