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SWRCB,January2M3 <br /> _ 9. Sj�,; Bucket Testing Report, aorm <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printoutsfrom tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: 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 /> Credentialsl: ❑x CSLB Contractor E ICC Service Tech. ❑SWRCB Tank Tester E Other(Specify) i cc <br /> License Number: 8016974 ut <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ❑X Hydrostatic Vacuum ❑ Other <br /> Test Equipment Used: tape measure Equipment Resolution:1/8 inch <br /> Identify Spill Bucket(By Tank 3 ANT FILL Z 4 GEA FILL 3 5 MOT FILL 4 6 WAS 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: 19.875 20.875 18.25 17.25 <br /> Wait time between applying 5 mins 5 mins 5 mins 5 mins <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 955 955 955 1102 <br /> Initial Reading(RI ): 18.875 19.875 17.25 16.25 <br /> Test End Time(TF ): 1055 1055 1055 1202 <br /> Final Reading(RF ): 18.875 19.875 17.25 16.25 <br /> Test Duration: 1 hour 1 hour 1 hour 1 hour <br /> Change in Reading(R F-RI ): 0 0 0 0 <br /> Pass/Fail Threshold or visual visual visual visual <br /> Criteria: <br /> MPass E] Fail MPass E Fail % Pass Fail % Pass Fait: <br /> Comments- (include information on repairs made prior to testing, and recommended Jo11ow-up for failed tests) <br /> CERTIFICATION OF TECIINICIAN 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: 04/13/2010 <br /> I State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br />