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SWRCB,January2006 <br /> 9. SLW,;1 Bucket Testing Report,;orm <br /> This form 0 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 DateofTesting: 03/24/2011 <br /> Facility Address: 1535 E PESCADERO AVE TRACY, CA, 95304 <br /> Facility Contact: KRIS/ ROY Phone: (209) 993-7946 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(if present during testing): TUEY TRAM <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: CHARLES FERRUCCI <br /> Credentials 1: ❑CSLB Contractor 0 ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Specify) <br /> License Number: 5323096-VT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: F-1 Hydrostatic ❑X Vacuum ❑ Other <br /> Test Equipment Used: Equipment Resolution: <br /> Identify Spill Bucket(By Tank i 1 WAS FILL Z 3 ANT FILL 3 4 GEA FILL 4 5 MOT FILL <br /> Number, Stored Product, etc.) <br /> ❑x Direct BuryX❑Direct Bury ❑X Direct Bury K❑Direct Bury <br /> Bucket Installation Type: <br /> ❑Contained in Sump ❑ Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 12 12 12 12 <br /> Bucket Depth: 18 18 18 18 <br /> Wait time between applying 1 min 1 min 1 min 1 min <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 1106 0839 0842 0857 <br /> Initial Reading(RI ): -30" -30" -30" -30" <br /> Test End Time(TF ) 107 0840 0843 0858 <br /> Final Reading(RF -30" -27" -28" -27" <br /> Test Duration: 1 min lmin 1 min 1 min <br /> Change in Reading(R F-Ri ): 0 -3-1 -2^ -3" <br /> Pass/Fail Threshold or _4" -4" -411 -4" <br /> Criteria: <br /> % Pass ❑ Fail 0 Pass ❑ Fail x❑Pqjjj Fail <br /> Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> bolts loose on bottom of bucket, tightened on t5: bucket to pass <br /> buckets are 15+ gallon buckets <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> hereby certify that all the information contained <br /> in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature:_T�h�e,�a//��_ Date: 03/24/2011 <br /> 1 State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br />