Laserfiche WebLink
i <br /> S WRCB,January 2006 <br /> Spill Bucket Testing Report Form <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 beprovided to the facility owner/operator for submittal to the local regulatory agency. <br /> I. FACILITY INFORMATION <br /> Facility Name: PG&E Date of Testing: 11/25/08 <br /> Facility Address: 4040 West lane,Stockton Ca <br /> Facility Contact: Michelle le Phone: (209)602-7038 <br /> Date Local Agency Was Notified of Testing: 11/14/08 <br /> Name of Local Agency Inspector(ifpresent during testing): Garrett Backus <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Gettler-Ryan Inc. <br /> Technician Conducting Test Christopher T12ormon-5238552-Ur <br /> Credentials: --CSLB Contractor X ICC Service Tech = SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 220793 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic Vacuum -Other <br /> Test Equipment Used: Tape Measure Equipment Resolution: 1 16" <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number,Stored Product, etc.) Waste Oil Unleaded Diesel Waste Oil Tra <br /> Bucket Installation Type: X Direct Bury X Direct Bury X Direct Bury ❑Direct Bury <br /> Contained in Sun3p 7 Contained inS I Contained in S 11Contained in Sump <br /> Bucket Diameter. 12" 12" 12" 20'.x 27%2 <br /> Bucket Depth 14" 14" 13" 10" <br /> Wait time between applying I min 1 min 1 min 1 min <br /> vacuum/water and start of test: <br /> Test Start Time(TO: 9:12am 9:04am 9:02am 10:15am <br /> Initial Reading(Ri): 12.00" 12.50" 11.50" 6.75" <br /> Test End Time(TF): 10:12am 10:04am 10:02am 11:15am <br /> Final Reading(RF): 12.00" 12.50" 11.50" 6.75" <br /> Test Duration(TF—Ti): 1 hr I hr 1 hr 1 In, <br /> Change in Reading(RF-Rt): 0 0 1 0 0 <br /> Pass/Fad Threshold or 0 0 0 0 <br /> Criteria: <br /> Tat Result: X Pan 0 Fall X Par 0 Fail I X Pan 0 Fail X Pan 0 Fall <br /> Comments—(include information on repairs made prior to testing,and recommended ollow-up jar ailed tests) <br /> Recommend replace spill bucket lid for unleaded fill <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:. Christopher Thornton Date: 11/25/08 <br /> t Staaelam a%&reodalawmdn not cum=tl <br /> y tequi¢teatcn-be perfixmed:hy agttali5edcamtractor.However,local requirements <br /> [stag be mom striogmEt <br />