Laserfiche WebLink
DEC-04-2008 02 :24 PM GETTLER—RYAN INC. 925 551 4770 P. 02 <br /> SWRCB,January 2006 <br /> Spill Bucket `resting Report Form <br /> This,form is intended for use by contractor'pe{forming annual tc•.clu+g of UST spill containment structures. The completed fiorm and <br /> printouts from tests (if applicable). should he provided to tht�faci(i(c otrne+;operwtor,fi r suhmiltal to the local regulatur v agency. <br /> I, FACILITY INFORMATION <br /> Facility Name: PG&l _ _ f Testing: 11,125/09 <br /> Facility Address: 4040 West lane. Stockton(:a — I�atc o ---_ <br /> Facility Contact: Michelle ie - -- — Phone: (209)602-7038 <br /> bate Local Agency Was Notified of Testing : _— 11:14:08Name of of Local Agency Inspector(ii presenr during reefing): Garrett Backus <br /> 2. '"ST ING CONTRACTOR INFORMATION <br /> Company Name: Gettler-Ryan Inc. <br /> Technician Conducting Test: Christopher Thornton-5238552-UT <br /> Credentials': 1_,CSLB Contractor XICC Service Tech. SWR('B I'ank'fcster Other(Speci&) _.,,,� __- <br /> License Nurnber(a): 220793 ~- <br /> 3. SPILL. BUCKET TESTING INFORMATION� <br /> I est Method Used: X Hydrostatic_—_— Vacuum __Other_ <br /> Teat Equipment Used: Tape Measure Equipment Resolution: 1/16" <br /> identify Spill Bucket(L v Tank 1 1 3 4 <br /> Number. Stored Product eta) Waste Oil Unleaded Diesel <br /> X Direct Bury X Direct Bury X Direct Bury <br /> Bucket Installation Type: i Direct Bury <br /> _ Contained in Sump .Contained in Swap Contained in Sump Contained in Sum <br /> Bucket Diameter: 12"---- I ------- 12"_— -- <br /> Bucket Depth: 14" <br /> Wait time between applying 1 min I min I min <br /> vacuumcwater and start of test: _. _. <br /> Test Stan Time(Ti): 9:12am 9:04atn 9:O am - <br /> - ----- — <br /> Initial Reading(R1): 12.00" 12.50" 11.50" <br /> fest End Time(TF): 10:12mr, 10:04atn 10:02am <br /> Final Reading(RP): 12.00" ��-- <br /> T'est Duration(TF—Tj): rlh,� I hr 1hr <br /> Change in Reading(Rr-Rt): 0 �Pass/Fail Threshold or 0 0 <br /> Criteria: <br /> Test Remit: Fx Pau 0 Fall X Pass 0 Fall X Paso 0 Fall E3 Pass ❑FaN <br /> Comments— (include infurmution an repairs nude prior ro resting, unit recommended follow-u or failed <br /> Re ommend reolux-mill bu(zk lidforr unIe fill___. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> hereby cord#that all the information eantatned in this report is true,accurate, and/n fall compliance with legal reyuiremeniv. <br /> "rechoiciaws Signature: Christopher'fhomton_ Date:_,_ <br /> ' Statc laws and regulations do not currently require testing to be performcd by a qualificd contractor. however,local requircments <br /> may be more stringent. <br />