COMPLIANCE INFO_2013 - 2018 - Laserfiche WebLink

Home Browse Search

SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FAC11,1TV INFORMATION Facility Name: FAST AND EASY Date of Testing: 06-11-15 Facility Address: 1399 YOSEMITE AVE MANTECA CA Equipment Resolution: 1/16 Facility Contact: DEEP Phone: 209-823-3460 Identify Spill Bucket (By Tank Number, Stored Product, etc. Date Local Agency Was Notified of Testing :05-19-15 ?04-` Lo Name of cal Agency Inspector (rf present during testing): SAN JAOQUIN CO ELENA 2_ TF.CTTNV rnNTRACTnR TNF(IRMATInN ENVIRONMENTN Company Name: AFFORDA TEST 4162 d Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 Technician Conducting Test: ❑ Lyle D. Nimmo ❑ Zane A. Nimmo ❑ David A. Winkler ® Felix G. Ramirez 5249115 -UT 5263322 -UT 5263373 -UT 5273934 -UT V Credentials': ® ICC Service Tech. ® SWRCB Tank Tester i 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: TAPE / H2O Equipment Resolution: 1/16 Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 87 2 91 3 DIE 4 Bucket Installation Type:El ® Direct Bury ❑Contained in Sump ® Direct Bury F1 Contained in Sump ® Direct Bury Contained in Sump ❑ Direct Bury ❑ Contained in Sum Bucket Diameter: 1 1 11 11 Bucket Depth: 13 13 13 Wait time between applying vacuum/water and start of test: Test Start Time (TI): 935 935 935 Initial Reading (RI): 12 12 12 Test End Time (TF): 1035 1035 1035 Final Reading (RF): 12 12 12 Test Duration (TF — Tj): 1 HOUR 1 HOUR 1 HOUR Change in Reading (RF - Rj): 0 0 0 Pass/Fail Threshold or Criteria: _ Test Result: ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail ❑ Pass ❑ Fail Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) OPW BUCKETS CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: Date:06-11-15 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.