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RE <br /> S B anu 2 <br /> Spill Bucket Testing Report Form APR 18 2008 <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 be provided to the facility owner/operator for submittal to the loctMWAD"�Y <br /> IRO ME Tr <br /> 1. FACILITY INFORMATION HEALTH DEPARTMENT <br /> Facility Name: ARP MINI MAR I Date of Testing: 3-17-08 <br /> Facility Address: 25775 S.Patterson Tracy Ca.95376 <br /> Facility Contact: Neilsh Patel I Phone: (209)835-7777 <br /> Date Local Agency Was Notified of Testing: March 12,2008 <br /> Name of Local Agency Inspector(f present during testing): Michelle Henry <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company RELIABLE PETROLEUM SERVICES INC. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials`: X CSLB Contractor X ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Specify) <br /> License Number(s): 883706 5250451-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used. Standard Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tank Tl:87 Blue Slave Fill T2: 87 Blue T3: 87 Blue T4: 91 Gold Fill <br /> Number, Stored Product, etc.) Master Fill Siphon Fill <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> X Contained in Sump X Contained in Sump X Contained in Sump X Contained in Sum <br /> Bucket Diameter: 12" 12" 12" 12" <br /> Bucket Depth: 13% 13% 13%" 13'/" <br /> Wait time between applying — <br /> vacuum/water and start of test: 2 min. 2min. — <br /> Test Start Time(TI): 2:10p.m 2:12p.m 2:00p.m 2:05p.m <br /> Initial Reading(RO: 10 15/16" 10 9/16" 2" 3" <br /> Test End Time(TF): 3:10p.m 3:12p.m 2:02p.m 2:06p.m <br /> Final Reading(RF): 10 15/16" 109/16 " 13/4" 2 7/8" <br /> Test Duration(TF—Tj): lhr. Ihr. lmin. 1 min. <br /> Change in Reading(RF-Rj): 0 0 3/4" 118" <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: X Pass Fail X Pass Fail Pass X Fail Pass X Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Order gaskets for drain valves and possibility new fill spill bucket like for like. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that aft the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature:- Date: 03/17/08 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br /> may be more stringent. <br />