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D�ECDM o <br /> a . LSD <br /> JUN 11 2009 �:�:.. SWRCB,144,a,y2006 <br /> ENXOPW26v�tN' <br /> MESpill Bucket Testing Report Form .o . <br /> � 4r use by contractors performing annual testing of UST spill containment s,;,—l s\`The ci: »� leted form and <br /> o tew&,(fapplicable), should be provided to the facility owner/operator for submittal to the k 44'�Ieegulatory agency. <br /> 1. FACILITY INFORMATION �I <br /> FFacifitye: ARP MINI MART 76 Date of Testiness: 25775 S.Patterson Pass Roadg: 03-27-09 <br /> act: Neilsh Patel Phone: (209)835-7777 <br /> gency Was Notified of Testing: 03-24-09 <br /> al Agency Inspector(f present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> FTe <br /> ny Name: Reliable Petroleum Services Inc. <br /> cian Conducting Test: Guadalupe Sanchez <br /> tials': X CSLB Contractor X ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Specify) <br /> e an <br /> 883706 5250451-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic a Vacuum ❑Other <br /> Test Equipment Used:Standard Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tank T1: 87 Blue Slave Fill T2: 87 Blue Master T3: 87 Blue Syphon T4:91 Gold Fill <br /> Number, Stored Product, etc. Fill Fill <br /> Bucket Installation Type: Direct Bury Direct Bury ❑Direct Bury ❑Direct Bury <br /> X Contained in Sum X Contained in Sump X Contained in Sump X Contained in Sum <br /> Bucket Diameter: 12" 12" 12" 12" <br /> Bucket Depth: 14" 12 ''/z" 13 ''/z" <br /> 14" <br /> Wait time between applying <br /> vacuum/water and start of test: I min. 1 min. I min. 1 min. <br /> Test Start Time(Ti): 9:20a.m 9:13a.m 9:05a.m 9:17a.m <br /> Initial Reading(R,): 12%" 10 '/2" 11 /,' " 12" <br /> Test End Time(TF): 10:49a.m 10:49a.m 10:48a.m 10:49a.m <br /> Final Reading(RF): 12% 10'/z" 11 %<" 12" <br /> Test Duration(TF—Ti): Ihr.29min. lhr.36mm. Mr.43min. Mr.32min. <br /> Change in Reading(RF-Ri): 0 0 0 0 <br /> Pass/Fail Threshold or <br /> Criteria: 1/16" 1/16" 1/16" 1/16" <br /> Test Result: X Pass ❑ Fail X Pass C Fail XPass ❑Fail X Pass ❑Fail <br /> Comments—(include information on repairs made prior to testing and recommended follow up for failed tests) <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 Signatu%e:_... ~ ' z �s �, _. Date: 03-27-09 <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 />