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Apr 16 10 02:58p Reliable PetroleumA 209-845-8953 p.2 <br />S WRCB, January 2006 <br />Spill Bucket Testing Report Form <br />This -form is intended for use by contractors performing annual testing of G'ST spill containment structures. The completed form and <br />printouts from tests (tf applicable), should be provided to the facility mvnerioperator for submittal to the local regulatory agency. <br />V A rrr 1TV TNT'ni? M A Trx"-m <br />Facility Name: <br />1 11-\ <br />ARP MINI MARTDate of Testing: 3/29/2010 <br />Facility Address: <br />25775 S. Patterson Pass Rd. Tracy CA 95376 <br />Facility Contact: <br />Neilsh Patel Phone: 209-830-7777 <br />Date Local Agency Was'\otified of Testing: March 15" 2010 <br />Name of Local Asency <br />Inspector (;'present during testing): Stacy Rivera <br />2. TESTTNr rnNTRAr'rnT? lf%'IinDmA'rTd-%w <br />Company Name: Reliable Petroleum Services Inc. <br />Technician Conducting Test: • Robert Barnhart <br />Credentials': X CSLB Contractor X ICC Service Tech. ❑ S WRCB Tank Tester ❑ Other (Specify) <br />License Number(s): 883706 "A" 5252540 -UT <br />3. SPILL, BUCkF.T TF.STiN(, TNTini AX4A-rinw <br />1V1 \ <br />Test Method Used: X Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: Standard Tape Measure Equipment Resolution: <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />T-1 87 Slave Fill <br />T-2 87 ]Master Fill <br />T-3 87 Sypon Fill <br />T-4 Premium Fill <br />Bucket Instal lation Type: <br />' ❑Direct Bury <br />X Contained in Sump <br />11 Direct Bury <br />X Contained in Sump <br />❑ Direct Bury <br />X Contained in Sump <br />❑ Direct Bury <br />X Contained in Sum ; <br />Bucket Diameter: <br />12" 12" <br />1 12" <br />12" <br />Bucket Depth: <br />14" <br />13 %." <br />13" <br />13'!," <br />Wait time between applying <br />vacuum/water and start of test: <br />1 MIN. <br />1 MIN. <br />l MIN. <br />1 MIN. <br />Test Start Time (Ti): <br />12:35 P.M <br />11:20 A.M <br />11:21 A.M <br />11:21 A.M <br />Initial Reading (R,): <br />13" <br />11 3/C" <br />117/8" <br />121/4" <br />Test End Time (TF): <br />1:35PM <br />12:35 PM <br />12:35 PM <br />12:35 PM <br />Final Reading (RF): <br />13" <br />11 3/" <br />117/811 <br />121/,» <br />Test Duration (TF — Ti): <br />1118. <br />IHR. 15 MIN. <br />1 HR. 14 MIN. <br />1 HR. 14 MIN. <br />Change in Reading (RF- R,): <br />0 <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />1 /16" 1/16" <br />1/16" <br />1/16" <br />Test Result: <br />X Pass 0 Fail <br />X Pass ❑ Fail <br />X Pass 0 Fail X Pass 0 Fail <br />ColmRt OM — (include information on repairs made prior to testing and recommended follox--up for failed tests) <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />1 hereby certify that all the information contained in this report is eine, accrtrate, and In full compliance with legal requirements. <br />! a / <br />Technician's Signature: sCDl aA-^Date: 3/29/2010 <br />State laws and regulations do not currently require testing to be performed by a qualified contractor. I'lowever, local requirements <br />may be more stringent. <br />