Laserfiche WebLink
RECHVED <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form APR 2 7 2015 <br /> This form is intended for use by contractors performing annual testing of UST spill contain m�II form and <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for subrl!nne 'W agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARP Mini Mart 76 1 Date of Testing: 03/10/2015 <br /> Facility Address: 25775 So.Patterson Rd.,Tracy,Ca.95376 <br /> Facility Contact: Neil Patel I Phone: (510)299-1219 <br /> Date Local Agency Was Notified of Testing: Fatinah Zareef — — <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Reliable Petroleum Services Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials': x CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 883706 5250451-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: xHydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution:N/A <br /> Identify Spill Bucket(By Tank 1 T1: 87 Slave Fill 2 T2: 87 Master Fill 3 T3: 87 Siphon 4 T4: 91 Fill <br /> Number, Stored Product, etc.2 I I 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: 14" 14" 13 '/4" 13 ''/z" <br /> Wait time between applying 1 minute 1 minute 1 minute I minute <br /> vacuum/water and start of test: <br /> Test Start Time(T,): 11:20 a.m. 11:20 a.m. 11:20 a.m. 11:20 a.m. <br /> Initial Reading(Rj): 12 5/8" 121/4" 121/2" 12 3/8" <br /> Test End Time(TF): 12:20 p.m. 12:20 p.m. 12:20 p.m. 12:20 p.m. <br /> Final Reading(RF): 12 5/8" 121/4" 121/2" 12 3/8" <br /> Test Duration(TF—Tj): 1 hr 1 hr 1 hr 1 hr <br /> Change in Reading(RF-Rj): 0 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: x Pass ❑Fail x Pass ❑Fail x Pass ❑ 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 Signature �<,e, Date 03/10/2015 <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 />