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AAA) <br />anuuy 2006 <br />Spit Bucket Testing Rep.ort Form <br />RECTI <br />Thisform is intended or use b contractors performing ormin annual testing- o UST s :ill containmentstructures. <br />tru ture . The D <br />f f y p rf g g f p sc s complete jor a <br />printouts from tests (if applicable), should be provided to the facilie-6wner/operator for submittal to the local'r � story agency. <br />�..1�A.(;W-JtV W --P 1Rl TAT..Yn 5TUN 2 3 2008 <br />FadilityNaine: W, i7y 7i''� Il.ate of..Testif�g:. s <br />Facility Address: / Q /Se�a�1.Wew C yl G ENVIRONMENTAL. <br />P4dility Contact: CZW a'ev^r 2 % o. TENT <br />:.Date Local Agency- Was Notif ed' of `Pes ` 6 <br />Name of Local Agency Inspector (if present during testing): <br />Company Name: <br />-Technician Conducting T. GV„ <br />redentials': CST con'tr2atory C SeF ice Tee 5 Otlrex (Specify) <br />License Number(s): t 1.2- <br />3. <br />.Z <br />3. SPS'�TrTfi`l'�''ft#d'i.]E�A:r?1tAT <br />'?,s MethodUsed:2cuniiT. In <br />'I est Egvipment <br />:Identify Spin;B.ucket (By Tank <br />bLu.. ber, Swred Product, etc.) <br />1 rust fG_t-17-�L <br />97 fel u,S`11--�K, <br />2''7 t1- oz- 3TC k-26 <br />7144-9 . <br />`s ueket Installation Type: <br />..: . <br />Direct Bnr. <br />ontaitied ifi Sum <br />D ect' B bi�r$ct'. trect Bty <br />Contaan l.:isa S "tied in Su nt'ainlici in S <br />t�yCket Diameter: <br />°I a <br />l <br />s}ieket Depth: <br />-, '.itt time een applying <br />vaduu. viater. 'd%stait'of test:. <br />et -k-eS <br />rey 1. ar -eS •i wd4� S <br />-gst:Start im8 (TO: <br />dal Reading (Rt)% <br />:-,',�st)?nd Time <br />` ? al Reading (RF)-, <br />�t tqr <br />est Duration. (TF - To.: <br />J~t • ,� 5 . <br />P'1 .r VvA <br />hange it, l2Bdirig (RF - RD: <br />/�3b C' (,c .;- <br />d' v-� rrJ U w <br />ass/Fail Thr6gfiold dr <br />lten.a.': <br />1 <br />:Q0Ir7104.6 - (utclude: info. rmghon on rg irs, tnczde b.rior to -0.4#n t-eobjhmezyd. �{� ¢QI1�o=tip�Qr f�tled tests) <br />CE1Fi`ICAT1tON OF TE +. �Jis�u� FOR CONDUCT > TEST 0 <br />I hereby certify that all the i anon cutttrtittetl t iers r pUt is true, curate, and in full compliance wtth`� gal requirements. <br />Technician's. Signatu Date: <br />' State laws and regulations do not currently require testing to be pery(rmed by a qualified contractor. However, local requirements <br />may more strinngent.- <br />