Laserfiche WebLink
� . r <br /> RECEIVED <br /> SWRC uary 2006 <br /> Spill Bucket Testing Report Form FF? 0 5 b <br /> This form is intended for use by contractors performing annual testing of UST spill containment st �TNMEN%qand <br /> printoutsfrom tests(if applicable),should be provided to thefacility owner/operatorfor submittal & ff*Trcy. <br /> 1. FACILITY INFORMATION <br /> Facility Name: RAINBOW ARCO Date ofTesting: 01-24-14 <br /> Facility Address: 130 WILSON WAY STOCKTON CA <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing:1-24-14 <br /> �Nameofl_ocal Agency Inspector(fpresent during testing): SAN JOAQUIN CO JEFF WONG <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 4162 d Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ❑ Lyle D.Nimmo [I Zane A.Nimmo ❑ David A.Winkler ® Felix G.Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials': ®ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: TAPE/H2O Equipment Resolution: 1/16 <br /> Identify Spill Bucket (By Tank 1 87 2 87 3 91 4 <br /> \umber, Stored Product, etc.) <br /> ❑ Direct Bury Direct Bury <br /> Bucket Installation Type: ❑ Direct Bury E]Direct Bury ® Contained in El Contained in <br /> ® Contained in Sump ®Contained in Sump Sump Sum <br /> Bucket Diameter: 11 1 I 1 I <br /> Bucket Depth: 13 13 13 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(Tt): 935 935 935 <br /> Initial Reading(RI): 12 12 12 <br /> Test End Time(TF): 1035 1035 1035 <br /> Final Reading(RF): 12 12 12 <br /> Test Duration(TF—Tj): 1 HOUR 1 HOUR 1 HOUR <br /> Change in Reading(RF-Rj): 0 0 0 <br /> Pass/Fail Threshold or _ <br /> Criteria: <br /> Test Result: ® Pass L1Fail ® Pass ❑Fail ® Pass L1 Fail ❑ Pass ❑ Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> OPW BUCKETS <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: i; A Date:01-24-14 <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 />