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SWRCB, January 2006 <br />9. Spill Bucket Testing Report Form <br />This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: ARCO #02186, CC 18022645 <br />DateofTesting: 05/13/2008 <br />Facility Address: 3212 N. CALIFORNIA @ ALPINE <br />AVE. PTO # N-79, STOCKTON, CA, 95210 <br />Facility Contact: MGR - KEVIN <br />Phone: (2 0 9) 941-2694 <br />Date Local Agency Was Notified of Testing: 04/28/2008 <br />1:1 <br />Name of Local Agency Inspector (if present during testing): <br />ARIS CACAPIT <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TANKNOLOGY, INC. <br />Technician Conducting Test: JOEY MESA <br />Credentials 1: <br />E <br />CSLB Contractor <br />E <br />ICC Service Tech. <br />1:1 <br />SWRCB Tank Tester <br />E <br />Other (Specify) ICC SERVICE <br />License Number: 5259458 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: <br />F-1 Hydrostatic <br />Vacuum <br />F-1 Other <br />Test Equipment Used: TAPE MEASURE <br />Equipment Resolution: VISUAL LOSS <br />Identify Spill Bucket(By Tank <br />Number, Stored Product, etc.) <br />1 REG FILL <br />2 1 REG FILL <br />3 2 REG FILL <br />4 3 PRE FILL <br />Bucket Installation Type: <br />Direct Bury <br />❑R Contained in Sump <br />E]Direct Bury <br />x0 Contained in Sump <br />Direct Bury <br />QX Contained in Sump <br />Direct Bury <br />❑X Contained in Sump <br />Bucket Diameter: <br />11 1/211 <br />11 1/211 <br />11 1/211 <br />11 1/211 <br />Bucket Depth: <br />13 1/2" <br />13 1/2" <br />13 1/2" <br />13 1/2" <br />Wait time between applying <br />vacuum/water and starting test: <br />5 MIN. <br />5 MIN. <br />5 MIN. <br />5 MIN. <br />Test Start Time (TI ): <br />11-00 <br />9: 0 0 <br />9: 0 0 <br />11: 00 <br />Initial Reading (RI ): <br />1211 <br />12 " <br />1211 <br />1211 <br />Test End Time (TF ): <br />12 : 05 <br />10: 05 <br />10 : 05 <br />12 : 05 <br />Final Reading (RF ): <br />12" <br />12" <br />12" <br />12" <br />Test Duration: <br />60 MIN. <br />60 MIN. <br />60 MIN. <br />60 MIN. <br />Change in Reading (R F - RI ): <br />0" <br />o" <br />0" <br />o" <br />Pass/Fail Threshold or <br />Criteria: <br />VISUAL LOSS <br />VISUAL LOSS <br />VISUAL LOSS <br />VISUAL LOSS <br />Test Result: <br />' ° <br />X Pass L]Fail -j <br />Puss: Fail <br />�"'Pass ;. ' � <br />��Faili� <br />M Pass, � FaII <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:�l I/ Date: 05/13/2008 <br />I 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 />