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JUN-03-2009 09 :07 AM GETTLER—RYAN INC. 925 551 4770 P. 05 <br /> SNAIRCli. .lanuary 2006 <br /> Spill Bucket Testing Report Form <br /> This fbrnt i.s intended for are by contractors perlorm1ng annual testing),of UST.vpill c-onfainment structure,%%. The Ctrmpleted,fortrr and <br /> printolav front tests(if apphcet Io, should he provhletl to the fivoli{t•(orner•i)jwrutor/hr,itrhminal to the local regiila011'ggew'. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Arco AmPm#2186 Bate of'festing: 5l'>2!09 <br /> Facility Address: 3212 N. California St.. Stockton Ca <br /> Facility Contact:._ -Kevin Vo� - - _.._-... Phoney-- (,209)941-2694 <br /> Date local Agency Was Notified of Testing <br /> Name of Local Agency Inspector/if'present draring,textin,K1: <br /> _2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Gettler-Ryan Inc. <br /> Technician Conducting Test: __Pete _ <br /> t:iarcia S.i11083�-UZ- <br /> Credentials': C CSLB Contractor X ICC Service Tech SW RC_B Iank_I'esler- Other GS'pecllVl ..,_,..__-._..�� - <br /> License Number(s); i?0793 � � � <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: _ I'ly,dro,_tatic _ _ -vacuum_ - - Other <br /> Test Equipment Used: iquipment Resolution: <br /> Identity+Spill Bucket (Hr Tank 1 2 3 4 <br /> Number, ,Slored product, etc'.) 1-87 Master 2-89 Master - <br /> � 2-87 Siphon 3-91 <br /> Bucket Installation Type: Direct Bury Direct Bulgy Direct Bury L. Direct Bury <br /> X Contained in Sump X Contained in Sump_- X Contained in Sump X Contained in Sum <br /> Racket Diameter: I.'..;._... �.,. ,,. - 12" <br /> - --- ,.I`;._ - 12 <br /> Bucket Depth: 1�_ 1' _ ._.. -- 12" -- - 12------ - <br /> Wait time between applying 15min 15min - l5min 15min <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 3:5 I pm 3:51 pm 3:S 1 pm 3:`i I pin <br /> Initial Reading(R,): 11 5/8" 1 1 7/8'_-_- "--__- <br /> 'fest End Time(TF): 4:51 pm ------ 4:51 pm...—_.._... .-•_-- 4:5 l pm r 4:'-I pin -_ <br /> Final Reading(Rr): 11 5i8" 11 7/8" 11 3.8 10 3/4" <br /> Test Duration(TF...T,): Ihr lhr lhr_ _ _ _..___._..._...�....._. <br /> Change in Reading,(Rr-P,0:..- o- -- <br /> Pass/Fail Threshold or 0 0 0 0 <br /> Criteria: _ - <br /> Test Result: X Paas 0 Fail X Pass 0 Fail X Pass 0 Fall X Paas 0 Fail <br /> Comments-/lncdude:in ormution on repairs muds prior to testing, aanel recommended fn//uH�failerd r�tsl -- <br /> All Fid spw Tested <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I herebv cerdfy that all the Information contafied in this report is true.accurate,and in full compliance whir legal requirements. <br /> T'echnician's Signature:. Daw. - <br /> Slate laws and regulations do not currently require w ting to be performed by a gjwIified eunlrHctor. Howev4r. local rCquirt meats <br /> may he more stringent. <br />