Laserfiche WebLink
May 02 12 01:29p Reliable PetroleumA 209-845-8953 p.6 <br /> C$,J anuary 2005 <br /> Spill Bucket Testing Report Form <br /> This form is intended r rise by contractors performing anneal testing of UST snip con!ainment strucrures. T compieted form and <br /> printouts from tests(if applicabie), shouid be provided to rhe facility[n4•ner,'operator-for submittal to the focal eguiatory agenic.. <br /> 1. FACILITY INFORMATION <br /> Facility Narte: A co Date of Testing: 03/ 0/2012 <br /> Facility Adctess: 1100 S-Main St,Manteca.Ca.95337 <br /> Facility Jessie Phone: 209-609-0117 <br /> Date Local Agency Wa Notified of Testing: rj <br /> Name of Local Agency nspector Ofroresent during testin - Nfuniappa Naidv <br /> 2. TESTING CONTRACTOR M ORMATIOl\ <br /> �(ln2pat)y dame; Reliable Petroleum Services lr•c. <br /> Technician Conducting est: Guadalupe Sanchez <br /> Credentials: x CSLB ontractor x ICC Service Tech 11 SWRCB Tank Tester Q Other(Sped) <br /> License Number(s): 883706 52.50451-UT = <br /> 3. SPILL BUCKET TESTING LNFORMATION <br /> Test Method Used: xHydmstatic C Vacuum D Other <br /> Test Equipment Usec: tandard Tape Measure Equipment Resolution:Ni <br /> identify'Spill Bucket( _ Tank 1 T1: 87 Fill(West) 2 TI:87 Fell (.Fast) 3 T2: 91 Fill 4 T3; 891 tl1 <br /> :Number,Stored Product ere. <br /> Bucket Installation.Type Tat eet guD Direct BuryDirect B;u-y Direct Bury <br /> x Contained ir. Sump x Contained in Sum x Contained in Sum x Contained in Sum <br /> Bucket Diameter: 12" _ ,>,' <br /> 12' 12': <br /> BuukrtDepth: 14 ,° :5 .4" l5'/4' 15 y" <br /> Wait time between apFing I <br /> vacuumrwater and start of test: 1 minute I minute I minute 1 minute <br /> Test Start Time(T.): 12:35 p.rn. 12:35 P.M. 12:36 p.m. 12:34 p.m. <br /> Init ai Reading(RI): 12 Sr6" 13 7/11" j 143 ,�, <br /> ., <br /> Test End Time jo: 1:35 P.M. 1:35 p.n. 1:36 p.m. 1:34 m. <br /> P <br /> Final.Reading(RF). 12 5/8" 13',." „., <br /> 14 13 <br /> Test Dutation(TF—Ti): I hr 1 hr 1 1 Cha <br /> ngeding(RI; ) 0 0 0 0 <br /> shold or 1116" 1116" l/l 6" 1r16" <br /> x Pass ❑Fail x Pass—DFail x Pass D Fail x Pass DFail <br /> Comments— (inciude formation on rLpairs made prior to test:rrg, and recommended(or'tow-up for failed tdds) <br /> CERFIFI TION OFT1ECUNICLA"N RESPONSIBLE FOR CONDUCTING THIS TEST! 4G <br /> hereby cerlif than ail 4e Mforma ion contained in this repos is trice, accurate,and in full copWtjance wit) legal requirements. <br /> 'T'echnician's Sigmztur Date 03/30!2C 12 <br /> State laws and regulations do not currcAy require testing to be performed by a qualified contractor.However, I l requirements <br /> may be more stringent <br />