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eco,,./ <br /> l \ � 111 I t CCOl:lllh COMAIANCC <br /> Spill Bucket Testing Report Form r CU <br /> This form is intended for use by contractors performing annual testing of UST spill containmEnt structures. The completedArrr[qnd <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 I Date of Testing: 10/26/2016 <br /> Facility Address: 550 W.Valpico Road,Tracy, CA 95376 <br /> Facility Contact: Edgar Rizkalli I Phone: (925)548-7910 <br /> Date Local Agency Was Notified of Testing: 10/12/2016 <br /> Name of Local Agency Inspector(i(present during testing): Stacy Rivera <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: ECO-CHEK Compliance, Inc. <br /> Technician Conducting Test: Nik Zagorov <br /> Credentials': N CSLB Contractor N ICC Service Tech. N SWRCB Tank Tester ❑ Other(Spec) <br /> License Number(s): 958763 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: N Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: Tape Measure/Level Change Indicator Equipment Resolution: 1/16"/0.0025 <br /> Identify Spill Bucket(By Tank 1 87-E 2 87-W 391 4 Diesel <br /> Number, Stored Product, etc. <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> N Contained in Sump N Contained in Sump N Contained in Sump N Contained in Sum <br /> Bucket Diameter: 12 Inches 12 Inches 12 Inches 12 Inches <br /> Bucket Depth: 14 Inches 14 Inches 14 Inches 14 Inches <br /> Wait time between applying 10 Minutes 10 Minutes 10 Minutes 10 Minutes <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 09:55 AM 09:55 AM 09:55 AM 09:55 AM <br /> Initial Reading(RI): 13 5/8 Inches 13 3/4 Inches 15 Inches 14 7/8 Inches <br /> Test End Time(TF): 10:55 AM 10:55 AM 10:55 AM 10:55 AM <br /> Final Reading(RF): 13 5/8 Inches 12 3/4 Inches 15 Inches 14 7/8 Inches <br /> Test Duration(TF—Tj): 60 Minutes 60 Minutes 60 Minutes 60 Minutes <br /> Change in Reading(RF-RI): 0 Inches 1 Inch 0 Inches 0 Inches <br /> Pass/Fail Threshold or 1/16 Inches 1/16 Inches 1/16 Inches 1/16 Inches <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail 1 ❑ Pass ® Fail I ® Pass ❑ Fail ® Pass ❑ Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Tank 87 WEST Spill bucket failed the test and must bereplaced "like for like". <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: N O r C)✓ Date: 10/26/2016 <br /> IQ <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 />