Laserfiche WebLink
ec✓ <br /> f CL'- IIEM C�NClF4:I <br /> 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 Date of Testing: 11/18/2016 <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: 11/15/2016 <br /> Name of Local Agency Inspector(ifpresent during testing): Muniappa Naidu <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: ECO-CHEK Compliance, Inc. <br /> Technician Conducting Test: Nik Zagorov <br /> Credentials': E CSLB Contractor ® ICC Service Tech. ® SWRCB Tank Tester ❑ Other(Spec) <br /> License Number(s): 958763 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used:Tape Measure Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 87-W 2 3 4 <br /> Number, Stored Product, etc. <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> ® Contained in Sump Contained in Sump ❑ Contained in Sump Contained in Sum <br /> Bucket Diameter: 12 Inches <br /> Bucket Depth: 14 Inches <br /> Wait time between applying 10 Minutes <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 10:00 AM <br /> Initial Reading(Rj): 13 5/8 Inches <br /> Test End Time(TF): 11:00 AM <br /> Final Reading(RF): 13 5/8 Inches <br /> Test Duration(TF—TI): 60 Minutes <br /> Change in Reading(RF-RI): 0 Inches <br /> Pass/Fail Threshold or 1/16 Inches <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-irp for failed tests) <br /> Tank 87 WEST Spill bucket was replaced "like for like" and retest with passing result. <br /> � ?1111 <br /> a-H <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 ree#1ireme nts. <br /> Technician's Signature:_ N o r 0✓ Date: 11/18/2016 <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 />