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CCC-CnCF COMoIAe+Ct <br /> 11 <br /> Spill Bucket Testing Report Form NOV 81 <br /> This form is intended for use by contractors performing annual testing of UST spill containmeEWRfAWVAIcil,"L4Wform and <br /> printouts from tests(if applicable),should be provided to the facility owner/operator for submittalR5WiIc RX,42 1k9ory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO I 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': Z CSLB Contractor Z ICC Service Tech. Z SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 958763 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Z 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: <br /> El Direct Bury ElDDirect Bury El 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(TO: 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-Rl): 0 Inches <br /> Pass/Fail Threshold or 1/16 Inches <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail I ❑ 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 was replaced "like for like" and retest with passing result. <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_ ___ OV-C)✓ 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 />