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-CEI <br /> Eqco <br /> 11 l LZ 9! <br /> NOV 14 2016 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill c �+�j� 3�Ate�Wbrm and <br /> printouts from tests(f applicable),should be provided to the facility owner/operatoralibhi !p� latory agency. <br /> 1. FACILITY INFORMATION F' <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(ifpresent during testing): Stacy Rivera <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: ECO-CHEK Compliance, Inc. <br /> Technician Conducting Test: Nik Zagorov <br /> Credentials': ®CSLB Contractor ®ICC Service Tech. ® SWRCB Tank Tester ❑Other(Specify) <br /> License Number(s): 958763 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used:Tape Measure/Level Change Indicator Equipment Resolution: 1/16" / 0.0025 <br /> Identify Spill Bucket(By Tank 187-E 2 87-W 3 91 4 Diesel <br /> :Number, Stored Product, etc.) <br /> Bucket Installation Type: <br /> El Direct Bur} ❑ Direct Bury El Direct Bury E] Dircct Bury <br /> ®Contained in Sump ® Contained in Sum ® Contained in Sump ®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(T,): 09:55 AM 09:55 AM 09:55 AM 09:55 AM <br /> Initial Reading(Rt): 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—Tt): 60 Minutes 60 Minutes 60 Minutes 60 Minutes <br /> Change in Reading(RF-R,): 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 ❑ Pass ® Fail ® Pass ❑ Fail ® Pass ❑ Fail <br /> Comments— (include inlornration on repairs made prior to t stim, and recoi?iiiiendeci1i)lloit,-tip forfailed 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: Q r C)✓ Date: 10/26/2016 <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 />