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eco/ <br /> EGO-CHER COMPLIANCE <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(f 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: 11/30/2015-12108/2015 <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: 11/24/2015& 11/30/2015 <br /> Name of Local Agency Inspector(f present during testing): Victoria McCartney/Cindy Vo <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/Level Change Indicator Equipment Resolution: 1/16"/0.0025 <br /> Identify Spill Bucket(By Tank 1 Diesel 291 3 4 <br /> Number, Stored Product, etc.) <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> ® Contained in Surrip Z Contained in Sum ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 12 Inches 12 Inches <br /> Bucket Depth: 14 Inches 14 Inches <br /> Wait time between applying 10 Minutes 10 Minutes <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 11:30 AM 01:20 PM <br /> Initial Reading(111): 12 3/4 Inches First Ring <br /> Test End Time(TF): 12:30 PM 01:50 PM <br /> Final Reading(RF): 12 3/4 Inches First Ring <br /> Test Duration(TF—Tj): 60 Minutes 30 Minutes <br /> Change in Reading(RF-RI): 0 Inches 0 <br /> Pass/Fail Threshold or 1/16 Inches 0.0025 <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail I ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Comments—(include information on repairs made prior to testing, and r•econnrrended follow-up for•failed tests) <br /> Both Tank 91 and Tank Diesel Spill buckets were replaced on 11/30/2015. <br /> Tank Diesel Spill Bucket passed the test on 11/30/2015. <br /> On 12/08/2015 Tank 91 Stainless Sleeve Fill Bucket was replaced with a new one. <br /> Tank 91 Spill Bucket passed the test on 12/08/2015. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I herebP certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: r oy Date: 12/08/2015 <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 />