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E-GEIVEL) <br /> ec <br /> NOV 0 9 2015 <br /> Spill Bucket Testing Report Form <br /> AA'' ��pp//''��������NN <br /> This form is intended for use by contractors performing annual testing of UST spill cont E NAV bltikklNMENTted form and <br /> printouts from tests(f applicable),should be provided to the facility owner/operator for sUNF1#1fto the9APa1YFB atory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO Date of Testing: 10/28/2015 <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: 10/13/2015 <br /> Name of Local Agency Inspector(if present during testing): Victoria McCartney <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 187-E 2 87-W 391 4 Diesel <br /> Number. Stored Product, etc.) <br /> Bucket Installation Type: <br /> E-1DirectBury El Direct Bury E] Direct Bun' El Direct Buri <br /> Z Contained in Sum Z Contained in Sum Z Contained in Sum Z 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,): 11:40 AM 11:40 AM 11:40 AM 11:40 AM <br /> Initial Reading(R,): 12 3/4 Inches 12 3/4 Inches 12 3/4 Inches 12 3/4 Inches <br /> Test End Time(TF): 12:40 PM 12:40 PM 12:40 PM 12:40 PM <br /> Final Reading(RF): 12 3/4 Inches 12 3/4 Inches 0 Inches 11 3/4 Inches <br /> Test Duration(TF—T,): 60 Minutes 60 Minutes 60 Minutes 60 Minutes <br /> Change in Reading(RF-R,): 0 Inches 0 Inches 12 3/4 Inches 1 Inches <br /> Pass/Fail Threshold or 1/16 Inches 1/16 Inches 1116 Inches 1/16 Inches <br /> Criteria: <br /> Test Result ® Pass ❑ Fail ® Pass ❑ Fail I ❑ Pass ® Fail L❑ Pass ® Fail <br /> Comments— (include information on repairs mac%prior to testing, and recoznnaencled follotir-up for failed tests) <br /> Tank Premium failed the test due to a bad drain vaiive. Must be replaced and rested. <br /> Tank Diesel failed the test due to a bad/damaged bucket upper lip. Must be replaced and rested. <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 fall compliance with legal requirements. <br /> Technician's Signature: ro✓ Date: 10128/2015 <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 />