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RECEIVED <br /> N0V11q6•2`AR?ary 2006 <br /> Spill Bucket Testing Report Form <br /> h:NV1I20NMEN'I'AL HEALTH <br /> This form is intended for use by contractors performing annual resting of UST spill conlainntenl slrttc[u'rA..Tih f v��orm and <br /> printouts from tests(if applicable), should be provided to the facility ownerloperator for submittal to the lova)regu a/orn agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO am/pm 83333 Date of Testing: 10/25/2017 <br /> Facility Address: 550 W.Valpico Ave. Tracy,CA 95376 <br /> Facility Contact: Edgar I Phone: (209)836-3327 <br /> Date Local Agency Was Notified of Testing: 10/5/2017 <br /> Name of Local Agency Inspector(fpresent during testing): Betty Ho and Aaron Ilan- <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Diamond Petroleum Services,Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials': x CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Speciji) <br /> License Number(s): 1005444 5250451 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: xHydrostatic Vacuum ❑Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 T1: 87 Fill West 2 TI: 87 Fill East 3 T2: 91 Fill 4 T3: Diesel Fill <br /> 'i <br /> Number,Stored Product, etc.) <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> x Contained in Sump x Contained in Sump x Contained in Sump Contained in Sum <br /> Bucket Diameter: 12" 12" 12" 12" <br /> Bucket Depth: 15" 14 3/4" 15 '/4" 15" <br /> Wait time between applying <br /> vacuum/water and start of test: I minute I minute 1 minute I minute <br /> Test Start Time(Ti): 1:45 p.m. 1:45 p.m. 1:45 p.m. 2:00 p.m. <br /> Initial Reading(Rt): 14" 13 %s" 13 '/2" 13 '/4" <br /> Test End Time(Tr.): 2:45 p.m. 2:45 p.m. 2:45 p.m. 3:00 p.m. <br /> Final Reading(RF): 14" 13 '/2" 13 '/2" 13 3/4" <br /> Test Duration(TF-Ti): I hr 1 hr 1 hr 1 hr <br /> Change in Reading(Rf-Ri): 0 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16'* 1/16" 1/16" <br /> Criteria: <br /> Test Result: x Pass ❑ Fail x Pass ❑ Fail x Pass ❑ Fail x Pass ❑ Fail <br /> Comments- (include inlrirnuaiion on repairs made prior to testing, and recommended Jolioir-upfor failed trsts) --- <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I herehY certify dial all the information contained in this report is true,accurate,and in full compliance roith legal requirenuentc. <br /> Technician's Signature.-. -..mss -.r�c� � b Date: 10/25/2017 <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 />