Laserfiche WebLink
SWRCB,January 2006 <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(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> Facility Name:CHEVRON#201383(N-2515-1-1) Date of Testing: 1/10/2020 <br /> Facility Address: 1960 W. 11TH STREET @ CORRAL HOLLOW,TRACY,CA 95376 <br /> Facility Contact:MGR-HELEN Phone:209-836-3181 <br /> Date Local Agency Was Notified of Testing: 1/3/2020 <br /> Name of Local Agency Inspector(if present during testing):SHEWIT W. <br /> 2.TESTING CONTRACTOR INFORMATION 18W 1 1 292n <br /> Company Name:T'ANKNOLOGY INC. <br /> Technician Conducting Test:Jesus Saldivar <br /> pop <br /> Credentials): ❑ CSLB Contractor V. ICC Service Tech. r SWRCB Tank Tester r Other(Specify) H <br /> License Number(s): <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used By: r Hydrostatic Iv Vacuum r Other <br /> Test Equipment Used:VACUUM TEST Equipment Resolution:0.1 gph <br /> Spill Box#Tank T2 Spill Box#Tank T I Spill Box#Tank T3 Diesel- <br /> Identify Spill Bucket(By Tank REGULAR-Fill 1-Direct- SUPREME-Fill 1-Direct- Fill 1-Direct-Grade level Spill Box# <br /> Number,Stored Product, etc) Grade level in containment Grade level in containment in containment sump <br /> sump sump <br /> Direct Bury f Direct Bury r Direct Bury r Direct Bury <br /> Bucket Installation Type: re Contained in Sump ro Contained in Sump re Contained in Sump r Contained in Sump <br /> Bucket Diameter: 12.00 12.00 12.00 <br /> Bucket Depth: 16.00 16.00 16.00 <br /> Wait time between applying <br /> vacuum/water and start of test 1 min I min 1 min min <br /> Test Start Time(Tl): 09:01:00 09:03:00 09:05:00 <br /> Initial Reading(Rj): 30.00 in.H2O 30.00 in.H2O 30.00 in.H2O <br /> Test End Time(TF): 09:02:00 09:04:00 09:06:00 <br /> Final Reading(RF): 30.00 in.H2O 30.00 in.H2O 28.00 in.H2O <br /> Test Duration(TF—TI): 1 min 1 min 1 min <br /> Change in Reading(RF—Rl): 0.00 in.1120 0.00 in.H2O -2.00 in.H2O <br /> Pass/Fail Threshold or Criteria: +/-4.00 +/-4.00 +/-4.00 <br /> Test Result: Pass Pass Pass <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) <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: /.)X— Date: 1/10/2020 <br /> 'State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent. <br /> WO:2343353 <br />