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0 0 <br /> Spill Bucket Testing Report Form SWRCB,January 2006 <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 ownerloperatorfor submittal to the local regulatory agency. <br /> I- FACILITY INFORMATION <br /> Facility Name: SB GAS&MART� Date of Testing: 05/16/08 <br /> Facility Address: 515 W.11"Street <br /> Facility Contact: Sanjay Birla one: (209)834-8838 <br /> p Date Local Agency Was Notified of Testing: 04/18/08 <br /> Name of Local Agency Inspector(ii(present during testing): Garrett Backus <br /> 2. TESTING CONTRACTOR INFORAIATION <br /> Company RELIABLE PETROLEUM SERVICES INC. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials': X CSLB Contractor X ICC Service Tech. 0 SWRCB Tank Tester 0 Other(Specify) <br /> LLicense Number(s): 883706 5250451-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic 0 Vacuum 0 Other <br /> Test Equipment Used: Standard.Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tank T1: 87 Fill T4:Diesel Fill T3: 91 Fill <br /> Number,Stored Product, etc.2 <br /> Bucket Installation Type: X Direct Bury X Direct Bury X Direct Bury Direct Bury— <br /> Contained in Sump Contained in Sump Contained in Sump Contained in Sump <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 14 Y2" 15 Y2 15" <br /> Wait time between applying I min. 1 min. — <br /> vacuum/water and start of test: I min. <br /> Test Start Time(Ti): 10:48am 10:47a.m 10:45a.m <br /> Initial Reading(Rj): 131/16" 14 Y2" 131/211 <br /> Test End Time(TF): 11:48a.m 1 1:47a.m 11:46a.m <br /> Final Reading(RF): 13 1/16" 14 Y2" 13 Y2" <br /> Test Duration(TF—TO: I Hour I Hour <br /> 7-7-7— - I Hour <br /> Change in Reading(RF-Rj: 0 0 0 <br /> Pass/Fail Threshold or <br /> Criteria: 1/16" 1/16" 1/16" <br /> Test Result: X Pass Fail X Pass Fail ypnee Fail Pass Fail <br /> Commeimts—(include information on repairs made prior to testing, and recommended follow-upfor failed tests) <br /> During the. 1St test test buckets failed due to Worn out fill caps- Renlaced fill <br /> Cos & retested — Test buckets passed- Inspector on site. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby cert t&that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signa tum-1--, <br /> Date:05/16/08 <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 />