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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(f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> F <br /> : Arco Date of Testing: 03/27/2012 <br /> ess: 1711 E.Yosemite Ave.,Manteca,Ca.95336 <br /> ct: Sonnie Phone: (209)451-8441 <br /> gency Was Notified of Testing: O al Agency Inspector(ifpresent during testing): Muniappa Naidu <br /> 2. TESTING CONTRACTOR INFORMATION <br /> FTechnician <br /> me: Reliable Petroleum Services Inc. <br /> onducting Test: Guadalupe Sanchez <br /> x CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Sped) <br /> ber(s): 883706 5250451-UT _ <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> PeMethod Used: xHydrostatic �I Vacuum ❑Other <br /> quipment Used: Standard Tape Measure Equipment Resolution:N/A <br /> fy Spill Bucket(By Tank 1 T1: 87 Fill 2 T2: 89 Fill 3 T3: 91 Fill 4 T4: <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" <br /> Bucket Depth: 123/4" 13 5/8" 13 '/," <br /> Wait time between applying 1 minute I minute 1 minute <br /> vacuum/water and start of test: <br /> Test Start Time(T): 1:06 pm. 12:25 p.m. 1:07 p.m. <br /> Initial Reading(RI): 12 V 117/8" 115/8" <br /> Test End Time(TF): 2:06 p.m. 1:25 p.m. 2:07 p.m. <br /> Final Reading(RF): 121/4" 117/8" 11 5/8" <br /> Test Duration(TF—TO: I hr 1 hr l hr <br /> Change in Reading(RF-RI): 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: x Pass ❑Fail x Pass ❑Fail x Pass ❑Fail Pass ❑Fail <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: Date 03/27/2012 <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 />