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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 /> Facility Name: Arco Date of Testing: 06/04/2014 <br /> Facility Address: 1711 E.Yosemite Ave.,Manteca,Ca.95336 <br /> Facility Contact: Sonnie Phone: (209)451-8441 <br /> Date Local Agency Was Notified of Testing: <br /> Fame of of Local Agency Inspector(if present during testing): Elena Manzo <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Reliable Petroleum Services Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials: x CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 883706 5250451-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: xHydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution:N/A <br /> Identify Spill Bucket(By Tank 1 T1: 87 Master Fill 2 T2: 87 Slave 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: 131/2" 121/2" 131/2" <br /> Wait time between applying 1 minute 1 minute 1 minute <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 2:30 p.m. 2:30 p.m. 2:30 p.m. <br /> Initial Reading(Rj): 11 3/4" 10 5/8" 11 '/4" <br /> Test End Time(TF): 3:30 p.m. 3:30 p.m. 3:30 p.m. <br /> Final Reading(RF): 11 3/4" 10 5/8" 11 '/4" <br /> Test Duration(TF—Tj): 1 hr 1 hr 1 hr <br /> Change in Reading(RF-Rj): 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 Pass x 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 frill compliance with legal requirements. <br /> echnician's Signature: < Date 06/04/2014 <br /> e laws and regulations do not currently require testing to be performed by a qualified contractor. However,local requirements <br /> be more stringent. <br />