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: Arco I Date of`resting: 03/22/2013 <br /> Facility Address: 1711 E.Yosemite Ave.,Manteca,Ca.95336 <br /> Facility Contact: Sonnie I Phone: (209)451-8441 <br /> Date Local Agency Was Notified of Testing: 03-a- 1--� <br /> Name of Local Agency inspector(if present during testing): Aris Cacapit <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 Fill 2 T2: 89 Fill 3 T3: 91 Fill 4 T4: <br /> Number, Stored Product, etc.) �r <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: 12%" 131/2" 131/4" <br /> Wait time between applying I minute 1 minute 1 minute <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 9:42 a.m. 9:43 a.m. 9:44 a.m. <br /> Initial Reading(Ri): 11 1/16" 12 1/16" 113/8" <br /> Test End Time(TF): 10:42 a.m. 10:43 a.m. 10.00 a.m. <br /> Final Reading(RF): 123/4" 12 1/16" 10'/4" <br /> Test Duration(TF—Tj): 1 hr 1 hr 1 hr <br /> Change in Reading(RF-Ri): 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/]6" <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 /> 91 fill shill bucket failed test Spill bucket needs to be replaced and permit needed <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 Signator • cof 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 />