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9. Spill Bucket Testing Reportlorm SWRCB,January 2006 <br /> This form is intended for use by contractors performing annual testing oJ'UST spill containment structures. The completed form and <br /> printouts from tests(tf applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO #06080, CC 18022649 1 DateofTesting: 08/25/2009 <br /> Facility Address: 85 E LOUISE AVE PTO N-71, LATHROP, CA, 95330 <br /> Facility Contact: MANGER Phone: (2 0 9) 983-9144 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(if present during testing): MICHELLE HENRY REHS <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: JOEY MESA <br /> Credentials 1: ❑CSLB Contractor a ICC Service Tech. ❑SWRCB Tank Tester E Other(Spec) ICC SERVI CE <br /> License Number: 5259458-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> l,:st Method Used: El Hydrostatic Vacuum ❑ Other <br /> Test Equipment Used: TAPE MEASURE Equipment Resolution:VISUAL LOSS <br /> Identify Spill Bucket(By Tank t 1 REG FILL 2 2 PLU FILL 3 3 PRE FILL 4 <br /> Number, Stored Product, etc.) <br /> Bucket Installation Type: <br /> ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> ❑X Contained in Sump X❑Contained in Sump ❑X Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 10" 10" 10" <br /> Bucket Depth: 15" 15" 15" <br /> Wait time between applying 5 MIN. 5 MIN. 5 MIN. <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 11:35 11:35 11:35 <br /> Initial Reading(Rt ): 13 1/2" 13 1/2" 13 1/2" <br /> Test End Time(TF): 12:35 12:3 5 12:3 5 <br /> Final Reading(RF ): 13 1/2" 13 1/2" 13 1/2" <br /> Test Duration: 60 MIN. 60 MIN. 60 MIN. <br /> Change in Reading(R F-Ri ): 0" 011 0" <br /> Pass/Fail Threshold or VISUAL LOSS VISUAL LOSS VISUAL LOSS <br /> Criteria: <br /> Fest Result: a Pass ❑ Fail Pass E Fail [z]Pass ❑ Fail 1:1 Pass ElFail <br /> Comments - (include information on repairs made prior to testing, and recommended follox,-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: �l'/� Date: 08/25/2009 <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 />