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SWRCB,January 2006 <br /> 9. 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 #02133, CC 18022644 DateofTesting: 03/26/2008 <br /> Facility Address: 2908 BENJAMIN HOLT DR. , STOCKTON, CA, 95209 <br /> Facility Contact: MARK Phone: (8 0 0) 964-0180 <br /> Date Local Agency Was Notified of Testing: 03/18/2008 <br /> Name of Local Agency Inspector(if present during testing): GARRETT BACKUS <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: DENNIS RUE <br /> Credentials I: ❑CSLB Contractor ❑X ICC Service Tech. F-1SWRCBTank Tester �Other(Specify) ICC <br /> License Number: 5246067-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: 1XI Hydrostatic El Vacuum 0 Other <br /> Test Equipment Used: TAPE MEASURE Equipment Resolution:VISUAL <br /> Identify Spill Bucket(By Tank 1 1 REG FILL 2 2 REG FILL 3 3 PRE FILL 4 <br /> Number, Stored Product, etc.) <br /> E] Direct Bury E]Direct Bury ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Type: 0 Contained in SumpX❑Contained in Sumpx❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 12 12 12 <br /> Bucket Depth: 14.50 14.50 14.50 <br /> Wait time between applying 5 5 5 <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 1230 1230 1230 <br /> Initial Reading(RI ): 10.75 10.25 10.50 <br /> Test End Time(TF): 1330 1330 1330 <br /> Final Reading(RF ): 10.75 10.25 10.50 <br /> Test Duration: 60 MINS. 60 MINS. 60 MINS. <br /> Change in Reading(R F-RI ): 0 0 0 <br /> Pass/Fail Threshold or P P P <br /> Criteria: <br /> 1 7-775 <br /> 1 7 <br /> y <br /> m M, <br /> ON <br /> Us ,r„ F F� ,�.„ ,_,,.s=� 3,.'='f v..r <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: 03/26/2008 <br /> I 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 />