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Ma, 25 13 10:55a Reliable PetroleumA <br />209-845-8953 P.9 <br />Spilt Bucket Testing Report Forms WRCB, January 2006 <br />ThFs fors: is imandedi r use by cora radars performing resting of (j spill containment "'uV cares. Th Completed farm and <br />printouts from tests (i AP11cable), should be provided fo thefacililp owmw1operatorforsubmWal to the local egulratory agency. <br />i. FACi1 ! O TION <br />Faci ' • Name: Country Club Mini Date afTesti� <br />Faci " +2512013 <br />+ 1856 Country Club Blvd, Stodmon, Ca. 95204 <br />Facility Contact: Flu! Phone: (209) 941-2765 <br />Date Local Agency Wa Notified. of Testing : �? � - I k 13 <br />Name of Lona! Agency aspector (tf present during testing): Garrett Badctas i <br />Teat ResultsI <br />Citmtteents - (rar.Clude <br />1 2 MMR CONTRACTOR INFORMATION <br />Company Name; <br />Reliable Petroleum Services, Ipc. <br />Technician Con <br />rest Guadalupe Sanchez <br />Crtdendals': x CSLB <br />ontractor x ICC Service Tech. 0 S'WRCB Tank Tester 3 biter (Specifv} <br />License Nurnber(s): <br />883706 5250451 -UT <br />I SP1L1-RUMTMTMG.Vff0RMATj0N <br />Test Method Used: <br />xHydtostatic D Vacu= 0 Other <br />Identify Spill Bucket A <br />Number: Stored Product <br />Tank I Tis 91 Fii! -i—n: 87 Fill 3 T3: <br />etc.) 4 T4; <br />Bucket Installation Type <br />Direct Bury xDirect Bury Direct Bury Direct Bury <br />x Contained in Sum <br />Bucket Diameter: <br />C Conttaiaed in S -_-j Contained in Sum In rnained in Sum <br />12" <br />12" <br />Bucket Depth: <br />13 r/J" 13'7— <br />3,:Wait <br />Wait time avi-ly <br />V8 <br />Vacuum water and star. <br />test: 1 minute I minute <br />Test Start Time ('l',): <br />09A t am. 09:54 a.m, <br />lnkial heading (R0: <br />1 125191, <br />12 V47' <br />Test End Tim (Ta): <br />10:41 a.m. 10:30 a.m. <br />Final Re lixig (Rr):12 <br />5,18" 12 411 <br />Test Duration (TP - Tt): <br />I hr t hr <br />Ch r. in (RF- Iak <br />Q <br />Pass/Fail Threshold+or <br />Crite1a: <br />I 1115" 1f IG" <br />Teat ResultsI <br />Citmtteents - (rar.Clude <br />$Pass <br />0 Fab <br />x Pass <br />11 Fail <br />Pass <br />❑Fail Pass ❑Fail <br />ornawron on r <br />rains made <br />pjcw to tesling <br />and recomr► wded <br />tors - <br />nr afied to is <br />I <br />I <br />I <br />CERTIFIC kTIONOF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTI G <br />heM&Y c 11j' that e!1 a iirfomratlas t ortl ed this is tore, te, Md in full c ante wa legal regiefg nts. <br />Technician's Sign <br />� .Date 2,a2,S,r201 <br />State taws and regulations not ,Wntly require testing, to be perf <br />way be marc stringent. bya. qualified contractor. However, cal requirwncnts <br />