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 (f applicable)should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: CRLLC#5448 Date of Testing: 2116/2011 <br /> Facility Address: 3202 W. HAMMER LANE, STOCKTON, CA 95209 <br /> Facility Contact: ARMEN MKRTYTCH/AN Phone: (925)884-0800 <br /> Date Local Agency Was Notified of Testing: 1/21/2011 <br /> Name of Local Agency Inspector(fpresent during testing): GARRETT BACKUS <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANK-TEK ENVIRONMENTAL CORPORATION <br /> Technician Conducting Test: RICHARD THOMAS <br /> Credentials': ® CSLB Contractor ® ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other(Spec) <br /> License Number(s): 803705(CSLB Contractor)—5254736-UT(ICC Service Tech.)—06-1672(SWRCB Tank Tester) <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum ❑ Other(Specify) <br /> Test Equipment Used: VISUAL Equipment Resolution: <br /> a . <br /> Identify Spill Bucket(By Tank <br /> Number, Stored Product, etc.) 87 FILL 91 FILL DIESEL FILL <br /> Bucket Installation Type: ® Direct Bury ® Direct Bury ® Direct Bury ❑Direct Bury <br /> ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump <br /> Bucket Diameter: 16.00" 16.00" 16.00" <br /> Bucket Depth: 15.75" 16.00" 14.75" <br /> Wait time between applying 10 MIN 10 MIN 10 MIN <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 8:30 AM 8:30 AM 8:30 AM <br /> Initial Reading(Rj): 15.75" 16.00" 14.75" <br /> Test End Time(TF): 9:30 AM 9:30 AM 9:30 AM <br /> Final Reading(RF): 13.75" 16.00" 14.75" <br /> Test Duration(TF—Tj): 1 HR 1 HR 1 HR <br /> Change in Reading(RF-Rj): -2.00" 0" 0" <br /> Pass/Fail Threshold or Criteria: NO LOSS NO LOSS NO LOSS <br /> ' st Tsuitt:, ❑''Pass, M Fail ® Pass, ❑ Fail Pass• ( ai <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> 87 UNLEADED FILL SPILL BUCKET FAILED--CRACKS WERE VISUALLY APPARENT INSIDE AT UPPER LIP ON OUTER <br /> WALL,NORTH SIDE ON BUCKET. OPW CAST IRON BASE SERIES 1 <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the informAation,contained in this report is true,accurate, and in full compliance with legal requirements. <br /> Technician's Signature: Date: 211612011 <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 />