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0 0 <br /> 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: SAN JOAQUIN CORP YARD Date of Testing: 3-8-2011 <br /> Facility Address: 18 STOCKTON CAI0 HAZELTON RD <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(fpresent during testing): JEFF WONG <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 4162 nd Street Galt,CA 95632 (209)744-0112 Fax: (209)744-0116 <br /> Technician Conducting Test: ❑ Lyle D.Nimmo ❑ Zane A.Nimmo ® David A. Winkler ❑ Felix G.Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials: ® ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑vacuum ❑ Other <br /> Test Equipment Used: h20 and tape measure Equipment Resolution: 1/16 <br /> ,. <br /> Identify Spill Bucket(By Tank 1 87 2 DSL 3 DSL RETEST 4 <br /> Number, Stored Product, etc. <br /> ❑Direct Bury ❑Direct Bury El Direct Bury E] Direct Bury <br /> Bucket Installation Type: ® Contained in ❑ Contained in <br /> ® Contained in Sump ® Contained in Sump SumpSum <br /> Bucket Diameter: i l 11 11 <br /> Bucket Depth: 14 18 18 <br /> Wait time between applying <br /> vacuum/water and start of test: - -- <br /> Test Start Time(Tj): 1 1 2 <br /> Initial Reading(Rj): 12.50 17 17 <br /> Test End Time(TF): 2 145 3 <br /> Final Reading(RF): 12.50 15 17 <br /> Test Duration(TF—Tj): IHR IHR IHR <br /> Change in Reading(RF-Rj): 0 0 0 <br /> Pass/Fail Threshold or 1/16 1/16 1/16 <br /> Criteria: <br /> Test Resin : 0 Pas ❑Fail [ bass Z Fail 0 Pass ❑ Fail ❑ Pass ❑ Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> HAD TO REPAIR DSL BUCKET THEN PASSED <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 3-8-2011 <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 />