Laserfiche WebLink
e <br /> 1 <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(if applicable),should be provided to the facility ownedoperator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> Faality Name: Unocal Date of Testing:3/31/11 <br /> Facility Address: 2701 March Ln. Stockton,CA 95219 <br /> Facility Contact: Darren Eppler (209)473-7337 <br /> Date Local Agency Was Notified of Testing: 3/22/11 <br /> Name of Local Agency Inspector (if present during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:Service Station Systems <br /> Technician Conducting Test: Randy Wilkerson <br /> Credenfialsf: ®CSLB Contractor I@ ICC Service Tech. ❑SWRCB Tank Tester ❑ Other(Specify) <br /> License Number(s): License:485184 ICC:5258560-UT <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑vacuum ❑ Other <br /> Test Equipment Used: Measuring Tape Equipment Resolution:1/16 in. <br /> Identify Spill Bucket (By Tank 1 Fill Bucket 2 Fill Bucket 3 Fill Bucket 4 <br /> Number,Stored Product,etc.) 01 Re u 02 Prem 03 Diesel <br /> ®Direct Bury ®Direct Bury ®Direct Bury C]Direct Bury <br /> Bucket Installation Type: <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter. 12.00 in. 12.00 in. 12.00 in. <br /> Bucket Depth: 14.00 in. 14.00 in. 14.00 in. <br /> Wait time between applying 5 min. 5 min. 5 min. <br /> vacuumhvater and start of test: <br /> Test Start Time(Ti): 12:30pm 12:30pm 12:30pm <br /> Initial Reading(Ri): 13.500 in. 13.250 in. 13.500 in. <br /> Test End Time(TF): 1:30pm 1:30pm 1:30pm <br /> Final Reading(IAF): 13.500 in. 13.250 in. 13.500 in. <br /> Test Duration(TF-T 1): 1.00 hr. 1.00 hr. 1.00 hr. <br /> Change in Reading(RF-111): 0.0000 in. 0.0000 in. 0.0000 in. <br /> Pass/Fall Threshold or Criteria: ZERO LOSS ZERO LOSS ZERO LOSS <br /> Test Result: m Pass ❑Fail .Pasa [ Fafif. �1 13asa ❑Fail 0ass 0-Fail <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 hue,accurate,and In full compliance with legal requirements. <br /> Technician's Signature: a Date:3/31/11 <br /> 1 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 />