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GEMER-RYAiv lits. GR Job# 1820- 2542 <br /> SW RCB,Januar}.2006 <br /> Spilt Bucket Testing Report Farm <br /> This fbim is intended ftrr use br contactors petftruring annrtal testing oJ' UST spill containneat <strrtentres The C°ourpleted Joan and <br /> printouts firer tests (if applicable), should be provided to the forcilitY ouneroperator for srdrrrrittcrl to the local rttguhttorr ggenci <br /> 1. FACILITY INFORMATION <br /> Facility Name: Arco 2093 DaicofTesting: 8 30/2018 <br /> Facility Address- 3425 Tracy Blvd. Trac . 95376 <br /> Facility Contact: Daryl Lee Phone: 415-902-5089 <br /> Datc Local Agency 7Vas Notified of Testing: <br /> Name or LocalAgencynspector(ij present curing testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: ('dolor-R.an 111c..0801 Nicrra( our t.Suite(:. Dublin.( a.94505 111.::e►';.-, <br /> Technician Conducting Test: David Rouse <br /> Credentials:(1) (M It(ontraetor ICC service Tech SWRCB Tang Tester Other(Specific) <br /> License Number. 220-93 ICC Tech Number: 8292530 <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Mclhod Used: l i%d rn11h r tic Vacuum Other <br /> Test Equipment Used. titandard"I a1n NIr:sl1w Equipment Resolution: I Iib" <br /> Identify Spill Buckct(Bs°Tank 1 Y 3 4 <br /> Namber,StaredProduct.etc) 87-PzOdUct 87-product 87-Product 91-ProdUCt <br /> Direct Bury Direct Bury Direct Bury irect Bury <br /> Bucket Installation T}pe: x Contamed in Sump ®Contained in Sump Ox Contained in Sump gX C'ontained in Sump <br /> [Bucket Diameter: 14 14 14 14 <br /> ucket Depth: 11 11 11 11 <br /> ait time bemce:n applyingacuumttsater and start of test: 5m1 riS SmiriS Sm1riS SmiriS <br /> est Start Time(Ti) 10:00 10:00 10 :00 10 : 00 <br /> Initial Reading(Ri): _ 9 1/2 9 1/2 9 112 9 1Z2 <br /> Test End Time(Ti), 11:00 11:00 11 : 0 0 11: 0 0 <br /> Final Reading(RI) 9 1/2 9 1/2 9 1/2 9 1 2 <br /> Test duration(Tf-Ti): 1 hr 1 hr 1 hr 1 hr <br /> Change in Reading(Rf-Ri), 0 0 0 0 <br /> PasstFail Threshold or Criteria; It It 1) It <br /> Test Results: ✓ Pass Fall ✓ Puss Fail ✓ Pass Fall ✓ Pass Fail <br /> Comments-(inclutle irtlirrmatiott on repairs rarrde prior to testing,and rowntirnended fidlow-upfior frtiled tests) <br /> CERTFICATION OF TECIINICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in his re Is true,accurate,and its futl compliance with legal reyra(renre►rrx <br /> Technicians Signature: hate 8/30/2018 <br /> (I) State laws and regulations do not currently require testing, to be performed by a qualified contractor. llouceer, local requirements <br /> may be more stringent. <br />