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GFTTLfR-RYAN lore GR Job# 1820- 2542 <br /> SWR+C'B.January 2(1()6 <br /> Spill Bucket Testing Report Form <br /> This form is inleruled Joe use hJ° contracuns pc►f r►ning manual testing of UST spill co►nai►rment smrca,res. The Completed foci r and <br /> prtnlot+h frown tests (if applicable). should 1w prorided to the firrillh1v ounerboperator fro' subatinal to the local retlnlatorr itgen(} <br /> I.FACILITY INFORMATION <br /> Facility Name: Arco 2093 Date of Testing: 8/34/2018 <br /> Facility Address: 3425 Tracy Blvd. Tracy 95375 <br /> Facility Contact: Daryl Lee Phone: 415-902-5089 <br /> Date Local Agency Was Notified of Testing: <br /> acne of EocalAgency Inspector(ilpresent c sing testing); <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: (:'lilts' RN an Inc.,680;%lora(saint.Staiflc t,. Dublin,Ca.9450S <br /> Technician Conducting Test: David Rouse <br /> Credentials.(1) ( til C t ontrac•trn ICC sen ice Tech. SWRCB Tani.Tester Other(Specify) <br /> License Number. �2tt"'t3 ICC Tech Number_ <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: It,dr4o4,l9+tit Vacuum Other <br /> Test Equipment Used: `+tuularsl l alit ticamw r Equipment Resolution' 1 Io" <br /> Identify Spill Bucket(Ba°Tank ' 2 3 q <br /> Number.SroredProrbrc1.ctrl 87-Vapor 87-Vapor 87-Vapor 91-Vapor <br /> irect Bury irecl Bury trect Bury irect Bury <br /> Bucket Installation i ypc: X ontamed in Sump ©Contained in Sump QX C'ontamed to Sump aortained in Sump <br /> Bucket Diameter. 14 14 14 14 <br /> Bucket Depth: 11 11 11 11 <br /> Watt time between applying <br /> -%, 5 mins 5 mins 5 mins S mins <br /> cacuunt1 aterandstartofit <br /> Test Stan Time jt): 10:00 10-00 10: 00 10 : 0 0 <br /> Initial Reading(Ri): 9 1/2 9 1/2 9 1/2 9 1/2 <br /> Test End Time(Tf)' 11.00 11 :00 11: 00 11 : 0 0 <br /> Final Reading(Rf) 9 1Z2 9 1Z2 9 1/2 9 1 2 <br /> Test duration(Tf-Ti); 1 hr 1 hr 1 hr 1 hr <br /> Change in Reading(Rf-Rt) 0 0 0 0 <br /> PasslFaih Threshold or Criteria: If 0 91 it <br /> Test Results: r Pass Fait r PassFaii r Pass ail r Pass QFail <br /> Comments-tinclude in ormrdio►t o+:,c rrrr>'::rade' mor to tesong.ttrre/rceomr►tcrrdfd ollu�r-rr r i>r :riled to°ste! <br /> CERTFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> hcrrby certify°ileal all rbc irrfarnradarr contained in this rt is true,accurate,and in ju!l caarpliarrce trltle legal rc yuircntrrtJs <br /> Technician's Signature rte` Date 8/30/2018 <br /> (1) State Tans and regulations do not currently require testing to be performed by a qualified contractor, llocceser, local requirements <br /> tttay be more stringent, <br />