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6ETTLER-RYAN INC. GR Job # <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 ownerloperator for submittal to the local regulatory agency, <br />rMiXe-T11*1 Iva 10 <br />Facility Name: Arco 2093 Date of TestinE 1=1 Of <br />Facility Address: 3425 Tracy Blvd Tracy. CA <br />Facility Contact: Phone: <br />Date Local Agency Was Notified of Testing: 8/18/2015 <br />Name Of Mca l Agency inspector ly preseni during lestinV: Fatinalt Zareef <br />zh it IN <br />2. TESTING CONTRACTOR INFORMATION INVIRONMENT.A <br />Company Name: Gettler-Ryan hic-6805 Sierra Court Suite G, Dublin, Ca. 1496-9 Pfi.9925-551-7555 <br />Technician Conducting Test: Chris San Nicolas <br />Credentials: (1) CSLB Contractor ICC semice Tech. SWRCB Tank Tester Other '(3peciT) <br />License Number: 220793 ICC Tech NumFer�544-Ul* <br />Test Method Ilse : flvdi-ostatic 'Vacuum 0 er <br />Test quipmen Used: Standard ape 141easurer Equipment Resolution: <br />Number, Stored Identify Spill Bucket (By Tank <br />87 Main Fill <br />2 87 Slave Fill <br />3 87 Siphon Flll <br />91 Fill <br />Bucket Installation Type: <br />Direct Bury <br />x Contained in Sump <br />Direct Bury <br />X Contained in Sump <br />Direct Bury <br />x Contained in Sump <br />Direct Bury <br />x Contained in Sump <br />Bucket Diameter: <br />13" <br />13" <br />13" <br />13" <br />Bucket Depth: <br />151, <br />151, <br />151, <br />151, <br />Wait time between applying <br />vacuum/water and start of test: <br />10min <br />10min <br />lomin <br />lomin <br />Test Start Time (Ti): <br />9:15 <br />9:15 <br />9:15 <br />9:15 <br />Initial Reading (Ri): <br />fill <br />III, <br />Ill, <br />IVI <br />Test End Time (Tf): <br />10:15 <br />10:15 <br />10:15 <br />10:15 <br />Final Reading (Rf) <br />Ill, <br />I I" <br />fill <br />fill <br />Test duration (Tf - Ti): <br />1 h <br />I lir <br />llir <br />lhr <br />Change in Reading (Rf-Ri): <br />0 <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or Criteria: <br />0 <br />0 <br />0 <br />0 <br />Test Results: <br />x Pass Fail <br />X Pass Fail <br />X Pass Fail <br />X Pass Fail <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />CERTFICATION 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: <br />' <br />Date: 91812015 <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 />a7 <br />I <br />