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Adlbk <br /> SWRM January 2006 <br /> Spill Bucket Testing Report Form <br /> This fann is intended far we by contractors perfan"ing annual testing of UST spall containment strucfures. The com <br /> ,pt,etedform and: <br /> printouts frim tests(#applicable),should be provided to thefaclAry ownery4wararfor submiffid to the local rquiatmy agency. <br /> 1. FAC UffY INFORMATION <br /> Pac" Name: Statewide Petroleum Valero) I Of Test' E- 7131/2014 <br /> Facility Address: 1700 E.Yosemite Ave.,Manteca,Ca 95336 ev dr—M <br /> Facility Contact: Sonny Phone: V <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(I <br /> rpresent during testing): Elem Mmmo n -in4,L <br /> AUU -k-41 <br /> 2. TESTING CONTRACTOR INFORMATION <br /> r-ompany Name: Reliable Petroleum Services,Cttc. ffALHEA <br /> T*c,hnicianCGnducdng'l*est: Guadalupe Sanchez r3ADThAE <br /> Credentials': x CSLB Contractor x ICC Service`tech. ri SWP-CB Tank Tester 0 6&_r�_S_p_elcj�' <br /> License Nurnber(s). 883706 5250451-UT <br /> 3. SPILL BUCKET USTLNG WORMATION <br /> Test Method U944d.' x Hydrostatic 0 Vacuum 0 00W <br /> Toot Equipmmt Used:StarLdard Tape Measure hquipMenL Resolution:N/A <br /> Identify Spill Bucket(By Tank Iti: 87 Fill 2 T2:91 rail 3~ 4 <br /> Number,Stared Product etc.) <br /> Bucket Installation Type-. x Direct Bury x Direct Bury ri Direct Bury L3 Di met Bury <br /> 0 Centainndm�Sump� 3 Contained in Sump 0 Contained in S 0 Contained in Sump <br /> Bucket Diarnew: IT, 12" <br /> Bucket Depth: 14" 14" <br /> Wait time between applying <br /> I minute I minute <br /> vacuum/water and sftn of lost: <br /> Test Stan Time(Tj}: 9129 a,rn. 9:29 a.m. <br /> Initial Reading(Rt: 13 V4" 131/8" <br /> Test End Time(Tp)- 10:28 a.m. 10:28 a.m. <br /> Find Reading(RF): 13 Y4" 13 M" <br /> Test Dargion(TF—Tt): I hr I hr <br /> Change in Reading(RF-Rt): 0 0 <br /> ftis/FaUt Threshold cyr <br /> Criteria: 1116" <br /> Fest u1t: - pass _T x Pass 0 Irall. 0 Pass 0 Wag a Pon 0 Fail <br /> Comments—(include information on repairs made prior to ftwinz and recommendL-dfollo-w-upfor failed tests) <br /> CERTIFICATION OF TFCHNICLAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> -1 hereby CCdify A Ot 90 Ike lAfOMM0011 WRIdned in this report k true,ercufflI4 and in,jblt compliance wft legal rwkliwa g� <br /> Technician's Date 7/31/2014 <br /> 'State laws and regulations do not currently reWire,testing to be performed by a qualified oontraour.However,local requirements <br /> may be more stringent. <br /> 6 L'd 69699t,860Z =6104ed el98lleld 189Z:Z0 V 4 6Z 6nV <br />