Laserfiche WebLink
From: Franzen-Hill Inc. To: 12094683433 Page:7/8 Date: 1/20/2014 4:36:48 PM <br /> LkjLl <br /> Form 12/2004 <br /> f <br /> Spill Bucket Testing Form J `_ 2 '2�, <br /> NV I R 0 N M E NTA L <br /> FACILITY INFORMATION A ''T"' F <br /> Facility Name:ESCALON MINI MART Date of Testing:1-9-14 <br /> Facility Address: 1097 E YOSEMI'T'E AVE ESCALON CA <br /> Facility Contact:BILL Phone: 209 838 1546 <br /> County: SAN JJAQUIN <br /> Name of Local Agency Inspector(if present during testing: Elena Mame — ._....._ <br /> i <br /> TESTING CONTRACTOR INFORMATION <br /> Company Name: Franzen Hill 1100 North J Street Tulare,CA 93274 (559)688-2977 <br /> Technician Conducting Test: ADAM TAYLOR <br /> Credentials: x CSLB Licensed Contractor Cl SWRCB Licensed Tank Tester <br /> License Type. A,B,C-61WQ HAZ License Number: 3041.47 <br /> SPILL BUCKET CONTAINMENT BOXES <br /> Facility is Not Bq*pped With S ' Overfidl Containment Boxes 11 <br /> Spill/Overfill Containment Boxes are Present,but were Not Tested 0 <br /> Test Method Developed By: D Spill Bucket Manufacturer 0 Indusfty Standard x Professional Engineer <br /> 3 <br /> 0 Otherfy) <br /> Test Method Used: 0 Pressure 0 Vacuum x Hydrostatic <br /> 0 Other(Specify) <br /> Test Equipment Used: VISUAL Equipment Resolution: <br /> Bucket:87 Buckeit:91 Bucket: Bucket: <br /> Bucket Diameter: 12 12 <br /> Bucket Depth: 16 16 <br /> Wait time between applying <br /> pressure/vacuum/water and I I <br /> starting test: <br /> Test Start Time: 900 900 <br /> Initial Reading(Rr}: 16 16 <br /> Test End Time: 1000 1000 <br /> Final Reading(Rr}: 16 16 1 <br /> Test Duration: IHR 1HR <br /> Change in Reading(RF-%. 0 0 <br /> Pass/Fail Threshold or PASS PASS <br /> Criteria: <br /> Test Result: ',Pais. ,L7aH' # X,:Ptsq; ,'I 1 Fael. © I! ,C]FailQ. <br /> I'a:'ss16 <br /> ; <br /> TECHNICIAN ADAM TAYLOR DATE 1-9-14 <br /> SIGNATURE COMPANY"FRANZEN-HILL_ <br /> This fax was sent with GFI FAXmaker fax server. For more information,visit: http://www,gfi.com <br />