Laserfiche WebLink
0 0 <br />Spill Bucket Testing Report i <br />SWRCB, January 2006 <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 owner/operator for submittal to the local regulatory agency. <br />Facility Name: LATHROP SHELL Date of Testing: 02/07/11 <br />Facility Address: 16500 S HARLAN <br />Facility Contact: NICK Phone: 209-403-3859 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (ifpresent during testing): THEUY TRAN <br />3. SPILL BUCKET INFORMATION <br />Test Method Used. X Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: Equipment Resolution: .0 1 <br />Identify Spill Bucket (By Tank 1 87 -gasoline <br />Number, Stored Product, etc.) <br />2 91- gasoline 3 <br />4 <br />Bucket Installation Type: X Direct Bury <br />❑ Contained in Sump <br />X Direct Bury ❑ Direct Bury <br />❑ Contained in Sump ❑ Contained in Sum <br />❑ Direct Bury <br />❑ Contained in Sum <br />Bucket Diameter: 11" <br />11" <br />Bucket Depth: 14" <br />14.25" <br />Wait time between applying 10 min <br />vacuum/water and start of test: <br />lomin <br />Test Start Time (Ti): 10:00 am <br />10:30 am <br />Initial Reading (RI): 13.50 <br />13.75 <br />Test End Time (TF): 11:00 am <br />11:00 am <br />Final Reading (RF): 13.50 <br />13.75 <br />Test Duration (TF — TO: 60 min <br />60 min <br />Change in Reading (RF - RO: 0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />Test Result: X Pass ❑ Fail <br />X Pass ❑ Fail ❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing and recommended follow-up for failed tests) <br />0 <br />.: r^ '?q Bi <br />CERTIFICATION 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: _Steve Zwahlen / Date:_2/7/11 I r <br />' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />