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Aug 13 10 08:39a Reliable PetroleumA 209-845-8953 p.2 <br /> w <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report For <br /> This form is intended for use b},contractors performing annual testing of UST spill containment istructures. The compieted_form and <br /> printoutsfrom tests(f applicable), should be provided to the facility ownerloperator fr submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION r <br /> Facility Name: Waterloo Food& Fuel I Dace of Testing:07-02-2010 <br /> Facility Address: 3032 Waterloo Rd. <br /> Facility Contact: Randy Singh Phone: 916-628-3300 <br /> Date Local Agency Was Notified of Testing: 07-01-2010 <br /> Name of Local Agency Inspector(ifpresent during testing):Jeff Wong I� <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:Reliable Petroleum Services Inc. <br /> Technician Conducting Test:Robert Barnhart <br /> Credentials: X CSLB Contractor X ICC Service Tech. C SWRCB Tank Tester 0 Other(Specify) <br /> License Number(s):883706 5252540-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic 0 Vacuum 0(Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 87 2 Diesel <br /> Number,Stored Product, etc. Fill Bucket Fill Bucket <br /> X Direct Bury X Direct Bury 0 Direct Bury 0 Direct Bury <br /> i Bucket Installation Type: 10 Contained in Sump 0 Contained in Sump D Contained in Sump 0 Contained in Sum <br /> Bucket Diameter: 12" 12" <br /> Bucket Depth: 151/2" 131/4" <br /> Wait time between applying 5 min 5 min <br /> Vacuum water and start of test: <br /> Test Starc Time(Ti): 9:00 a.m. 9:00 a.m. <br /> Initial Reading(R'): 15" 12 3/8" <br /> Test End Time(TF): 10:05 a.m. 10:05 a.m. <br /> Final Reading(RF): 1599 <br /> 12 3/8" <br /> Test Duration(TF—Ti): Ihr 5min lhr 5min <br /> Change in Reading(RF-Rj): <br /> Pass/Fail Threshold or 111611 111611 <br /> Criteria: <br /> Test Result: X Pass 0 Fail X Pass 3 Fail ❑ Pass ❑ Fail O Pass O Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up}or failed tests} <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> ,l hereby certify that all the information contained in this report is true,accurate, and in full compliance with legal requirements. <br /> Technician's Signature: ', '` ` •- ''-`'` >_ Date 07-02-20I0 <br /> 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 />