Laserfiche WebLink
SWRCB, January 2006 <br />9. SAW Bucket Testing Repo or <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 />1. FACILITY INFORMATION <br />Facility Name: KAISER MANTECA <br />Date of Testing: 0 8 / 0 3 / 2 011 <br />Facility Address: 1777 W YOSEMITE AVE , MANTECA, CA, 95337 <br />Facility Contact: ENGINEERING MANAGER <br />Phone: (2 0 9) 825-3460 <br />Date Local Agency Was Notified of Testing: 07/28/2011 <br />Name of Local Agency Inspector (if present during testing): unknown <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TANKNOLOGY , INC. <br />Technician Conducting Test: JARROD COOKE <br />Credentials): <br />E <br />CSLB Contractor E ICC Service Tech. ❑ SWRCB Tank Tester E Other (Specify) a <br />License Number: 7 4 316 0 <br />I State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />..,.,., U- ...,..o ..*..:.,,.o.,« <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: <br />Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: tape <br />Equipment Resolution:1 / 16 " <br />Identify Spill Bucket(By Tank <br />1 1 DIE FILL Z 3 4 <br />Number, Stored Product, etc) <br />QX Direct Bury E]Direct Bury ❑ Direct Bury ❑ Direct Bury <br />Bucket Installation Type: <br />❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump <br />Bucket Diameter: <br />14 " <br />Bucket Depth: <br />13. 5 " <br />Wait time between applying <br />5min <br />vacuum/water and starting test: <br />Test Start Time (TI ): <br />9:3 0 <br />Initial Reading (RI ): <br />13.51, <br />Test End Time (TF ): <br />10 : 3 0 <br />Final Reading (RF ): <br />13.511 <br />Test Duration: <br />1hr <br />Change in Reading (R F - RI ): <br />0 <br />Pass/Fail Threshold or <br />0 <br />Criteria: <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <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:" <br />Date: 08/03/2011 <br />I State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />..,.,., U- ...,..o ..*..:.,,.o.,« <br />