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SWRCB, January 2002 <br />�13 <br />0 QDii IF InUTOWn.i. irnVTd11NM1WVT RnWr, <br />Page 8 of 8 <br />Facility is Not Equipped With Spill/Overfill Containment Boxes U <br />Spill/Overfill Containment Boxes are Present, but were Not Tested U <br />Test Method Developed By: <br />U Spill Bucket Manufacturer XJ Industry Standard U Professional Engineer <br />0 Other (Spec) <br />Test Method Used: <br />U Pressure <br />U Other (Spec) <br />U Vacuum N Hydrostatic <br />Test Equipment Used:Equipment <br />Bucket Diameter: <br />Spill Box # 1 <br />1211 <br />Spill Box # 2 <br />1 211 <br />Resolution: <br />Spill Box # 3 Spill Boz # <br />1 211 <br />Bucket Depth: <br />1 21t <br />1 211 <br />1 211 <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />N/A <br />N/A <br />N/A a <br />Test Start Time: <br />10: 0 0 <br />10: 00 <br />10: 00 <br />Initial Reading (RI): <br />0 <br />Test End Time: <br />10: 05 <br />10: 0 5 <br />10: 05 <br />Final Reading (RF): <br />411 <br />411 <br />411 <br />Test Duration: <br />5 minutes <br />5 minutes <br />Change in Reading (RF -RI): <br />411 <br />411 <br />411 <br />Pass/Fail Threshold or <br />Criteria: <br />4" in 5 min. <br />411 in 5 min. <br />41° in 5 min. <br />Test Result: <br />U Pass Mail <br />U Pass Mall <br />U Pass XI Fail U Pass U Fail <br />Comments — (include information on repairs made prior to testing, Aad recommended follow-up for failed tests) <br />Please direct any comments regarding this form to: <br />SWRCB UST Program, Attn: Scott Bacon <br />1001 "1" Street, Box 944212 <br />Sacramento, CA 95814 <br />Phone: (916) 341-5873, Fax: (916) 341-5808 <br />e-mail: bacons@cwp.swrcb.ca.gov <br />