Laserfiche WebLink
SWRCB,January 2006 <br /> 9. Sty1 Bucket Testing Repor*orm <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: CHEVRON #201383 (N-2515) Date of Testing: 02/27/2009 <br /> Facility Address: 1960 W. 11TH STREET TRACY, CA, 95376 <br /> Facility Contact: MGR - HELEN Phone: (2 0 9) 836-3181 <br /> Date Local Agency Was Notified of Testing <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: EDWIN BUECHLER <br /> Credentials : ❑CSLB Contractor D ICC Service Tech. [:]SWRCB Tank Tester ❑Other(Spec) <br /> License Number: <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Hydrostatic 1-1 Vacuum ❑ Other <br /> Test Equipment Used: Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 1 SUP FILL 2 1 SUP VAPOR 3 2 PLU VAPOR 4 2 PLU FILL <br /> Number,Stored Product, etc) <br /> Ej Direct Bury 0 Direct Bury ❑Direct Bury Ej Direct Bury <br /> Bucket Installation Type: Contained in SumpX❑ Contained in Sump OX Contained in Sump Contained in Sump <br /> Bucket Diameter: 10.5 10.5 10.5 10.5 <br /> Bucket Depth: 11 11 11 11 <br /> Wait time between applying 5min 5min 5min 5min <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 9:00a 9:00a 9:00a 9:00a <br /> Initial Reading(RI ): 10.75 10.5 10.5 10.5 <br /> Test End Time(TF ): 10:0 0 am 10:0 0 am 10:0 0 am 10 :0 0 am <br /> Final Reading(R F ): 10.75 10.5 10.5 10.5 <br /> Test Duration: lhr lhr lhr lhr <br /> Change in Reading(R F-RI ): 0 0 0 0 <br /> Pass/Fail Threshold or 0 0 0 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: -•X Date: 02/27/2009 <br /> I State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br />