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ixiurir% 2006 <br /> Spill Bucket Testing Report Form <br /> This form is irate rmLedfor use by contractors performing annual testing of UST spillS,i%jcfow <br /> _r" <br /> tests(ffapolicable),should be provided to the facility ownerlopelator for submittal to Pie lc;,--al <br /> l. FACILITY INFORMATION <br /> Facility Name: Wilson Way Chevron <br /> Facility Address: 437 N.Wilson Way,Stockton CA 95205 <br /> Facility Contact: Lam (209)94 <br /> Name of Local Agency Inspector tilpiesentdiving resfingt Ray Von Flue <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Compliance Solutions, Inc. <br /> Technician Conducting Test: Kevin R,Matlock <br /> Credentials,: 0 CSLB Contractor El ICC Service Tech. SWRCB Vank I eslot <br /> License Number(s): ICC#5069874-UT 'SWRCB9 02 i <br /> 3. SPILL BUCKET TESTING INFORMA flON <br /> Test Method Used: []Hydrostatic [_1V@C7 ifUUro Jfl <br /> Test Equipment Used: Tape Measure, Watch <br /> Identify Spill Bucket(By Tank <br /> Number,Stored Product,etc.) <br /> F-Unleaded Premium <br /> Bucket Installation Type: <br /> Sump Sump <br /> Direct Bury/Sum <br /> Bucket Diameter: 12" 12" <br /> t <br /> Bucket Depth: 13" 13" <br /> Wait time between applying 5 min 5 min <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 1243 1243 <br /> i Initial Reading(Ri): 11 !12" 8 1/41' <br /> I --_____ I <br /> 11 Test End Time(TF): 1343 1343 <br /> 103 <br /> Final Reading(Ri�): /4"" <br /> Test Duration(TF-Tf): 1 hour 1 hour <br /> Change in Reading(RF-R,): 'r® 1 '12" <br /> Pass/Fail Threshold or Criteria: No Loss No Loss <br /> Test Result Pass/Fail FAIL 1FAIL <br /> Comments- oil i�epairs tnadeprim to lasutW,and tecommoWed <br /> CNI spill containers. <br /> Waste water left onsite. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TES f ING <br /> I hereby cerbfy that all the infornwhon contained in this report is true,accurate,and In fall compliance with legal requirements. <br /> Technician's Signature: Date: 3/3"08 <br /> State law;and regulations do not currenth require testing to he licrlorincO h% it <br /> stringent. <br />