Laserfiche WebLink
c fs* Y SWRCB,January 2Q06 <br /> 9. S i Bucket Testing epor 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: CHEVRON 208118 Date of Testing: 03/02/2010 <br /> Facility Address: 3355 E. HAMMER LANE @ HOLMAN RD, STOCKTON, CA, 95212 <br /> Facility Contact: MANAGER Phone: (2 0 9) 477-3699 <br /> Date Local Agency Was Notified of Testing: 02/24/2010 <br /> Name of Local Agency Inspector(if present during testing): Barrett <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: STEVEN WILLEMS <br /> Credentials): E CSLB Contractor E ICC Service Tech. 0 SWRCB Tank Tester E Other(Specify) icc <br /> License Number: 8016974 ut <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Z Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used:tape measure Equipment Resolution:1/8 inch <br /> Identify Spill Bucket(By Tank 1 1 SUP FILL Z 2 UNL FILL 3 4 <br /> Number,Stored Product, etc) <br /> Bucket Installation Type: Direct Bury ®Direct Bury ❑Direct Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 12 12 <br /> Bucket Depth: 13.25 13.75 <br /> Wait time between applying 5 mins 5 mins <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 1447 1447 <br /> Initial Reading(RI ): 13 .25 13.75 <br /> Test End Time(TF ): 1547 1547 <br /> Final Reading(RF ): 13 .25 13.75 <br /> Test Duration: 1 hour 1 hour <br /> Change in Reading(R F-RI ): 0 0 <br /> Pass/Fail Threshold or visual visual <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: 1�J Date: 03/02/2010 <br /> I State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br />