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SWRCB, January 2002 <br />o c> ./IIVF.RFTi.T. CnNTATNMFNT BOX]& <br />Page �—' of �- <br />Facility is Not Equipped With SpillJOverfill Containment Boxes ❑ <br />Spill/Overfill Containment Boxes are Present, but were Not Tested ❑ <br />Test Method Developed By: <br />❑ Spill Bucket Manufacturer ndustry Standard ❑ Professional Engineer <br />❑ Other (Spec) <br />Test Method Used: <br />❑ Pressure ❑ Vacuum Hydrostatic <br />❑ Ot er (Speck) <br />Test Equipment Used: <br />_ ..•. <br />j! <br />Bucket Diameter: <br />Equipment Resolution: <br />nz, b 1 1. <br />. :5.M�Vew..-�VW.¢'l9VMN.F•FF�M'N.tlf40ps'P�DM'WI�AYWFKnP4`{P.'.fYrn'M <br />Spill Box # Spill Box # Spill Box # Spill Box # <br />D <br />Bucket Depth: <br />��► . <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />Test Start Time: - <br />/ ✓r 3✓� <br />Initial Reading (Rj): <br />3� <br />Test End Time: <br />Final Reading (RF): <br />IS z <br />Test Duration: <br />Change in Reading (RF -RI): <br />Pass/Fail Threshold or <br />Criteria: <br />Test Result: <br />❑ Pass Fail <br />❑ Pass ❑ Fail ❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />_Commenis — (include information on repaif's made prior to testing and 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 />