COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

SWRCB,January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name:YRC#813(Tracy) I Date of Testing: 2-13-2020 Facility Address: 1535 E.Pescadero Avenue Tracy 95304 Facility Contact:Ruben Byerley Phone: (913)344-3644 Date Local Agency Was Notified of Testing:1/24/2019 Name of Local Agency Inspector(if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name:Confidence UST Services,Inc. Technician Conducting Test:Michael Stromecki Credentials: 0 CSLB Contractor ❑�ICC Service Tech. 0 SWRCB Tank Tester Other(Specify) License Number(s): 804904 8339168 3. SPILL BUCKET TESTING INFORMATION 'Test Method Used: OHydrostatic ❑Vacuum ❑Other Test Equipment Used:Ruler Equipment Resolution:1/16" Identify Spill Bucket(By Tank 1 2 3 4 Number, Stored P T-1 10,000 G Soap roduct, etc. Bucket Installation Type: ®Direct Bury ❑Direct Bury ❑Direct Bury []Direct Bury ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum Bucket Diameter: 13 Bucket Depth: 221/2 Wait time between applying 10 vacuum/water and start of test: Test Start Time(Tj): 2:06 PM a Initial Reading(Ri): 21 1/4" Test End Time(TF): 3:06 PM r L u > 6 f „1 Final Reading(RF): 21 1/4" Test Duration(TF—Tj): 60 min r } L HENTH Change in Reading(RF-Rj): 0" DEPARTMENT Pass/Fail Threshold or 1/-011 Criteria: Test Result: 0 Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) First test was visibly losing water.test aborted and cause of leak investigated.Found fill adapter cracked.Replaced fill adapter.retested to pass. See data page attached for additional information. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. Technician's Signature: Date: 2-13-2020 State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent.