Laserfiche WebLink
YC <br />fp Y <br />p 1 e <br />Spill BucketTesting Report Form66 <br />This form is intended for use by contractors performing annual testing of UST spill containme NWROorm and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for subnsittcilt ��t`he�ocaP egulatory agency. <br />Facility Name: <br />24 Hours Gas & Mart I Date of Testing: 08/12/2015 <br />Facility Address: <br />1901 S. EI Dorado Street, Stockton, CA 95206 <br />Facility Contact: <br />Sayed I Phone: (209)207-1252 <br />Date Local Agency <br />Was Notified of Testing : 07/28/2015 <br />Name of Local Agency Inspector (if present during testing): Stacy Rivera <br />Company Name: ECO-CHEK Compliance, Inc. <br />Technician Conducting Test: Nik Zagorov <br />Credentials: ® CSLB Contractor E ICC Service Tech. E SWRCB Tank Tester ❑ Other (Specify) <br />License Number(s): 958763 <br />Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: Caldwell Level Change Indicator <br />Equipment Resolution: 0.0025 <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />187 291 <br />3 <br />4 <br />Bucket Installation Type: <br />® Direct Bury ® Direct Bury <br />❑ Contained in Sump ❑ Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sum <br />❑ Direct Bury <br />❑ Contained in Sum <br />Bucket Diameter: <br />12 Inches 12 Inches <br />Bucket Depth: <br />12 Inches 12 Inches <br />Wait time between applying <br />vacuum/water and start of test: <br />10 Minutes 10 Minutes <br />Test Start Time (Ti): <br />03:00 PM 03:15 PM <br />Initial Reading (Ri): <br />0 0 <br />Test End Time (TF): <br />03:30 PM 04:15 PM <br />Final Reading (RF): <br />0 4 <br />Test Duration (TF —T,): <br />30 Minutes 30 Minutes <br />Change in Reading (RF - Ri): <br />0 4 <br />Pass/Fail Threshold or <br />Criteria: <br />0.0025 0.0025 <br />Test Result:" <br />® Pass ❑ Fail ❑ Pass ® Fail <br />❑ Pass ' ❑ Fail <br />❑ Pass < ❑ Fail <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />Tank 91 Spill Bucket failed the hydrostatic test and must be replaced and retest. <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: -- ��".C�rC>V Date: 08/12/2015 <br />State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />may be more stringent. <br />