Laserfiche WebLink
SWRCB, January 2006 <br />Spill Bucket Testing Report Form <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 (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: VERIZON-MANTECA CO Date of Testing: September 29, 2009 <br />Facility Address: 460 W. CENTER ST. <br />Facility Contact: MASOOD CHOUDHURY Phone: 909-337-0000 <br />Date Local Agency Was Notified of Testing: September 29, 2009 <br />Name of Local Agency Inspector i resent during testing): MUNIAPPA NAIDU <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: SUNWEST ENGINEERING <br />Technician Conducting Test: RUDY ALMAZAN <br />Credentials : CSLB Contractor❑ ICC Service Tech. SWRCB Tank Tester❑ Other (Specify) <br />License Number(s): 5256842 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: HYDROSTATIC <br />Test Equipment Used: WATER <br />Identify Spill Bucket (by Tank <br />Number, Stored Product etc. <br />�._ _ _ <br />1 DIESEL 2 3 4 <br />Bucket Installation Type: <br />❑Direct Bury C] Direct Bury ❑Direct Bury Direct Bury <br />Contained in Sump Contained in Sump Contained in Sump Contained in Sum <br />Bucket Diameter: <br />10 1/2" <br />Bucket Depth: <br />10 1/2" <br />Wait time between applying <br />vacuum/water and start of test: <br />15 MIN. <br />Test Start Time (TI): <br />9:00 AM <br />Initial Reading (Rj): <br />7" <br />Test End Time (TF): <br />9:30 AM <br />Final Reading (RF): <br />7" <br />Test Duration (TF- Ti): <br />30 MIN. <br />Change in Reading (RF- RI): <br />0" <br />Pass/Fail Threshold or <br />0.002 <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: <br />Date: September 29, 2009 <br />1 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 />