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51NKC:tf, January 1UU6 b�l <br />9_ SC/OVERFILL CONT NT BOJA <br />Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ <br />Spill/Overfill Containment Boxes are Present, but were Not <br />Tested ❑ <br />Test Method Developed By: <br />0 Spill Bucket Manufacturer <br />0 Other (Spec) <br />ndustry Standard 0 Professional Engineer <br />Test Method Used: <br />0 Pressure <br />0 Other (Spec) <br />❑ Vacuum ydrostatic <br />Test Equipment Used: <br />Equipment Resolution: <br />Spill Box # <br />Spill Box # <br />Spill'Box # <br />Spill Box # <br />Bucket Diameter: <br />Bucket Depth: <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />12 <br />Test Start Time: <br />�f <br />Initial Reading (Rj): <br />Test End Time: <br />Final Reading (RF): <br />' ` <br />1 6 <br />` <br />Test Duration: <br />h <br />1hr <br />Change in Reading (RF-Rj): <br />Pass/Fail Threshold or <br />Criteria: <br />Result: <br />9-15ass ❑Fail <br />ss <br />ass Fail <br />ass ❑Fail ❑ <br />❑Pass ❑Fait <br />Commenis — (include information on repairs 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 />