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SWRCB, January 2002 <br />,AK,,,xTv-nwiT r nrim-'ATV_ft4VATT RnYU& <br />Commenis — (include information on repaifs made prior to testing, and recommended <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 />- <br />Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ <br />Spill/Overfill Containment Boxes <br />are Present, but were Not Tested ❑ <br />Test Method Developed By: <br />❑ Spill Bucket Manufacturer ❑ Industry Standard ❑ Professional Engineer <br />❑ Other (Spec) <br />Test Method Used: - <br />❑ Pressure ❑ Vacuum rostatic <br />❑ Other (Specify) <br />Test Equipment Used: <br />l <br />�7 ` � � <br />Equipment Resolution:, <br />"? Spill Box # % Spill Box # <br />u Spill Box # Spill Box # <br />Bucket Diameter: <br />---- <br />Bucket Depth: <br />Wait time between applying <br />pressure/vacuum/water and <br />- <br />starting test: <br />Test Start Time: - <br />(7-v--7 <br />% <br />Initial Reading (Ri): ,- <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading (RF-Ri): <br />- <br />Pass/Fail Threshold or <br />'-::-�= <br />'-;^ I <br />�.� <br />Criteria: -4 <br />Test Result: <br />:0 Pass ❑ Fail <br />©Pass ❑Fail <br />0"Pass ❑ Fail ❑Pass ❑Fail <br />Commenis — (include information on repaifs made prior to testing, and recommended <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 />