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0 <br />Spill Bucket Testing Report Form <br />E <br />I.- FACILITY INFORMATION <br />1 Facility Name: ARCO <br />i: Facility Address: 880 E. VICTOR RD <br />Facility Contact: AT <br />Date Local Aggency Was Notified of Testing: <br />Name of Local Agency Inspector (ifpresent during testing): 11 b <br />Company'llame: BZ Service Station Maintenance <br />Technician Conducting Test: TIM BURKART <br />Cre <br />dentials': N K <br />N# o <br />CSLB Cntractr Se rvice Tech. <br />6 1 1 <br />rx—�■M i r � <br />Test Method Used: Hydrostatic 0 Vacuum El Other <br />Test Equipment Used: RULER <br />......... .. Equipment Kesolution: 1/16 <br />Bucket Installation Type: <br />YA3 I salift <br />ENIArik urm all <br />bucket Diameter: <br />Test Start Time (Tj): <br />Test End Time (TF): <br />Final Reading (RF): <br />Test Duration (TF — T& <br />Pass/F ail Threshold or <br />Criteria: <br />�K�1111 1! 11111 <br />11111�piiiiii�ii <br />11 -111 -IN-1 I MW "I f �,j ow 11 � Ili 0 P., ii i ii Kmr� I P <br />1904M# 9" � i I <br />I aq film 1IN111 IWX <br />Technician's Signature: Date: 9/22/2016 <br />State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more <br />stringent. <br />Monitoring Certification Test Report <br />