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• RECEIVED <br />Spill Bucket Testing Report Form FEB 2 ,2015 <br />This fim-ni is inte�nc ed./br use l� ceuuractors performi)kv annual testing of E,.ST .v{gill ctrntaininew strrrciures_ The coral>� e led orni and <br />printouts, from aWs (if applicable), should be provided to the facility; ownen'operator.fearcubmittal toENINRO <br />' L <br />. ,-vrrr .•..�a� ■wry, rt r)a.a x �Y'il4lii Wt' �! f'�N 'fail-&, r <br />Company° Name: RZ Service Station Maintenance <br />_ ...._._ .--- — ..... _..._. <br />Technician Conducting Test: ALEXANDER TATE <br />Cst.1:3 Contract1. or IC C'. cervi Tech. ❑ SWRD fank 'fester ❑ C)ther (.Sperinri <br />Credentials <br />: _ <br />License Number(s): 433159- <br />3. SPI 11, BUCKET TESTING INFC)RMATIO <br />Test .Method Used:® Hydrostatic E]m VacuuC>thcr <br />Test Equipment Used TA PE MEASURE Equipment Resolution 1116" <br />Facility Name: ARCO AMPM <br />_..__ <br />. <br />Faciliky Address: 884 E• VICTOR RD <br />i tt: Gf7i1i1 <br />Facility Contact: KARAN <br />( Phone: 209-349-495€3 <br />Date Local Agency Was Notified of Testing: <br />Wednesday, August 20, 2014 <br />Name of l..ocaI Agency inspector irf present during testing: <br />Company° Name: RZ Service Station Maintenance <br />_ ...._._ .--- — ..... _..._. <br />Technician Conducting Test: ALEXANDER TATE <br />Cst.1:3 Contract1. or IC C'. cervi Tech. ❑ SWRD fank 'fester ❑ C)ther (.Sperinri <br />Credentials <br />: _ <br />License Number(s): 433159- <br />3. SPI 11, BUCKET TESTING INFC)RMATIO <br />Test .Method Used:® Hydrostatic E]m VacuuC>thcr <br />Test Equipment Used TA PE MEASURE Equipment Resolution 1116" <br />Identify Spill Bucket (By Tank 2 T2-91 � 3 "T3-1)SE. 4 <br />.'.'Umber, Scored l`roduct, etc) �.. <br />1 ry t3tiry ❑ Direct l�uS <br />��� � <br />�3 ��ectd <br />_.... Cota�tned �rect nuSun3 <br />Bucket Installation Type: Contained n Sump ±[0 n Snm �j Contained nl hum <br />[ j p <br />_._._._......_ a _[—� _. <br />Bucket Diameter: <br />t 1" <br />I V. <br />E i" <br />�_.. <br />Bucket Depth: <br />___. ...._ <br />13.21" <br />..__- ...................... <br />11" <br />......._. <br />13°' <br />Walt time between applying <br />5 MEN <br />5 MIN <br />5 MIN <br />vacuum/water and start of test: <br />Test Start Time (TT): <br />9:40 <br />9:40 <br />9:40 <br />Initial Reading (R,): <br />13.25" <br />11" <br />13" <br />___....... _._ <br />_ <br />Test End Time (Ti.): <br />10;40 <br />14:40 <br />N/A <br />..__............ ..._ <br />_ <br />_... <br />Final Reading (iii): <br />_ <br />13.251, <br />................_.._.___-__ <br />11'" <br />Test Duration (T'.., .. Ti): <br />1 11R <br />1 11R <br />__.._........ .......... __ <br />....... _..... <br />_ t <br />Change in Reading (Rr—R,): <br />0 <br />0 <br />FAIL <br />I <br />Pass/Fail Threshold or <br />4 <br />0 <br />4 <br />Criteria: <br />-.❑'Fail <br />Pass ❑ PstiE ; <br />Pass ® Fail <br />❑ Pass ❑ Fail <br />Comments — (include inbrinaiion on repairs made prior, to testing, anClYc'tCJinmCn(la'1X ffiltfJtl irJ±,fOr/cailCCit(sis) <br />............ <br />OPW BUCKETS <br />DSL Iii>C:KI I FAILED NEED TO REI'AIR AND R TESTE; <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:. .___..__.__.___..._. Date: 9/23/2014 <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 />4 of <br />